'Radical' reforms to mental health law will mean forcible treatment for community patients who refuse to take their medication.

A government green paper published on Tuesday proposes that compulsory treatment orders (CTOs) could be given to patients deemed to require supervised treatment. They could be issued without the patient's consent if there was a 'substantial risk of serious harm' to the patient or others. Failure to adhere to treatment regimes would be most likely to mean recall to a hospital or clinical setting but could mean treatment in the community.

Health secretary Alan Milburn promised modern laws to underpin services which were 'fast and fair, safe and sound'.

The recommendations are the government's response to proposals from an expert panel chaired by Professor Genevra Richardson, dean of the faculty of law, Queen Mary and Westfield College.

Its report - published simultaneously - backs an emphasis on public safety with extensive proposals for legal checks, including a seven-day review following the use of compulsory powers and a tribunal hearing at 28 days.

But the green paper flags up the 'significant practical implications' of having both checks in place, and questions the 'real need' for a review of orders at seven days. It proposes three models of tribunal - highlighting the 'resource implications' of the first, a four-strong panel - and calls for further discussion.

Mr Milburn said 'getting rid of tiers of bureaucracy' in the shape of current Mental Health Act tribunals and managers' hearings would help meet the financial implications of new laws.

Additional costs would be met from mainstream NHS funding.

He announced extra measures to improve services, vowing to 'up the ante' of the mental health modernisation programme. These include increasing the target of an extra 300 secure beds by April 2002 to 500 beds by April 2001.

He promised an additional£53m of modernisation funding and mental health grant so that all health authorities could provide 24-hour access for severe cases by next year. He said the number of assertive outreach teams would double to 123 by next April, and rise to a total of 170 by April 2001.

Mental health charity Mind attacked the 'exaggerated emphasis on public safety' in the green paper, and urged Mr Milburn to heed the warning that 'introducing compulsion will backfire'.

On the day the reforms were launched, the National Schizophrenia Fellowship handed in a petition demanding a greater focus on patients' rights and revealed a survey showing one in four patients had been turned away from hospital in times of crisis.

But Sane said the government was right to tackle the 'contentious issue' of compulsory treatment in the community. It believes the new measures should only be used as a last resort .

Health minister John Hutton insisted that instances of patients being denied treatment laid out in CTO care programmes because of NHS and social care failings was something 'that quite frankly we wouldn't expect to arise'.

Consultation on overhauling the Mental Health Ac t ends in March .

Reform of the Mental Health Act 1983: proposals for consultation.