Plans for mental health could be hard to deliver, experts predict

The first framework to be issued requires health and social services to meet seven standards - including 24hour access to all services - and sets benchmarks for the prevention and treatment of mental illness. The government's promise to end the 'postcard lottery' in mental health is supported by£700m in this and the next two years, drawn from the modernisation fund.

The framework - due out in April and finally launched last week - was generally well received, with commentators praising its scope, sensitivity, and the flexibility given to local services.

But despite the government's unusually explicit focus on implementation issues, there are fears that the standards will exacerbate the pressures on frontline managers and staff.

Fiona Wise, chief executive of Enfield Community Care trust, and a member of the expert reference group which advised the government, said:

'The targets are quite straightforward - but we shouldn't underestimate what will be required to implement them.

'It means significant work for all of us and a long-term development agenda.' She added that it was 'too early to say' whether the£700m would be enough.

Dr Matt Muijen, director of the Sainsbury Centre for Mental Health, said the framework had achieved 'a good balance between a national blueprint and local flexibility'.

But he questioned the decision to leave the workforce implications to an action group, which will produce an interim report by March next year.

'The framework does not directly address the complex but crucial problems around developing and retaining a skilled workforce. Well-trained and motivated people are the key to achieving real improvements in care.'

However, patients' group Breakthrough was confident that managers and staff would be ready.

Chief executive Tony Russell said: 'If anything in the framework comes as a shock to mental health personnel then they are in the wrong job.'

The framework opens the way for primary care trusts to provide specialist mental health services, a move the NHS Primary Care Group Alliance said 'confident' groups would welcome.

But Dr Muijen warned that more structural change risked diverting attention from improving services.

Asked if any PCTs would want to take on mental health, he said: 'There is always an idiot willing to have a go.'

The first priority under the framework will be to address gaps in services for people with severe mental illness. By April 2000, local delivery plans will have to be agreed with regional offices of the NHS Executive.

Progress reports, including performance reviews of health authorities, must be delivered by October 2000.

The seven standards To promote mental health for all, and combat discrimination.

To identify and assess needs and offer effective treatments.

To provide round-the-clock access to local services.

To provide care for patients on Care Programme Approach that prevents or anticipates crisis and reduces risk.

To ensure access to hospital or an alternative bed for all who need it.

To ensure carers have an annual assessment of their own needs , and a written care plan.

To reduce the level of suicide.