Mental health patients in parts of England have little or no access to care and treatment, health and social care watchdogs have found.
Striking regional variations in the quality of adult community mental healthcare are laid bare in a study of services that will call into question the effectiveness of the national service framework for mental health, introduced in 1999 to eradicate local variations in standards.
Local implementation teams are made up of mental health providers, commissioners, carers and patients. They are responsible for ensuring that services meet local needs.
In the South East - the worst-performing region - only 37 per cent of teams were rated excellent or good for access to services, care arrangements and involving patients in decisions about their care.
The joint report by the Healthcare Commission and Commission for Social Care Inspection says: 'Care reforms have not permeated all local implementation team communities across the country equally.'
Teams in the most affluent neighbourhoods were significantly more likely to be performing well than those in more deprived areas.
The review also found that many patients were not fully involved in decisions about their own care. Only 42 per cent said they definitely had a say in their medication.
But the findings show a steady improvement in the range and quality of services from 1999 to 2006.
The report recommends more robust leadership, greater respect for patients and higher expectations from professionals in health and social care.
Mind chief executive Paul Farmer called the findings 'alarming' and said they revealed 'the patchy state of people's experiences of mental healthcare'.
He told HSJ: 'The scale of the disparity between regions is concerning. There's clearly work to be done, especially in areas like London.
'In some areas it's taking a long time to deliver the objectives of the knowledge and skills framework and there's still a long way to go.'