The government says it is committed to modernising mental health services. In September 1999, it launched the mental health national service framework (NSF) for services in England for the next 10 years. The NHS plan allocates more than £300m extra by 2003-04 to "fast forward" the NSF.

Which areas of mental health care will be affected and how?
The plan targets eight areas of mental health care:
• Most mental health problems are managed in primary care. To alleviate the strain on GPs, the plan says 1,000 graduate primary care workers and 500 community staff will be on hand to help GPs, accident and emergency departments and NHS Direct. However, at a time of such recruitment pressure, there are questions as to where all these new staff will come from.
• Over the next three years, 50 early-intervention-in-psychosis teams will be established to support young people, mainly those with schizophrenia, and their families.
• 335 crisis resolution teams will be set up. By 2004, the aim is for mental health service users to have access to crisis help at any time.
• For people with severe mental health and other problems, such as addiction and chaotic lifestyles, who are not in touch with mainstream services, 170 new assertive outreach services should be in place by April 2001 and 50 more are promised over the next three years.
• By 2004 there will be women-only day centres in every health authority.
• By 2004 support for carers is to be increased, with 700 staff boosting respite care and strengthening support networks.
• By 2004 up to 400 people in secure hospitals who do not need to be there should be rehoused. The government has earmarked £25m to provide 200 long-term secure beds and employ 400 community staff to support them.
• Prison services are to be strengthened. 300 extra staff will support new NHS and prison partnerships, with the aim that no one with a serious mental illness should leave prison without a care plan and care coordinator.

What are the plan's main strengths and weaknesses?
Service users need to be clearer about the care they can expect, providers about doing their bit and inspectors about what needs to be monitored. However some fear that blanket rules will reduce innovation and sensitivity to local needs.

The Sainsbury Centre for Mental Health (SCMH) is concerned about the use of graduate helpers for primary care, suggesting that they may prove to be unstable and keen to move on. It questions the need for women-only services, and whether there will be enough extra staff. It says crisis intervention often fails and that the nature of carer support needs to be more carefully defined. It is unclear how scaling down high security provision fits with government plans to increase places for those with severe anti-social personality disorders who are deemed to put the public at risk. The focus on improvements for prisoners has been welcomed, but the SCMH asks why the changes focus on the seriously ill. It points out that all people in prison, regardless of their degree of mental distress, share basic rights to health care.

How has the plan been received?
Cliff Prior, chief executive of the National Schizophrenia Fellowship, has been appointed to the NHS modernisation board to oversee implementation. He says: "These plans are backed up by some hard cash and a welcome recognition of the role of carers." However, he adds: "There must also be a commitment to long-term training of health and social services staff and a high-profile public campaign to end the stigma surrounding mental illness." Strategies to recruit and train staff need careful planning and more thought needs to go into the incentive scheme, where rewards or punishments are given to green, yellow and red (good, OK and bad) services.

Has the plan missed anything out?
The SCMH would like to see improvements in hospital ward quality, a higher profile given to mental health promotion and recognition of the challenges posed by interaction between providers.

The plan allocates an extra £300m for mental health serices by 2004. The SCMH doubts this is enough. It is also unclear whether the plan will be partly financed by the general (non-mental health) NHS budget.