For somebody who once helped sail a 90ft Victorian fishing smack to Hull from the Faroe Islands, bringing the government's mental health bill safely into port must seem a doddle. But Rosie Winterton knows she has her work cut out if she is to deliver a legislative framework for a community-based, 21st century model of mental health care.
"I know that people are anxious about it, but the commitment is there," insists Winterton, the minister of state for the Department of Health. "What's important is that we have something that would be able to reflect what stakeholders are saying, but at the same time would not be moving away from the principles of the bill."
The problem is that stakeholders have been saying rather a lot about the bill, including its principles, and not much of what they have had to say has been positive. In the considered opinion of Paul Farmer, chair of the Mental Health Alliance, which has coordinated opposition to the measure, the draft proposals were "terrible".
However, fresh dialogue has taken place and the alliance reports that Winterton is listening. Now, six years after the government embarked on the reform process, revised proposals are due to be tabled. "There has been a series of things that we have looked at," Winterton says. "That has taken some time, but we will come back with a draft bill in this [parliamentary] session."
There is no disagreement that the existing legislation, the 1983 Mental Health Act, is woefully out of date, having been designed for a hospital-based system of care. The government has fallen out with the mental health community (the alliance represents more than 60 organisations from the Royal College of Psychiatrists) over how far a new measure should dwell on the perceived risk of a minority of people with mental health problems.
The first draft bill, published in 2002, provided compulsory treatment in the community as well as in hospital (at present, this is possible only in hospital). It moved to widen the definition of "mental disorder" to include people with a drug and alcohol dependency and it proposed to remove the condition of "untreatability", which psychiatrists have cited when not treating some people with personality disorders.
Opponents said the bill would result in increased compulsory treatment, mitigated only marginally by proposals to boost the rights of the patients.
So how far is the government willing to change this approach? When she was appointed last year, Winterton inherited a series of stakeholder meetings set up by her predecessor, Jacqui Smith, and the Department of Health has undertaken even further research on attitudes to extended compulsory treatment.
"What became clear to me during the meetings with stakeholders was that, to a certain extent, there was quite a lot of misunderstanding about the bill, saying that it would lead to a kind of warehousing of people," Winterton says. "But at the same time, others were saying: 'What would it mean in action? What would I be doing as a professional? What would I be doing as a service user?'"
Winterton thinks that in talking through the "practicalities", as she puts it, she and her officials have been able to clarify doubts, pacifying some critics. And it is evident that the revised draft bill will show movement on some of the most contentious points of the first model. But the minister concedes she is not confident of winning over all members of the alliance.
"I think we will be able to give a lot of reassurance, but there will be some people who just want a different bill," she says. "They don't want many of the changes we are looking at and are not going to be satisfied by that.
"I think that the way we are working with stakeholders and professionals at the moment is managing to convince them that we are thinking seriously about the points that they have been making. But we are also making sure it is a bill that is practical."
Besides the bill, Winterton is responsible for ensuring that mental health services this year meet targets set out in 2000 in the NHS plan, including creation of early intervention, crisis resolution and assertive outreach teams and appointment of 1,000 graduate primary care mental health workers to assist GPs.
Assertive outreach is no problem - the target of 220 teams having been met. But the health department admits that only 25 early-intervention teams are so far in place. This is against a target of 50, while fewer than 140 crisis resolution teams have been set up with the target of 335. Twelve training programmes have been established for primary care workers, but it is thought that only 640 workers will be in post by the year's end.
In a bid to stimulate progress, mental health trusts or primary care trusts with responsibility for mental health services are being offered bonuses of £200,000 if they achieve "effective, coordinated 24/7 crisis services" against an agreed plan from March to December.
Winterton says: "Some areas have been able to do that more easily than others. What we are trying to do through the scheme is make sure that everybody is rewarded and 'incentivised' so that the approach we set out becomes a reality.
"There are some difficulties that individual areas in the country have faced, and it would be foolish to deny that. But by and large, particularly when [the new teams] are up and running, people are understanding how some of the changing working patterns, some of the earlier interventions, have had an incredible knock-on effect on the length of stay in hospitals - and the ability to attract people into the profession."
Most important is the effect on the people with mental health problems themselves. "Service-users I have met say: 'This has completely changed my experience in that I used to get very low and had to go into hospital, then come out again, then go back in again. I now know there are people that I can call on when I am getting to that situation, people who are there for me, and it has prevented that'."
While some patients are noticing an improvement in services, many will have been dismayed by evidence - in the Department of Health's own three-yearly survey - that the public has grown more fearful and intolerant of those with mental health problems.
The findings have raised questions about the effectiveness of anti-stigma campaigns, notably the government-sponsored Mind Out For Mental Health. Winterton says she is not ruling out a more aggressive drive, but insists that previous campaigns have had a positive impact.
"There is increasing recognition about the need for the community to see the links between housing problems, debt problems, employment problems and mental health problems," Winterton says. "People take a much more holistic view nowadays of the stresses and strains that are faced and how we, as a society and individual communities, can tackle these.
"I think that is quite a turnaround from 20 or 30 years ago when people probably just associated mental health problems with people being locked up in large establishments. I think there has been that kind of shift in attitude and it's just taking it on further than that. We need to make sure we don't ever take our eye off the ball."
The CV
Age 45
Status Single
Education Doncaster Grammar School, Hull University
Career Assistant to John Prescott, MP for Hull East; parliamentary officer, London Borough of Southwark; parliamentary officer, Royal College of Nursing; managing director, Connect Public Affairs; head of the private office of John Prescott
Political background MP, Doncaster Central since 1997; junior minister, Lord Chancellor's Department, 2001-2003; minister of state, Department of Health, since 2003
Interests Sailing
For more on the draft mental health bill: www.doh.gov.uk/mentalhealth/mhbillroadshows.htm
For more on the Mental Health Alliance: www.mentalhealthalliance.org.uk
