Mental health has been made one of the government's three clinical priorities, with much energy expended on a National Service Framework, extra help in the NHS Plan and a review of mental health law. However, my recent experiences revisiting people living with mental illness, their families and those running mental health services show that the realities for many people remain as distant from the rhetoric and reforms as ever. The consistent pattern of the 1,000 calls a week to our helpline SANELINE shows that those using services are seeing very little change.

With sufficient support, people with mental health problems can sustain fulfilling lives in the community. The newer, atypical medications for schizophrenia, which have different but generally more easily tolerated side effects, can transform the lives of some individuals, as can psychological therapies. Professional staff collaborate to provide holistic care, working in partnership with individuals on care plans and crisis directives. But the continuing neglect of community services means that it is still the minority who receive this quality of care, the majority left to struggle with starved services and demoralised staff with no time to gain the skills and training they need.

Although the newer medications are readily available, they are still severely and unfairly rationed. SANE has campaigned for them to be offered as first line treatment. It is unacceptable that people should be given the older, cheaper medications with their stigmatising and distressing side effects which can lead patients to reject all medical help. The least we can do for people already enduring a tormenting mental illness is to offer them respect, hope and the potential of modern drugs and treatments.

The National Institute for Clinical Excellence has been examining these newer medications. If its guidance and the response of the funding authorities put an end to cost driven prescribing, we will have achieved more for people living with enduring mental illness than any other reform in recent years.

But even well supported, people can only sustain life in the community if they have access, when they need it, to a hospital or nursed unit. With the failure to replace the 50,000 psychiatric beds lost over the past two decades with sufficient nursed beds, and housing, we have removed the backstop of somewhere to go when a person is no longer able to cope on their own or living with their family.

Those who do obtain a hospital bed face depressing conditions in the many acute wards that are overcrowded, dilapidated and rife with street drugs and aggression. Lack of trained staff and structured activities means that many units offer little more than bleak containment. The single thing that the overwhelming majority of psychiatrists agree on is that the one choice people do not have is good in-patient care. The government has announced a grant for refurbishment, but this will achieve little if patients are left without a therapeutic environment or constructive occupation.

The National Service Framework promised the right bed, in the right place, at the right time. Yet professionals and others on the ground tell us that monies seem to be channelled into new and untested initiatives, depleting core services such as community mental health teams. The government has recently declared that by intervening early, crisis resolution teams have shown that 85 per cent of people can be kept out of hospital and successfully treated in their own homes. However the flimsy networks of community, crisis resolution, assertive outreach and other such teams are unlikely to be strong enough to hold together the splintered lives of so many people who need consistency, security and, above all, time and space to recover from their illness.

Current policy asks too much of everyone - the professionals who have to make the best of an impoverished system, the families and carers who all too often have to live as unpaid staff, and the individuals who may be passed like unfortunate parcels between the health, social services and criminal justice systems or left in the name of "independent living" to their own DIY care, bandaging their torments and distress as best they can.

What people need is not systems and one-for-all placements but recognition of their individuality, at times fragility, and need for choice - not directed by plans and targets but by their changing needs, which may involve at times expensive 24-hour nursing or the rationed hospital bed. The government must ensure funding and policy momentum to prevent the plethora of initiatives undermining core community services and leaving hospital wards shabby and under-funded outposts of care. If it does not, these will become the new twin scandals of mental health care.