There are few votes in madness - and fewer in those who commit serious offences because of mental illness. It was pretty brave of Labour to put mental health top of the agenda in creating one of the first national service frameworks (NSFs). The mental health NSF spells out, for the first time, what patients can reasonably expect from the NHS by setting clear standards for all NHS providers. The NSF rightly puts great emphasis on serious and enduring mental illness and targets our high rates of suicide. More boldly, the NSF calls for greater action in the promotion of good mental health and a greater role for general practitioners and others in primary care. This is where the majority of people with mental health needs live and engage with the NHS. Better performance in primary care could do much to improve people's experience.

All opinion formers in the mental health field have broadly welcomed the NSF but, to date, implementation is patchy. A key target was for primary care organisations to review their management of depression last year, in consultation with user and carer groups. A recent survey from a pharmaceutical company suggests that few have achieved this target - and fewer still bothered to consult lay opinion. A recent report from the Zito Trust showed that scandalously low numbers of people with psychotic experiences were accessing the newer atypical drugs, which offer the individual far less risk of debilitating side effects. If this were happening in any other disease, there would be a national outcry. Yet for the mentally ill, second best - it seems - is good enough.

There is a risk that policy has been dominated by over emphasis on secure provision for mentally disordered offenders and the vexed question of what to do with severely personality disordered individuals who are or might be considered a danger to society.

Government has successfully been expanding secure health beds - but at what cost to other bread and butter services? In a knee-jerk reaction to a report from Sir Richard Tilt, the government has invested millions of pounds into increased physical security at our three High Secure Hospitals. All professional opinion was against this and saw absolutely no need for it. There have been no escapes from these places in years, yet money has been poured into this policy folly. That money could have been better spent in providing step down accommodation for the many women and ethnic minority patients who should not be in these environments, but are trapped by a sclerotic NHS framework.

The drive to find better solutions to the management of personality disorder is giving some tangible benefits in the shape of better-focussed R and D. The Home Office and Department of Health are jointly piloting some new approaches in the NHS and in prison healthcare units. This is important work and could tell us a lot about working with this complex group of people more effectively. These departments are also working better together to seek tangible improvements to the health status of the prison population, where much mental illness is to be found. Joined up government in action!

The real problem government has is in its proposed review of the mental health act. The broad thrust of the review suggests the use of greater powers to force compliance with treatment outside of an institutional setting and new provision to detain people deemed to be personality disordered and dangerous, even where no offence has been committed.

People with serious mental health problems who choose not to comply with prescribed treatments at times of lucidity are vulnerable. If we introduce greater coercion, there must be a risk that these people may be less likely to engage and remain engaged with statutory services. Outside of a hospital setting it will be nurses in the front line that will have to enforce new orders. Nurses do not want this imposed upon them and see this as a threat to the therapeutic relationship with the patient.

In personality disorder we are in danger of creating some bad law. The notion that we might label a citizen personality disordered and remove civil liberties without limit of time, based on what they might do in the future, is dangerous. The science of diagnosis of this condition is at best, pretty thin. Psychiatrists around the world cannot even agree on this, let alone on appropriate care and treatment.

The notion of applying such a framework where no offence has been committed seems absurd. Government should rethink some of this, as advised by the report on mental health from the Commons Health Select Committee. Over the long term policy should focus on delivering the NSF. If that happens I would argue that we have a chance of making the NHS and other services in mental health much more acceptable to individuals and carers, leading to a reduced need for coercion. The government is doing a great job increasing patient power across the rest of the NHS. When it comes to mental health, government risks barking up the wrong tree.