The Minister of State for Health and the Zito Trust propose introducing community treatment orders in an amended Mental Health Act (Where is the care for the mentally ill? Letters, November 26th) as the solution to Tim Salmon's critique of the culture of mental health services (My son has schizophrenia. Why can't the system cope? Focus, November 19th). Detention under the Act is of course required in the management of some psychiatric patients, but community treatment orders could well make the culture of mental health services worse by making them more custodial and less therapeutic. Community treatment orders are not the correct response to the bureaucratic, defensive failings of mental health services described by Salmon.

D B Double
Consultant Psychiatrist
Norfolk & Waveney Mental Health Partnership NHS Trust, Norwich