Dr Jim Dyer, director of the Mental Welfare Commission for Scotland, said a shortage of medium and low security alternatives to Carstairs State Hospital meant patients were being "entrapped" behind bars when they were not a danger to the public.

The knock-on effect of this blockage was that there were fewer places available at Carstairs for those who were a risk to the public.

"There is a serious problem with the lack of proper forensic inpatient provision," said Dr Dyer.

"There are currently 30 people who have been in Carstairs for three months when it has been decided that they are fit to leave.

"This is a serious human rights problem," he said.

"There is always the danger that this increases the threshhold for people who go into Carstairs," he added.

Severely disturbed

Speaking on the day the government-backed commission launched its annual report, Dr Dyer added that lack of places for mentally disordered offenders also meant some people were being kept for months in intensive psychiatric units, designed for short-term severely disturbed people.

This meant their needs might be being ignored as staff's time was more taken up with patients who were very ill.

The problem of lack of mental health places extended to patients who were not offenders, with patients being kept in hospital too long because of a shortage of community provision.

This meant there were fewer places for those who needed to be treated in hospital.

The scaling down of hospitals also meant some patients with moderate problems were being forced to share wards with people who were severely disturbed.

National strategy for offenders

The commission welcomed the government's stated intention to improve provision for the mentally ill.

A national strategy document on mentally ill offenders is expected before the end of the year.

The Scottish Office has also stated that mental health is a top priority.

Dr Dyer said: "It has to be a priority and not just a paper priority. Spending has to be increased in real terms."

The commission's annual report also calls for legislation to ensure patients' savings are protected while they are in hospital.

It says some patients find on emerging from hospital that their funds have been used to buy goods or services which the NHS should have provided free of charge.

The Scottish Office agrees the law needs clarification, but says this will probably have to wait until the Scottish Parliament is set up.

However, it is considering whether interim guidance can be introduced beforehand.

Compulsory treatment

The commission also says some patients are not being properly informed of their rights regarding treatment in hospital and whether they can appeal against a decision to treat them in hospital.

The annual report calls for an overhaul of mental health legislation to bring it in line with "modern life", including provision for the compulsory treatment of patients in the community.

Sam Galbraith: mentally ill should not be forced to take drugs out of hospital

Dr Dyer said: "The Mental Health Act needs to be changed so that it is tailored to individuals.

"If necessary, they should be treated in the community, but they should not be forced to take medication in the home."

He said patients could be treated in clinics and doctors should have the power to recall them to hospital if they are felt to be a risk to themselves or the public.

However, Scottish health minister Sam Galbraith says that, although he agrees that the Mental Health Act needs overhauling, he believes it is "not possible" to force people to take medication when they are not in hospital.

Mr Dyer says that, until April 1996, Scottish patients were treated in the community when they were on leave of absence.

Over 100 people had been on leave of absence for more than a year when the law was changed, he stated.

"The history of Scotland shows patients can successfully receive medicaiton in the community," he said.

Controversial

The issue of compulsory drug treatment of mental health patients has proved controversial.

Mental health charities such as SANE believe it should be a last resort and that it is more important to offer adequate support to community care patients.

Debate over the issue has heated up in the wake of a number of high profile cases of community care patients attacking patients.