The service is improving - but has some way to go
Almost half of community mental health patients in England are unable to access any out-of-hours care, an NHS inspectorate survey suggests.
The Healthcare Commission also found one-third of patients are not told about side-effects of new medication.
Critics said the survey showed mental health patients were being treated as "second class citizens".
But ministers said the report had found steady improvements overall, and further progress was in the pipeline.
The Healthcare Commission found growing numbers of patients had confidence in mental health professionals, receive copies of their care plan and have a number to contact out-of-hours in a crisis situation.
Overall, most of the 14,000 respondents rated their care highly, with 78% describing it as "excellent", "very good" or "good".
However, 24% said they were not involved in deciding what was in their care plan, and 16% said their diagnosis was not discussed with them.
In addition, of the 62% of service users who did not receive any counselling almost a third (32%) would have liked to.
Almost half (45%) of service users had no access to a crisis number to call out-of-hours - although the proportion is rising.
A greater share of users report that they were involved in decisions about their medication - up from 40% in 2004 to 44% in 2008.
But almost a third (32%) of those who had been given new prescriptions over the previous year said that they were not told about possible side-effects.
Anna Walker, chief executive of the Healthcare Commission, said: "The survey shows steady improvement in how service users rate key aspects of their care.
"But more must be done to improve access to care, in particular to talking therapies and out-of-hours crisis care, and to involve people in decisions about their treatment."
Norman Lamb, Liberal Democrat health spokesman, said: "Too often people with mental health problems are treated like second-class citizens.
"There needs to be a change in the government's mindset. They talk about empowering patients, but the reality is often different, particularly for mental health.
"These shocking findings are a reminder of how far we have to go before people with mental health problems are treated with respect and dignity by this government."
Emily Wooster, of the mental health charity Mind, said: "There are still significant numbers of people with long-term health needs who are not involved in planning their care, do not know who their care co-ordinator is, and don't even own a copy of their care plan.
"Co-ordinated, tailored support is vital for caring for people with enduring mental health needs, and these are failings in principles that underlie the whole system."
Marjorie Wallace, chief executive of the mental health charity Sane said: "Nine years ago, we were given guidelines which said that people with severe mental illness should be able to access appropriate services 24 hours a day, 365 days a year.
"This report shows we still have a long way to go."
But Louis Appleby, national director of mental health services, said the results showed "hugely encouraging" improvements.
However, he added: "We are still making improvements including giving people more choice in the way they are treated.
"Our programme of expanding psychological therapies, backed with £173m in funding by the third year, will help achieve this."