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After months of anticipation, many health and social care professionals have excitedly unwrapped the government's Choosing Health white paper and been unable to hide their disappointment with what's inside.

Told to expect a far-reaching reorganisation of policy that would place public health at the top of the political agenda, they have been presented with a document that is long on good intentions but short on concrete proposals. The document pledges £1bn to be spent over the next three years and a new partnership between the statutory, voluntary and private sectors. Yet, aside from the headline-grabbing plan to ban smoking in the workplace by 2008, much of the document seems to be stymied by a fear of being accused of creating a "nanny state".

Despite one of the largest public consultations ever undertaken, and more than 1,000 submissions from individuals alone, the white paper has left many care professionals wondering what all the fuss was about.

Most crestfallen have been those working in the sexual and mental health fields who feel that the needs of their service users have been either misunderstood or ignored. Many mental health professionals feel that the white paper's emphasis on lifestyle issues and the importance of taking personal responsibility for one's own health have little relevance to those suffering mental health problems.

"The public could be forgiven for thinking that Britain's health problems are confined to smoking and unhealthy eating," says Richard Brook, chief executive of mental health charity Mind.

"Healthy lifestyles are important - that cannot be denied. But we would like to see the government recognise that improving the nation's mental health is an integral part of a much bigger picture."

Angela Greatley, chief executive of the Sainsbury Centre for Mental Health, points out that, although an individual's risk of heart disease or cancer may be influenced by his or her lifestyle and dietary choices, the same cannot be said for illness such as depression or schizophrenia.

"Nobody chooses to have a mental health problem," she says. "Mental illness cannot be prevented by promoting healthy lifestyles. Promoting mental well-being is about tackling the things that put people at risk of mental ill health and taking action to offer fair chances in life to those with mental health problems."

This will require more public health measures to be focused on the needs of people suffering mental health problems and more resources allocated to mental health promotion, says Greatley. "It is vital for our nation's health that efforts to promote good mental health become a real priority for public health professionals, and that more resources are put into mental health promotion. To date, mental health promotion has been starved of resources and existed on a shoestring."

The Royal College of Psychiatrists says the white paper's emphasis on self-help could lead to the impression that mental health is a matter of choice. This could "increase the guilt, shame and stigma felt by patients, carers and their families", it says.

The RCP has called for a complementary - but separate - public health strategy for mental health. This would include measures to promote mental health in the workplace, improve access to mental health care, increase public education on mental health issues and address the problems caused by the "prevailing social and economic climate".

Mental health is not totally ignored in the white paper. There are proposals to improve access to mental health services for ethnic minorities. It also pledges guidelines on the management of mild to moderate mental ill health in the workplace, to be in place by 2005, and to use the Sure Start programme to protect children and young people against mental health problems later in life.

However, mental health user groups are annoyed at the lack of any proposals to address the specific physical health needs of people who use mental health services.

"It is a scandal that mental health is not at the heart of the government's public health plans," says Rethink chief executive Cliff Prior. "All the available research shows that people with mental illness face an earlier grave because their physical health is often neglected. People with mental illness need extra support and information to ensure all their health needs are met."

Prior points out that problems such as obesity and smoking are particularly prevalent among mental health care users, yet the white paper offers no specific measures to address these problems.

There are also concerns that the proposed smoking ban in the workplace could work against the needs of people being treated in psychiatric institutions. While it is hard to argue against a smoking ban on the grounds of physical health, its implications for mental health may not be so clear cut. It is estimated that up to 70 per cent of people treated in psychiatric wards smoke. Many use cigarettes as a coping mechanism and there is even evidence that nicotine may help alleviate the symptoms of some brain illnesses. To ban smoking within psychiatric hospitals may therefore be counter-productive. Likewise, a smoking ban in the prison service may also be impractical.

While mental health campaigners have been the most vocal in their criticisms of the white paper, others have voiced disquiet about the plans to improve sexual health, saying they fail to promote sex education in schools and do not go far enough.

The white paper proposals include a new national campaign targeted at those at greatest risk of catching a sexually transmitted infection or having an unplanned pregnancy, a national chlamydia screening programme in place by 2007 and a pledge that by 2008 everyone referred to a genitourinary medicine (GUM) clinic will be offered an appointment within 48 hours.

What the proposals do not include, says Deborah Jack, chief executive of the National Aids Trust, is anything likely to meet the specific needs of people affected by HIV/Aids. Particular challenges with HIV, including stigma and discrimination are also not addressed, she says.

Rod Griffiths, president of the Faculty of Public Health, says the white paper's sexual health proposals should be welcomed. However, he questions why the public has to wait so long to see their benefit. He says: "The year 2008 will be too little, too late. The government recognises that delay in access to treatment has a major impact on future health and fertility. How, then, can they justify a four-year wait to implement its goal of 48 hours for a GUM appointment - a recommendation made by the health select committee in June 2003."

Serious infectious diseases, such as chlamydia and HIV, should be treated as emergencies and access to GUM services should be made available within four hours - in line with other accident and emergency cases, says Griffiths.

Jan Barlow, chief executive of the Brook sexual health advisory service for young people, sees the white paper as a missed opportunity. She says: "Research shows that young people who have received good sex and relationships education, combined with access to confidential services, start having sex at a later age and are more likely to use contraception when they do become sexually active.

"If the government is serious about bringing down rising rates of sexually transmitted infections and achieving a consistent drop in rates of teenage pregnancy, sex and relationships education must be made a compulsory part of the national curriculum."

WHAT HAPPENS NEXT:

The public health white paper emerged from a consultation process that ran between 3 March and 28 June 2004.

More than 2,500 responses were received, with individuals contributing more than 1,000 responses.

The government will publish a delivery plan early next year outlining how each of the commitments in the white paper will be achieved.

 It will also establish a public health research initiative which will receive £10m by 2007-8 to help develop front-line practice.