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Objective: To describe a recent process by which mental health service sector leaders identified key elements of strategic, systemic and structural mental health reform. These elements could guide an incoming Federal government., Method: The paper describes the process undertaken by the Sydney Mental Health Policy Forum between 2019 and 2022. This work generated principles, key domains and finally a set of actions., Results: Five immediate actions were identified that are cost neutral or require minimal investment. Five further actions requiring realignment of existing funds and/or new funds were also identified., Conclusions: The task of mental health reform in Australia is both large and overdue. Continued investment in fragmented or piecemeal programmes and services will not propel desired change. Reform must facilitate new regional control of planning, funding and responding to community mental health needs. The actions identified by the Forum set out a menu of opportunities to guide reform over the life of the next Parliament, starting now.

Objective: To consider the changing profile of Australia's mental health workforce and the implications, particularly for specialist psychiatry services., Method: We analyse data from a national collection that describes changes in the workforce over a decade, to 2017-2018., Results: While single practitioner-based psychological services flourish, other areas of more complex and team-based care are struggling to remain relevant. Psychiatry and mental health nursing, two areas that previously led Australia's response to complex mental illness, are under enormous pressure., Conclusion: The shifting balance of specialised mental health workforces is affecting the mental healthcare available in each region of Australia. Questions arise regarding the desired or optimal mix of professionals we wish to deploy. What roles should each professional group play and how should they work together? What does this mean for how various groups should be trained and paid? These data challenge the role specialist psychiatry wishes to play in leading reform. Current mental health reforms risk foundering should psychiatrists fail to take up the challenge of leadership.

Objective:: The objective of this study was to present an assessment of Australia's mental health system performance, within its social context, by comparison with other countries., Method:: A review of existing literature and databases from both Australia and overseas was undertaken. Systems permitting international comparison of mental health and its social context are few. The review is limited in scope., Results:: Although Australia was one of the first nations to develop and adopt a national mental health policy (in 1992), the data that are available suggest that we are not World leaders across the identified domains., Conclusions:: While international benchmarking can play an important role in fostering quality improvement, there are only limited mental health or social system performance data sources to utilise. It would be desirable for a more systematic international process to be established to review existing approaches and design a new multilateral strategy. It would be important that this new strategy reflected the full experience of mental health and its broader social context.

Objective: In this second and final part of this series about mental health commissions, we consider the extent to which it is possible to find hard evidence that these new structures really can drive mental health reform. Four key domains of improvement are established for the purposes of this review: do commissions lead to better resources, better services, better accountability and better stakeholder engagement? A review of the evidence from both Australia and overseas is presented. The article also considers how the commissions, federal and state, will organise their relationships productively to avoid duplication and promote synergy. What of those jurisdictions without commissions? Is this genuine national reform or merely more piecemeal activity in mental health? The authors have been informed by the varying structures and functions of mental health commissions internationally and were part of the New South Wales taskforce to establish a mental health commission. They had the opportunity to visit the Western Australian and New Zealand Commissions as part of this process., Conclusion: Addressing mental illness requires a joined up approach to government and services. Commissions offer a new organisational structure designed to deliver this contiguity. There is also evidence that nascent and established commissions are delivering real reforms, including in terms of additional resources and influence. Without concerted efforts to coordinate activity, the intersection between federal and state commissions will be confused and duplications might arise. The paper calls for a new network of commissions to be established across Australia and New Zealand, to share resources and common tasks, clarify roles and build common approaches.

Objective: Partly in response to ongoing concerns about the state of mental health care, several jurisdictions across Australia, including the federal government, are hoping to drive change via the establishment of a mental health commission. This is the first of two articles in a series which aims to describe the background to this new trend. The commissions are being established with different powers and structures. This variety is explored and considered against a typology of commissions. Some consistent themes and goals emerge. The paper then provides a contemporary assessment of the 'state of play' of the nascent commissions and describes important emerging issues and differences between the models., Conclusion: There are significant differences not only in the construct of the respective commissions but also in the political circumstances in which each must work. At the same time, the problems facing mental health in Australia are ubiquitous and profound. For commissions to be successful they will require not only astute leadership but also durable, bipartisan political support and an enduring capacity to generate new resources for the mental health sector.

Objective: This paper proposes a framework for a systematic evaluation of the Better Access Program, the largest single component of mental health reform announced under the Council of Australian Governments National Action Plan on Mental Health 2006-11., Method: The article explores the genesis of the Program and considers extant data sets and information available with which to establish the impact of the Program on consumers and service providers., Results: There are useful data available in Australia from which to derive pre- and post-implementation analysis about the impact of the Better Access Program. There is doubt as to whether these data form part of the Federal Government's current approach to evaluation of the Program., Conclusions: Anything less than a genuine and comprehensive evaluation will leave Australia unable to assess the real impact of the Better Access Program. The merit of further expenditure in the vital area of primary mental health care will be in doubt as a consequence.