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Australia has a demonstrated commitment to the development of national plans and policies regarding mental health. Just how effective have these policies been in driving real reform and generating new models of effective, collaborative mental health care? This article examines some of the progress and gaps over a 20-year national planning process and considers contemporary developments affecting our federated health system. Some dangers to the trajectory of Australia's reform process become clear just when the public and political profile of mental health has reached new heights. A key gap is in relation to accountability and Australia's capacity to demonstrate clearly the real impact services have on the lives of people with a mental illness. This article gives an overview of the legacy of Australian mental health reform and presents examples of collaborative and innovative practice across mental health care, housing, employment, and quality improvement. From this analysis, the ongoing challenges for Australian mental health reform become clearer. [ABSTRACT FROM AUTHOR]