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Australia was one of the first countries to develop a national mental health strategy. This article reviews the progress of reform, outlining some strengths, weaknesses and prospective challenges. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: This presentation will report on the journey taken in the Australian Capital Territory (ACT) towards development of an integrated regional plan for mental health and suicide prevention. Description of Policy Context and Objective: Despite some apparent natural advantages (limited size and population), mental health care in the ACT is more fractured than integrated. Our health system is under enormous pressure and currently subject to formal, independent inquiry. Our mental health services are fragmented, too often leaving people to fall into the gaps between services. Yet the ACT has the second highest expenditure on mental health services per capita in Australia. To address this situation, the Capital Primary Health Network and the ACT Health Department have invited the community to contribute to a process of co-designed reform. This has involved consumers and carers, as well as public and private health professionals from primary, secondary and tertiary services. It has also engaged people from outside of health in a broader conceptualisation of change in relation to the social determinants of health: housing, education, employment, community services, the police, prison services and others. Target Population: The entire Canberra community, as well as the broader region. Highlights (innovation, impact and outcomes): Our method began with identification of key archetypal case studies which account for around 80% of all mental health business in the ACT. We invited the Canberra community and experts to test these case studies. We asked people what would fundamentally shift the trajectory of these typical consumer journeys towards better outcomes? Responses came at different levels; some were immediate and practical short-term ideas for service improvement; others were longer term and more complex solutions to enhance integrated care - for example to shift from fee for service models of financing to other models. The level of public engagement in thinking about the future of mental health in the ACT is unprecedented. Working groups have been established, public consultation has occurred, and online feedback has been secured. A new plan is emerging from this work. But the future is uncertain. Federal and Territory governments seem to support separateness rather than integration. There are competing policy and funding paradigms - individual choice vs population-based rationing. Staff under pressure working in public services struggle to engage in processes of reform. Perspectives on priorities differ considerably between stakeholders. Comments on Transferability: The experiences of the ACT tell a story of universal interest about local change and reform. Conclusions (key findings, discussion and lessons learned): Even in a small place, where key stakeholders know each well, integration is by no means obvious or straightforward. Policy reforms must be supported by sustained effort to drive the culture of integration. With consumers and their families at the centre of this integration, care must be taken to nurture inter-disciplinary recognition and respect. This is the wellspring of genuine integration. Without this, a rich country like Australia risks wasting resources and leaving people vulnerable to poor care. [ABSTRACT FROM AUTHOR]