An important first step towards the goal of greater whole of government responsibility articulated in the policy has been the inclusion of ministerial advisory councils on the reference group responsible for the development of this fourth plan. This has enabled the fourth plan for the first time to articulate the current roles and responsibilities of these non-health portfolios in contributing to improved outcomes for people with mental illness.

The relationships between relevant portfolio areas must continue to be developed. It is envisaged that the fourth plan will provide a basis for governments to include mental health responsibilities into policy and practice in a more integrated way, as represented in Figure 1, to create better links between the work of national advisory committees.

It is recognised that the needs of people with mental illness, their families and carers, is not the core area of responsibility by these sectors. However, better integration and reciprocal service enhancements will benefit both the recipients of services, and result in more appropriate and effective use of services in all areas. The circumstances in which other sectors come into contact with individuals, either directly or through the transition of people through service systems, provide valuable starting points for further collaboration and integration. There are already good examples of work across portfolios at a jurisdictional level, such as between police and mental health, or child protection services and mental health, but there is considerable opportunity to strengthen and expand these.

The fourth plan is guided by a recognition that good mental health, like good physical health, is determined by many factors - within the individual, and also within families and communities. How and where we live, our work, our access to education, and our relationships all influence mental health and wellbeing. Equally, when health services are needed, and how and where these are provided, influences our experience and the speed and extent of return to health and wellbeing. To improve this will need action and commitment from all areas of government, and the community. Health ministers and mental health ministers at the state, territory and Commonwealth level need to work with their ministerial colleagues in relevant portfolios to advocate for complementary policy and service development, including prioritising these in budget decisions.

Mental health reform operates in a dynamic environment. Early intervention strategies are important early in life, early in illness and early in episode, but each might involve different approaches and different components of the service system. Mental health awareness and promotion is just as important in treating environments as it is in schools and the workplace. Some reform areas are mutually dependent - for example, housing, support and employment are important for ensuring wellbeing for people who suffer mental illness - but are often difficult to maintain when a person experiences symptoms of their illness. Likewise a person's illness may become difficult to treat when they do not have secure housing, meaningful employment and personal support. Some issues will achieve the best outcome through nationally consistent approaches, while others will require actions tailored to address local imperatives. Top of page

There are also areas where further consideration of how services could or should respond is warranted. Some of the areas are primarily under the direction of the Commonwealth Government such as employment services, while others such as correctional services are primarily determined by policy at a state or territory level. In each, there are areas that will impact on mental health and mental health services. In some of these areas the state based COAG Mental Health Groups, developed through the COAG National Action Plan on Mental Health 2006–2011, have made some progress towards a whole of government approach and to foster stronger partnerships across service sectors. Providing staff in areas outside health with better skills to recognise mental health problems, and ensuring that they have knowledge about the mental health system and are able to access support through advice and referral, will mean that all systems better respond to a person's needs.