Positive attitudes, hope and expectations of recovery need to prevail within all the services provided for people with mental illness. This requires eliminating stigmatising attitudes and practices, and education of the many and varied workforces that provide clinical and psychosocial services. All service providers need to maintain a positive attitude toward people with mental illness, and their families and carers, and this will require innovative work and training practices that enable the mental health workforce to develop and maintain an optimistic approach to treating and supporting people who have been seriously affected by mental illness. Two innovations in this regard are peer consultants to acute and clinical services who provide positive role models of people coping well with mental illness, and the rotation of staff through different service settings, particularly acute care staff into community settings, so that they have opportunities to see people coping effectively in the community.

One of the things they need to do is to rotate nursing staff through acute wards, community and NGOs. Then they get to see people who aren't sick all the time. They won't get those negative impressions. —Consumer
Workforce development also needs to focus on supporting a more holistic and comprehensive approach to mental health care that emphasises a bio-psycho-social understanding of mental health (see Engel 1980), recognising that the factors that affect mental health and mental illness occur in biological, psychological and social domains. This means an emphasis on updating the knowledge and skills of service providers, as well as increasing their ability to work within partnership models and systems of integrated care.

Mental health services must reorient to routinely work within frameworks that not only aim to reduce the clinical manifestations of illness, but that support the empowerment of consumers and encourage personal capacity building and support self-management. This will entail training the diverse components of the mental health care system to interact effectively, so that specialist mental health services, primary care services, allied health services, psychosocial services, and inpatient and community services, all recognise each other as equal partners in the provision of continuing care and communicate effectively with each other. It also means accepting the central role of consumers and their families and carers, and being open to innovation and change as new evidence becomes available in this dynamic field.

I was very lucky, I've hit a stroke of luck in this new mental health service and outpatient unit. A social worker happened to pick up my file and decide to have a look through it and she could not believe what she saw, she thought, "My god, this person has been in the system for nearly 20 years and she's only ever seen a psychiatrist", and so she got the team together and said, "Right this woman has really not had any treatment except drugs". I was so lucky, I felt really humbled, I got offered a social worker to work with me. What I liked about it was then I knew what was going to happen, I had this process going. She got me to see this psychologist who has taken me through a whole lot of stuff – stuff I'd never done before and that has really helped. —Consumer Top of page
The importance of primary care must be highlighted. As reform of the mental health system has progressed and mental health care has moved increasingly from institutionalised care to care within the community, primary care has become an essential community resource: supplying information about mental health and wellbeing to the general community, meeting the increasingly complex and diverse mental health care needs of patients, as well as being the gateway to specialist health care and many allied health services. This is an extremely demanding role, one that requires a high level of support and continual learning. While there are many initiatives underway enhancing mental health care within primary care, these need to be expanded and prioritised to ensure that primary care, including general practice, has the capacity to fulfil its essential role in continuing care for people seriously affected by mental illness.