Australia's Federated system means that health care planning must be undertaken at several different levels: the Australian Government is responsible for some elements of the mental health care system; State/Territory governments are responsible for other elements; and some responsibility is held by local councils, communities and services. The level of responsibility appropriate for different actions must be ascertained so that planning and accountability processes are apparent. Furthermore, clear understanding of where responsibility lies is essential to effectively advocate for improved resourcing and system change.

The entire range of individuals and organisations identified earlier in Figure 2 needs to be committed to working together to implement the 4As Framework. Each of these sources of support has specific responsibilities in terms of implementation, which are described below.

People who have been seriously affected by mental illness
Families and carers
All service providers
Service managers and planners
Communities
Governments

People who have been seriously affected by mental illness

There is a great deal that people who have experienced mental illness can do to promote their mental health and prevent future episodes of mental illness. This involves day-to-day self-management, as well as working with family and/or carers, and with service providers to put in place supports for mental health and wellbeing. The level of responsibility that a person is able to take is determined by their age, personal circumstances and current level of wellness.

Beyond personal responsibility, people who have experienced mental illness also have a vital role in supporting others through peer support. This role extends to educating and advising other elements of the mental health care system regarding the needs of consumers through education, advice and advocacy.

Top of pageResponsibilities for people who have been seriously affected by mental illness are:
  • Awareness
    • Develop self-awareness, including awareness of personal risk and protective factors for mental health, and early warning signs of becoming unwell
    • Support other consumers to develop awareness
    • Support family/carers to develop awareness
    • Support services to understand awareness
    • Help reduce the stigma of mental illness in services and in the community

  • Anticipation
    • Self-manage mental health, to the extent able, by having daily plans to support staying well
    • Be an active participant with service providers and family/carers in planning for relapse prevention, rehabilitation and recovery
    • Be an active participant in discharge planning to ensure supports are in place for continuing care
    • Have a crisis plan
    • Educate others about consumer participation in planning
    • Advocate for consumer participation in planning

  • Alternatives
    • Actively self-manage personal wellness by knowing the risk and protective factors for mental health and ways to reduce the risks and increase the protective factors
    • Be an active participant with services to make sure that all wellness needs are met by focussing on risk and protective factors for mental health
    • Educate others about risk and protective factors for mental health
    • Advocate for service alternatives that address all the wellness needs for people who have experienced mental illness

  • Access
    • Learn about the local services available and how to access them
    • Educate others about the services available and how to access them
    • Advocate to improve service access Top of page

Families and carers

The families of people who have experienced mental illness span the entire range of family arrangements: some people live alone and have limited contact with their family of origin; many young people live with their family of origin, including parents and siblings; many consumers have spouses or partners, which can include same-sex partners; and many have children of their own. There are also people who live with friends, including other consumers, and see these people as family. In the context of this Framework, the term 'family' refers to people whose lives are affected by their close relationship with a person who has been seriously affected by mental illness, and whose behaviour impacts on them. The role of family members in this Framework is to support the consumer to manage their ongoing day-to-day health and wellbeing.

A carer is a person whose life is affected by a close relationship with and caring role for a consumer. Carers are often, but not necessarily, family members. The carer's role within this Framework is to support and facilitate the day-to-day management of the consumer's health and wellbeing.

Responsibilities for carers, but also for families, are:
  • Awareness
    • Develop awareness, including awareness of risk and protective factors for mental health and early warning signs of illness
    • Support family member/consumer to develop awareness
    • Support other families and carers to develop awareness
    • Support services in their understanding of the development of awareness
    • Help reduce the stigma of mental illness in services and in the community

  • Anticipation
    • Support self-management by family member/consumer
    • Be an active participant in planning for relapse prevention, rehabilitation, and recovery, where appropriate
    • Be an active participant in discharge planning, where appropriate
    • Be an active participant in crisis planning, where appropriate
    • Educate others families and carers about family and carer participation in planning
    • Advocate for carer participation in planning

  • Alternatives
    • Understand the wellness needs of family member/consumer in terms of risk and protective factors for mental health
    • Be an active participant with services to attain a holistic approach to wellness
    • Educate others about risk and protective factors for mental health
    • Advocate for service alternatives that address all the bio-psycho-social wellness needs

  • Access
    • Learn about the local services available and how to access them
    • Support family member/consumer to access services
    • Educate others about the services available and how to access them
    • Advocate to improve service access Top of page

All service providers

A diverse range of individuals and organisations provide services directly to people who have experienced mental illness, and all these are essential to implementing this Framework. Relevant service providers include all those that contribute to continuing care through their roles providing services related to self-management, rehabilitation, relapse prevention and mental health promotion.* This means: specialist mental health services, emergency and crisis services, primary care (including general practice and allied health), psychiatric disability services, community support services (such as housing and employment), forensic services, drug and alcohol services, general health services, other human services (such as education), and importantly, peer support services.

The roles and responsibilities of providers of different types of services are not differentiated here because the principles and elements of the Framework apply to all of these service providers. While it is recognised that services specialise in the provision of particular types of clinical or psycho-social support, it cannot be overstated that the Framework is common to all service providers, who need to enact its principles and elements within the context of their day-to-day work roles and responsibilities.

Responsibilities for service providers are:
  • Awareness
    • Have a positive attitude toward people who have experienced mental illness and their families and carers and work with a recovery orientation
    • Understand the factors that affect the development of awareness for consumers/clients/patients
    • Understand the risk and protective factors for mental health and early warning signs of illness
    • Support consumers/clients/patients to develop awareness
    • Support families and carers to develop awareness
    • Support other service providers to better understand mental health and mental illness
    • Help reduce the stigma of mental illness in services and in the community

  • Anticipation
    • Support self-management by consumers/clients/patients
    • Ensure participation of the consumer/client/patient in their planning: relapse prevention, rehabilitation, and recovery planning; discharge planning and crisis planning
    • Enable family and carer participation at all levels of planning, where appropriate
    • Develop a trusting, respectful therapeutic relationship with consumers/clients/patients
    • Be an active and collaborative participant in planning with other services
    • Implement plans

  • Alternatives
    • Adopt a holistic approach and determine and address all the risk and protective factors for mental health
    • Work collaboratively with other services to attain a holistic and integrated service approach for consumers/clients/patients
    • Educate other service providers about risk and protective factors for mental health
    • Advocate for service alternatives that address all the bio-psycho-social wellness needs

  • Access
    • Respond quickly and effectively to changes in the wellness needs of consumers/clients/patients
    • Respond quickly and effectively to the needs of families and carers
    • Ensure access to all consumers/clients/patients in a way that is responsive to a diverse range of needs, including developmental and cultural needs and complex care needs, through training and collaboration with other services
    • Ensure access to other service providers in the form of providing advice, referral, support and collaboration
    • Advocate to improve service access Top of page

Service managers and planners

Service managers and planners are the managerial and organisational support for direct service provision in all the different sectors of support. Their role is to enable service providers to apply the principles and elements of the Framework.

Responsibilities for service managers and planners are:
  • Awareness
    • Enable service providers to support the development of awareness for consumers, their families and carers, and staff
    • Help reduce the stigma of mental illness in services and in the community

  • Anticipation
    • Enable consumer participation in planning at all levels
    • Enable family and carer participation in planning, where appropriate
    • Enable the development of therapeutic relationships between consumers and staff
    • Train staff to be active and collaborative participants in planning
    • Provide resources and training for planning at all levels
    • Ensure implementation of plans

  • Alternatives
    • Enable service providers to provide a holistic approach through recruitment, training and resourcing
    • Enable service providers to provide a holistic service approach by working collaboratively with other services and sectors to address risk and protective factors for mental health
    • Advocate for service alternatives that address all mental health needs of consumers/clients/patients

  • Access
    • Enable service access by reducing access barriers that result from policies, staff training and recruitment, and resourcing within the service
    • Enable service access by facilitating collaborative partnerships with other services and consumers and their families and carers
    • Advocate to improve service access Top of page

Communities

Communities are the environments where people carry out their daily lives—where they live, work and play—and, therefore, have a profound impact on wellbeing. Communities have a vital role promoting the mental health of all community members. Importantly, people who have been seriously affected by mental illness and their families and carers need to be able to participate in community life and be seen as valued community members.

Major responsibilities of communities are to provide safe opportunities for community living and participation for all community members, to help to inform community members about mental health and mental illness, and to reduce discrimination and stigma. Communities also need to be able to identify their own needs and ensure that service alternatives and access to services meet the needs of community members who have been seriously affected by mental illness.

Communities must respond to the special needs of population groups that are part of the community. This includes Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse backgrounds, younger and older population groups, and people with complex care needs. Communities must also recognise and address their unique needs in terms of being urban, rural or remote, and other local circumstances that affect the wellbeing of community members.

Responsibilities for communities are:
  • Awareness
    • Reduce the stigma of mental illness in the community
    • Educate the community about mental health and mental illness
    • Ensure community participation for people who have been seriously affected by mental illness and their families and carers
    • Monitor community media to ensure that they do not perpetuate stigma and discrimination

  • Anticipation
    • Provide a supportive environment for planning by enabling all services within the community to work collaboratively

  • Alternatives
    • Ensure that the community provides service alternatives that address all the mental health needs of community members

  • Access
    • Ensure that the community provides effective service access to all community members Top of page

Governments

The Australian Government, State/Territory governments, and local government bodies all have roles to play in implementing this Framework. It is important to note that it is not only the health sector of government that is required to act, but other sectors such as housing, employment, justice, welfare, and education, which also impact on the mental health of people within communities.

The main responsibilities of government are to provide policy support for the Framework and to fund, purchase or provide services to implement the Framework, where appropriate. Policy support for the Framework is already evident in most jurisdictions and the major challenge for governments is implementation. To ensure implementation of the Framework different levels of government need to use their powers to monitor and regulate the provision of services for continuing care.

Footnotes

* Note that recovery is not listed as a specific type of service for continuing care. This is because recovery is an overarching principle and orientation that should be applied within all services.