Australia needs a mental health system the community can rely on and long-term strategic and systemic reformation of mental health care is critical. The featured papers in this Special Focus comment on the Oakden Report and the agenda for change and organisational reform, the use of stepped care approaches to enable effective mental health care, the vital role of family carers and their partnerships with mental health providers, eMental health care as a treatment option for young people, the need to facilitate ongoing development of ‘lived experience’ roles, the scarcity of quality guidelines to address the physical health of people with severe mental illness, and the largely unrecognised and valuable skill set of the mental health nurse.