Contemporary health policy dictates that health services have a demonstrable consumer focus and actively progress the issue of consumer participation in services. Given that costs of such initiatives are not insignificant, there is a responsibility to ensure that the resources are being directed to appropriate means, and are achieving worthwhile results. In examining the impact and effectiveness of consumer participation initiatives in their own Service, the authors undertook a qualitative study exploring the extent and quality of consumer participation following a three-year period of support and funding. Using trained consumers as interviewers, current consumers were asked about their perceptions and personal experience of "participation". Findings identified low familiarity and involvement with the concept of consumer participation overall. Barriers to involvement included lack of motivation or invitation, stigma, and a lack of information. A need to integrate consumer participation activities into the wider system was also noted. The authors conclude that simply devoting energy and resources to consumer initiatives, and thereby achieving a politically correct approach, may not be a worthwhile exercise. Such initiatives need to be based on evidence, available resources and identifiable and achievable outcomes, with a balance struck between endorsing the value of consumer participation and establishing realistic goals for what can be offered and managed.

Using Quality Improvement project methodology, complex organisational and clinical practice change was broughtabout to improve services for people with co-existing mental health and alcohol and drug misuse. The project describeslocal uptake and adaptation of national and state policy to achieve change that is sustainable within existing resources.Emphasis on engagement of staff and consumers and carers throughout the change was an essential component. Theproject has implications for the introduction of changes in response to other national policy directives.

An urban, public sector Area Mental Health Program reviewed its own bilingual counsellor program as part of an Area-wide quality improvement project, and found that the counsellors' roles needed to be better defined; that mainstream staff needed to have more access to their expertise as cultural consultants; and that their function as an Area team, rather than as service based staff, needed to be encouraged. The bilingual counsellors decided to take up this challenge, and with the support of the Area Director of Mental Health, worked together to redefine their roles.

Following the recognition of patients with first onset psychosis as a special needs group, there has been a significant growth in clinical and research interest in this area [1]. Identified issues have included: the earliest possible detection of the illness [2]; the interaction between developmental needs of adolescents and the trauma of the illness [3]; evaluating the evidence concerning the relative effectiveness of early interventions [4]; and determining the impact on long term health outcomes for young persons who are treated assertively in the early stages of psychosis [3].