Depression is a major public health issue in Australia.1 Although more than 800 000 Australians experience depression each year, less than 40% of affected individuals present for care and fewer than one in six receive an evidence-based treatment.1 Most people with depression experience significant disability (reduced productivity on "seven of the past 28 days"2) and those who present for care are likely to have relapsing or chronic disorders.3 The current health burden of depression, and the projected future impact on our society, prompted the Federal and Victorian governments to develop beyondblue: the national depression initiative.4 The initiative has bipartisan political support and has grown to include active participation by other States and Territories and the development of partnerships with a range of non-government and community-based organisations.5

The aim of beyondblue is to promote effective population health-based strategies.6 Current projects focus on:

• increasing community awareness of key aspects of depression (such as characteristic symptoms, risk factors, pathways to care, preventive and effective treatment strategies);

• promoting destigmatisation of people with depression and related disorders;

• confronting barriers that discourage full social participation; and

• advocating for improved primary-care-based mental health services.

With regard to secondary services, the initiative is focused on improved specialist support for the primary care sector.

To meet the specific needs of people with depression and their carers, beyondblue has initiated a range of studies, some of which are outlined in this Supplement, and promoted the rapid dissemination of results to the medical profession. The review by Jorm et al7 (page S84) of complementary and self-help therapies used for treating depression represents a landmark study. It departs from the traditional debate about access to strategies that people say they want (such as access to counselling8) and evidence about what professional services people actually receive (eg, medication and non-specific psychological support9), and presents a scientific, dispassionate appraisal of treatments that people often use. Elsewhere, the same authors have noted that people not only use such complementary therapies,8 but also prioritise the use of harmful substances such as alcohol.

The report by Jorm et al7 and the community survey on how Australians perceive depression10 (page S63) highlight that the community does not see doctors as a critical part of the public health response to depression. This is due to the persistent view that mental health is, at best, a marginal health issue, in combination with a lack of knowledge about available services and treatments.10 Unfortunately, the experiences of consumers and carers11 (page S69) indicate that interactions with different levels of the healthcare system reinforce the belief that depression is not a major concern of healthcare providers. Furthermore, the ongoing stigma within the community has major negative effects on people with depression and their carers. This results in overt and covert barriers to social participation that continue even when these people have recovered. The lack of leadership by both primary care and specialist doctors in promoting destigmatisation is clear to people with depression who use our healthcare system. For beyondblue, the promotion of the direct voice of consumers and carers is critical to the process of destigmatisation and ongoing medical education.

Given the lack of detailed knowledge about depression in the community,10,12,13 beyondblue needs to find new ways of providing authoritative information to people who have not sought care and to those who have, because, all too often, access does not lead to the receipt of sufficient information to make treatment or personal choices. Advances in information technology are often seen as one solution. The review of Australian depression websites by Griffiths and Christensen14 (page S97) is intended to assist doctors and other healthcare professionals in recommending websites to patients and their carers. It is also intended to encourage healthcare professionals, particularly in primary care, to promote the use of high-quality Internet sites.

Finally, if consumers are to make informed choices, they require access to the most up-to-date syntheses of professional knowledge. Evidence-based guidelines can assist consumers to avoid treatments that do not work (or do more harm than good), that do not justify the personal or wider social cost, or that delay access to more effective treatments. beyondblue felt that it was essential to commission recommendations for the management of depression in primary care and that the key recommendations be made directly available to doctors and other primary care professionals (page S77).15

Over the life of the beyondblue initiative, it will be critical to continue to evaluate community recognition of depression, the impact of this recognition, and the extent and persistence of personal and social barriers to full social participation. The results presented here10,11 provide baseline data and underpin an agenda for promoting the concerns of consumers and carers.11 In turn, beyondblue hopes that these articles will promote a variety of new methods (including novel instruments for measuring consumer- and carer-based concepts of recovery and other illness outcomes), and the development of quality monitoring and outcome systems within our healthcare environment.16,17 beyondblue looks forward to reporting the outcomes of such endeavours in the near future.