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Stepwise expansion of evidence-based care is needed for mental health reform

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One of the greatest opportunities in Australian public health is to reduce the mortality and morbidity caused by mental illness. In contrast to cancer and cardiovascular disease, there have been no improvements in rates of death or disability from mental illness in recent decades. Indeed, rates of suicide have increased,1 and mental illness is the largest and fasting growing source of disability.2 Prevention, early diagnosis and sustained access to evidence-based treatment have underpinned health gains in other diseases, yet these are poorly provided by a mental health system that is characterised by a self-perpetuating focus on acute care and welfare payments.3

With mental illness projected to have the greatest impact on global economic output of all non-communicable diseases,4 there is an economic imperative to replicate what has been accomplished for other diseases. The mental health reforms announced by the Prime Minister and the Minister for Health on 26 November 2015 outlined new directions,5 two of which, in particular, are highly congruent to achieving this goal. However, the reform package is constrained by a focus on cost containment and will need further strengthening if it is to be successful.

The first welcome aim of reform is to shift the focus of mental…