Broken promises and missing steps in mental health reform

Patrick D McGorry and Matthew P Hamilton
Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00329
Published online: 19 June 2017

We are still seriously failing to resource and integrate mental health into the mainstream of the health care system

A young colleague recently shared his family’s experience of the Australian health system. His older brother has schizophrenia, an illness that is typically serious, persistent and reduces life expectancy by a minimum of 15–20 years.1,2 He was untreated and seriously ill for 2 years before he gained access — as a result of a life-threatening crisis — to a mental health system that could no longer avoid a response. Expert early intervention services (an Australian innovation), which improve health, social and economic outcomes,3,4 were then and now simply not available in his community and remain embryonic nationally. The inexcusable treatment delay cost him his chance of recovery,4 and he has languished for years with severe symptoms and disability. His care now consists of brief general practitioner visits, non-evidence-based support from a non-government organisation, and stress-laden hospital admissions that achieve nothing more than risk management. He has no meaningful access to specialist expertise or the multidisciplinary team-based approach that is essential to remission and recovery. In 2016, his sister was diagnosed with cancer. The contrast was a revelation to the family. The cancer diagnosis galvanised the same local health system, which this time delivered truly exemplary care. Rapid investigation, effective treatment and widespread support followed, leading to full remission. Not only was the medical care high quality, intensive and sustained, but the young woman was even provided with expert mental health care, of much higher quality than that offered to her brother, for as long as it was needed, with no rationing of sessions or barriers to specialist care.

  • 1 University of Melbourne, Melbourne, VIC
  • 2 Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, VIC


Competing interests:

Patrick McGorry is a Director of headspace.

  • 1. Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013; 346: f2539.
  • 2. Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry 2011; 199: 441-442.
  • 3. Tsiachristas A, Thomas T, Leal J, Lennox BR. Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England. BMJ Open 2016; 6: e012611.
  • 4. Hegelstad WT, Larsen TK, Auestad B, et al. Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. Am J Psychiatry 2012; 169: 374-380.
  • 5. Morgan VA, Waterreus A, Carr V, et al. Responding to challenges for people with psychotic illness: updated evidence from the Survey of High Impact Psychosis. Aust N Z J Psychiatry 2017; 51: 124-140.
  • 6. Castle DJ, Galletly CA, Dark F, et al. The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders. Med J Aust 2017; 206: 501-505.
  • 7. Nielssen O, McGorry PD, Castle D, Galletly C. The RANZCP guidelines for schizophrenia: why is our practice so far short of our recommendations, and what can we do about it? Aust N Z J Psychiatry In press.
  • 8. National Mental Health Commission. Report of the national review of mental health programs and services. Sydney: NMHC; 2015.,-thriving-communities-review-of-mental-health-programmes-and-services.aspx (accessed May 2017).
  • 9. Reavley NJ, Jorm AF. National Survey of Mental Health Literacy and Stigma. Canberra: Department of Health and Ageing, 2011.
  • 10. Australian Institute of Health and Welfare. Mental Health Services in Australia. Expenditure on mental health services: table EXP.32, expenditure on mental health-related services by source of funding, 1992–93 to 2014–15. Canberra: AIHW; 2017. (accessed May 2017).
  • 11. Australian Institute of Health and Welfare. Mental Health Services in Australia. Expenditure on mental health services: table EXP.4, recurrent expenditure per capita on state and territory specialised mental health services, constant prices, states and territories, 1992–93 to 2014–15. Canberra: AIHW; 2017. (accessed May 2017).
  • 12. Duckett S, Cuddihy M, Newnham H. Targeting zero: supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care. Report of the review of hospital safety and quality assurance in Victoria. Melbourne: Victorian Government; 2016.
  • 13. Andrews D. Safety overhaul to put Victorian patients first [press release]. Melbourne: Government of Victoria, 14 October 2016. (accessed May 2017).
  • 14. McGorry PD. Back to the future: schizophrenia in retrospect and prospect. Aust N Z J Psychiatry 2017; 51: 431-433.
  • 15. Torrey EF. American psychosis: how the federal government destroyed the mental illness treatment system. Oxford: Oxford University Press; 2013.
  • 16. Harris MG, Hobbs MJ, Burgess PM, et al. Frequency and quality of mental health treatment for affective and anxiety disorders among Australian adults. Med J Aust 2015; 202: 185-189. <MJA full text>
  • 17. Bloom DE, Cafiero ET, Jané-Llopis E, et al. The global economic burden of non-communicable diseases. Geneva: World Economic Forum; 2011. (accessed May 2017).
  • 18. Turnbull M. Address — 2016 Australian Mental Health Prize. Canberra: Australian Government; 2016. (accessed May 2017).


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.