Mental illness is the largest and fastest growing source of disability in Australia and more needs to be done to improve mental health reform, according to the authors of a "For debate" published in the Medical Journal of Australia.

"In contrast to cancer and cardiovascular disease, there have been no improvements in rates of death or disability from mental illness in recent decades," wrote Professor Patrick McGorry and Mr Matthew Hamilton from Orygen, the National Centre of Excellence in Youth Mental Health.

McGorry and Hamilton wrote that mental health reforms announced by the federal government last year will never achieve their goals unless adequately financed. Although welcoming the government's aim to shift the focus of mental health care towards earlier intervention and stepped care, the authors warn that "this crucial plank of reform may remain more rhetoric than reality" as the government plans to finance new early intervention services for young people with cuts to existing cost-effective and evidence-based early psychosis services.

While supporting the regionalisation of health care, the authors highlight international evidence suggesting that the reform program's emphasis on devolving commissioning to primary health networks "is not a magic bullet to improve health outcomes" and stress that "the virtue of regional planning flexibility cannot overshadow the need to invest in programs that work".

The authors note that funding constraints mean that expert, specialised treatment is currently heavily rationed and mainly restricted to late presentations. "Of Australian adults with depression and anxiety, 16% receive only 'minimally adequate treatment', and the situation for those with psychotic illnesses reflects similar poor access to and variable quality of care," the authors wrote.

Another area of concern was the "missing middle" group of patients, those with complex disorders who were unlikely to receive the expert care they needed from state-funded public health services.

The authors said a new model of care for this group needed to be designed, which should be a federal responsibility.

"Care for this group should involve a step up in expertise from the initial GP and allied health professional, and ideally should involve a team approach, with input from a psychiatrist," McGorry and Hamilton wrote. The authors believe Australians now have a greater understanding of the impact that mental illness can have on their lives and society.

"The challenge is to transform this into targeted investment so that access, quality and outcomes in mental health care match those seen in physical health care," they concluded.

Article: Stepwise expansion of evidence-based care is needed for mental health reform, Patrick D McGorry and Matthew P Hamilton, Medical Journal of Australia, doi: 10.5694/mja16.00120, published 16 May 2016.