After 12 years of national mental health reform, major service gaps and poor experiences of care are common. The mental health community reports little progress in implementing its key priorities, such as expanded early‐intervention programs, comanagement of people with mental health problems and related alcohol or substance misuse, and widening of the spectrum of acute care settings. We propose new national targets for reducing the social and economic costs of poor mental health; these include increased access to effective care, reduced suicide rates and improved rates of return to full social and economic participation. We detail specific service reforms designed to maximise the chance of achieving these targets, and prioritise youth health and integrated primary care programs. New independent and national reporting systems on the progress of mental health reform are urgently required.

Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Objective : To describe the key features of the ‘Better Outcomes in Mental Health Care’ initiative (2001–2005) and to detail some of the conceptual, community, professional and epidemiological forces that shaped its content. Conclusions : The ‘Better Outcomes in Mental Health Care’ initiative represents a major development in mental health care in Australia. It recognises the central role of primary care, promotes integrated medical and psychological care, rewards treatments that occur over an episode of illness, promotes active purchasing of non‐pharmacological interventions earlier in the course of illness, and attempts to better link general practitioners, non‐medical mental health specialists and psychiatrists to meet population‐based mental health needs. Central to its development has been a commitment by general practitioners to develop progressively better mental health skills and measure both individual consumer and system‐related outcomes.