Five years ago I sat in a room trying to explain Open Dialogue to a funder, and watched their eyes glaze over. We had little Australian evidence, no formal demonstration site, and no easy way to explain what we meant by “Open Dialogue” to anyone outside a clinical room. Underneath all of it was one simple idea: that people experiencing distress should be met by their community, not passed through a system. What we had, at that point, was one major philanthropic funder prepared to back that idea before we could prove any of it.

I’ve written previously about the well-documented problems with Australia’s mental health system — the crisis cycle, the fragmented services, the families left out of care. I won’t revisit that ground here. What I’m asked about far more often is the harder question: not what’s broken, but what it actually takes to fix it.

Despite unprecedented investment in mental health and growing public awareness about the issues, we’re not seeing the outcomes we need. Crisis presentations continue their upward trajectory. Emergency department presentations for mental health rose 16% between 2019-20 and 2021-22 (AIHW). People wait months for care. Families and friends—often the most consistent source of support—remain systematically excluded.

Attending my first TheMHS Conference in Brisbane this September was an eye-opener—and a wake-up call.

The conference theme ‘Envisioning 2050’ had me thinking not just about where AI might take us, but about a more fundamental question: after decades of mental health reform, why are we still failing people and their families so spectacularly?

It is a good question, and particularly relevant in the light of a new Grattan Institute report Special treatment: Improving Australians’ access to specialist care. The report reveals that almost a million people delay or miss specialist care – such as seeing a psychiatrist – because they cannot afford it. Initial psychiatrist consultations can cost up to $670.

During a recent trip to the UK and Finland I was fortunate to meet with several leading mental health services as part of the NHS to talk about the increasing optimism in mental health care due to the highly anticipated soon to be released findings from the ODDESSI trial.