Mental health week gives us all a chance to reassess where we are in the long struggle for a fair deal for the mentally ill.

Some four million Australians are significantly affected by mental health every year. We may not be dealing with a fully fledged epidemic, but that is still an enormous amount of preventable suffering and premature death.

Awareness is at an all-time high and stigma is in retreat. At least for the more socially acceptable forms of mental illness, the ones we can all relate to, like depression and anxiety. Economists have become great allies in demonstrating that mental illness damages national and international economies more than any major non-communicable disease.

It has double the impact of all cancers. The Australian Prime Minister has realised this, and constantly refers to the need to protect the “mental wealth” of the nation.

This is health care with a return on investment, simply because mental illnesses are the chronic diseases of the young and sabotage productivity across decades.

Dr Thomas Insel, the outgoing director of the National Institute of Mental Health in the USA, recently highlighted that, even as we await neuro-scientific breakthroughs, we already have great opportunities to transform outcomes in mental illness. Firstly, to ensure that the current evidence-based treatments are delivered as early and consistently as possible to everyone who needs them, and secondly, to harness the power of new technologies in e-health to complement and strengthen treatment. He has made two recent visits to Australia for compelling reasons.

Firstly, Australia has pioneered and scaled up innovative systems of early intervention for young people with emerging mental disorders – systems which are now inspiring the rest of the world. Secondly, our innovation in e-mental health, through a number of pioneeering Australian programs, notably via the Young and Well CRC, Black Dog, Orygen and Reach Out, is well ahead of the curve. Dr Insel has confirmed that we are more than a decade ahead of the US and the northern hemisphere in these areas.

The youth mental health reforms have been a rare bipartisan success, and have strong grassroots as well as scientific support. At the recent federal election, this progress was recognised by a recommitment to and growth in proven templates of youth mental health reform in “headspace” early intervention programs and early psychosis care, and to e-mental health through the $30 million investment in Project Synergy.

Yet, despite these positive developments, for most people with mental ill health the situation remains unacceptable. Suicide rates are rising with a 5 per cent increase last year and over 3000 people dying with what is typically a preventable death. Poor mental health is the common pathway to suicide, so timely and expert support, enhanced by technology, must be central to the suicide prevention trials which the federal government has generously funded.

Despite saturation levels of national awareness around depression, only 16 per cent of people with clinical depression in Australia receive even minimally adequate evidence-based care.

Awareness cannot be an end in itself, and has so far failed to drive action to address the need. Care is increasingly rationed in a way that would cause an outcry in cancer or diabetes.

In primary care, there is an annual cap of 10 sessions of psychological care under MBS rules (reduced in 2011 from the original 18 sessions), and there are moves to simplify and de-professionalise psychological interventions, based on UK models. These changes are watering down rather than building upon the ground–breaking primary mental health care reforms of the Howard era.

For more complex mental disorders, the situation is truly grim and unacceptable. The mainstreaming of mental health care in the 1990s, with a major reduction of beds, depended totally on a dynamic and expanding system of expert multidisciplinary community mental health care being built to reduce the extreme and desperate acute presentations to hospital.

This was begun but has been largely abandoned.

Over the past two decades we have seen serious underinvestment in community mental health, especially in the rapidly expanding growth corridors of our major cities. Victoria once invested more per capita in mental health care than any other state. Now we languish at the bottom of the list. This reflects complacency, irresponsibility, and ultimately discrimination in the health care of many of the most seriously ill Victorians.

The solution is not just a matter of money. There are many core features that need to change. The governance of the state mental health system now sits within major acute hospitals which are financially challenged, and which always prioritise physical health needs. It is an anomaly for hospitals to have large community programs – their priority is beds and they are incapable of grasping the importance of strong community services to make any inpatient system viable. The cultures and spaces for people with mental illness, through no fault of the clinicians, have become degraded and unsafe for patients and staff.

They must be completely rethought and redesigned. The wider community, too, is less safe with preventable deaths from suicide and violence an increasingly frequent occurrence. A beleaguered risk-focused approach has largely replaced the very thing that will actually increase safety and save lives; timely and humane evidence-based care. Safety is core business for a state government.

The Andrews government, to its credit, took office promising to deal with this serious decline. It is now grappling with the facts and the scale of the problem, as revealed in the Duckett report and in other internal government analyses of the problem. Window-dressing and Band-Aids will not work this time. Major redesign and investment and integration with primary care and third sector programs is urgent and essential.

A key priority is to refocus on young people with emerging mental illness as the most effective way to transform outcomes. We know that 75 per cent of disorders develop before age 25 and that the social and economic impacts are enormous and lifelong if they are not effectively helped. So while the whole system needs reform, a central pillar must be a strong evidence based system of care for all young people with mental health building on the progress that has been achieved already with headspace, Orygen and the growing capacities of new technologies.

Patrick McGorry is president of the Society for Mental Health Research and former Australian of the Year.