Australia, a vast continent of 7 700 000 km2 (including the island state of Tasmania), is roughly the size of Western Europe or mainland USA, but with a population of only 20.2 million (2004 estimate), mainly concentrated in coastal areas.

Australia's official language is English and its largest religion is Christianity (76.4%). Of the current population 92% are Caucasian, 7% Asian and 1% ‘other’ in origin, including 350 000 who claim Aboriginal descent. Australia's population growth once relied largely on migration from Britain, and to a lesser extent Ireland, but after the Second World War it was broadened by refu-gees and others from many other parts of Europe. Since the 1970s there has been more substantial migration from Asia. While refugees continue to be taken in and supported, Australia takes a tough stance on unauthorised arrivals, including prolonged detention, which is beginning to be softened due to growing public concern.

The Commonwealth (national) government is responsible for general policy directions in health, disability, education, employment and so on. The state governments retain responsibility for organising all their own health services and facilities, including mental health services. Consequently, such provision is diverse. Further, Australia has developed a substantial private medical sector, now funded nationally by taxpayers through the Health Insurance Commission, as well as via private health insurance schemes.

Epidemiology

A national cross-sectional community survey of mental health and wellbeing (Andrews et al, 1999; Jablensky et al, 1999) was conducted via lay surveyors from the Australian Bureau of Statistics. It revealed that 17.7% of adult Australians met criteria for the common anxiety, affective and/or substance use disorders. More than 20% were likely to have a diagnosable and treatable mental disorder when psychotic, cognitive and personality disorders were included. Only 38% of individuals with a mental disorder (more women than men) sought professional help, which is concerning, and in most cases this was from a general practitioner rather than from a specialist mental health professional. Half as many Australians have a longterm mental disorder as have a long-term physical disorder, with physical disability being more common in the elderly and mental disability being more prevalent in young adults.