We do poorly because of high out-of-pocket costs, a lack of equity and poor access, particularly in primary care, mental health and oral health.

Now it is clear the focus of the Rudd government's $7.3 billion new investments is refunding of our acute hospital networks, it is unlikely that we will be winning any gold medals in health in the near future.

In distinct contrast to the past 10 years of genuine reform in Britain and other European countries, very few substantial changes in the way we do business have been achieved.

We now have five layers of bureaucracy (national, state, local hospitals, private health and "Medicare local").

There are no mechanisms for greater competition between public or private insurers or public or private health professionals.

It is more likely that the new system will accelerate rather than contain healthcare costs.

Sadly, there has been no substantial shift to reward systems that manage those with chronic illness outside hospital settings. Some smart investments have been signalled, including expansion of sub-acute beds and development of personally controlled electronic health records.

The easier commitments in prevention (the tobacco tax increase) have been implemented, while the harder ones have been rejected (change in the taxation process for alcohol).

Despite the size of the new investments, there are two big losers, dental health and mental health. Hips and hearts are in, mouths and minds are out.

If only it was that easy to choose which illness you, or your family, will get.

When it comes to real pain and suffering, diseases of the mouth or mind are close to the top of most lists. From a medical perspective, doing health reform by body part or illness type is senseless. From a financial perspective, it would be hard to pick two areas of greater significance to working families.

Mental illness accounts for 24 per cent of health-related disability in this country and is a major driver of unemployment, underemployment, alcohol and substance misuse, emergency department presentations, family breakdown and suicide.

We spend about 6 per cent of the health budget on mental health services and most distressingly, only 13 per cent of young men and 31 per cent of young women with mental illness receive any help.

Over the past two decades, we've had numerous government inquiries, Human Rights Commission Reports, Senate standing committees and community-based advocacy recommending urgent action and investment.

In 2006 John Howard and then NSW premier Morris Iemma picked up the ball and started running on these issues.

The real issue now is why, in this phase of substantial health change, are Kevin Rudd and the premiers so determined to abandon some of the most vulnerable people in our community?

When pressed to explain the active exclusion of mental health, the PM and the Health Minister Nicola Roxon have been evasive.

First, there has been denial of any exclusion.

Given that less than 2 per cent of the new monies are to be spent on mental health, this won't wash.

Second, the government says it has more urgent needs. That's obvious. In 2009, before receiving the Bennett commission's recommendations, the Rudd government invested more than $2 billion in a new national cancer plan.

The PM has been photographed opening new regional cancer centres ever since.

Following the 2010 budget, Roxon has now offered a new excuse for inaction.

There are already many dysfunctional programs and the sector lacks the capacity to use new monies to deliver effective services.

So, the government's priority is to reshuffle the existing deck chairs ("putting our own house in order").

This will leave the state-based services and, most importantly, the essential community-based mental health, alcohol and drug and supporting housing agencies to rot.

By contrast, the minister has proudly announced major new capacity-building programs in every other health area (hospital beds, sub-acute services, e-health, primary care and medical and nursing workforces).

In the past, there were many obvious answers as to why mental health was neglected.

From the 1960s to the early 80s, particularly among the children of the centre-left, it was important to deny the very existence of mental illness. Mental disorders were self-induced or socially induced and were not core business.

Even among progressive governments, there was no great need to build relevant services, support medical or psychological research or train relevant workforces.

From the 90s onwards, national estimates of the prevalence of mental disorders in developed economies indicated the very broad economic and social impacts of untreated mental illness. During the past 20 years, the successful treatment of many people with common depressive disorders has underpinned a wider community acceptance of the central role of mental health.

This has culminated in smart governments (as in Britain) using the available brain and psychological sciences to underpin social and health policies that will maximize the future mental wealth of developed nations.

The big unanswered question for the Prime Minister is why has his government been deaf to the benefit to be gained by investment in early intervention services, the new brain sciences and the urgent needs of those who live with mental disorders every day.

Ian Hickie is executive director of the Brain and Mind Research Institute of the University of Sydney.