Abstract
Once again the mental health profession should be grateful to Gavin Andrews for raising a fundamental question regarding the provision of services for people experiencing mental disorders and mental health problems. The introduction of the notion of health gain as an additional parameter influencing the distribution of resources is clearly attractive and logical. My purpose in this brief contribution is to point to some of the inevitable oversimplifications which seem to creep in when reform is strongly advocated. I will do this from a sympathetic standpoint but also from a safety-first perspective.