Each year in Australia, tens of thousands of people living with mental illness die from preventable physical health conditions. Australia is yet to meet its 2008 commitment to provide equal healthcare for people with disabilities (Article 25, United Nations Convention on the Rights of Persons with Disabilities). In May 2024, a national forum of 240 delegates called for urgent action to address the life expectancy gap for people living with mental illness. This article presents perspectives of forum delegates about: (1) where we need to be, (2) critical reform elements and (3) foundational components to address this health inequity. Attendees overwhelmingly expressed the need for lived experience leadership and human rights to underpin the health system. Foundational components included respectful and inclusive practices, co-learning and co-production, a strong and integrated lived experience workforce, strategic support for reform, and societal shifts in values. Recommendations for government, advocacy bodies, services and individuals were provided, including conducting analyses of mental health legislation to align with Article 25 of the United Nations Convention on the Rights of Persons with Disabilities; establishing strategic lived experience leadership positions; providing workforce training on the increased risk of premature death and human rights approaches to improving healthcare equity; and taking every opportunity to advocate for physical health equality for people with mental illness. Urgent public health action is needed to incentivise and instil accountability for change, ensuring that reform efforts add power to the voices of those most impacted by mental illness and the services designed to support them.