Persons accessing inpatient mental health services generally experience reduced access to and quality of primary health care. The objective of this study was to compare health service utilization and perceptions, and receipt of specified health services, in Australian adults with and without a previous mental illness diagnosis. Across-sectional survey was administered by computer-assisted telephone interviewing in 2011; the main outcome measures were receipt of services in the previous 12 months, satisfaction with health care services, and concerns regarding health care affordability. Participants included 1275 adults residing in Queensland, Australia; 292 (23%) participants reported a diagnosis of mental illness, largely depression and/or anxiety (87%). The mental illness group had higher scores for concerns regarding health care affordability (mean ranks 778 vs. 706, respectively; z= -2.90, P = 0.004) and lower scores for perceptions of health care service quality and accessibility (mean ranks 631 vs. 701, respectively; z= -2.90, P = 0.004). After adjustment for increased utilization of services, the mental illness group had an increased likelihood of having received only 5 of 19 services in the past 12 months (odds ratios: 1.54–1.71). Compared to those with no mental illness, Australians with a mental illness report increased dissatisfaction with health care affordability, accessibility, and quality, and generally have similar odds of primary care services per health care utilization despite being at significantly greater risk of chronic disease.