Introduction: The quality of general practitioner-delivered primary mental health care (PMHC) is a concern for Canadian policy-makers. To improve quality, policy reforms must target the length of consultations, interdisciplinary collaboration, and system coordination. PMHC governance and physician remuneration are structural barriers that impede quality improvement efforts. Purpose: The purpose of the research is to determine which PMHC governance and mode of physician remuneration policy reforms can most effectively facilitate greater system coordination, interdisciplinary coordination, and longer, more involved consultations in Canadian PMHC. Methods: A comparative case study of three Canadian provinces, specifically British Columbia, Manitoba, and Saskatchewan, was completed. These cases represent the range of Canadian PMHC policy reforms. To evaluate progress and performance, reforms were ranked on a PMHC best practices ordinal scale. New Zealand and Australia were selected for comparison with the Canadian cases. Ultimately, the integration of international cases in the comparative case study supplied policy lessons on revolutionary and evolutionary PMHC. Results: In Canada, governance and remuneration PMHC reforms are incremental. In fact, British Columbia and Manitoba physician remuneration policy reforms demonstrate some progress towards improving physician-delivered PMHC remuneration structures. While governance was not a component of the PMHC reforms implemented by British Columbia, Manitoba, and Saskatchewan, PMHC reforms in Australia and New Zealand demonstrated evolutionary and revolutionary options to reform governance and physician remuneration to improve PMHC quality. Conclusion: PMHC quality improvement requires governments to address the structural barriers imposed by governance and physician remuneration. The legacies of these barriers influence the capacity of health systems to support high quality, innovative, and more collaborative primary mental health care. Key Words: primary mental health care, physician remuneration, governance.