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ObjectiveTo quantify Hepatitis C virus (HCV) testing, positivity rates and risk factor prevalence in mental health service consumers.MethodThis retrospective study (March 2019-April 2020) included consumers accessing mental health services at a public metropolitan hospital network. HCV testing was determined by data linkage with pathology results. Demographic characteristics, type of mental health care and assessment of HCV risk factors were analysed to investigate predictors of HCV positivity.ResultsEleven percent (n = 2065) of consumers had HCV testing; most commonly among inpatient-only consumers (22.6%; n = 513) and least common among community-only consumers (5.3%; n = 1,040). HCV antibody (Ab) positivity was observed in 31.2% of consumers (n = 215). Among those who underwent PCR testing (n = 42), 33.3% were PCR-positive.Predictors of active HCV infection were persons who injected drugs (PWID), evidence of liver disease and recent contact with custodial settings. Forty-three percent of consumers without HCV testing had at least one known HCV risk factor.ConclusionThe high HCV (Ab and RNA) positivity rate and prevalence of risk factors support consideration for increased screening in mental health services as a public health strategy to meet Australia's target of HCV eradication by 2030.