Abstract: In preparation for its 2014 four yearly review of the health system, the Health Performance Council (HPC) held a series of consultation forums, including with Health Advisory Councils (HACs). From this initial consultation process, it was clear that mental health was an important issue for regional South Australia. In response to that feedback, the HPC conducted a review of mental health outcomes and mental health services in country South Australia. In summary, the HPC’s findings from that review are: - Health Advisory Councils have considerable, valuable knowledge of their local communities’ perspectives, health outcomes and service needs. - Well-being and mental health care are major concerns for country South Australia. - On many indicators, the health of residents in some regions of country SA is indeed lagging behind their metropolitan counterparts. - Alcohol, illicit substances and personal safety are a significant concern for rural and regional South Australians yet access to corresponding services is less outside the metropolitan area. - While there have been some improvements in the accessibility of mental health services in country areas, particularly for crisis interventions, levels of service are not yet appropriate for the level of need and complexity. - Rural and regional South Australians access community mental health services less, are admitted to hospital at higher rates, receive specialised psychiatric care in hospital less and receive less community follow-up once released. - An adequate and well-supported workforce – both generalist and specialist – will be critical to the system’s efficiency and medium and long-term sustainability. - Active contribution of individuals and communities will be the foundation of the system most efficiently meeting challenges in a way that responds to the diversity of rural SA. The Health Performance Council has prepared this report as a part of its 2014 review of the health system in South Australia. It reflects the current elements that contribute to or diminish rural and remote South Australians’ mental health and well-being, their mental health outcomes and health system responses to their needs. The conditions which impact rural South Australians – the economy, the environment, technology and social factors – change and will continue to change. Systems such as health, education and housing impact, and are impacted by, South Australians. These systems are also influenced by external factors. This report therefore reflects a point in time with the information available at the time.