Between 28 and 30 October 2019, at the Adelaide Convention Centre, South Australia (SA), more than 270 consumers, carers, practitioners and researchers from across rural and remote Australia and New Zealand met at the 11th Australian Rural and Remote Mental Health Symposium to discuss mental health. They networked, shared insights and learnt from experts and each other with the intention of enhancing their own understanding and practice. The symposium began with the international launch of the Orange Declaration on Rural and Remote Mental Health.1 This was followed by an international panel on challenges and opportunities in rural mental health. In this panel, Senator Rachel Siewert summarised the findings of the Australian Senate Inquiry into Rural Mental Health2 and Karla Thorpe (Mental Health Commission, Canada) and Barbara Kuriger (Parliamentary Whip, Government of New Zealand) summarised progress, challenges and opportunities from their countries. Similar issues were discussed in the South Australian context by Mr Chris Burns (Commissioner, SA Mental Health) and John Brayley (Chief Psychiatrist of SA). The rate of suicide is much higher in rural communities, and suicide prevention was one key focus of the opening day. The Prime Minister's National Suicide Prevention Adviser and CEO of the National Mental Health Commission, Christine Morgan, convened a special consultation forum on rural suicide. The results of this rural forum will be fed back into the National Suicide Prevention Taskforce. A series of focused workshops on mental health leadership, child and family well-being, gambling and hoarding were conducted immediately before the official opening of the symposium. From across nine plenary presentations, 56 concurrent sessions and seven workshops, key messages and themes emerged. The following sections summarise the key themes as determined by the session chairs and as voted on by the delegates. To be effective, mental health policy development must include stakeholders from rural communities. However, rural mental health policy should not be a product of only “bottom-up” processes and placed-based planning. On the other hand, it certainly should not be a product of only “top-down” processes. Effective and legitimate policy development, planning, provision and evaluation of services for rural mental health is a product of an ongoing collaborative relationship between the city and the country, in which the place-based expertise of rural stakeholders is valued and respected. A partnership approach to rural mental health policy and planning combines the latest research evidence and national priorities with the knowledge of existing service networks and local community contexts. Opportunities exist to more effectively capture local expertise to enhance the delivery of services in rural and remote locations. There needs to be a recognition that rural communities are not homogeneous, so different options need to be provided for consumers. Further, strategies should be put in place to ensure active and credible engagement between those with lived experience, their carers, the practitioners who support them and local mental health leaders. While this takes more time and effort than the “top-down” approach, it is an moral and practical imperative. The symposium theme of effective engagement and partnership resonated across rural, consumer and Aboriginal and Torres Strait Islander communities. This was exemplified by the strong theme of cultural safety and working effectively with Aboriginal and Torres Strait Islander community leaders that was evident throughout the symposium. Three keynote presentations and subsequent concurrent sessions explored the theme of how to effectively respect the wisdom within local Indigenous communities. The presentations examined the need to work respectfully with communities, and the tradition of “yarning” as a strength that should be embraced. Professor Ernest Hunter presented his research demonstrating how political, social and economic issues are the drivers of psychological distress, suicide and incarceration, and how we cannot separate social policy from community well-being. Rosemary Wanganeen's presentation looked at understanding loss and grief and its impact on Aboriginal communities, and Dr Marshall Watson (a descendant of the Noongar people) shared his insights gained from working with young people with complex trauma, offending and problematic behaviours. There is a strong and developing body of evidence as to the efficacy of digital mental health services, and Australia is leading the world in this research. Digital mental health platforms offer great opportunities for rural and remote communities. However, many speakers underscored the need for digital mental health services to integrate with local services. In an already highly fragmented system, online programs can result in further service fragmentation and the undermining of the existing local mental health workforce. Professors Titov, Cavanaugh and others noted that the provision of digital mental health services must be coordinated and integrated, and delivered in ways that support the mental health workers in situ. This includes offering a mix of face-to-face and online support, linking with local mental health teams and using the online environment for supervision and training of local mental health staff. Access to e-services means real-time assessments can lead to real-time responses. Digital technology can provide choice, control and flexibility for service users. Current poor Internet speeds and lack of consistency in the delivery of rural e-services mean rural and remote service users are disadvantaged—this needs to change. There is a need to invest in communication infrastructure as poor quality digital connections compromise the ability to deliver services online. Digital platforms offer tremendous opportunities to enhance and expand the delivery of rural mental health services. However, poor rural digital infrastructure is hampering these initiatives. The amazing resilience of professionals who deliver services to rural communities was acknowledged. Different agencies in rural communities work together effectively often because there is no option. This was highlighted in the local-level responses to the recent floods and bushfires. However, there is an ongoing need for national leadership to prepare for future challenging circumstances as they arise. Opportunities to plan, prepare and prevent rural crises exist, and it was agreed this will be a major focus of our October 2020 National Symposium in Canberra. Rural practitioners exhibit enormous resilience, but can so easily burnout unless they receive ongoing and supportive supervision. Far too often rural mental health is neglected in mental health workforce policy.3 Rural Australians comprise 28% of the total population, and we deserve better representation on key planning and decision-making processes. City-based state and national committees composed solely of city-based experts are not acceptable to rural Australians. It is disrespectful, unrepresentative and most importantly results in poor policy and inefficient deployment of our limited mental health funding and resources. The governance principles and practices outlined in this communique will help to ensure that people living in rural and remote areas can enjoy quality mental health services. The lessons learned in making rural mental health services ‘fit for purpose’ offer insights for the planning, delivery and evaluation of mental health services to other disadvantaged groups and indeed all population groups. The symposium itself embodied the partnership approach between experts in lived experience, cultural safety, place-based context, research, implementation and policy. Each partner brings a unique contribution that is valued and appreciated. Respect and recognition were given to where we have come from and anticipation of what the future might hold by working together and ‘playing to each other's strengths’. We are better together. The conference concluded with a moving presentation by Beth McEwan whose husband died after a long struggle with mental illness. This highlighted the lived experience and the impact of mental illness on individuals and families. It also underscored the critical importance of our work in rural mental health, and the need for a robust system where people are not ‘lost in the cracks’. The following papers in the Special Supplement were submitted and subjected to peer review and comprise a snapshot of the work presented at this symposium. The full conference program is available at https://anzmh.asn.au/rrmh/. We sincerely thank and acknowledge the Scientific Committee of the 11th Rural and Remote Mental Health Symposium who reviewed all submitted abstracts, and the academics on the committee who reviewed the written papers submitted for publication. Professor Russell Roberts (Chair and Convenor) Ms Sandra Batistisch Ms Sally McEvoy Dr Keith Miller Professor David Perkins Dr Angela White Mr Kim Hosking Dr Vivian Isaac Assoc Professor Martin Jones Ms Lee Martinez Ms Amelia Traino