Undeniably, timely access to effective mental health services is essential for people in rural and remote contexts. Even though attention generally focusses on access issues, the effectiveness of services is even more essential. Providing access to services that are ineffective or inappropriate can be worse than providing no service at all. Inappropriate services waste finite resources and may even cause harm. The scourge of inappropriate healthcare is a global phenomenon that affects not only mental health services but health services generally. Key to providing appropriate care is attention to patient preferences and goals. In this regard, two changes to our current mental health systems are urgently required. One change is conceptual and the other is pragmatic. Conceptually, the framework of patient-centred care has failed us because it focusses attention on the positioning of the patient rather than their preferences. It is the perspective of the patient, not where they are positioned, that is paramount to the provision of appropriate care. A paradigm of patient-perspective care, rather than patient-centred care, is desperately needed. Pragmatically, there is an appalling lack of routine evaluation of mental health services in ways that are meaningful and beneficial to service recipients. In order to ensure the appropriateness of services, ongoing monitoring and evaluation must become a routine standard for rural and remote mental health services. The scheduling of mental health appointments is a simple but powerful example of the way in which the framework of patient-perspective care can be combined with ongoing monitoring and evaluation to dramatically improve mental health services in rural and remote areas. Undoubtedly there could be many more examples. With a patient-perspective paradigm of care, and the establishment of ongoing monitoring and evaluation as a routine habit, improving mental health services and outcomes outside urban centres will not be a remote possibility.