This paper reports on changes in referral patterns of a rural mental health telephone triage service based in Gippsland, Victoria, Australia. A retrospective audit of service data over the period 1999–2005 was undertaken as part of a quality improvement exercise. Data collected included service utilization statistics and critical reflection on the role of the mental health triage clinician within the service. There was an average of 2771 referrals each year and a trend for increased use by general practitioners and hospital emergency departments. Triage nurses reported concerns about: professional isolation, lack of formal education, difficulties in making decisions based on limited data as well as poor understanding of the role by users (patients and referrers). Further research is needed to evaluate the impact of this form of patient assessment on psychiatric nursing practice and clinical outcomes.