Social return on investment (SROI) is an approach built on cost benefit analysis and is used in the evaluation of projects with social benefits, as an alternative to cost benefit analysis and theory-based evaluation. This paper provides an analysis of SROI as an evaluation tool compared to theory-based evaluation, based on an evaluation of a community based mental health rehabilitation program in regional South Australia. The paper describes the process of constructing a SROI impact map and identifies the issues at each stage. Establishing the resources used, the activities and the outputs appears relatively straightforward. Arriving at an agreed theory of change is much more contested, even when using a high level of involvement of the service beneficiaries. The single greatest difficulty is to find the indicators and the financial proxies to value the outcomes. Outcomes such as improved wellbeing are difficult to value. It is particularly difficult to establish the level of outcomes immediately after or during an intervention. The paper concludes with an analysis of landscapes where SROI is unlikely to fit.

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The attitudes of rural South Australian mental health workers are not a barrier to mental health nurse prescribing. The implementation and sustainability of mental health nurse prescribing will require additional staff training in psychopharmacology and a governance framework to assure quality and safety. Policy-makers need to focus their attention on the uptake of mental health nurse prescribing in parts of Australia that struggle to attract and retain psychiatrists.

Objective To measure the effect of depression awareness and management training on the attitudes of rural primary health care workers. Design A repeated measures design in which participants acted as their own controls. Setting The training program occurred in 6 locations across rural South Australia. Participants The study enrolled primary care workers in general practitioner surgeries, Aboriginal Community Controlled Health Organisations, community health centres, public hospitals, regional health services and non‐government organisations. Intervention A six‐session training workshop that was informed by the National Institute for Health and Care Excellence guidelines for the treatment and care of people with depression. Main outcome measure The 22‐item Revised Depression Attitude Questionnaire comprised the main outcome measure. Participants were assessed 12 weeks before the training, again on the day of commencement of the training and after the training. Results Seventy‐two primary health workers completed the training program in depression awareness, building therapeutic relationships, working with ambivalence, and goal setting. Between the 2 pre‐training assessments mean scores showed no significant difference. There were statistically significant improvements on the overall attitudes and the subscales therapeutic optimism and professional confidence between pre‐training and post‐training. Conclusion Training rural primary health care workers in depression may improve their attitudes to working with people living with depression.