Objective: To examine how the rates of the use of particular face-to-face primary mental health care services changed in the first 4 years (2006–2010) of the Better Access initiative in both urban and rural regions of South Australia. Design: Time-series analysis of the number of psychology session, psychiatry assessment and general practitioner care plan services recorded in Medicare Australia data. Setting: South Australia. Pre-existing data set of South Australian residents who accessed Medicare between 2006 and 2010. Main objective measure: Number of services per 100 000 population (service rate). Results: Psychology session service rates increased in all regions, but continued to follow a ‘location gradient’, being higher in areas closer to Adelaide and lower in areas more distant from Adelaide. Psychiatry assessment service rates increased in Adelaide but did not change in other regions. Rates in remote areas were subject to substantial variation over time. General practitioner care plan service rates increased in Adelaide and in the Riverland, but declined in the Murray Mallee region. Conclusions: Overall, service rates increased in Adelaide and nearby regions, but the results for rural and remote regions were mixed. Possible explanations for the geographical variability include population characteristics (such as socio-economic status), methods of service delivery (visiting practitioners, telepsych), the relative proportion of total health services provided by general practitioners versus other practitioners, or real variations in the need for primary mental health services.