Background: Rural and island health care staff in Scotland are required to manage patients experiencing mental health crises. To ensure practitioners in remote and rural areas have the necessary skills, the Remote and Rural Healthcare Educational Alliance (RRHEAL) were asked to develop a pre-hospital mental health care course. Methods: Several mental health care experts were asked to express an opinion on the essential content of such a course. Stakeholder review informed the development of a survey to identify the priority areas for training. The first round of the survey process involved an expert group of 16; the second round used a survey of over 300 remote and rural practitioners involved with the British Association for Immediate Care, Scotland (BASICS). Results: The stakeholder review identified key content, summarised under the following topics: risk assessment; patient assessment; crisis management; handling difficult situations; engagement skills; mental health law; management of retrieval; pharmacology; theory and classification of mental illness; and understanding your network. Discussion: This article shares how the needs within a national pre-hospital mental health care programme were identified, and demonstrates how consensus over the content of a national course was achieved through the use of a modified Delphi approach. The Clinical Skills Managed Educational Network (CSMEN), Self-Harm Mitigation Training (STORM®) and BASICS, alongside RRHEAL, contributed to this development. Using blended learning techniques the resulting course encourages a contextual approach to user needs, specifically teaching generic mental health care skills to staff who are often working single-handed, and are required to respond appropriately, locally and safely as they work towards achieving National Mental Health crisis standards.