It is mental health consumer's human right to lead a fulfilling life as they are empowered to actively manage their recovery. This can be facilitated through care planning, yet research suggests that the care plan is not routinely created, discussed, or updated in acute mental health settings. Research on care planning and the role of the mental health nurse highlights the importance of therapeutic communication in care plan development. This paper argues that the lack of meaningful care plan discussions between consumers and mental health nurses in an acute setting is a limitation to the practice of fully accountable mental health nursing care. We explore this limitation in quality care provision by examining literature on accountability and conclude that in mental health nursing, accountability is frequently enacted through an overarching focus on the organizational need to manage risks, rather than on therapeutic engagement.

Recovery-oriented mental health practice guidelines recommend regular consumer involvement in care plans, yet in many acute settings, these are not routinely created thereby compromising accountability. This study explored the impact of workplace culture on the capacity of mental health nurses to involve consumers in care planning and consequently to work accountably. A focused ethnography was undertaken in one Australian inpatient unit involving mental health nurses and other health professionals. Data were derived from in-depth semistructured interviews with 12 nurses and 6 months of nonparticipant observation of multidisciplinary meetings and clinical handovers. Workplace culture had an impact on mental health nurses' accountability practices. A culture that prioritized reduction in length of stay resulted in less recovery-oriented care. Health professionals who paid more attention to crisis and risk management resulted in fewer opportunities for consumer-involved care planning. K E Y W O R D S accountable, consumer participation, mental health services, patient care planning, risk management workplace culture, recovery 1 | INTRODUCTION Consumer involvement in mental health care planning is an essential element of recovery approaches to care (Australian Government, 2010; Bee, Price, Baker, & Lovell, 2015), enabling consumers to set goals and develop meaningful relationships (Jacob, 2015). These goals and outcomes should be documented in a care plan (McHugh & Byrne, 2012), to enact accountability to the consumer. While mental health services often purport to follow recovery-oriented mental health practices, meaningful involvement with health staff and consumers does not always occur (Bee et al., 2015; McHugh & Byrne, 2012). The study described here is part of a larger research project and reports findings of a qualitative study that explored how mental health nurses enact accountability in care planning and consumer involvement in the process (Rio, 2019). More specifically, this study examined the perceived impact of workplace culture on the capacity of mental health nurses to involve consumers in care planning and work accountably. 2 | BACKGROUND Health policies internationally have emphasized the centrality of consumers as active participants in their own care planning (Australian Government, 2010; Department of Health UK, 2011; World Health Organisation, 2001). Care planning in Australia has been a part of the

In the rural and remote setting, nurses are often the first point of contact with mental health services. Nursing roles may include community-based rural or remote area nurses, nurse practitioners, or mental health nurses. Nurses work collaboratively with tertiary healthcare teams and other community services such as ambulance and police. The role of the nurse is multifaceted as they need to consider engagement with a whole community approach. This chapter will examine the distinctive features of the nursing role in the setting and what is required for effective practice. Similarly to urban mental health settings, interpersonal therapeutic relationships are vital, but the nurse in rural and remote communities undertakes many different tasks and activities while monitoring and assessing the consumer's mental state. Especially in very remote Aboriginal and Torres Strait Islander communities, it takes time to develop these relationships,