The recent review of mental health nursing recommended that nurses refocus their attention on people with serious mental illness. There are some encouraging trends in the training of nurses in problem-oriented case management. However, mental health nursing needs to face various problems. These include the need for the large-scale retraining of nurses currently working in traditional psychiatric hospitals and difficulties in the new Project 2000 programmes. In addition, there is a clear lack of leadership in the profession, largely because of the recent emphasis on management rather than clinical and academic attributes. Finally, nursing needs people who care what happens to the seriously mentally ill.