Nursing has always struggled for recognition and status, and there has always been exploitation and shortages, and no more so than in psychiatric settings. Today, however, nursing is in truly dire straits and, as a consequence, psychiatric nursing is more precariously positioned than ever. In order to think constructively about psychiatric nursing's future, it is crucial that this wider context in which it operates is fully appreciated, and this paper begins by summarizing the key features of this context from an international perspective. It is argued that dramatic changes occurring in ‘Western’ societies call for radical changes in public and professional thinking, and in their vision for health care in the future. Beginning with the general nursing context, this paper depicts the perilous state of psychiatric nursing and mental health care in Australia and elsewhere, and suggests some of the causal factors. It concludes by arguing that the future mental health workforce should be a graduate specialist who stands outside existing disciplinary identities.