Objective: To explore, advance and evaluate mental health practices in a rural general paediatric unit through participatory action research. Design: A participatory action research approach guided this study, providing an opportunity for nursing staff to become actively involved in the design, direction and outcomes of the research. Setting: A 16-bed paediatric unit of a rural general hospital. Participants: A purposive convenience sample of all paediatric nursing staff (n = 20; of 24 nurses). Outcome measures: In the first phase of this study, focus groups were conducted to explore the experiences of nurses. Results: Participants considered mental health to be a specialist discipline area and the role of the mental health nurse to be complex. They felt that their lack of training and experience with mental health issues was detrimental to the delivery of optimal patient care. There was concern about differing approaches to treatment, relationships with other mental health services and the suitability of the ward environment for young people with a mental health problem. Participants called for training by qualified mental health staff and the development of policies and clinical guidelines to facilitate their delivery of care to patients with a mental health problem in an acute medical environment. Conclusions: There is a clear need for nursing specialities to work together to ensure that optimal care is given to patients admitted to general hospital with a mental health issue. Given the absence of accessible specialist child mental health inpatient units in regional and remote areas, upskilling paediatric nurses must be a priority. © 2009 The Author Journal compilation © 2009 National Rural Health Alliance Inc.