This research identifies therapeutic roles that mental health nurses (MHN) and consumers believe are most helpful in the nursing care of people with serious and ongoing mental illness. Consumers believed the nurse’s attitude is the most important therapeutic factor and wanted MHNs to provide care in a way that empowered them, encouraged their achievements and instilled hope. They identified wellness planning, a recovery focused approach to care and cognitive behavioural therapy as important therapeutic strategies in maintaining client wellbeing and preventing relapse. Nurses believed empowering therapeutic relationships with clients, a recovery oriented approach, communication and counselling skills and excellent mental and physical assessment skills were the most important therapeutic skills for MHNs. They enthusiastically support incorporating evidence-based psychological therapies in their current nursing practice. They identified agency and structural relationships hindering their ability to practice therapeutically. Amongst these is a conviction that educational preparation for nursing is inadequate and that bio-medical and custodial practices restrict therapeutic ability.