AIM: This paper reports a study to describe patients' conceptions of how the spiritual dimension is addressed in mental health care. BACKGROUND: Spirituality is a broad concept, and is highly subjective, multidimensional and difficult to define. Spirituality and religiousness are two separate concepts but have several common features. In mental health care, it is essential that nursing care be built on a holistic view, and the spiritual dimension has an important function in nursing care. The notion of spirituality is full of nuances, and in a multi-cultural society patients express their spirituality in different ways. METHOD: Data were collected by interviewing 12 strategically selected patients in mental health care and analysed according to a qualitative method inspired by the phenomenographic approach. The data were collected in 2003 in Sweden. FINDINGS: Three descriptive categories emerged: patients wish to have their spiritual needs addressed; patients must see to it that their spiritual needs are addressed; patients lack confidence in nurses with regard to discussing spirituality. The findings show that patients actively sought the assistance of nurses to meet their spiritual needs. They turned their thoughts inwards and found community with other patients, while nurses often avoided addressing the spiritual dimension. CONCLUSION: Nurses should work actively to seek new knowledge about how they can address patients' spiritual needs. It is also important that there be scope for discussing and reflecting on spiritual questions at the workplace. Additional research is needed to explore how knowledge about spirituality should be implemented in mental health care and nursing education.