It is clear that many university students across all disciplines (including nursing) experience a diverse range of intrapersonal and interpersonal difficulties. Some students are exposed to circumstances and expectations that may place them at risk for mental health or substance use disorders or exacerbate pre-existing problems. Research shows increasing rates of diagnosable mental health conditions such as substance use disorders, depression, personality disorders, and behavioural challenges that present themselves while students are undertaking their university education. It is therefore important that nurse educators are able to identify student problems in both academic and clinical settings, so that symptoms, signs and inexplicable behaviours are not ignored, and steps towards referral and early intervention are taken. In this paper, we discuss rates of mental health problems and substance use among undergraduate nursing students, problems in the teaching–learning and clinical settings which nurse educators are likely to witness, and the consequences of unacknowledged psychiatric difficulties and problematic behaviours.