Recognition of physical deterioration in patients with mental health problems has been recognized as a significant problem. Areas of particular concern include rapid tranquilization, physical restraint, the consumption of alcohol and illicit drugs have the potential to result in sudden and catastrophic patient deterioration. Simulation sessions, using patient mannequins, are widely used to support the education of nurses but its use in mental health has been somewhat restricted. The aim of this study was to design and deliver simulation scenarios to develop the skills and knowledge of mental health nursing students in the recognition and management of physical deterioration. A series of three scenarios were developed and delivered to a group of final-year nursing students. Evaluation of the sessions was undertaken using analysis of video footage from the sessions and through two focus groups. The results show that simulation is a useful catalyst for discrepancy creation which in turn leads to the student focusing their future learning towards addressing any identified deficits in skills and knowledge identified. Authenticity of the simulation sessions also plays a role in ensuring student engagement and faculty support during sessions is vital to support the students in managing unfamiliar situations.