Abstract Black and ethnic minority groups need special consideration in terms of their mental healthcare. They often present with different idioms of distress and pathways to care. Culture strongly influences presentation, help-seeking and therapeutic alliance. Clinicians dealing with black and ethnic minority groups must therefore use a culturally appropriate approach. This article highlights some of the factors clinicians must be aware of and makes recommendations regarding assessment and management. Assessment must take account factors including primary language, religion, cultural identity and, where applicable, migration history.