INTRODUCTION:
mental illness is a major contributor to global morbidity and mortality. asylum seekers and refugees face elevated risk yet underuse services. how culturally grounded beliefs intersect with clinical encounters remains underexplored. this study examined meanings of mental illness and care pathways to inform culturally safe public health practice.

METHODS:
guided by social constructivism and leininger’s culture care theory, a qualitative phenomenological design was used. purposive and snowball sampling recruited eleven adult asylum seekers and refugees in england from sudan, south sudan, ethiopia, kuwait, iran, zimbabwe and india. face-to-face semi-structured interviews were conducted and thematically analysed using braun and clarke’s approach. ethical approval was obtained, and informed consent and confidentiality were assured.

RESULTS:
participants described insight as culturally mediated rather than a simple deficit; explanatory models that foregrounded spiritual, moral and social causation alongside biomedical views; and patterned use of medical pluralism within a shared “hierarchy of resorts,” in which family, faith and traditional healers preceded biomedicine and were often misread as delay. community cohesion provided coping and practical help but created tensions around consent and confidentiality. purity and washing requirements (wudhu) affected dignity, engagement and perceived well-being. limited health literacy and language proficiency impeded navigation of services and adherence to written instructions. additional barriers included difficulties registering with a general practitioner and short consultations. stigma shaped concealment and late presentation. gaps in cultural competency, including communication style and the meaning of touch, influenced trust and adherence.

CONCLUSIONS:
public and mental health services should reframe “delay” as culturally patterned care-seeking. integrate a brief cultural formulation into assessment and care planning. strengthen interpreting and health literacy supports. provide environmental adaptations that enable washing for prayer, and allow longer, relationship-centred consultations for newly arrived populations. these actions can reduce misdiagnosis, improve timely engagement and advance equitable mental healthcare for displaced communities.