This article describes the culturally determined understandings of good mental health and distress of older Pakistani-Punjabi immigrants in Britain, and of how these beliefs may determine specific goals and needs during the help-seeking process for distressed minority ethnic service users. This includes a discussion of how these beliefs determine the perceptions of appropriateness and efficacy of statutory treatment options. The data is drawn from a qualitative, largely interview-based study of Pakistani immigrants, statutory healthcare service providers, and traditional Pakistani healers in Northern England. The study aimed to assess the reasons for the low uptake and apparently poor efficacy of statutory services provided to the immigrant group, despite a high prevalence of distress in this group. The study found that interaction (usually surgery consultation) between service users and providers was unsatisfactory for both parties. The unsatisfactory results of service use for both providers and users appeared to be rooted primarily in cultural misunderstandings that led to divergent goals, and thus divergent approaches to service use/provision behaviour. It is hoped that this article may serve as a guideline for the development of more appropriate and effective services for similar groups.