Background: Despite the risk of essentialising, there is reason to highlight the fact that certain syndromes and health strategies are to some extent culture-specific. “Culture” as a theoretical concept is needed if we are to understand differences between ethnic groups. Aim: To discuss how certain notions of mental health and disease, and views and expectations of the Swedish health care system, may affect health seeking behaviour. Method: Qualitative interviews with Swedish Somalis in Malmö, some of them with a formal diagnosis of mental ill-health. Basic interview questions were, ‘What is mental ill-health?’ and ‘How can it be dealt with?’ Result: Interviewees highlighted themes such as shame and the importance of social networks. Various expressions of mental ill-health were classified along a continuum including both mild ailments and “madness”. Culture-specific strategies to deal with mental ill-health were identified. Views of the Swedish health care system were positive, but turning to mental health care was generally seen as a last resort. Conclusion: Suffering and mental ill-health are universal phenomena. But our ways to categorise symptoms and classify ill-health are culture-specific. Cultural aspects of mental ill-health ought not be over-emphasized at the expense of social and biological dimensions. However, awareness of culture-specific expressions of mental ill-health and local strategies to deal with them may be of value in the health care sector in a multicultural society.