The Tibet-TPO project in Dharamsala, North India aims to provide culturally sensitive psychosocial support to Tibetan refugees. In this study we have examined the cultural and spiritual constructions of mental distress of Tibetan exiles from a secondary analysis of previously published data. Tibetans refugees' constructions of mental distress were intimately linked to cultural, religious and political factors. Family and religious support were regarded as key coping strategies, yet many new refugees lacked both family support and detailed knowledge and understanding of Tibetan Buddhism. Not all of those interviewed were positive about ‘western approaches’ to dealing with mental distress, but those using the service seemed to do so in a pragmatic and integrative way. We conclude that culturally sensitive psychosocial support can usefully ‘fill a gap’, especially for new refugees who lack both family support and access to, or understanding of, traditional religious coping mechanisms.