Background: Mental health problems in Aboriginal and Torres Strait Islander peoples are common, changing and challenging. Particularly in remote settings, doctors will need to untangle the complex interplay of culture, context and clinical significance. 

Objective: This paper emphasises the importance of local knowledge and cultural respect in complementing clinical competence in the management of Aboriginal and Torres Strait Islander peoples with mental health problems. 

Discussion: Anxiety, depression, psychosis, self-harm and problems of childhood and old age are used to exemplify differences by comparison with practice in non-Indigenous populations.