Providing culturally responsive mental health care requires healthcare professionals to balance respect for patients’ cultural beliefs with their professional and ethical responsibilities. Although cultural competence has received increasing attention, less is known about how ethical challenges arising from cultural differences are negotiated in everyday psychiatric practice.

An interpretive qualitative study was conducted using face-to-face, semi-structured interviews with 18 healthcare professionals (three physicians and 15 nursing professionals) working in mental health services in Slovenia. Data were analysed using Braun and Clarke’s reflexive thematic analysis, supported by NVivo 14.

Three themes were identified: (1) ethical tensions arise from competing understandings of mental illness; (2) ethical care is negotiated through culturally responsive relationships; and (3) ethical responsibility extends beyond the clinician but is constrained by the system. These findings indicate that ethical challenges are addressed through ongoing negotiation between patients’ cultural perspectives, clinical judgement and organisational conditions.

Ethical challenges in culturally responsive mental health care are negotiated rather than resolved. Supporting healthcare professionals requires not only cultural competence but also organisational commitment, ethical reflection, effective communication, and practical training. Strengthening these areas may contribute to more equitable, person-centred mental health services for culturally diverse populations.