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This paper aims to describe culturally sensitive rather than culturally specific mental health practice in East London, and to show how this can be achieved with a small team. It tracks the development of a specialised service for a diverse population of refugees with a diagnosis of post-traumatic stress disorder since 2000. Demographic information for the first 432 patients illustrates their wide ethnic, linguistic and psychological backgrounds and needs. Cultural sensitivity has assisted patients in engagement with Western psychological treatments. Attendance rates are as good for refugee patients as for non-refugees, and for non-English speakers as for English speakers. Cognitive– behavioural techniques are employed which include groundwork to establish trust, direct exposure to traumatic memory, and multi-agency rehabilitation to increase social engagement and prevent relapse. Outcomes of treatment are being evaluated but cultural issues in diverse and changing communities have to be addressed pragmatically by clinicians working collaboratively with their refugee patients.