Culture is linked to the way emotions, mental distress, social problems, and physical illness are perceived, experienced, and expressed. Beliefs about what constitutes illness and what can be done about it vary considerably across cultures. Defining mental health and measuring mental health outcomes have been the focus of academics and mental health professionals across a number of disciplines from psychiatry and psychology to anthropology and sociology. Mental health diagnostic constructs and subsequent treatment practices designed in developed countries are often used in the provision of care in the developing world and in care practices for ethnic minorities, asylum seekers, and refugees. However, there are concerns about the limitations of using mono-cultural outcome measures in these culturally diverse contexts. This article reviews the role of health beliefs and culture in the development and use of mental health outcome measures. Suggestions are made for criteria to improve the reliability and validity of mental health outcome measures used in multicultural contexts. In particular, the role of language in describing salience and severity of symptoms is discussed alongside a number of methodological approaches to improve the development of mental health outcomes in cross-cultural contexts.