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This field report outlines a mental health and psychosocial programme provided by Médecins Sans Frontières for Rohingya refugees in Cox’s Bazar, Bangladesh. This specialised programme focuses on the identification, assessment and management of moderate to severe mental health disorders whereas the majority of mental health and psychosocial support programmes within this context are providing focused non-specialised care. The activities provided by the programme include counselling, psychological intervention and treatment with psychotropic medication. An outreach model utilising volunteers from the refugee community is critical for case identification and community sensitisation. There were challenges with recruitment of appropriate human resources and adequate space for consultations. The most common presentations are psychotic disorders − many of the patients have long histories of untreated illness. Discussion considers cultural factors relating to mental health in the Rohingya community and comparisons with mental health and psychosocial support programmes in a number of humanitarian contexts.