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This paper emerged from a talk delivered to the community and members of the Tower Hamlets African and Caribbean Mental Health Organisation (THACMHO) for Black History Month in October 2022. A growing body of evidence exposes the persistence of racism and inequality within health service provision and the psychological professions. This has led to a commitment across all professional bodies to address as a significant matter. This paper explores the links between racism and intergenerational trauma and the consequences on Black men's mental health. The author probes the gaps in services and inequalities using a psychoanalytic lens. Men from Africa and the Caribbean face disproportionate rates of mental health diagnoses and poor care provision. However, little or no consideration is given to intergenerational trauma and cultural factors. At the heart of the paper sits the question: What happens to Black men in the mental health system and why? The author considers whether cultural insensitivity might be a barrier to accessing mental health care and explores the differential treatment options, outcomes, and possible reasons and solutions for the future. [ABSTRACT FROM AUTHOR]