This exploratory study examined the intersections of Middle Eastern and North African (MENA) American cultural identity and attitudes towards mental health and mental health services. Fifteen in-depth narrative interviews with participants of MENA descent in the United States were analyzed using qualitative thematic content analysis, revealing five primary themes within these data: denial, lack of awareness, stigma/shame, collective identity, and resistance. These results indicate cultural identity plays a unique and significant role in how this population understands and responds to mental health and substance use challenges, in a way that often creates barriers to social service provision and success. Implications and suggestions for how these findings might be used to develop more culturally competent and effective social work interventions for MENA communities are discussed.