Background <p>University students from racially minoritised backgrounds are at an increased risk of experiencing mental health difficulties but are less likely to seek support compared to students from racial and ethnic majority backgrounds. To increase the accessibility and appropriateness of mental health support for university students, it is important to understand the attitudes towards seeking help for mental health of underserved student groups. This is the first systematic review to synthesise the available qualitative data which explores attitudes toward seeking help for mental health problems among students from racially minoritised backgrounds.</p> Methods <p>This systematic review includes qualitative studies exploring attitudes towards seeking help for mental health difficulties among racially minoritised university students. A literature search was carried out using PsycINFO, CINAHL, Medline and Web of Science in March 2024. Participants were racially minoritised university students. Data were synthesised using a thematic synthesis.</p> Results <p>Of 493 papers identified, 15 were included in the final thematic synthesis following methodological appraisal of their quality using the Critical Appraisal Skills Programme. There were a total of 314 participants across all included papers. Four analytical themes were identified: “cultural attitudes” outlined how culturally specific experiences of stigma, lack of conversations about mental health, faith, and gender influenced attitudes; “interpersonal relationships” explored the impact of family and peer relationships on attitudes; “psychological barriers” described how psychological constructs, such as preference for self-reliance and feared consequences of disclosure, were culturally-informed barriers to help-seeking; and “systemic barriers” encompassed the structural barriers, discriminatory practices and perceived cultural incompetence of services and institutions that negatively impacted on attitudes towards help-seeking for mental health difficulties.</p> Conclusion <p>Culture, identity and social inequality inform attitudes towards help-seeking among racially minoritised students. Exploration of how these factors interact with university systems may improve the provision of mental health support. Systemic change is needed within universities and mental health services to tackle inequality and improve support for racially minoritised students.</p>