Background <p>Language barriers in healthcare continue to pose major challenges to equitable, high-quality care, particularly in mental health settings where communication is central to diagnosis, therapeutic alliance, and treatment planning. Translation technologies, including machine translation applications, offer potential solutions, but their real-world usability in mental health care remains underexplored. This cross-country qualitative study examined the experiences, attitudes, needs, and suggestions regarding the use of translation technologies to overcome language barriers in mental health care.</p> Methods <p>Semi-structured interviews were conducted with 175 participants, including healthcare providers, interpreters, service users, supporters, and stakeholders (e.g., policymakers, community organisation representatives), across five countries: Germany, South Africa, Romania, the Netherlands, and China. The data were analysed thematically using a hybrid deductive-inductive approach, with Bronfenbrenner’s ecological systems model applied as a sensitising framework.</p> Results <p>Six overarching themes emerged: (1) perceived effectiveness and limitations of translation tools, (2) cultural, linguistic, and social fit, (3) human aspects of communication and care, (4) ethical and attitudinal dimensions, (5) implementation and improvement pathways, and (6) access barriers. Participants often found the translation tools to be helpful for basic communication but inadequate for complex or emotional interactions central to mental health care. Key concerns included translation accuracy limitations, cultural inappropriateness, reduced empathy and trust, data protection issues, and poor workflow integration. Infrastructure constraints, institutional barriers, and lack of formal guidance hindered effective implementation. Participants emphasised the importance of hybrid models combining technology with human interpreters, tailored training, and clear policy frameworks to address these challenges.</p> Conclusion <p>Translation technologies can help bridge language gaps in mental healthcare, particularly in urgent or resource-constrained settings. However, their effective use remains highly context-dependent and constrained by technical, ethical, relational, and infrastructural challenges. Adequate and equitable implementation requires system-level investment, participatory design, and safeguards that protect both the emotional and cultural dimensions of communication, among others. Translation tools should be seen as supplementary, not substitutive, in delivering safe and person-centred mental healthcare.</p> Clinical trial registration <p>Not applicable.</p>