In recent decades, debate on global mental health has focused on what Fassin has described as the “empire of trauma”. PTSD has been the center of debate concerning the potential role of psychiatric diagnosis in misrepresenting the needs of vulnerable groups. Others have argued that the critique of the diagnosis of PTSD is misguided and has provided a rationale for diminishing or diverting resources for much-needed mental health care. In this paper I argue in favor of a research framework that places the diagnostic processes within broad sociopolitical contexts of care. Drawing on examples from mental health programs for refugees and asylum seekers in Europe and internal migrants in Brazil, I argue for a critical engagement with epistemologies of care in relation to the mental health of vulnerable groups. In doing so, I offer an outline of an emerging framework for the study of global mental health in which diagnosis is examined with avenues of access to mental health care.