There is a lack of research examining the mental health of practicing mediums, yet the nature of mediumship work inherently presents a number of challenges to the mental health of practitioners. In this study, we aimed to gain an understanding of how mediums experience their mental health in relation to their mediumistic practice and how they recognise and respond to psychological difficulties experienced by their clients. Fourteen mediums from the North West of England took part in one-to-one interviews, which were transcribed and subject to interpretative phenomenological analysis. Four themes were identified: from past traumas to mediumistic identity; spirit makes sense, mental illness is chaos; being resilient but vulnerable; and ethical mediumistic practice. The research highlights the value of not dismissing or attempting to change appraisals of valued aspects of mediums’ anomalous experiences. However, the findings do indicate that support for exposure to clients’ difficulties might be helpful.