Parental mental distress may pre-date or even precipitate a child’s adoption, but adoption can also cause birth family members psychological distress. There is a lack of research that has measured the mental distress of birth relatives in contemporary adoptions, most of which are initiated by the child welfare system. The objective of this study was to measure the mental health of birth relatives in contemporary UK adoptions using a self-report measure, the Brief Symptom Inventory (BSI). 164 birth relatives (89 birthmothers, 32 birthfathers and 43 extended family members), drawn from three separate samples, completed the measure. Data were collected between 2002 and 2008. In 89% of cases, the child had been adopted from the public care system. The length of time since adoption varied from 0 to 12 years (M = 3.8). The scores of birth relatives on the nine symptom dimensions and three global indices of the BSI are reported and compared with previously published results from a community sample and a psychiatric outpatient sample. The scores of birth relatives were considerably higher than the community comparison sample. Fifty-seven per cent of all birth relatives had scores on the global severity index within the clinical range. Separated into three groups (birth mothers, birth fathers and extended family members), these figures were 67%, 56% and 35% respectively. For all groups of birth relatives, scores on the ‘paranoid ideation’ subscale were particularly elevated, raising questions as to the meaning of this symptom dimension for this group of people. Social models for understanding mental distress are argued to be particularly relevant, and it is suggested that the distress of birth relatives is more usefully seen as ‘unease’ than ‘disease’ and that support services should draw on Recovery models of intervention. Practice suggestions for adult mental health service providers and adoption support services are discussed.