Background <p>Sexual and gender minority (SGM) populations in Uganda experience significant mental health challenges, exacerbated by widespread stigma, discrimination, and hostile legal frameworks. Despite increasing mental health needs, access to appropriate and affirming services remains limited within the existing health systems. This study explored the psychosocial and mental health needs of SGM individuals and the barriers they face in accessing care.</p> Methods <p>We conducted a qualitative study using focus group discussions (<i>n</i> = 3 groups) and in-depth interviews (<i>n</i> = 11) with SGM individuals across sexual and reproductive health clinics and community-based organizations in Uganda. Overall, thirty-eight participants were purposively sampled to reflect a diversity of sexual and gender identities (<i>N</i> = 38). Thematic analysis was used to identify patterns and insights from the data.</p> Results <p>Participants reported a high burden of mental health concerns, including depression, anxiety, trauma, and substance use, often linked to structural violence, familial rejection, and internalized stigma. Key barriers to care included fear of discrimination, lack of trained and affirming providers, and limited access to safe, confidential mental health services. Participants emphasized the need for community-based interventions, peer-led support structures, economic empowerment initiatives, and the integration of mental health care into HIV services. Structural reforms—particularly decriminalization and health worker training—were also viewed as critical to improving access and outcomes.</p> Conclusion <p>Addressing the mental health needs of SGM populations in Uganda requires a multifaceted, rights-based approach that strengthens health systems, promotes inclusive service delivery, and amplifies community voices. Integrating mental health support into existing health services and scaling up peer-based models may offer effective and sustainable pathways to care.</p>