The intricate relationship between mental health and surgical outcomes is examined in this chapter, emphasizing the multifaceted impact of mental illnesses and behavioral health disorders on patient care. The prevalence of mental and behavioral health disorders among surgical cohorts exceeds the general population, underscoring the need for nuanced healthcare strategies. Mental health disorders contribute to adverse postoperative outcomes, with depression, anxiety, and substance abuse linked to complications, prolonged hospital stays, and increased mortality. Financial strain arises as individuals with mental and behavioral disorders experience heightened healthcare expenditures. Social determinants of health, including socioeconomic status further amplify vulnerability, affecting surgical outcomes. Access to mental healthcare emerges as a critical factor with geographical disparities influencing patient outcomes. Ethical considerations, such as capacity to consent and inequities in treatment, add complexity to the surgical management of patients with mental health diagnoses. There is a need for increased mental health awareness in surgical practices and an integration of mental healthcare with surgical approaches to address disparities and foster holistic patient care.