Despite the longstanding global recognition of its importance, mental health in the Caribbean has not advanced with the same intensity as physical or social health. This calls for critical reflection on why poor parity of esteem between mental and physical health remains elusive in the region. The lack of parity and inadequacies in mental healthcare infrastructure require urgent attention. While individuals and small-scale efforts, including those led by mental health professionals, have effected incremental change for the region, significant institutional and systemic barriers persist. This chapter examines the factors specific to Caribbean mental health, including institutional and systemic prejudice, stigma and discrimination and the poorly defined framework of mental health in the region. Recommendations are proposed to address these challenges and foster a more equitable and effective mental health landscape for the Caribbean.