Egypt, a lower middle-income country in North Africa, is witnessing increasing attention toward mental health amidst a shifting burden of non-communicable diseases. Psychiatric disorders are among the most pressing public health concerns, yet the country faces a significant treatment gap, particularly in underserved regions. This chapter explores the historical evolution, current structure, and challenges of mental health care access in Egypt. It begins by outlining the development of psychiatric institutions and the integration of mental health into the primary care system. Key barriers discussed include inadequate funding and research, workforce shortages, geographic disparities in service distribution, limited child and adolescent services, high out-of-pocket costs, poor mental health literacy, persistent stigma, and non-standardized referral and prescribing practices. Special emphasis is placed on the roles of the General Secretariat of Mental Health and Addiction Treatment (GSMHAT), private sector clinics, telepsychiatry platforms, and day care centers for addiction treatment. The chapter concludes with a set of evidence-based policy recommendations focused on expanding community-based care, enhancing training and regulation, reducing stigma, strengthening legislation, and promoting national and international collaboration to improve mental health service delivery in Egypt.