This chapter examines the provision of mental health services in Somalia within the broader context of prolonged state fragility, post-humanitarian transitions, and enduring system-level neglect. Drawing on recent WHO-supported assessments, national planning documents, and illustrative case studies, it analyzes the structural, institutional, and sociocultural factors that continue to shape the delivery of mental health care in a fragmented governance landscape. The chapter highlights how mental health services have largely emerged through community-led initiatives, NGO–state partnerships, and donor-funded pilot programs. These models have played a crucial role in sustaining access to care but often operate in parallel to formal systems, creating gaps in integration, regulation, and long-term sustainability. By applying a resilience lens, the analysis foregrounds the adaptive practices that communities, providers, and institutions employ to sustain care in the absence of robust state infrastructure. It also interrogates the systemic vulnerabilities—including weak governance, inadequate financing, and the lack of legal protections—that continue to undermine reform. Case studies from Borama and Mogadishu illustrate both the innovation of hybrid and community-driven approaches and the risks associated with unregulated, short-term interventions. A notable dimension of Somalia’s experience is the increasing reliance on task-sharing approaches, whereby responsibilities for mental health care are distributed across specialists, primary health workers, and community actors. This strategy has expanded access and created new opportunities for scale despite the severe shortage of psychiatrists and clinical psychologists. Ultimately, the chapter argues for a recalibration of policy, financing, and legal frameworks to embed mental health as a central component of Somalia’s health sector development. Building an equitable, culturally grounded, and rights-based mental health system will require coordinated reform, national ownership, and sustained international support.