Despite increasing global recognition of the burden of mental health and psychosocial problems—particularly in low- and middle-income countries (LMICs) and humanitarian settings—the effective scaling up of evidence-based Mental Health and Psychosocial Support (MHPSS) interventions remains a significant challenge. This paper synthesizes key dilemmas and potential pathways forward for scaling MHPSS interventions, drawing upon a review of current literature and expert perspectives. Key dilemmas include balancing standardization with contextual relevance, navigating the complexities of horizontal and vertical scaling, ensuring quality and fidelity in nonspecialist delivery, addressing demand-side barriers, and securing sustainable resources. Pathways forward emphasize the need for integrated approaches, rigorous adaptation processes, and robust training and supervision frameworks. They also call for comprehensive monitoring and evaluation systems, community engagement strategies, phased implementation, a strong evidence base for effectiveness and cost-effectiveness, and supportive policy environments. By addressing these dilemmas through contextually informed and evidence-based strategies, the field of global mental health can move toward achieving greater reach and impact with MHPSS interventions.