The global population is ageing. 25% of the global ageing population live in eight countries in the Asian continent. They are experiencing accelerated demographic transition. Risk factors such as physical disability, chronic illnesses, social isolation, poverty and inequality contribute to mental health burden of these elderly population in South Asia. The authors have tried to review the published literature from the region to address some of these issues. The authors highlight importance of psychiatric conditions like depression, anxiety, psychosis, dementia and substance use as well as impact of elder abuse within the context of local resources and cultural diversity in access to services. Despite these burden, mental health services for the elderly remain inadequate. Barriers such as stigma, lack of trained professionals, rurality and lack of national policies and infrastructure play a role. The authors highlight an urgent need to address these issues to develop policies and infrastructure and train professionals to bridge this gap and to improve the population mental health of elderly population in South Asia.