This chapter commences with defining colonisation, colonialism, coloniality, and the coloniality of power, which are central to understanding mainstream global mental health efforts. By doing so, we examine the concepts beyond economic plundering and exploitation and present a critical understanding of the impact of imperialism and colonialism on the Global South, its historical and socio-economic roots in expansionism and exploitation, its social, cultural, and physical violence and its contribution to the industrial revolution and global Western dominance. We go on to explain the coloniality and experiences in Malawi and in Sri Lanka, and the coloniality of biomedicine by combining theoretical explanations with experiences from communities. In so doing we have characterised the operationalisation of the biomedical mental health approach as analogous with the historical engagement between colonisers and the colonised, whereby locals are trained through GMH task-shifting approaches, mental health professional education, and research, to progress the colonial project. Such an understanding of power and control that is being exerted by initiatives such as the MGMH and secured within formal health care structures, can be seen as a biomedical ‘gaze’ whereby surveillance within the postcolonial environment, and structures of class and education are reinforced by a Western medicalising influence. The chapter will conclude by underlining how, by viewing mental health purely through a biomedical lens, we are operating a colonial tool to oppress people—in Malawi and Sri Lanka—not only by negating their experiences and responses to distress, but also as a distraction from the structural social, economic, and political challenges that impact on peoples’ life chances, inequalities and health; all of which are integral to a capitalist market system.