The Great Indian Ocean Tsunami of 2004 remains one of the most cataclysmic events ever to have occurred in the history of mankind. It caused horrendous loss of life and widespread destruction on an unparalleled scale, affecting a large number of people and communities. Psychosocial support and mental health services (PSSMHS) were called upon as an ineluctable concern and need in the wake of the catastrophe. There were efforts on various fronts to cater to the emotional needs of the affected communities; notably, the National Institute of Mental Health and Neurosciences (NIMHANS) played a pivotal role in delivering community-based psychosocial support to the survivors in five states of India. The multifaceted nature of the tsunami disaster necessitated a coordinated and multisectoral approach to delivering PSSMHS in its aftermath. Recognizing this imperative, NIMHANS designed and implemented psychosocial care programs to the affected communities though community-based, culturally sensitive approach though trained community-level workers (CLW) who understood the needs of the survivors and communities, enabling them to deliver psychosocial support effectively. The post-tsunami outreach interventions, for the first time, included rapid needs assessment, psychosocial assessments, psychological first aid, and psychosocial care. Moreover, psychosocial rehabilitation and referrals were substantial components in ensuring continuity of care for survivors. The development of psychosocial care modules and informational, educational, and communication materials was carried out in a manner that suited the cultural and linguistic setting of affected communities. These resources facilitated the training of CLW through standardized trainings, enabling them to deliver psychosocial support effectively. The spectrum of care approach ensured the integration of psychosocial interventions into other mainstream services, thereby promoting resilience and recovery. Under this framework, a comprehensive capacity-building program was instituted, equipping government officials, healthcare providers, educators, NGO staff, and community volunteers with the requisite skills to deliver psychosocial care effectively. Special emphasis was placed on addressing the needs of vulnerable groups, such as children, elderly, and individuals with pre-existing mental health conditions, ensuring their inclusion within the broader scope of PSSMHS interventions. The tsunami served as a watershed moment in the realm of PSSMHS in India; NIMHANS’ efforts catalysed PSSMHS policy transformations at a national level, culminating in the preparation and release of PSSMHS guidelines for the nation. This chapter discusses psychosocial care in the tsunami and its future implications.