This chapter explores the current challenges and trends in forensic psychiatry and prison mental health in Pakistan. It emphasizes the challenges impacting this field in systematic, social, and cultural domains. A lack of awareness about mental health has prevented many prisoners from attaining appropriate input, resulting in a deleterious impact on their well-being. Consequently, increased governmental funding is required to provide mental health practitioners, forensic psychiatry, and prison mental health services for implementing evidence-based interventions where required. Additionally, training of prison staff to increase awareness of mental illness, as well as training of newly appointed mental health practitioners, is needed, which will likely require international collaboration. Particular focus is required for protecting women and juveniles with mental health difficulties. Supporting such changes with empirical evidence will be optimal, with culturally adapted, evidence-based randomized controlled trials targeting mental health disorders and other factors potentially impacting engagement in therapeutic interventions, including stigma pertaining to mental illness.