Pakistan is currently confronted with the significant challenge of an increasingly ageing population that experiences a heightened prevalence of psychiatric and neurocognitive disorders. However, the field of geriatric psychiatry remains critically underdeveloped. The existing challenges are intensified by the limitations in psychiatric infrastructure, shortages in the workforce, and insufficient investment in healthcare. Furthermore, cultural stigma and a predominant reliance on family caregiving serve to obstruct timely interventions. Addressing these deficiencies necessitates expanding specialised training programs, strengthening community-based services, and incorporating telemedicine to enhance accessibility. In addition, legal and ethical reforms are crucial to protecting older adults against neglect and exploitation. A multidisciplinary, policy-driven framework is essential for the establishment of a sustainable geriatric mental healthcare system in Pakistan, guaranteeing equitable and evidence-based care for its ageing population. This chapter thoroughly examines the systemic barriers present and highlights the imperative need for an integrated approach to care.