Climate change is rapidly turning South Asia into one of the most climate-vulnerable regions in the world. Flooding, heatwaves, and agrarian distress are accelerating the burden of mental disorders across populations. This perspective examines how extreme weather events, particularly floods, droughts, and heat stress produce acute and chronic psychological impacts that include anxiety, post-traumatic stress disorder, depression, eco-anxiety, and agrarian despair. We propose a framework for climate-resilient mental health systems in South Asia, highlighting gaps in the current national programs of India’s National Mental Health Program and Pakistan’s resource constraint psychiatric healthcare system. We suggest specific actionable pathways: integrated surveillance systems, community-level task-shifting, digital mental health and psychosocial support tools, climate-finance alignment, and cross-border cooperation mechanisms. We aim to draw the attention of policymakers and disaster-management authorities operating at the intersection of climate change, mental and public health.