The Philippines’ mental health situation is an amalgam of its rich pre-colonial history, the influence of Spanish and American colonization and the Filipinos’ subsequent quest for identity and national consciousness. Beliefs attributing illness to changes in the natural environment, witchcraft and sorcery, transgressions of social norms and punishment by environmental spirits and the healing power of the shamans permeated the archipelago even before the colonizers came and continue to persist even up to this day. Spain left its imprint on the country through Roman Catholic teaching and rituals and the introduction of Western medicine and the hospital system. The Americans, on the other hand, introduced Protestantism, which had its own impact on the understanding of mental health, and reoriented the health-care system with the introduction of private institutions and the establishment of a system of health professional training based on that of the United States of America. In the 1970s, Sikolohiyang Pilipino (Filipino psychology) emerged and sought to probe into indigenous concepts and descriptions of personality and mental health at about the same time as when the country was put under an oppressive martial law regime that was ended by the 1986 EDSA People Power revolution. The earliest formal and institutionalized mental health services in the country were provided by the Hospicio de San Jose, a mental health asylum established in the mid-nineteenth century. Since then, the predominant system of mental health care has been mental hospital-based. A National Mental Health Program (NMHP) was set up post-1986 revolution to reevaluate the mental health situation and services in the country. Through the years, the NMHP met serious challenges in its implementation with the dearth of epidemiologic data on mental health, serious financial and human resources limitations, low government prioritization and the absence of a dedicated mental health law in the country. Despite being few and sometimes isolated, efforts to deinstitutionalize mental health care and bring programs to communities and special population groups, like migrant workers, have been documented. Among prevailing and emerging mental health issues in the Philippines at present are: (1) the inadequacy of work around the indigenous concepts of mental health; (2) disparities in mental health practices and care due to multiculturalism and economic differences; (3) the effects of the Overseas Filipino Worker phenomenon especially to families; (4) the gap between Western-trained professionals and popular culture; (5) the continuing predominance of custodial and isolated care; (6) mental health care in disasters; and (7) the need for reorientation of the teaching and practice of psychiatry. Psychiatry in the Philippines needs to face up to many old challenges as well as new ones. Filipino psychiatrists will need to take on multiple roles in relation to these challenges, not just as clinicians but also as community trainers, advocates, researchers, leaders and civil servants, with a sensitivity to culture and history.