Background: Nepal faces significant disparities in mental health care, especially in rural areas like Karnali Province, which are often overlooked. The First International Conference on Community Mental Health, held in Jumla from May 4–5, 2024, sought to address these gaps by promoting innovative, community-driven, and culturally sensitive mental health initiatives. Methods: Jointly organized by Massachusetts General Hospital and Karnali Academy of Health Sciences with national and international partners, the conference used a participatory approach. Data were gathered from session notes, participant feedback, and thematic literature review. The program included keynotes, scientific discussions, workshops, and demonstrations. Results: Despite logistical challenges, 250 participants attended. Discussions focused on task-sharing, stigma reduction, integrating traditional and biomedical practices, and strengthening primary mental health care. Workshops recommended practical models like telemedicine and community health volunteer networks. The event concluded with the “Jumla Declaration,” outlining plans to establish KAHS as a mental health hub. Key barriers included limited professional involvement, infrastructure gaps, and the need for culturally tailored strategies and stronger policy alignment. Conclusion: The conference marked a pivotal step in reimagining mental health care in Nepal, showing the promise of inclusive, ethical, community-based approaches to bridging the mental health gap in low-resource settings. While challenges in implementation and scale remain, the event laid a foundation for long-term policy reform and sustainable service innovation in rural Nepal.