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Flooding can disrupt psychological well-being, social support networks, and everyday functioning, particularly in rural communities with limited access to psychosocial services. This study assessed the availability, utilization, and perceived effectiveness of psychosocial services among flood-affected communities in Kilosa District, Tanzania. A convergent mixed-methods design was employed, combined a household survey of 214 respondents with key informant interviews and structured observations. Quantitative data were analyzed using descriptive statistics and chi-square tests, while qualitative data were thematically analyzed and integrated during interpretation. Findings showed that 62.95% of respondents received at least one psychosocial service following flooding. Counselling was the most frequently reported service (47.66%), followed by therapy (30.84%) and public awareness or mental health education (21.03%). Village of residence was significantly associated with participation in public awareness and mental health education (χ² = 13.0572, p = 0.0015), therapy utilization (χ² = 16.6930, p = 0.0002), and perceived effectiveness (χ² = 24.5579, p < 0.0001). Duration of residence was also associated with perceived effectiveness (p = 0.0400). Education level was associated with counselling (p = 0.0205) and therapy utilization (p = 0.0425). Qualitative findings highlighted geographical disparities, shortages of trained personnel, limited continuity, and reliance on community-based support. Effectiveness reflects perceived usefulness, not measured psychological outcomes, and does not demonstrate improved coping, recovery, or resilience.