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This narrative review examines how asylum seekers navigate access to mental health care and identifies where barriers most consistently emerge. We synthesized peer-reviewed literature from high-income host countries and interpreted it using the Levesque patient-centered access framework. Included studies were read qualitatively and mapped across dimensions of approachability, availability, affordability, acceptability, and appropriateness, alongside corresponding abilities to perceive, reach, pay for, and engage with care. Across contexts, several patterns appear repeatedly. Fragmented service structures, heavy reliance on frontline gatekeeping, and administratively complex enrollment processes often delay or prevent entry into care. Limited interpreter availability and time-pressured clinical encounters further constrain communication and therapeutic fit. Legal uncertainty and financial precarity appear to shape whether individuals remain engaged once care is initiated. Taken together, the literature suggests that the presence of services does not guarantee meaningful access. Policy responses may be most effective when they reduce administrative friction, clarify referral pathways, strengthen interpretation support, and better equip providers to work within trauma-informed and culturally responsive models of care.