The 2023 Odisha train accident in India is one of the deadliest train accidents in recent history, which is expected to have a massive psychological impact on the survivors and their families. Despite train accidents being common, there is an apparent lack of a process to support the psychosocial needs of the survivors. This narrative review highlights the catastrophic nature of the accident and possible psychological consequences of train accidents based on the literature and discusses approaches that can be taken to provide mental health support for the survivors. While there was appreciable support for the treatment of the injuries, financial compensation, and other practical help, it appeared that there were unmet needs for psychological support. With a greater understanding of trauma manifestation and effective strategies, it is feasible to set up an implementation plan that can take care of survivors from crisis support to long-term psychological intervention and rehabilitation. It would need multidisciplinary and multilevel cooperation and support. While preventing accidents should be the primary focus, providing timely and appropriate care for the survivors is of paramount importance. This review highlights the gap in psychological support for train accident survivors and provides a feasible approach that can be easily integrated into the existing health and social care system.