**Background**
Mental health conditions are a major contributor to the global disease burden, with three-quarters of this burden in low- and middle-income countries (LMICs). In Ghana, the treatment gap for mental health conditions is estimated at 95%–98%. Despite evidence that integrated care models like the WHO Mental Health Gap Action Programme (mhGAP) and the Programme for Improving Mental Health Care (PRIME) can improve access, little is known about the specific gaps and opportunities at the district level in Ghana. This study, part of the Ghana Somubi Dwumadie programme (2020–2024), aimed to conduct a situation analysis of mental health infrastructure and service provision in five districts to inform the development of context-specific district mental healthcare plans.
**Methods**
A cross-sectional situation analysis was conducted between November 2020 and March 2021 in five purposively selected districts: Anloga (Volta Region), Ahanta West (Western Region), Asunafo North (Ahafo Region), Tolon (Northern Region), and Bongo (Upper East Region). The PRIME situation analysis tool, adapted to the Ghanaian context, was used to collect secondary healthcare data and conduct interviews with key informants (district health directors, health administrators, health information officers, public health nurses, and district mental health focal persons). Data sources included annual health reports (2019–2020), District Health Information Management System (DHIMS) data for 2020, medium-term development plans, and the 2010 Population and Housing Census. Ethical approval was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC025/08/20) and King’s College London Research Ethics Committee (LRS-20/21-20866). Data quality was managed through training, accuracy checks, and a report validation workshop. Narrative data were analysed thematically, and quantitative data were reported as numbers, frequencies, or proportions. Treatment coverage was estimated using prevalence estimates from the 2019 Global Burden of Disease study, district population, and registered patient numbers.
**Key Results**
The districts were predominantly rural (>60% rural in four districts). Literacy varied from 33.2% (Bongo) to 75.1% (Anloga). None of the districts had a district mental healthcare plan or a dedicated mental health budget. There were no psychiatrists, neurologists, clinical psychologists, or occupational therapists in any district. The ratio of mental health professionals to population varied widely: Tolon had 1 per 18,414 population, Bongo 1 per 892, and Anloga 1 per 14,895. Supervision of mental health professionals was weak and unstructured. Access to psychotropic medications was a major challenge; only antiepileptics were readily available. Psychological treatments were extremely limited; for example, in 2020, Bongo provided an average of 2 sessions to 40 patients, while Tolon provided 8 sessions to 50 patients. Treatment coverage for depression, schizophrenia, and epilepsy was estimated at <1% across all districts: Anloga 0.15%, Bongo 0.55%, Asunafo North 0.09%, Ahanta West 0.21%, and Tolon 0.58%. Mental, neurological, and substance use (MNS) disorders did not appear in the top-ten reasons for outpatient attendance in any district. Community support systems included a well-established network of community volunteers (ranging from 35 in Anloga to 246 in Bongo) and some collaboration with traditional and faith-based healers (TFBHs). In Anloga, 25% of mental health clients were seen by TFBHs; in Ahanta West, 15%; in Tolon, 8%; in Asunafo North, 5%; and in Bongo, <1%. Only Tolon and Bongo had active mental health support groups. The District Health Information Management System (DHIMS) collects mental health data, but data quality issues (completeness and accuracy) were noted.
**Clinical Implications**
The study reveals a severe unmet need for mental health services in these five districts, with treatment coverage below 1% for common conditions. The lack of mental health professionals, unreliable medication supplies, and weak supervision systems are critical barriers. However, opportunities for strengthening mental health systems exist: committed district leadership can improve medication supply; the DHIMS can be enhanced for better data collection; community volunteers and collaborations with TFBHs provide platforms for community-based care; and existing programmes (e.g., maternal health, HIV) can integrate mental health services. The findings have directly informed the selection of three priority demonstration districts (Bongo, Asunafo North, and Anloga) for the next phase of the Ghana Somubi Dwumadie programme, which will design, implement, and evaluate district mental healthcare plans. The standardized situation analysis tool proved useful for informing district-level planning in low-resource settings and may be transferable to other sub-Saharan African countries.