School Based Interventions for Students With Mental Health Problems in Ghanaian Basic Schools

Design

This study employed qualitative research that used a phenomenological approach. The methodology employed in this study captured participants’ subjective insights as they described their unique views, feelings, experiences, and perceptions of the nature and challenges of SBIs in their respective basic schools. As posited by Creswell and Poth (2018), phenomenological approach was ideal for exploring how participants perceive and make sense of their experiences with the shared phenomenon.

Participants

The study targeted professionals responsible for providing mental health services to students at the basic education level in the Greater Accra Region of Ghana. This region was selected because it hosted two of the country’s three public psychiatric hospitals and served as the launch site for several Inclusive Education (IE) pilot programs (Mantey, 2014), suggesting relatively better access to mental health services for children.

In total, nine participants were selected using convenience and purposive sampling. Two participants were selected through social media, and six participants were directly contacted through their schools. The final participant was recruited with the help of the School Social Workers Association of Ghana (SSWAG). Recruitment stopped once data saturation was achieved (Kvale, 1996).

Participants’ Background

Five female and four male mental health professionals working in basic schools were interviewed for this study. All participants had at least a Bachelor of Arts (BA), with only one having a Master’s degree. One was trained as a special educator, and four of the participants had counseling certifications in addition to their undergraduate degrees. They all worked with basic school children, but most of them specifically worked with Junior High School (JHS) students. Pseudonyms were assigned to protect participants’ privacy, and verbal informed consent was obtained prior to data collection. A summary of participants’ qualifications, roles, and the population they served is presented in Table 1.

OPEN IN VIEWER

Table 1.

Participant qualifications, roles, and population served.

Pseudonyms	Qualifications	Roles	Population served
Abena	BA Social Work + Peer-Counseling Certification	School Social Worker	Public school (primary)
Kojo	BA Education	Teacher + Guidance Counselor	Private school (mostly JHS)
Yaw	BA in Clinical Psychology + Mental Health Certification	Mental Health Consultant + School Administrator	Private school (KG to primary)
Alison	BA Education, Master’s in Guidance and Counseling	Teacher + Guidance Counselor	Public school (mostly JHS)
Amina	BA Education	Teacher + Guidance Counselor	Public school (JHS)
Kofi	BA Education in Special Education	Special Educator	Over 16 public schools
Sandy	BA Social Work	Social Worker	Public & Private (primary-JHS)
Kukuwa	BA Social Work + Peer-Counseling Certification	Peer Counsellor	Public school (mostly JHS)
Daniel	BA Education	Teacher + Guidance Counselor	Public school (mostly JHS)

Note. Most participants had Bachelors of Arts (BA) degrees, and experience in various educational positions within public and private basic schools in Ghana. While some served all educational levels in their schools, others primarily worked with students’ at the Junior High School (JHS) level.

Data Collection

A semi-structured guide with open-ended questions was used to interview the nine (9) participants. The guide included open-ended questions across five key domains: participant background, population served, interventions utilized, perceived effectiveness, and systemic factors (see Supplemental Material for the full interview guide). Questions on participants’ background, student population, interventions used, and their effectiveness addressed the first objective by exploring the nature of SBIs in basic schools. Concluding questions focused on systemic challenges and recommendations, aligning with the second objective on the need to improve SBIs. The average session duration was 50 min, with the longest lasting over an hour and the shortest lasting 28 min. The more professionals engaged with students with MHP, the longer they spent discussing their interventions. To maintain confidentiality, no identifiable information was collected, and any sensitive details shared by participants were either paraphrased or redacted. Interviews were scheduled at participants’ convenience, with most opting for phone interviews. The sessions were recorded on a password-protected laptop.

Data Analysis

While interviewing participants, notes and memos were taken on recurring themes in their responses which later aided the analysis. The recorded interviews were transcribed with Otter.ai technology and the recordings were deleted after a second researcher confirmed the accuracy of the transcripts. The transcripts were meticulously reviewed line by line for familiarization, error correction, and manual transcription of words not detected by the Otter.ai technology. The transcribed data were carefully examined to remove any identifiable information, and each transcript was read again for familiarization and cleaning. Each transcript was then color-coded to capture recurring meanings related to treatment, interventions, approaches, suggestions on improving SBI, characteristics of students served, risk factors, involvement of stakeholders, parental influence, assessment, engagement, and impact of mental health.

This process followed the coding techniques of organizing and differentiating, as described by Miles and Huberman (1994). The research team organized recurring codes and used a data analysis table to guide the development and refinement of initial themes. The preliminary themes, initially generated by the principal investigator, were subsequently reviewed by a second researcher, who proposed additional refinements to improve thematic clarity. Finally, two researchers collaboratively finalized the themes to enhance coherence and ensure stronger alignment with the study’s objectives. After developing the adjusted themes, the participants, a non-involved professional peer, and the supervising researcher were consulted to verify accuracy and ensure alignment with the data shared. No major changes were made during this stage, aside from addressing any ethical concerns raised by participants. The cross-checking process enhanced the trustworthiness of the data, as Miles and Huberman (1994) asserted that revising codes and concepts based on feedback from participants, colleagues, and supervisors promotes accountability and supports analyst triangulation

Objective 1: The Nature of SBIs in Ghanaian Basic Schools

This section presents the first objective which was to explore the nature of SBIs in Ghanaian basic schools by examining how mental health needs are identified, addressed, and supported within the school system. It examined how mental health needs among students are identified for intervention, the processes through which support is provided, and the structural or contextual elements in the implementation of SBIs within these educational settings. The goal for this objective was to provide an in-depth understanding of the current practices and capacities surrounding mental health support in basic schools across Ghana.

Objective 2: The Need for Improving SBIs During Basic Education in Ghana

This section addressed the second objective of the study: to explore the need for improving SBIs within Ghana’s basic education system. It investigated the existing gaps and systemic barriers that hinder the effective delivery of mental health services in schools and considers areas where current practices can be strengthened. The objective also sought to capture insights on how interventions might be enhanced to better support students’ mental health and well-being in both school and national contexts.

The Nature of SBIs in Ghanaian Basic Schools

Participants unanimously emphasized the importance of SBIs to address MHP among students. Their interventions helped to mitigate the impact of mental health risk factors (like academic stress, negative peer interactions, parental financial difficulties, and abuse or neglect) that exacerbate the symptoms of MHP. This finding corroborated Ghanaian research about the socio-environmental impacts on psychological distress (Ame & Mfoafo-M’Carthy, 2016; Baidoo-Anu & Acquah, 2021; Mnookin, 2016).

Participants in this study supported students who exhibit internalizing and externalizing MHP, which they described with symptom-based language (e.g. crying, scared, frightened, troublesome, afraid, and aggressive), rather than clinical terminology. As asserted by Kleinman (1988), such local expressions of MHP show how symptoms are perceived in a society. These shapes help-seeking behaviors and ultimately the nature of interventions in that society. For instance, many Ghanaians interpret mood-related issues as personal or spiritual weakness, which can hinder them from seeking assistance from mental health professionals who are not faith-based counselors (Addy et al., 2021; Osei-Tutu & Affram, 2024). Also, behavioral problems of students in Ghana are often labeled as disobedience or truancy, leading to punitive responses rather than supportive interventions (Gyansah et al., 2015). Nonetheless, participants in this study did not report using punitive measures in response to students’ behavioral challenges, even when they labeled such students as “troublesome.”

Additionally, participants’ responses reflected an awareness of how MHP affects academic achievement and recognized such struggles as warning signs that prompted the need for their support. Scholars like DeSocio and Hootman (2004) have discussed that addressing MHP improves students’ concentration, participation, and overall well-being, which directly affects academic performance. This corresponds with evidence that MHP, if left untreated, can undermine cognitive function and learning abilities, which will lead to poor academic performance of students (DeSocio & Hootman, 2004; Durlak et al., 2011; Zhang et al., 2023).

Participants identified students with MHP through selective methods and relied mostly on teachers as primary referral sources. Gyansah et al.’s (2015) findings indicated that teachers were likely to refer students for counseling in Ghanaian schools. Selecting students for SBIs only through observation and referrals from teachers can inadvertently fail to notice students with less observable symptoms or those at risk of developing mental health disorders. Such selective procedures can further reinforce disparities in access to mental health support among children and young adolescents.

Instead of systematic screening processes, most participants used informal conversations to assess students’ problems. Though such a method of assessing students by the participants is easily accessible and cost-free, it lacks the rigor required for precise assessment. The underutilization of standardized assessment tools by participants may lead to unreliable assessments that can affect the appropriateness and effectiveness of interventions (Connors et al., 2022).

Furthermore, a few participants reported involving parents and teachers to gain a more comprehensive understanding of students’ problems. Although most participants did not include these stakeholders in their assessments, it is encouraging that some practitioners recognized the importance of incorporating other members of the child’s support system. This is notable, given that the exclusion of such stakeholders has been a primary criticism of SBIs globally (Chodkiewicz & Boyle, 2016; Cossu et al., 2015). The variation in assessment procedures across schools reflects the absence of a standardized assessment protocol for school-based counseling in the country.

The interventional approaches participants used in their resource-limited schools reveal both strengths and limitations. The preference for cost-effective, targeted interventions aligns with the practical realities of implementing mental health support in schools with limited resources (Mabrouk et al., 2022). However, the lack of universal interventions and the reliance on unstructured but practical interventions resulted in implementation variations of SBIs across basic schools. This inconsistency points to a significant gap in uniformity and evidence-based approaches that diminishes the quality of interventions delivered in schools. Moreover, the reliance on anecdotal feedback and observations as the main method of determining the effectiveness of interventions further restricts the reliability of SBIs outcomes in Ghanaian basic schools. Nevertheless, participants’ recognition of their professional limitations and the need to refer complex cases to other mental health experts highlights their commitment to providing students with appropriate CAMH care.

The Need for Improving SBIs in Ghanaian Basic Schools

The research identified various structural and systemic issues affecting the effectiveness of SBIs in Ghanaian basic schools, which calls for fundamental improvements. The challenges mentioned by the participants emanated from the family, school, and national level. Findings on challenges align with previous findings of Asiedu-Yirenkyi et al. (2019) and the Ghana Education Service (GES, 2019). They reported ongoing challenges in implementing mental health programs such as the Guidance and Counseling Program and the SHEP to promote students’ mental well-being. The challenges raised by participants mirror those highlighted by other researchers over the past decade, yet little progress seems to have been made in addressing these issues within basic schools. Participants in this study also highlighted the need to adopt a multi-level approach to address these barriers and enhance the overall quality and accessibility of mental health care in basic schools.

Consistent with findings in pre-tertiary institutions in Ghana (eg, Gyansah et al., 2015; Mills, 2019; Special Attention Project, 2011), educators who assume multiple roles have limited availability to address mental health concerns of students since these school-based professionals are already overburdened with other educational tasks. They also reported having insufficient mental health training, confirming the findings of Asiedu-Yirenkyi et al. (2019), who asserted that most pre-tertiary schools in Ghana lack trained counselors. Although a more recent study by Panford-Quainoo et al. (2024) found that most senior high school counselors held master’s degrees in psychology or counseling, this finding does not extend to basic schools. The lack of specialized staff was compounded by GES’s poor allocation of professionals who could effectively deal with students with special needs, thereby confirming concerns earlier voiced by Mills (2019).

Since the professional competence gap has a direct impact on the quality of SBIs, participants stressed the need for ongoing professional development and mental health training of all school staff. This would enhance their capacity to identify early warning signs of MHP, respond appropriately, and refer students to relevant CAMH services. Increasing mental health awareness facilitates early detection and prompt intervention, both of which are essential to promoting students’ academic performance (Connors et al., 2022).

Inadequate funding and limited resources are reported as major barriers to the effective implementation of mental health programs in Ghanaian schools (Asiedu-Yirenkyi et al., 2019). Most recommendations from participants reflect a recognition of systematic investment in SBIs that ensures sustainable and quality mental health interventions. Their recommendations call for increased funding allocation for mental health programs, the recruitment and retention of qualified mental health professionals, and the enhancement of resources necessary for delivering effective SBIs within private and public primary schools. The absence of sustainable investment in school-based mental health services nationwide underscores systemic apathy since educators and mental health professionals are left to navigate the challenges of implementing SBIs with minimal institutional support.

Moreover, national-level challenges such as cultural stigma of MHP created barriers to seeking help and open communication about mental health within schools. This finding is consistent with other Ghanaian studies (e.g. Asiedu-Yirenkyi et al., 2019). Participants highlighted that cultural stigma often prevents families from acknowledging their children’s mental health needs and seeking appropriate support. Mental health stigma not only discourages parental involvement and help-seeking behaviors among students but also creates barriers to the development of quality mental health interventions in basic schools. This stigma is deeply rooted in societal attitudes and beliefs that regard MHP as a source of shame or weakness (Barke et al., 2011). Participants believed that addressing MHP stigma through targeted education campaigns and awareness initiatives at both community and national levels would encourage more families to seek help and engage with mental health services. This perspective aligns with existing research (Kirmayer et al., 2017; Ma et al., 2023), which emphasized the importance of mental health literacy in reducing stigma and encouraging help-seeking behaviors.

Although Ghana has health policies and legislation to support the delivery of SBIs, the challenges discussed pose significant barriers to their effective implementation. Bridging the chronic treatment gap for MHP in Ghana depends on the effective implementation of existing policies, which foster school-based mental health programs. Although Ghana’s mental health policies align with global standards (Ame & Mfoafo-M’Carthy, 2016), the World Health Organization’s (WHO, 2022) situation analysis reported a 98% treatment gap for mental health conditions. Policy directives alone are insufficient without tangible actions such as investment of resources, and systematic implementation of feasible, cost-effective CAMH services in the country. By addressing the multi-level barriers to SBIs, a more supportive and inclusive environment can be created for basic school students with mental health needs, ultimately enhancing both their well-being and academic outcomes.

Implication for Counselors and Psychologists in Schools

Psychologists, school counselors, educators, and school social workers are crucial to the well-being of basic school students. Therefore, it is essential to improve their skills, enabling them to effectively serve as mental health practitioners in their roles. School counselors in Ghana primarily focus on academic and career guidance rather than mental health or counseling services, as they do not receive specialized training in psychological interventions like their counterparts in Western countries (Asiedu-Yirenkyi et al., 2019). With specialized training, they will have the competencies and ethical mandate to provide mental health support or make appropriate referrals. Additionally, CAMH and SBIs should be integrated into undergraduate curricula, particularly in Psychology, Education, and Social Work programs, to ensure the availability of competent on-site mental health professionals in basic schools. Basic schools can leverage the expertise of students in such programs by recruiting interns who have received training in SBIs. This approach offers a practical and cost-effective way to expand mental health support for students in basic schools.

Since school mental health practitioners in Ghana rarely use evidence-based practices, research on this topic in psychology and counseling can focus on the adaptation of evidence-based interventions, such as Cognitive Behavioral Therapy (CBT), which has been proven effective with different student populations worldwide (Feiss et al., 2019; Zhang et al., 2023). Adapting CBT in schools is crucial for developing culturally responsive and sustainable SBIs that will enhance early access to mental health care, foster emotional resilience and regulation, and address the psychological needs of children in Ghana (Jopling et al., 2025). Therefore, future studies could use an evidence-based cultural adaptation framework to inform the development and piloting of a contextually appropriate and feasible CBT-based intervention in basic schools across the country.

Limitations

The qualitative design utilized in this study limits the generalizability of findings to all basic schools in Ghana (Creswell & Poth, 2018). The use of a small, purposively selected sample of nine mental health workers from the Greater Accra Region limits the geographical diversity represented in the data. Additionally, all data were based on self-reported perceptions, which may be subjected to recall errors, selective memory, and social desirability biases (Krumpal, 2013). While member checking and peer review supported the trustworthiness of the themes, the study’s scope may be limited by the lack of student perspectives to corroborate professional viewpoints.