BACKGROUND: Evaluation frameworks are relevant to understanding health service providers' views regarding existing services and possible improvements, but their application to mental health services is limited, particularly in Low Middle-Income Countries. AIM/QUESTION: To identify a program theory that explains the contextual factors and mechanisms that could enhance mental health service outcomes in Ghana. METHOD: A three-phase approach was followed: initial theory and assumption, analysis, and CMO configuration. Systematic reviews were used to develop a middle-range theory and assumptions in phase 1. A purposive sample of 30 mental health professionals was recruited to participate in in-depth interviews in phase 2. Thematic analysis was used to analyze the qualitative data and further configure the CMO in phase 3. RESULTS: The analysis identified five CMO configurations: ripple effects and financing source sustainability
unavailability of modern equipment and logistics to support holistic services
promoting inclusivity and geographical proximity of services
information, sensitization, and awareness encourage mental health quality
and monitoring and evaluation improve mental health service quality. CONCLUSION: This study concludes that government stakeholders should integrate mental health services into the ongoing insurance policy and provide adequate modern equipment and logistics. Moreover, mechanisms and priorities given to vulnerable consumers should be integrated into policies.