Young people’s preferences for mental health intervention in Ghana and Zimbabwe

Common mental disorders (CMDs) are a leading but under-addressed burden among young people globally, with prevalence estimates among the 10–19 age group reaching up to 52.6% in sub-Sahara Africa. Despite this, health systems across the region remain ill-equipped to meet the mental health needs of young people, contributing to persistent gaps in universal health coverage. This study explored young people’s preferences for mental health delivery services in in Ghana and Zimbabwe, examining how social contexts, trust and stigma may influence engagement with care. A qualitative cross-sectional design was implemented in Ghana and Zimbabwe during the formative phase of cluster-randomized feasibility trial of the Youth in Mind Consortium. Twenty-two young people exposed to mental health services were purposively selected to participate in semi-structured in-depth interviews and 43 participants naïve of mental health services participated in 4 focus group discussions. The qualitative data was analysed thematically and triangulated across countries and methods by a multidisciplinary, multicounty research team. Findings revealed a strong convergence around three key emerging themes: intervention characteristics, attributes of interventionists and characteristics of service delivery. Young people described pervasive unmet mental health needs and openness to a dedicated context-sensitive intervention for young people. Preferences of an ideal intervention centred on services that were trustworthy, confidential, minimally stigmatising. Notably, participants favoured one-on-one, in-person sessions delivered by competent interventionists perceived as trustworthy and culturally resonant. These findings underscore the urgency of incorporating young people’s perspectives into the design of mental health interventions and better still, co-producing these approaches with beneficiaries. Contextually grounded, young people-informed approaches are essential to enhance acceptability, optimise uptake and ensure equity of mental health service delivery in underserved young people within African settings.