# Providers’ insight into quality mental health services – Context-Mechanism-Outcome (CMO) approach

## TL;DR

This study explores how to improve mental health services in Ghana by analyzing factors that influence service quality and outcomes.

## Contribution

The study introduces a CMO framework to evaluate mental health services in Low Middle-Income Countries like Ghana.

## Key findings

- Five CMO configurations were identified to enhance mental health service quality.
- Government stakeholders should integrate mental health into insurance policies and provide modern equipment.
- Inclusivity, awareness, and monitoring are crucial for improving mental health outcomes.

## Abstract

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.

To identify a program theory that explains the contextual factors and mechanisms that could enhance mental health service outcomes in Ghana.

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.

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.

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.

The online version contains supplementary material available at 10.1186/s12913-025-12372-x.