Background: This systematic review aims to critically evaluate the landscape of mental health systems and policies in Ghana, focusing on identifying strengths, weaknesses, and opportunities for improvement within the existing framework. Objectives: The main objective of this review is to examine the current state of mental health systems and policies in Ghana, highlighting areas for enhancement and providing recommendations for future interventions and policy changes. Methods: Studies and reports focusing on mental health systems and policies in Ghana, published in peer-reviewed journals, books, or grey literature between 2014 and 2024, were included in the review. Databases such as PubMed, PsycINFO, and Google Scholar were searched to identify relevant studies. The last search was conducted in January 2024. The risk of bias in the included studies was assessed using established criteria for quality assessment, considering factors such as study design, methodology, and reporting. The results were synthesized using a narrative approach, summarizing key findings and themes across the included studies to provide a comprehensive overview of mental health systems and policies in Ghana. Results: A total of 43 studies were included in the review, encompassing a variety of study designs such as cross-sectional, ethnographic, and alternative methodologies. The studies provided insights into the strengths and challenges of mental health systems in Ghana. The synthesis of results highlighted key issues in mental health policy and practice in Ghana, emphasizing the need for integrated and evidence-based approaches to address gaps in service delivery and coordination. Discussion: Limitations of the evidence included in the review includes study risk of bias, inconsistency in findings, and imprecision in data reporting. The findings of this review underscore the importance of addressing deficiencies in mental health systems and policies in Ghana to improve service delivery and promote better mental health outcomes. Recommendations for policy changes and interventions are provided to guide future efforts in this area.