The effectiveness of school counselling and psychological services, especially in low- and middle-income nations, remains understudied. We investigated the relationship between school counselling and psychological services, mental health, health literacy, academic performance and physical health in Ghana, a developing country. Using data from 386 school students (Mage = 12.63; SDage = 1.57; 58% male), we used structural equation modelling in a cross-sectional design premised on the health belief model and the health promoting schools framework. The results indicated that mental health and health literacy played crucial roles as mediators in the relationship between school counselling and psychological services and students’ physical health and academic performance. This study highlights the importance of school counselling in improving students’ mental health, health literacy and academic performance, providing key insights for schools and families. Importantly, our findings show the potential of enhancing mental health and health literacy as pathways to improve student outcomes. However, further research is needed to confirm these relationships across diverse educational settings and populations in Ghana and other low- and middle-income countries.
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