This paper explores existing strategies for mental health care in Sub-Sharan Africa and points to the need to underpin the relevant approaches with a local equity framework. Using a case-study, it highlights that the approaches need to reflect local conceptualizations and lived experiences of mental health. The insights are presented against a background of the disproportionately low attention given to mental health care, despite its high burden tying to social, cultural and economic distress among affected persons and their communities. Reviewing the dominant approach to mental health, the articles shows how the underlying epistemic assumptions over shadow local voices while informing approaches that do not appropriately reflect the realities of those experiencing mental health problems, especially given inherent social, cultural and moral nuances that complicate access to services in African contexts. As a way forward, it proffers that an African communitarian equity framework, which reflects the contextual realities of mental health, should guide the relevant approaches towards creating spaces for local values and ethics in mental health reforms.