School-based mental health programs (SBMHP) are designed to influence students' emotional, behavioral or social functioning. Ensuring mental well-being among children and adolescents is essential, because a significant proportion of adult mental illness begin in adolescence, yet mental health challenges among adolescents mostly go undetected and untreated for years. SBMHP has the potential of reaching young people in need of mental health support and stands the chance of aiding in early detection, diagnosis and treatment of adolescent mental illness in the school setting. Although SBMHP is limited in Ghana, counselling services are provided by school nurses to adolescents in senior high schools (SHS) but the impact of this intervention has not been assessed. The purpose of this study was to assess students' perceptions (experience, acceptability and barriers) of counselling services provided in school and elicit their recommendations for a SBMHP. Twenty-two adolescents between 16 and 19 years from 12 different SHS were interviewed via electronic media. The interviews were transcribed and thematically analyzed. Accessibility of formal counselling services was low, although participants perceived the formal counselling to be useful and helpful for their needs. Discomfort with formal counselling was a significant barrier to accessing formal support, hence participants recommended that a SBMHP should include informal forms of support such as peer support and school health clubs. It is recommended that the current school-based mental health support in Ghanaian schools is reviewed, and students are involved in that review process.