From 2021 to 2024, this ethnographic study delves into the mental health perspectives and day-to-day practices among professionals at a community home or non-governmental organization and at a psychiatric hospital in the capital city of Malabo, Equatorial Guinea. Based on the paradigms of the cultural constructions of social bodies and spaces and the anthropology of medical systems, community organizations, and institutional psychiatry, this study finds the phenomenology of a web of complexity in perceptions of mental health, assessments, and states of the body and mind. Some key findings suggest homelessness and addiction as common problems embedded in intersections of biological and cultural epistemologies and a consequential formulation of problem-toward-action plans at both sites. Professionals at the community home strategize on family and personalized care and implement community rehabilitation in day-to-day practice to accomplish employment and social integration. However, since the COVID-19 pandemic, despite some inability to address emerging women's mental health care needs, stigma, and conflict with global mental health and institutional psychiatry, some significant challenges highlight a lack of complete social integration due to social, economic, and organizational marginalization, and non-existent governmental investment. Professionals at the psychiatric hospital promote professional advancement and continued psychiatric-related education, as well as community psychiatry, to ensure treatment compliance. Despite some significant advances as a new medical field in the country, some internal needs exist, such as professional capital. Community psychiatry finds it challenging to advocate for mental health among diverse communities and families due to skepticism, rooted and traditional systems of belief, and ontological cosmologies. Some conclusions integrate a connection between the findings, anthropological analysis, and mental health histories in Equatorial Guinea. Interactions between actors, including ‘usuaries’ at the community home and ‘patients’ at the psychiatric hospital, unfold meanings of culture, embodied identities, power, and impacts of political economies.