The purpose of this study was to determine and identify the pattern of mental health disorders found at a referral hospital in eSwatini. In this retrospective study, 307 patient medical records of people living with mental health disorders seen at a referral hospital in eSwatini, were consecutively sampled. Results are summarised as frequencies and percentages. Comparison between the groups was determined by chi-squared tests, and a p-value ≤0.05 was considered statistically significant. Three hundred and seven patient medical records were selected from 1 304 available records of people living with mental health disorders seen from January to December 2016. Of these, 53% were males, 73% were aged ≤40 years and 60% were unmarried. Nearly half (47%) had secondary education, 65% were unemployed and 55% were outpatients. Bipolar affective disorders, schizophrenia and major depressive disorders were the leading mental health disorders. These three conditions represent 78% of mental health disorders in this study. Bipolar affective disorders were the leading mental health disorders in the ≤25 years age group and 26–40 years age group, while schizophrenia was the most common in adults aged >40 years. Results seem to indicate that risk identification, early intervention, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services are vital to addressing these issues.