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The capacity of the pre disaster mental health system in Pakistan was weak, and the earthquake affected areas in the North-West Frontier Province (NWFP) of Pakistan were among the most underserved areas in the country in terms of adequate mental health services. The natural disaster exposed the weaknesses in the mental health delivery system in most of these areas. This paper describes a mixed methods field based assessment to design a mental health intervention in the earthquake affected district of Mansehra of NWFP. The assessment had two objectives: 1) to get a more complete and comprehensive understanding of mental health issues and priorities in this earthquake-affected district; and 2) to help in selecting and designing mental health intervention for the earthquake affected population. Both qualitative and quantitative data were collected. Qualitative data collection methods included open-ended semi structured key informant interviews, structured focus groups, and unstructured participant observation. Quantitative data collection methods included a community survey and a multiple choice mental health knowledge test. Equal priority was given to quantitative and qualitative data collection and analysis. Both types of data were analysed separately and integrated in the final results of the assessment. The results showed that a mental health training for both primary health care staff and community volunteers was a feasible and high priority intervention to improve the mental health of the earthquake affected population in the Mansehra District. The assessment helped in selection of topics for training interventions.