Bullying is a public health concern impacting mental health globally, particularly in schools. Both perpetrators and victims experience mental health challenges. The objective of this review is to systematically review studies on the link between school bullying and mental health outcomes in sub-Saharan Africa by exploring how the well-being of victims and perpetrators is affected. The review searched the Web of Science and Scopus databases. The search strategy combined terms representing “school bullying” with terms related to “mental health” in sub-Saharan Africa. A total of 29 peer-reviewed articles were included. Findings indicate that involvement in bullying, whether as a victim, perpetrator, or bully-victim, is associated with adverse mental health outcomes such as anxiety, depression, psychological distress, suicide behaviour, psychosis, and substance abuse among learners. These findings highlight the importance of understanding bullying and its association with mental health outcomes and carry policy implications for education and mental health systems in sub-Saharan Africa. Governments should develop monitoring tools within school systems to track bullying and identify learners involved as bullies, victims, or bully-victims. Schools should implement screening measures to detect mental health problems. Furthermore, anti-bullying interventions should be integrated with school-based mental health programmes to ensure a coordinated response that supports the well-being of learners.