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OBJECTIVE: Health extension workers' (HEWs') knowledge and attitude regarding mental health problems are vital for integrating mental healthcare into primary healthcare services. However, information in this context is scarce in Ethiopia. So, this study aimed to assess HEWs' knowledge and attitude towards mental health problems in Jimma, Ethiopia. DESIGN: A cross-sectional study. SETTING: Five districts in Jimma Zone, Ethiopia, 2020. PARTICIPANTS: A total of 259 HEWs working in selected five districts were included in the study. OUTCOME: The knowledge and attitude status of HEWs towards mental health problems. RESULTS: Nearly half of the respondents had inadequate knowledge (122,47.1%) and an unfavourable attitude (125, 48.3%). Most (139, 53.7%) described mental illness as due to evil spirits' possession. Almost all (240, 92.7%) of the respondents reported talking or laughing alone as a manifestation of mental illness. Almost two-thirds (157, 60.6%) of the respondents reported people with mental illness are dangerous. About a quarter (63, 24.3%) of the participants stated witch doctors should manage mental illnesses. CONCLUSIONS: A significant proportion of the study respondents had poor knowledge and attitude towards mental health problems. Short-term and long-term mental health training is needed to improve their perception level and to provide effective community mental health services.