Abstract Background Paranormal beliefs are common among patients with mental illness. Such beliefs may mediate conceptualization of illness, treatment satisfaction and medication adherence. Objective To study the level of paranormal beliefs and its relationship with explanatory models, treatment adherence and satisfaction using standardized assessment tool. Methods Eighty nine patients with mental illness in remission were assessed with Sociodemographic proforma, Revised Paranormal Belief Scale (RPBS), Mental Distress Explanatory Model Questionnaire (MMAS), Morisky Medication Adherence Scale (MMAS) and Short Assessment of Patient Satisfaction (SAPS). Results Results revealed a high level of paranormal beliefs on RPBS (Mean 83.96, SD ± 23.91). Variables that had a statistically significant group difference on the score of RPBS were domicile status (p < 05), diagnosis (p < 001), method of treatment sought before (p < 001). In a linear regression analysis four variables explained 35.4% of the variance (R2 = .38, R2Adjusted = .35, F = 13.04, p < .001) in RPBS Score. These variables were total score of MDEMQ (Beta = .308, t = 3.435, p < .001), total score of MMAS (beta = .357, t = 3. 716, p < .001) and magico-religious treatment received earlier (beta = .306, t = 3.52, p < .001) and SAPS. Discussion Based on the finding of this study, it may be concluded that the level of paranormal beliefs may vary with some demographic variables. Levels of paranormal beliefs is positively associated with explanatory models and adherence in patients with mental illness in remission.