There is a general decline in biodiversity and the environment of coastal wetlands worldwide. Reasons for the decline obviously include overexploitation of wetland resources, climate change and industrialization, to mention but a few. This study used a purely qualitative approach using mainly focus group discussions (FDGs) in the framework of Driver–Pressure–State–Impact–Response (DPSIR) to examine the changes occurring in the largest coastal wetland in Ghana—the Keta Lagoon Complex Ramsar Site (KLCRS). The results indicate that the state of the environment is bedevilled with species loss, increases in salinity, decreases in the physical size of fish species and many others. Pressures and related drivers were noted by the respondents. The results point to the fact that communities are not oblivious to the adaptation measures to implement in order to overcome the degradation of KLCRS. Overall, this study points to the fact that local communities have a good knowledge and understanding of their environment and are always in a position to offer ideas related to managing the environment if given the chance.