Despite reforms and the passage of a landmark mental health law, experts say Nigeria’s mental health system remains crippled by poor financing, weak governance, and heavy out-of-pocket spending.
The experts said about 98 per cent of mental health costs are borne directly by patients, leaving millions without access to care.
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At a panel discussion on Financing Mental Health Services during the ongoing National Health Financing Dialogue in Abuja, psychiatrists, civil society actors, and private sector leaders stressed that without dedicated budgets, stronger institutional frameworks, and public-private partnerships, mental health will continue to be sidelined in broader health financing reforms.
They noted that the treatment gap remains staggering: nine out of ten Nigerians who need mental health services cannot get them.
The dialogue, which runs from 1-4 September brings together health officials, development partners, civil society groups and the private sector to craft new strategies for sustainable health financing in Nigeria.
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The four-day event, themed “Reimagining the Future of Health Financing in Nigeria,” is expected to produce commitments to reduce out-of-pocket spending, improve accountability, and strengthen domestic funding for the health sector.
Nigeria’s mental health burden
Nigeria carries one of the heaviest mental health burdens globally. According to the World Health Organisation (WHO), one in four Nigerians, about 50 million people live with a mental health condition.
Yet the country has fewer than 350 psychiatrists serving a population of over 200 million, representing a ratio of 0.1 per 100,000 people, far below the global average of nine per 100,000.
To address these challenges, the National Mental Health Act 2021 was signed into law in January 2023, replacing the colonial-era Lunacy Act of 1958.
The new law provides for a rights-based framework, prohibits discrimination against persons with mental health conditions, and calls for the creation of a Mental Health Fund as well as integration of services into primary health care.
However, two years after its passage, implementation remains limited.
A dedicated mental health desk at the Federal Ministry of Health and Social Welfare is yet to be established, and no clear budget line has been created for mental health financing. So far, only Lagos and Ekiti states have domesticated the Act.
‘The cost is unbearable’
Speaking during the panel session, Taiwo Obindo, President of the Association of Psychiatrists in Nigeria, said Nigerians living with mental health conditions face enormous challenges in accessing care.
Mr Obindo, a professor at the University of Jos noted that despite decades of advocacy for integrating mental health into primary healthcare, the policy has not been fully implemented.
“Most mental health facilities are located in city centres, yet over 65 per cent of Nigerians live in rural areas. This forces patients to travel long distances adding to their financial burden,” he said
He added that the cost of treatment has soared, with consultation fees in his institution rising from N300 before 2023 to N2,000, while drug prices have tripled or quadrupled.
According to him, the direct cost of care is compounded by indirect costs such as patients’ inability to work and the economic disruption faced by caregivers.
“The economic burden is significant, and with only one in 10 people able to access care, the treatment gap remains very wide,” he said.
Lack of budget and governance structure
Lateef Sheikh, a consultant psychiatrist and professor at Ahmadu Bello University, Zaria, said Nigeria lacks a clear financing mechanism for mental health despite existing policy frameworks.
Mr Sheikh stated that while laws such as the National Mental Health Act and the Basic Health Care Provision Fund (BHCPF) mention provisions for mental health, these commitments have not been translated into actionable budgets.
“There is no dedicated budget for mental health in Nigeria. What we have are hospital allocations covering overheads and personnel, not patients’ needs,” he said.
“We need a systematic overhaul, including creating a department of mental health within the Ministry of Health to design and manage budgets.”
He also argued that mental health automatically places individuals in the category of vulnerability regardless of their socioeconomic status.
“As long as you have a mental health challenge, you fall into that vulnerable group. We must implement existing laws to make mental health affordable and accessible to all,” he added.
The role of the private sector
In his remark, Taiwo Falowo, the Chief Operating Officer, Intersect Consortium, highlighted the growing role of private providers in expanding access to mental health services.
Ms Falowo explained that her organisation set up its first private mental health clinic in Abuja in 2010, at a time when private facilities in the sector were scarce.
She said one of the greatest barriers patients face is affordability. “Many people come to our facilities but are unable to afford the care they need,” she said.
According to her, public-private partnerships (PPPs) could ease these constraints.
“If certain services are concessioned to private providers, the government can reduce its financial burden while patients benefit from more affordable services,” she noted.
Essential medicines and local production
Nigeria’s country manager for Johnson & Johnson, Funke Jaiyesimi, drew attention to the lack of local production of psychotropic medicines.
Ms Jaiyesimi, who was represented by Utena Uguleke, a pharmacist said Nigeria’s regulatory instruments, including NAFDAC’s five plus five framework and the ceiling list for transitioning importation to local production, currently exclude psychotropic medicines.
“This means we still lack local capacity and will remain dependent on imports for at least the next few years. There is an urgent need for capacity building,” she explained.
Ms Jaiyesimi suggested contract manufacturing and intellectual property-sharing models as interim solutions.
“Through partnerships such as the Medicines Patent Pool, innovative companies can transfer technology and allow local manufacturers to produce affordable equivalents. This approach has worked in other countries and could expand access here,” she said.
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