When Amaka began waking up night after night with her heart racing and her mind spinning, she thought it was just stress. Job pressure, perhaps. “Everyone is stressed,” she told herself.

But the feeling grew worse. She couldn’t eat, couldn’t sleep. Her hands trembled during meetings. When she finally stepped into a small counselling clinic in Surulere, just a few streets away from her office, she wondered if speaking out loud to a stranger would make her feel better or worse.

“I sat down, told the woman everything, and by the end of the session, she smiled and handed me a paper,” Amaka recalls. “I looked at it ₦20,000 for one hour. I laughed. I told her, ‘Madam, I don’t think I can afford to be sad.’”

It was meant to be a joke, but the truth lingers. For many Nigerians, therapy isn’t just a luxury–it’s almost impossible to afford.

 A Country in Quiet Pain

Nigeria’s mental health crisis is widespread but largely under-recognised. According to estimates by health researchers, over 50 million Nigerians suffer from some form of mental illness. Yet fewer than 10 per cent ever receive any professional help.

The reasons aren’t hard to find. According to NAFDAC’s Director of Narcotics and Controlled Substances, Ramatu Momodu, only 300 psychiatrists serve more than 200 million Nigerians. Worse still, most of them work in metropolitan cities such as Lagos, Abuja, and Port Harcourt. Rural communities are almost completely left out.

“I’ve had to turn patients away,” says Dr Femi Ogunleye, a consultant psychiatrist at the Federal Neuropsychiatric Hospital in Yaba. “Not because I want to, but because we are overwhelmed. There are no beds, no drugs, no funding. Mental health is still not seen as a priority.”

In 2023, Nigeria passed a new Mental Health Act meant to protect the rights of people with mental illness and integrate mental care into public health services. But two years later, implementation remains slow. Many Nigerians still don’t know the law even exists. The Act promised mental health funds and community-based services, but they remain ideas on paper rather than realities on the ground.

Counting the Cost

Even when therapy is available, it’s often out of reach. In private clinics, a session costs anywhere from ₦15,000 to ₦30,000, and sometimes more depending on the therapist’s qualifications and location. At ₦30,000 per session, that’s nearly half the minimum wage, and a steep price to pay for 60% of Nigerians who earn far less than the national average.

Unlike malaria treatment or surgery, therapy sessions are not covered by most health insurance schemes, forcing nearly all clients to pay out of pocket.

“I had to choose between therapy and going to work one morning,” says John, a 32-year-old civil servant in Abuja. “I was falling apart. But how do you explain to your boss that you’re skipping work to talk to someone? They’d think you’re unserious.”

John eventually saved up to attend six sessions. It helped him cope, but the cost forced him to stop. “I wish I could continue,” he says. “But therapy in this country is for the rich.”

Therapy in public healthcare facilities is more affordable but no less challenging. At the Federal Neuropsychiatric Hospital in Yaba, a session can cost as low as ₦2,000, but the waiting lists are long, appointments are hard to get, and drugs are frequently unavailable. “It’s heartbreaking,” says Dr Ogunleye. “We have the will to treat, but not the tools. Without funding, we’re running on fumes.”

Nigeria allocates less than four per cent of its total health budget to mental health. Of that, over 90 per cent goes to a few federal psychiatric hospitals, leaving almost nothing for community programmes or preventive care. The result is visible on the streets—people living with untreated psychosis, wandering, talking to themselves—but the deeper crisis is hidden in homes and workplaces where countless others suffer in silence.

The Stigma That Silences

Beyond money, there’s a stigma that quietly began with mental health being regarded as a taboo in many Nigerian homes. Depression is quickly dismissed as “laziness.” Anxiety is brushed aside as “overthinking.”

“If you tell someone you’re seeing a therapist, they look at you like you’re mad,” says Fatima, a 45-year-old mother from Edo State. “When my son started behaving strangely after a traumatic incident, people said he had evil spirits. I took him to prayer houses, not hospitals because that’s what everyone advised.”

When the prayers didn’t help, Fatima travelled to Lagos to see a counsellor. “I sold my chickens to pay for the bus fare,” she says. “It helped him. But not everyone can do what I did.”

Religious and cultural beliefs remain powerful barriers. While faith often provides comfort, it can also delay help. “We can pray and also seek treatment,” says Pastor Olawale Adeboye, who now runs mental health workshops at his church, Christ Renewal Assembly in Ikeja. “The brain is an organ too — just like the heart,” he says. “We can pray, but we must also treat. It’s not a lack of faith to seek professional help.”

An Unequal System

Therapy, when available, is mostly urban, reflecting the country’s broader inequalities. Lagos, Abuja and Port Harcourt have growing mental health clinics and online platforms— MyTherapist.ng, among others—but rural areas remain neglected.

In a health centre in Nasarawa, a nurse named Hauwa describes how they handle mental cases: “We just counsel small, or refer to Yaba [in Lagos]. But that’s very far. Most patients never go.”

Without insurance coverage, therapy remains largely the domain of those who can afford it. And though the Mental Health Act promises reform, it has yet to move from policy to practice.

Experts say the law includes progressive provisions: the establishment of a mental health department within the Federal Ministry of Health, a dedicated funding mechanism, and the protection of patients’ rights. But bureaucracy and budget neglect continue to impede implementation.

“Mental health is still treated as an afterthought,” says Dr Ogunleye. “It’s as if we forget that mental well-being affects productivity, crime and even national stability.”

A Slow Awakening

Change, however, is coming, albeit slowly. Young Nigerians are leading conversations online, using social media to share their experiences, stories of anxiety and burnout, and encourage others to seek help.

Platforms like Mentally Aware Nigeria Initiative (MANI) run mental health awareness campaigns and hotlines. NGOs are training community volunteers to provide basic counselling in schools and local centres.

“Ten years ago, people laughed when you mentioned therapy,” says mental health advocate Dedoyin Ajayi. “Now, we have influencers and pastors talking about it. Awareness is growing. But access hasn’t caught up.”

She believes the next phase of progress must go beyond hashtags and seminars. “If HMOs start covering therapy, and if we train more professionals, therapy will stop being a luxury. It will be as normal as seeing a doctor when you have malaria.”

The Real Price of Silence

Back in Lagos, Amaka still goes to therapy once a month. She budgets for it the way others plan for groceries or rent.

“I can’t lie, it’s not easy,” she says. “But therapy helped me find myself again. Before therapy, I was drowning quietly.”

“I wish we didn’t have to choose between healing and surviving because everyone deserves a mind that works.”

Mental health shouldn’t be a privilege—not in a country where so many are hurting. And until therapy becomes accessible and affordable, Nigeria could continue to lose people, not to death, but to despair.

Because sometimes, survival isn’t about food or shelter. It’s about being able to breathe again and knowing that it’s affordable to ask for help.