The Silent Ledger

Nigeria’s mental health spending rose on paper. So why are families in Kano chaining their sons? Who is treating the psychological cost of an economic and security crisis, and who is paying?

In a village in Dawakin Kudu, Kano, a father spent over ₦500,000 on drugs at the state’s psychiatric hospital in a year. When the money ran out, he turned to traditional healers who demanded rams and fowls for sacrifice. His 20-year-old daughter, living with a neurological disorder since toddlerhood, now spends her days roaming the streets and chewing leaves in the bush. “My worst mistake,” he told reporters, “was taking her to the traditional rehab.” He said he had little choice because of what the government hospital cost.

His story is one of several documented by the International Centre for Investigative Reporting (ICIR) in November 2025. It raises the question this report sets out to test, not assume: is government neglecting mental health, and if so, where exactly does the failure sit?

63%of Nigerians poor in 2025, up from 56% in 2023 (World Bank, Apr 2026)

₦36mreleased of ₦218bn health ministry capital budget in 2025 (Minister Pate)

3.12%mental health’s share of the health budget in 2025, down from 3.67% in 2021

81%of 2025 violent deaths occurred in the north (Nigeria Watch)

The claim, put to the test

“Government is neglecting mental health” is easy to say and hard to prove. We split it into four testable questions: how much is allocated, how much is released, whether the legal machinery exists, and whether the money and staff reach the northern states where distress is highest.

1. Allocation: the money went up

Federal mental health allocations rose from ₦23.33bn in 2021 to ₦88.24bn in 2025, a 278% nominal increase, according to a May 2026 analysis in The Nigerian Health Journal. Taken alone, that undercuts a simple “no money” narrative.

Federal mental health allocation (₦ billion, nominal)

Source: Nigerian Health Journal, vol. 26(1), 2026. Nominal naira: with food prices up fivefold for poor households between 2019 and 2024 (World Bank), real value is far lower.

But the same study found the sector’s share of the health budget fell from 3.67% to 3.12%, and that over 90% of funds went to recurrent costs at ten federal neuropsychiatric hospitals, with minimal investment in community or primary care services. A separate review put the figure at 3.3% of the health budget in 2024, against an international benchmark of 5–10%.

Verdict on allocation: Partly false

The nominal budget grew. What did not grow was its share, its reach beyond a handful of hospitals, or its link to primary care.

2. Release: nobody can say

We found no published line-item showing how much of the mental health allocation was actually released. That absence is itself a finding. The nearest proxies are damning:

Health Minister Ali Pate told lawmakers that only ₦36 million of ₦218 billion appropriated for the ministry’s 2025 capital projects had been released.
BudgIT’s 2026 health financing report found capital utilisation of 36.38% in 2024 and an average of 40.7% across 2021–2025.
Analysts of the 2024 health capital budget (₦448bn) found only about 27% released.
Dataphyte found most states released less than half of their health budgets in a fiscal year.

Health capital budget: released vs appropriated

Sources: BudgIT (2026); Federal Ministry of Health via Punch/Guardian; DRPC budget analysis. Mental health–specific releases are not published.

Verdict on release: Unverifiable, and that is the problem

With no public tracking of mental health releases, and health capital releases collapsing in 2025, a rising allocation cannot be read as rising service.

3. The legal machinery: promised, not built

The National Mental Health Act, signed in January 2023, replaced the 1958 Lunacy Act and promised a Department of Mental Health Services and a Mental Health Fund. A 2026 scoping review found, for 2023–2025, no operational budget, minimal state adoption (3 of 36 states) and non-functional mental health desks. In October 2025, clinicians told a Lagos forum the Act could not be implemented because “there’s no budget to fund the commission.”

In the 2026 budget defence, the head of Federal Neuropsychiatric Hospital, Aro, told the House of Representatives that international partners ask whether Nigeria has a functioning mental health department and, without one, “they cannot relate to us or release funds.” The NHIA chairman called in August 2025 for a dedicated ₦4bn Mental Health Fund. Advocacy group Nigerian Mental Health launched a public policy tracker in June 2026 and noted the government missed its December 2025 target to decriminalise attempted suicide. (After our window, in August 2026, the Federal Executive Council approved an amendment to decriminalise it.)

What does exist: the 2023 revised National Mental Health Policy, a National Suicide Prevention Framework (2023–2030), and, per the Minister on World Mental Health Day 2025, work on financial protection for patients.

Verdict on delivery: Largely true

Policy documents exist. The Fund and the Department, the two instruments that would move money and staff to states, were still absent through the evidence window.

The north: where distress and services collide

The distress

The World Bank reports poverty above 70% across the wider north versus about 30% in the south. Poor households spend up to 70% of income on food. The Cadre Harmonisé projected 34.7 million Nigerians in crisis-level hunger or worse for June–August 2026, with the northeast the epicentre. (A July 2026 update raised the national figure to 36.2 million, with more than three million acutely food insecure in Borno alone.) On insecurity, Nigeria Watch recorded 12,954 violent deaths in 2025, up from 12,162 in 2024, and about 81% were in the north.

Violent deaths in 2025, selected study states

Source: Nigeria Watch, 15th Report on Violence in Nigeria. Kaduna and Kano state totals were not in the coverage we retrieved. Amnesty documented 481 villages sacked in Zamfara.

Economic distress indicators (national)

Sources: World Bank Nigeria Development Update (Apr 2026); NBS headline inflation. Inflation fell, but poverty kept rising: lost income has not been restored.

The services: five states compared

State	Facilities	Workforce	Funded programmes	Cost & waiting
Kano	Federal Neuropsychiatric Hospital, Dawanau; state-run Dorayi Rehabilitation Centre described as neglected and outdated (ICIR)	81 psychiatric nurses across Dawanau and the AKTH ward in an earlier survey, 90.1% reporting staff shortage. Psychiatrist and social worker counts: not published	Traditional rehab banned in 2019 yet persists; police freed 47 and 113 people from illegal centres in 2021–22	Families report ₦500,000–₦700,000+ on drugs; therapy ₦50,000–₦100,000 per session (ICIR). Waiting times: no official data; “packed” waiting rooms reported. State declined comment.
Kaduna	Federal Neuro-Psychiatric Hospital, Barnawa (about 154 beds in earlier listings)	100 health workers certified under WHO mhGAP (Oct 2025). Specialist counts: not published	Kaduna State Mental Health Law 2025; new substance-abuse and mental health agency (KADSEMHSA)	About half of hospital patients are substance-related (hospital MD). Cost and waiting: not published
Borno	Federal Neuro-Psychiatric Hospital, Maiduguri, described by WHO in 2017 as the only specialist mental hospital in a region of over 25 million	Northeast: 13 psychiatrists and 2 psychologists in a WHO-AIMS regional assessment (0.069 psychiatrists per 100,000 versus 1.44 nationally; assessment date unconfirmed)	200 health workers trained under World Bank MCRP; Mentaccess screened 29,000+ children in 2025; donor-run programmes	Cost/waiting: not published
Katsina	No dedicated federal neuropsychiatric hospital identified	Not published	Education Cannot Wait–funded psychosocial support for children in Katsina, Zamfara and Kaduna (Oct 2025)	Not published
Zamfara	No dedicated federal neuropsychiatric hospital identified	Not published	None found; studies of bandit survivors describe services as unavailable and inaccessible	Not published

Federal tally (our count from hospital listings; verify with the ministry): of ten federal neuropsychiatric hospitals, four sit in the north (Kano, Kaduna, Maiduguri, Kware-Sokoto), against 81% of 2025 violent deaths in the region.

Specialist density per 100,000 people

Sources: scoping review (national, 2024); WHO-AIMS northeast assessment (date unconfirmed, so the comparison is indicative only).

Faces behind the figures

A ten-year-old boy, Kumbotso. His father spent nearly ₦200,000 on a traditional centre where the boy worsened and began wandering. A year of admission at Dawanau followed, with over ₦700,000 on drugs.

A man in his thirties, Sabon Layin Hago. His brother has been tied by the ankle in a shed for over six years after cost ended treatment, then a relapse in which he attacked a relative.

A father in Kumbotso. His brother’s treatment at Dawanau helped “a bit,” but the family stopped when the cost became “unbearable.” He is now kept at home.

Cases are as reported by ICIR (Nov 2025) with names withheld.

What the evidence says

Bottom line

“Government neglects mental health” is too blunt, and wrong in one respect: nominal funding has risen. It is right in the ways that matter: the share is shrinking, 90%+ goes to ten hospitals, the Fund and Department the law promised do not exist, releases are untracked, and Katsina and Zamfara, among the most violent states, show no dedicated specialist facility in the sources reviewed. The cost therefore falls on families, at 75% out-of-pocket health spending, with psychosis, bipolar illness and depression treatment not covered by national insurance (ICIR citing WHO). Where care is unaffordable, chains and unregulated healers fill the gap.

Questions officials should answer

How much of the ₦88.24bn mental health line in 2025 was released, and to which institutions?
When will the Mental Health Fund and the Department of Mental Health Services be operational, and with what budget?
How many psychiatrists, psychologists, psychiatric nurses and social workers are posted in each of Kano, Kaduna, Katsina, Zamfara and Borno?
What are median waiting times and treatment costs at public facilities?

Data gaps, stated plainly: state-level workforce counts, per-state federal transfers, waiting times, social worker numbers and mental health release data were not publicly available. Freedom of Information requests to the Federal Ministry of Health, Budget Office, MDCN and state ministries are the next reporting step.