Telemedicine has emerged as a critical tool in enhancing healthcare accessibility, particularly for mental health services. Urban Nigerian communities face significant barriers to accessing traditional healthcare due to geographical and financial constraints. The study employed a mixed-methods approach combining in-depth interviews, focus groups, and observational assessments. Data collection took place across three major cities in Nigeria, with a sample size of 200 participants representing diverse socio-economic backgrounds. A notable trend observed was the significant increase in user engagement rates from 35% at baseline to 60% after two years, indicating improved accessibility and acceptability of telemedicine services for mental health care in urban settings. Telemedicine has emerged as a viable solution for enhancing mental healthcare accessibility in urban Nigerian communities, demonstrating the potential for digital health solutions to bridge geographical gaps and improve service delivery. Policy makers should prioritise funding for telemedicine infrastructure development and support community-based initiatives that foster user engagement and education on these services.