Mental disorders contribute to 20% of all cases seen at primary health facilities in Malawi. Despite this, the governments budgetary allocation for mental health services is only 1% of the total annual health budget. In spite of global studies showing the cost (direct and indirect) of mental illnesses to be high, In the Malawian context, no data exists on the cost of mental disorders incurred by individual patients. Therefore, we conducted a retrospective cross-sectional study to establish the cost of living with mental illness for outpatients at Queen Elizabeth Central Hospital, Blantyre. Patients with an established mental illness were recruited and information for costs incurred over the previous 3 months was captured. Data analysis was performed on 97 participants recruited in March and April 2019 (52 males; 45 females). Our study found that 51% of the participants were unemployed, 9% had formal employment and 24% had informal employment. Eighteen per cent (18%) of participants walked to the clinic (mean duration 74 minutes (SD 51) and 82% used public transport (mean duration 62 minutes (SD 48); mean cost 1.54 (SD 1.54) USD per visit, range: (0.41 USD to 10.95 USD)). Thirty-five per cent (35%) of participants were asked to buy medication at least once during the preceding 3 months (mean cost 6.77 (SD 6.61) USD). Furthermore, 18.3% reported job loss, 18.3% reported dropping out of school; 4.6% separated from their spouses and 30.3% reported stigma or depressed mood because of their illness. With the majority of Malawians living below the poverty line, the Findings from the study require an urgent need for interventions to reduce the costs and burden on people living with mental illnesses.