The Neuropsychiatric Hospital Aro Abeokuta is a 537-bed mental health care federal institution with a rich historical legacy since inception as a world acclaimed first purposed built psychiatric hospital in Nigeria. It came into global limelight with its novel Aro village system of mental health care. Armed with a tripartite mandate of clinical service delivery, training of various cadres of mental health professionals, and research; with a current vision ‘To be a national centre of excellence and an international point of reference in mental health’; and a mission - ‘To provide quality mental health service, training and research in a conducive environment with community participation and international collaboration’. The hospital has in line with the above vision, achieved and maintained a national feat of ranking as the 1st Hospital in Nigeria by the International Webometric Ranking of World Hospitals from 2013 to date.
In addition to several specialised service delivery innovations, the hospital recently embarked on a state wide programme of integrating mental health care into primary health care for accessible and affordable treatment of priority mental health conditions at PHC centres in all the 20 local government areas of Ogun state, for which it bagged the Winner of National Healthcare Excellence Award as ‘Primary Health Care Provider of the Year’ – 2015 - a landmark achievement in mental health service delivery in Nigeria. The hospital has also significantly reduced the stigma associated with it in the last decade through the deliberate ‘opening up’ strategies which include the establishment of a general medical practice and antenatal care clinic for members of the immediate community. The hospital also participated in the WHO field trial of the International Classification of Diseases (ICD-11) diagnostic manual in 2017, and enjoys wide local and international collaborations in service delivery, training and research in mental health.
The Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria, came into existence in 1954; but its progenitor, then an asylum, now called Lantoro Annex, came into existence on the 13th of April, 1944. This was when 13 health attendants were transferred from the Yaba Asylum, Lagos, to open the Lantoro Institution with five mentally ill patients. These were Nigerian soldiers repatriated from the Burma war front during the Second World War. Lantoro was a former Local Government Prison which was taken over, first by the Military, and later by the then Colonial Medical Department.
In January 1946, the first civilian patients were admitted into Lantoro. Later on in the same year, criminal patients who were adjudged to be mentally ill were also admitted into Lantoro, on the order of the courts in accord with the Lunancy Ordinance. The Lantoro Institution soon became over populated and a decision was taken to establish a well-equipped hospital for mental and nervous diseases.
In 1948, through an arrangement made by the late Dr. (Later Sir) Samuel Manuwa, Deputy Director of Medical Services, Western Provinces of Nigeria, the present site of Aro Neuropsychiatric Hospital, sitting on an expansive 732 acres of land was acquired with the assistance of the then Alake of Egbaland, Abeokuta, the late Oba (Sir) Oladapo Ademola II.
Though, as far back as the late 1930’s, the present site of Aro Neuropsychiatric Hospital had been labeled “Site for Mental Hospital”, it was not until 1954 that the Aro Complex, the main hospital which is about 18 kilometers from Lantoro Annex, was begun by the doyen of psychiatry in Nigeria and Africa, the late Professor Thomas Adeoye Lambo (OFR), upon his return to Nigeria, having completed his course of study in psychiatry at the University of Birmingham. He worked alongside Mr. Leonard Oliver, the then Chief Nursing Superintendent, and other nurses like Mr. Owodimilehin, Mr. Sodunke and so on.
The defunct Western Region of Nigeria managed the hospital until 1976, when the region was split into three, namely, Ogun, Ondo and Oyo States. The Federal Government took over the hospital and set up a board to oversee it, along with two other psychiatric hospitals at the time, namely: Psychiatric Hospital, Yaba, Lagos and Psychiatric Hospital, Uselu, Benin City. Decree 92 of 1979 was promulgated in October 1979 to back the Board. The same decree formally declared Aro Complex as an affiliate of the University College Hospital, the teaching hospital of the University of Ibadan, Ibadan.
This hospital, then known as an asylum, was first administered by the late Dr. Cameron, who was designated as the “Hospital Superintendent”. After him, other heads of the institution since inception include:
Professor T. A. Lambo (1954 - 1963)
Professor T. Asuni (1963 - 1976)
Dr. J. A. Oluwole (1976-1978)
Professor J. C. Ebie (1981-1983)
Professor B. O. Osuntokun (1983-1985)
Professor M. O. Akindele (1985-1993)
Professor O. A. Sijuwola (1993-2001)
Dr. (Mrs.) T. A. Adamson (2001-2009)
Dr A.O Ogunlesi (2009-2013)
Dr A.O Akinhanmi (2014-2016).
Dr. T.O. Adebowale (2016 till date)
The world recognition of the hospital came about during the pioneering efforts of the late Professor Thomas Adeoye Lambo (OFR), when he innovated, way back in 1950s, the 'Aro Village System' of treating the mentally ill. The thrust of this system was a community participatory system of treatment of the mentally ill that involved psychiatric professionals, patients' relatives and co-tenants, neighbours and the community where the patients were admitted.
This treatment paradigm was achieved by creating the “Aro Village System” in the neighbourhood of Aro Hospital, where patients were admitted into “normal” houses with other tenants living alongside patients and their relatives. The principle of the village system was subsequently adapted all over the world and virtually opened the hitherto locked gates of psychiatric hospitals all over the world.
Filling a Gap in the late 1970s'
In 1978, a visiting team of the World Health Organization (WHO) Consultants recommended the development of the Aro Neuropsychiatric Hospital Complex as the headquarters of a national and regional centre for research and training in mental health, neuro-psychiatry, psychiatric nursing, clinical psychology and related disciplines in bio-behavioural sciences. The premises for this recommendation were that there was a need for a focal strategy that will seek both African and external resources to permit the immediate development of the high level facilities, necessary to make accelerated impact on training of health personnel, conduct of research and clinical services delivery.
The development of Aro as a national and regional mental health resource centre was supported by the Federal Military Government headed by General Olusegun Obasanjo (GCFR), as being entirely consistent with national health priorities and Nigeria’s policy to play a leadership role in Africa, the then focus of Nigerian’s foreign policy.
WHO Collaborating Centre in 1979
In August 1979, following the consent of the Board and the Federal Ministry of Health, the WHO designated the Aro Complex as a Collaborating Centre for Research and Training in Mental Health. With assistance from the WHO, a team of expert consultants in neuro-psychiatry, psychology, sociology, anthropology and psychiatric nursing visited Nigeria in 1980 and, in collaboration with Nigerian colleagues, recommended a detailed plan of work for the Aro Complex.
This included the setting up of a national Neuro-Psychiatric Institute, which will initially serve as an integral part of the Aro Complex, but eventually will serve as a structure to incorporate other centres of significance in the mental health specialty elsewhere in Nigeria, and in other African countries. The plan of work was accepted by the Federal Government which rapidly moved to initiate the development of the Aro Complex, especially the hospital part to provide high level clinical services which are required in an institution designed for advanced training and research on mental health and related disciplines.
The title, ‘Provost’, was recommended by the WHO to reflect the status of Aro Complex as an “Institute of Psychiatry”, training of health personnel and research activities as primary functions. The development of the 'institute status' of the complex has, however, been hampered by insufficient funding. And this led to the establishment of the Aro Endowment Fund, which was launched April 14, 1984, by the then Provost and Medical Director, Professor B. O. Osuntokun (NNMA, OFR), in a campaign for extra-governmental budgetary funds, to enable Aro maximally perform its tripartite functions of research, training and clinical service, as spelt out in the plan of work for the Aro Complex. The formal launch had as its Chief Launcher, the late Chief MKO Abiola, with the Alake of Egbaland, Oba Oyebade Lipede I, as Chairman.
At present, there are still ongoing efforts to steadily and assiduously develop the planned “Institute” status of the complex.
Mental Health Service at the Neuro psychiatric hospital Aro: Journey so far
Mental health service delivery at the Neuropsychiatric Hospital Aro had undergone tremendous development from inception in the 50s to the 80s with evidence based care of the mentally ill despite the very limited but well trained professional manpower. The demise of the Aro village system of care during this period was not unconnected with factors which include: urbanization of the villages around the hospital; relatives demands and preference for full inpatient care for very disturbed patients; and their need to return to their social life activities while patient receive care as inpatients.
The beginning of residency training programme in the 80s, and the commencement of development of sub-specialisations (such as drug abuse treatment, forensic practice, rehabilitation, child and adolescent and old age psychiatry units among others), in service delivery marked another era in mental health service delivery at Aro. All these advancements however, inadvertently further reinforced the institutionalized and stigmatised perception of mental health service delivery in the eye of the public.
The new millennium marked a turning point in the history of Aro with concerted effort at winning the age long battle with the negative public perception of the institution as a psychiatric hospital. A two-pronged approach of ‘Opening up’ and ‘Going out’ was simultaneously adopted.
‘Opening up’ - De-stigmatising Aro
The establishment of the Community/ NHIS clinic in 2005, with the appointment of consultant family physician. The clinic currently provide primary and secondary general medical services to member of the public living in the immediate communities around the hospital, and fast changing the old status of Aro as a mental hospital. The climax feat of this de-stigmatisation step was achieved in 2012, when the clinic took the first baby delivery of a member of the community, and many has since followed.
Some of the other deliberate ‘opening up’ strategies of the hospital management since the early 2000 include: The establishment of a Physiotherapy department and a gymnasium; the opening up of hospital conference hall and cafeteria hall for use by community members for social events and activities; the conversion of some residential quarters into Guest Houses for hospital guests and members of the community. The hospital grounds and football pitch were also opened up for social and sporting activities by members of the community.
‘Going Out’ – Community Mental Health Programme
Community activities in the hospital commenced officially with the establishment of the directorate of community mental health services in 2006. The programmes of the directorate include:
Intensive Mental health education and enlightenment campaign to special community groups (secondary school students, artisans etc) was commenced in 2007. The hospital secured a paid slot on NTA Abeokuta every Tuesday 7.30 p.m. – 8.00 p.m., with the programme tiltled: ‘Mental Health’ – during which various topics and issues on mental health were discussed between June 2007 and July 2008 including live phone-in programmes. Community mental health enlightenment drama were also performed at community halls in Abeokuta with large turnout of members of the community.
Liaison consultation/out patient clinic services was commenced at a popular mission-owned secondary health care facility in the Abeokuta; Sacred Heart Hospital, Lantoro Abeokuta.
Community Assessment Treatment Services (CATS) was also established for domiciliary care in the community. Services rendered include assessment, treatment and transfer to the hospital when necessary, and can be accessed through personal or telephone requests to the overall nursing supervisor on duty.
A rehabilitation unit was established in 2002, for long-stay and abandoned patients who had before then been managed alongside acutely ill one, and often neglected at the fringes of the wards. The hospital also established an 11-room purpose built rehabilitation hostel (‘Hope Villa’) near the Lantoro annexe of the hospital, for newly discharged patients to prepare them for gradual re-integration into the community. Sheltered vocational training (apprenticeship) arrangements were also made with artisans in the community for training placements in various vocations e.g. barbing, shoe making, vulcanizing, ICT etc for patients in the rehabilitation ward, and discharged patients. In addition an Industrial therapy and sheltered work scheme for long-stay patients was established in 2009, for rehabilitative paid employment of long-stay patient groups on out-sourced jobs in the hospital.
The Aro Primary Care Mental Health Care Programme
The hospital embarked on a primary care mental health service programme, to bring mental health service close to the people at the Primary Care level. The project was conceived during the commemoration of the 2009 World mental Health Day with the theme: “Mental Health in Primary Care”, which drew attention of the world to the global burden of mental illness as well as the level of deficiency in service provision mainly due to its neglect at the primary care level. The programme took off in March 2010, with a pilot scheme at two health centres within Abeokuta North Local Government health council. The hospital expanded the service to the other 19 local government councils of the state in 2011, in collaboration with Local Government Service Commission. The state wide expansion involved the training of primary care health professionals to deliver care using established guidelines for priority mental health conditions at the PHC level under the support and supervision of visiting psychiatric nurses. One of the most exciting aspect of the innovation is successful negotiation of the barriers between tertiary healthcare and the primary healthcare management structures for a mutually beneficial collaborative work at the PHC level. The programme has also opened up opportunities for community mobilisation and engagements for mental health service delivery in the very remote rural communities of the state.
SPECIALISED SERVICES PROVIDED BY THE HOSPITAL
The Drug Addiction Treatment Education and Research (DATER) Unit
The DATER unit was established in 1983 as the first specialized drug addiction unit in Nigeria. It operates both residential and outpatients services. It also operates monthly aftercare drug clinic and receives patients from all over the country. The unit is currently one of the three UNODC designated TREATNET resource centres in Africa. It is also South-West Training centre for TREATNET and one of the 11 TREATNET Model treatment centres in Nigeria. The unit has in the last two years designed and delivered special training courses for mental health professionals from all over the country on drug abuse counselling, treatment and rehabilitation. The unit currently participates and provides technical support for the UNODC coordinated Nigerian Epidemiology Network on Drug Use (NENDU).
The Child And Adolescent Mental Health Service Unit
The hospital as a point of reference in mental health service delivery, established the Child and Adolescent Mental Health unit in 2009, separating the care of the young persons with mental health problems from adult services. A purpose built structure was erected in 2011. The unit has collaborated with the Ogun State Ministry of Women Affairs and Social Developments to carry out a state-wide training of workers from motherless babies and juvenile homes, on child and adolescent mental health care skills. The unit currently partners with other national and international agencies for the community care of children with special needs, including Autism.
Amenity Ward/Corporate Clinic Complex
The hospital established a purpose built 15-bed Amenity ward and corporate clinic complex in 2012, to provide five star professional and confidential inpatient and outpatient mental health services to members of the public who desires it.
Psychogeriatric (Old Age Mental Health) Service Unit
This unit was established in 2012 to provide inpatient, outpatient and community mental health service for the elderly in a separate facility within the hospital. A new purpose built 14-bed ward was commissioned in 2016.
In conclusion it should also be mentioned that the emergency assessment unit, and the general adult outpatient clinic of the hospital are currently undergoing expansion to accommodate increased service demands occasioned by the enhanced mental health awareness in the society through the hospital’s entry into the community.