There are nine Federal Psychiatric Hospitals and five State Psychiatric Hospitals in Nigeria. The Eight Federal Psychiatric Hospitals are Neuropsychiatric Hospital, Abeokuta; Federal Neuropsychiatric Hospital, Yaba; Federal psychiatric Hospital, Calabar; Federal Neuropsychiatric Hospital, Uselu, Benin, and Federal Neuropsychiatric Hospital, Maiduguri. Others are: Federal Neuropsychiatric Hospital, Enugu; Federal Neuropsychiatric Hospital, Kaduna; Federal Neuropsychiatric Hospital, Sokoto, Federal Neuropsychiatric Hospital, Budo-Egba. The five State Psychiatric Hospitals are: Psychiatric Hospital, Abia State; Neuro-Psychiatric Hospital, Awka, Anambra; Psychiatric Hospital, Eket, Akwa Ibom; Psychiatric Hospital, Sokoto; and Kano State Psychiatric Hospital, Kano.
The Neuropsychiatric Hospital Aro, Abeokuta is a 735-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
“To be a national centre of excellence and an international point of reference in mental health”.
“To provide quality mental health services, training and research in a conducive environment with community participation and international collaboration.”
In consonance with the above vision, the hospital has achieved and sustained a national feat of ranking as the 1st hospital in Nigeria by the International Webometric Ranking of World Hospitals from 2013 to date. Furthermore, the hospital embarked on a state-wide programme of integrating mental health care into primary health care for accessible and affordable treatment of mental health conditions at Primary Health Care (PHC) centres in all the twenty (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 services delivery in Nigeria.
In the last decade, the hospital has also significantly reduced the stigma associated with it 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. In 2017, the hospital also took part in the World Health Organisation (WHO) field trial of the International Classification of Diseases (ICD-11) Diagnostic Manual, and enjoyed wide local and international collaborations in service delivery, training and research in mental health.
The genesis of the Neuropsychiatric Hospital, Aro, Abeokuta popularly called ‘Aro’ dated back to 13th April, 1944 when thirteen Attendants were transferred from Yaba Asylum in Lagos to open Lantoro (Abeokuta) institution with five mentally ill patients who were soldiers repatriated from the Burma War.
Lantoro was a former Local Government Prison which was initially taken over by the Military and later by the then Colonial Medical Department. Dr Banks, the Medical Officer in charge of General Hospital, Abeokuta looked after Lantoro which he visited on Tuesdays and Fridays. He was subsequently assisted by Dr Murray (1946) and Dr Quantoll (1948).
This system of supervision continued till 1949 when the first Colonial Psychiatrist then referred to as an ‘allenist’: Dr. Cameron who was residing at Aro Senior Quarters took on full time work at Lantoro. In January 1946, the first civilian patients were admitted into Lantoro and later that same year, criminal patients who were judged to be mentally ill were admitted on the order of the courts, in accordance with the Lunacy Ordinance.
With time, Lantoro institution became overpopulated and there was a need to establish a modern and well-equipped hospital for mental and nervous diseases. In 1948, through an arrangement made by Late Dr Sir Samuel Manuwa, Deputy Director of Medical Services, Western Province of Nigeria, the present site of the hospital made up of 232 acres of land was acquired with the assistance of the then Alake of Egbaland, the late Sir Oladapo Ademola II. It is instructive to note that as far back as the late 1930s, the present site of Aro, has been labeled, ‘Site for Mental Hospital’. Between 1951 and 1958, Aro Hospital and residential quarters for both senior and junior staff were built.
In 1954, Professor Thomas Adeoye Lambo, the first indigenous Psychiatrist arrived from the United Kingdom to succeed Dr Cameron. He was assisted by two indigenous nurses and an expatriate as Chief Nursing Superintendent. The Federal Military Government took over the management of the hospital in 1976 under Decree 92 “The Psychiatric Hospitals Management Board Decree”, from the old Western State Government. Immediately Prof. Lambo took over the leadership of the hospital, he initiated modern psychiatric services which included: insulin therapy, electroconvulsive therapy, chemotherapy and psychological therapy among others.
In 1956, Professor Lambo introduced the innovatory village system of management of psychiatric patients in Nigeria. Through negotiations, patients were admitted to nearby Aro and Ope-Oluwa villages.
Under this scheme, nurses were posted to provide 24 hour services for the patients, each of whom had as a rule one or two relatives who lived with the patients. The village system, the principle of which was subsequently adopted all over the world virtually opened the hitherto locked gates of the hospital for mental patients. For this innovation and his many primordial contributions to psychiatry, Professor Lambo, while the Vice-Chancellor at the University of Ibadan was in 1970 awarded the Haile Selassie prize. An important landmark in the contributions of Aro to the development of psychiatric services and research occurred in 1961 when Dr. Lambo organized the first Pan African Conference on Neuro-Psychiatry. Many eminent Psychiatrists and Neuro-Psychiatrists from all parts of the world attended the conference hosted by Aro. The Aro Village System was of enormous interest to the participants at the conference, and thereafter, the Rockfeller Foundation provided research funds for its further development and evaluation.
In 1963, when Dr Lambo assumed the Chair of Psychiatric in the University of Ibadan, Dr Tolani Asuni became the Medical Superintendent of the Hospital.
On 14th March, 2004, Professor Lambo passed on to glory at the ripe age of 81. The many works of this erudite scholar and colossus psychiatrist lived after him. Apart from his “Aro village system” that launched the hospital into international limelight, the Late Professor Lambo contributed immensely to the serene look of Aro hospital. History has it that he planted the tree edges at the hospital in company of his bossom wife Dinah. In recognition of his prowess in medicine, particularly in the area of mental health, he was conferred with the Chieftaincy title of “Baasegun of Egbaland” by Late Alake of Egbaland, Oba (Dr) Mofolorunso Oyebade Lipede.
Until his call to eternal glory, Professor Lambo was Baba Ijo of African Church, Igbore, Abeokuta. He was happily married with children, grandchildren and great grandchildren. With the same enthusiasim of Late Professor Lambo on the development of Aro, Dr Asuni founded two villages, Olomore and Idi-Ori where he created another type of developmental relationship.
Dr Asuni was appointed Professor of Psychiatry at the University of Ibadan in 1976 and like his predecessor, he moved to Ibadan. It should be noted that Prof. Asuni administered the hospital for a period of 13 years 1963-1976 becoming the longest serving Head of the Institution to date.
Thus, the substansive Medical Directors are:
Professor T. A. Lambo 1954-1963
Professor T. Asuni 1963 -1976
Dr J.A. Oluwole 1976 -1978
Dr John C. Ebie 1981 -1983
Professor J.B. 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 – 2020
Dr. A. A. Agboola 2020 till date
The hospital provides mental health training for different medical and para-medical professionals, interns, and students. Post-Basic training for nurses is also available. The institution is accredited for Postgraduate Fellowship Programmes of the National Postgraduate Medical College of Nigeria, West African Post- Graduate Medical College, and West African College of Nursing in Mental Health. The hospital has won at least four different awards which include:
i The Best Primary Health Care Provider 2015: Won the Nigerian Health Care Excellence award as the Primary Health Care Provider of the year 2015. The award was presented to the Ogun State-NPH Aro Primary Health Care Programme, in recognition of the outstanding service delivery in the field of health care in Nigeria.
ii The Health Facility Utilization Award, 2010: 3rd position in health facility utilization, tertiary health category, considering the 2007-2009 rendered data among tertiary health institutions in Ogun State. This was awarded by the Ministry of Health, Ogun State and presented on the 29th July 2010.
iii The Best Specialty Hospital in Nigeria 2007 was awarded by the 50th National Council on Health, Nigeria, in recognition of her contribution towards improved health services in Nigeria.
iv The Most Outstanding Public Sector Organisation, 1999, a merit award as the most outstanding public sector organization for the year 1999.
The world recognition of the hospital came 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 regular 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 Organisation (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. This led to the establishment of the Aro Endowment Fund, which was launched in 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 services, 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, efforts are still ongoing to steadily and assiduously develop the planned “Institute” status of the complex.
Mental Health Service at the Neuropsychiatric 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: urbanisation of the villages around the hospital; relative’s 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 institutionalised 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.
The Hospital established of the Community/NHIS Clinic in 2005, with the appointment of a Consultant Family Physician. The clinic currently provides primary and secondary general medical services to members 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 had 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 the Hospital’s Conference Hall and Cafeteria 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.
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 an enlightenment campaign to special community groups (secondary school students, artisans, etc.) 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 titled: ‘Mental Health’ – during which various topics and issues on mental health were discussed between June 2007 and July 2008. Community mental health enlightenment drama was also performed at community halls in Abeokuta with large turnout of members of the community. Liaison consultation/outpatient clinic services 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 included: assessment, treatment and transfer to the hospital when necessary, and could 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 the acutely ill, 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 Annex 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, vulcanising, ICT, etc for patients in the Rehabilitation Ward, and discharged patients. In addition, an Industrial therapy with 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 Service
The hospital embarked on a primary care mental health service programme to bring mental health service close to the people at the primary health 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 Primary Health Care (PHC) level under the support and supervision of visiting psychiatric nurses. One of the most exciting aspects of the innovation was the 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 services delivery in the very remote rural communities of the state.