Comment: Closing institutions abandons those most in need

A commentary by a retired social worker.

One of the advantages of being old is that you may be lucky enough to say “I told you so” to the world.

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Tragically for the people involved, many of them had lives that were totally disrupted and in some cases lost, while the authorities tried to prove the advantages of the New Order.

In the fall of 1963, I arrived on the steps of Centre Lawn, in the Provincial Mental Hospital (PMH), known to its neighbouring suburbanites as Essondale.

I was a master’s student in psychiatric social work, and I was to work there two days a week until April. I can give you an idea of the architecture and decor by telling you the buildings became a cash cow for the province from the film industry. I think all the most popular ­horror films made in Vancouver were on location there.

Those were exciting days. De-institutionalization was the rallying call: “Back to the community.” I was very uncomfortable with some elements of the changes, but as a student my job was to keep an open mind.

At first, the changes were exhilarating, There was plenty of money available to assist the folks coming out of the institution. If people needed special dental work while hospitalized, for example, they were given dental care free of charge in the hospital. No one wondered who would pay when they lived “in the community.”

At first, there was a lot of time taken in reviewing the charts of people who had been in PMH for terms as long as 40 or more years.

There was no handbook given those who returned after decades, as to how to get around in Victoria. I suppose it was expected that the persons in charge of the “rest homes” the ex-patients were “placed” in, would provide, in a proactive manner, any information the person might need.

PMH had many of the aspects of daily life available for the patients. Recreation, hair and nail care, socialization and many other comfort activities were available. A tuck shop allowed for small purchases of low-cost treat items. Tea was available and so on.

I am not saying it was a ­perfect setting, but it certainly bettered the alternatives that the long-term patients experienced when they left PMH, There was even a small but regulation-size bowling alley.

Because of the spacious (many acres) green space, and the classic arboretum featuring many tree species, people could wander for several minutes and neither meet another person nor change the direction of their roaming.

There were cottages up the hill that were originally meant for doctors as an incentive to move to Vancouver to work in PMH, with the incentive of low or no rent for the doctor and his or her family.

Later, they were used as semi-independent low-cost rentals for long-term patients who did not need the supervision and oversight of the 24-hour care hospital itself, but would benefit from connections with hospital staff that had worked with them for years.

One suggestion given at the time was that a village be built for long-stay patients, but instead some of the land was sold to build subdivisions.

So what happened later?

At first, each referral that came from PMH to the Victoria Mental Health Centre was very detailed and several pages long. We knew the patients very well before they arrived, and knew what needs should be addressed, as outlined by the client while still at PMH.

A lot of care was taken, and most of the time, our low “case load” allowed for listening to what was wanted by the client, offering alternatives, helping to have them decide their choices.

Over time, we should have known there would be changes. While there was a worldwide embrace of “Closer to Home” care, there was not sufficient money allocated.

Some dental work, for example, that had been routinely done at PMH was no longer available, given the reduced list of dental services that the Ministry of Social Assistance would cover.

Although the governments of the day had assured had us that this movement of people was not a cost-saving measure, it became clear that many of the opportunities that had been open to in-patients were not available “in the community.”

When de-institutionalization was first discussed, there was a lot of debate about money. The authorities insisted that removing the patients from the hospital was not a cost-saving ploy.

I recall ministers from both large parties stating that it would be at least as costly, and possibly more costly, to continue with ­de-institutionalization, whenever the subject was brought up.

But it was thought to be the right thing to do, and would remain a high priority issue in all subsequent budgets.

One very vocal critic of the lack of adequate financial ­support and the subsequent reduced quality of life for the clients was Dr. E. Fuller Torrey.

He was a valiant leader in the fight for decent care and the need, for some, of a wrap-around care that ensured the patient’s security and opportunities for growth. He spoke to this on several occasions in B.C,, and he was the recipient of many family-and-friends advocate groups’ awards.

His sister was a long-term patient of the psychiatric hospital in Elizabeth, New Jersey. He countered the arguments of those who spearheaded ­de-institutionalization this way: The latter group said their methods were developed in keeping with maintaining the rights of the patients. Torrey fought desperately to keep his sister in hospital, saying he didn’t want her to become one of those who “died with their rights on.”

This, of course, is not to say that every long-term patient needs to stay in hospital. But there are some — and we don’t know how many, because research on outcomes has too often been closed though very incomplete, due to lack of funding — who truly are in danger if they are not in a secure setting. I am guessing it is a small number.

But until we can guarantee that all the person’s needs can be readily met, and they are safe from harm, we shouldn’t be ­closing all the institutions.

There have been excellent follow-up programs in some locations that showed how successfully some very long-term in-patients could be supported outside of the hospital. Their lives in the community have truly been “in the community.”

But too many times, when budgets tighten and new planners, who don’t understand the programs, are expected to “find some savings,” they comply and the program is lost.

Frustratingly, to me at least, a few years later, with great fanfare, a new and “better” version of the same plan opens up. And the cycle continues; often ­leading to repeating closings/new openings/closings.

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