nursingforsocialjustice

In a 2007 Macleans article former British Columbia Liberal Premier Gordon Campbell called the (by then) almost 50-year process of deinstitutionalization “a failed experiment.” Some might call this a strange way to describe a not only Canadian movement toward a different understanding of those deemed mentally ill, and thr physically and intellectually disabled, but a global movement that in part stemmed from a human rights perspective. Instead of rounding up and institutionalizing those that did not fit into the category or normal, they stayed amongst us. Society was changing.

At that time Vancouver Mayor Sam Sullivan, who experienced a skiing accident that resulted in quadriplegia had a differing opinion of the deinstitutionalization movement, sharing his perspective that it allowed more people to live within communities rather than spending a lifetime on hospital wards. At that time comparisons of the process in BC and the closure of the Lower Mainland provincial mental hospital were made to progressive organizations like the Centre for Addiction and Mental Health (CAMH) in Toronto, which was reconceptualizing and revisioning mental health inpatient treatment spaces. Was it really possible for the chronically and persistently mentally I’ll to live among us?? Back in the early 2000s we began to embrace this idea.

The result? A provincial plan to speed up the thirty year plan to scale down the centralized mental hospital. In 2002 a plan was made to close Riverview Hospital as it was then organized and run by the year 2012. A spotlight was shone on the potential for a revisioning of Riverview Hospital because of the upcoming 2010 Olympics being hosted by Vancouver and Whistler. The crux of the argument was that reopening such an institution would allow the homeless victims of the Vancouver Downtown Eastside (DTES) to find solace and refuge in a hospital setting instead of being ravaged by the predatory drug dealers of the DTES. At that time the final closure of Riverview Hospital was still an event waiting to happen, but the evidence and recommendations had been made since the 1960s about the unsustainable, inefficient, and in many ways antiquated large-scale publicly run centralized mental institutions.

Shifts from a centralized provincially-run mental institution had been happening for almost half a century. Experts knew the cause and solution to the problem. Not enough housing and not enough social service and healthcare support. In 2007 romantic ideas about the good old days of Riverview providing optimal care for the down and out in the DTES were floated around media outlets. The solution to the problem, re-open the provincial mental institution. Mental Health clinicians, advocates and activists at that time cautioned against this paternalistic view, limiting freedoms to optimize safety. I started practicing as an RN in Vancouver in 2008. I listened to (and still sometimes hear) the stories of the heyday of Riverview. I also hear the stories about limitations with the understanding that it was the best that could be done at the time.

Flash forward 15 years later. The housing crisis is worse. Social service and healthcare services have not been adequately resourced and scaled up to meet the needs of the population across the Lower Mainland and across the province. The solution? Involuntarily admit people deemed the highest risk which now includes more than those who meet the legislated criteria for admission under the provincial Mental Health Act. Re-open the large provincial mental institution. But, I think we need to take a step back and remember why the large centralized provincial hospital closed, to begin with. Riverview Hospital did not exist in a wonderful heydey of mental health treatment. It was a different time when we had a different understanding of mental health and mental illness.

In 2022 we have a very different understanding of human rights. We really have to have a big collective think about if issues like the opiate overdose crisis are best addressed with solutions that may have been somewhat effective a century ago when we didn’t know about things like intersectionality, structural racism, and trauma-informed care. And we have to have a really big collective think about if a social justice issue can best be addressed by human rights violations.

Love,

Michelle D.