Authors: Rosalyn Choi, MSN, BSN, RN, Vancouver Coastal Health, and Dr.Geertje Boschma, PhD, RN, UBC School of Nursing.
Rosalyn Choi works as a staff nurse and as a community health nurse. She has recently written a major essay on the historical trends of mental health care within British Columbia.
Dr. Geertje Boschma, PhD, RN, is an Associate Professor at the School of Nursing of the University of British Columbia. She teaches in the undergraduate and graduate programs. Her research focuses on the history of nursing and mental health care.
We examined the history of survivor groups in BC as part of a larger project on the history of deinstitutionalization, which in BC began in the late 1950s. In BC, the most important provincial institution. Patient numbers peaked at 4,630 in the 1950s, whereafter the hospital continued to downsize (1). An important response to this change was increased patient and family activism, often born out of necessity, if not desperation, because few resources were available in the community when a large number of ex-patients had to find accommodation and support outside of the hospital. We believe it is important for all people involved with mental health care to understand the important shift brought about by active ex-patient, client, survivor, and consumer involvement – terms we will use interchangeably in the remainder of this article.
When consumers began to organize themselves, the notion of “being a patient” gave way to new identities that signified how people with mental illness took on an active and often critical role in the organization of support and resources. A movement of consumers, survivors, and ex-patients (c/s/x) became a critical voice and established a range of new resources (2). Despite the new opportunities brought about by community care, availability of resources was often insufficient to accommodate all people in need of support. Increased homelessness, increased family stress, stigma, and continued discrimination became more apparent. In 1971, one critical response came from a group of ex-patients in Vancouver, who formed the Mental Patients Association (MPA) (3). This organization was led by Lanny Beckman, a client at the Burnaby Psychiatric Day Program, who felt that there were noticeable gaps in service, particularly a lack of emergency psychiatric coverage on weekends and holidays. While in a day program, Lanny noticed three clients had committed suicide, all on weekends. In reaction, Lanny understood the need for patients to organize themselves. He began exchanging phone numbers with other consumers. Among themselves, they generated a phone list so they could find “more real support from their information network” (3, p.1). From then on they began to establish support services and housing, forming a cooperative member-led organization in which consumers had a central role, and, supported by grants and governmental funding, also found employment.
The critique that arose over the mental health care system must be understood in the context of psychiatry also being a history of power. Foucault described the history of psychiatry as a ‘genealogy of power’ (4, p. 41). The power of psychiatry is, for example, reflected in its diagnostic power; medical diagnoses are determined by medical professionals, whose power in turn, is backed by a governmental and legal regulation. Individuals experiencing medical treatment may not always agree with the appropriateness of the services or with its beneficial intent. Moreover, amongst service providers, insights vary as to what is deemed appropriate treatment. The anti-psychiatry movement arose over such differences, with opposing views over many aspects of mental health care, including the notion of mental illness itself. Notions of “consumer” and “survivor” highlight a focus on rights of mental health patients as citizens (4).
Consumers established their own power. MPA leaders Lanny Beckman and Barry Coull, for example, were influenced by the Radical Therapy Movement in North America (3), stemming from a “viewpoint which approaches emotional problems by determining sources of oppression, exploitation and repression in our society” (3, p. 4). MPA members formed self and mutual help groups, sharing their personal experiences. The MPA recognized the need for mental health consumers to obtain a voice. In addition, many consumers also needed to learn basic skills of day-to-day living, which were not usually learned in mental hospitals. The organization identified these skills as ‘participatory democracy’ (3). One of the main goals was to “assist and promote welfare of mental patients and former mental patients” (Vancouver Mental Patients’ Association Society, 1983, p. 1), and create housing, vocational, and recreational resources. The MPA still exists today, but has changed the meaning of its acronym. It now stands for Motivation, Power and Achievement (MPA, 2009).
Consumer organization continued to grow as a participatory and critical response to a changing mental health context. Soon the Lower Mainland saw a variety of consumer and social activist driven organizations, which now form the backbone of the community mental health service system. Various organizations formed drop-in centers, clubhouses and supportive housing, including Coast Mental Health Foundation, Kettle Friendship Society and Mental Health Housing (5). Other important organizations in BC from the 1950s onwards were the BC Division of the Canadian Mental Health Association, which became an important advocate for changes for legislation and mental health policy, and the BC Schizophrenia Society, formed in the 1980s by families and friends of people living with schizophrenia. Finally, we mention the Vancouver/Richmond Mental Health Network Society founded in 1993 by consumer Garry Long (6), later renamed West Coast Network Society. This client-run group provides advocacy, counseling and crisis management for individuals with mental illness. Increased activism resulted in consumer representation on mental health committees, boards and councils at various levels of the government over the last few decades. The history of the consumer movement highlights the importance of critique, collaboration, participation, and continuous renegotiation of the terms on which mental health care is build.
1. BC Mental Health and Addiction Services, History, 2008, retrieved from http://www.bcmhas.ca/AboutUs/History.htm
2. Shimrat, Irit. (1997). Call me crazy: Stories from the mad movement. Vancouver: Press Gang Publishers.
3. Vancouver Mental Patients’ Association Society (1983). Head on: Into the eighties. Vancouver: Carolina Publications.
4. Everett, B. (2000). A fragile revolution: Consumers and psychiatric survivors confront the power of the mental health system. Ontario: Wilfrid Laurier University Press.
5. Killam, J. (1999). “Advocacy” and the mental health consumer/survivor: In pursuit of quality of life for all British Columbians with a mental illness. Vancouver, BC: ARA Mental Health Action Research & Advocacy Association of Greater Vancouver.
6. ARA Mental Health Action Research and Advocacy Association of Greater Vancouver, 2009, retrieved from http://www.aramentalhealth.org