Reinventing the asylum

New uses for old mental hospitals are innovative but highly controversial
By Ken MacQueen
The massive old Crease Clinic of Psychological Medicine — on the southern fringe of the grounds of the Riverview Psychiatric Hospital in the Vancouver suburban of Coquitlam — exudes the sort of ominous aura that raises hairs on the back of your neck even on a glorious June day.
This vague unease isn’t helped by a crew on site from the science fiction TV series Battlestar Galactica filming a particularly creepy episode. “Terrified Man” and “Child in Cage” — two of the labels on mobile dressing room doors — hint at the fictional mayhem inside the decaying four-storey brick pile.

Riverview, once a self-contained city for the mentally ill, has always played on the greater community’s fears, more so now when many of its buildings are empty and neglected.
This perception isn’t helpful as people like Vancouver Mayor Sam Sullivan make the case for the provincial government reversing the gradual closure of Riverview and restoring it to what it was for much of a century: a vital residential psychiatric centre.
“When Riverview is mentioned, it causes an emotional reaction for some people because of the more feudal approach that might have been adopted in the old days,” Sullivan concedes. “That’s certainly not what I’m advocating.”
Critics accuse Sullivan of trying to export Vancouver’s homeless in advance of the 2010 Winter Olympic Games — in much the same way asylums of old locked up those deemed defective.
The mayor makes no apologies for using the Olympics as a lever. He has already extracted significant funds for social housing and other initiatives for his “Project Civil City” initiative. His message to senior governments is blunt. “In 2010 Vancouver will represent you to the world. I’m afraid to tell you that you have a problem.”
Riverview is part of what he hopes will be an Olympic legacy of effective treatment for the homeless and the vulnerable. Far from locked wards and electroshock therapy, Sullivan wants a reopening of some of the empty cottages and independent housing units scattered on Riverview’s park-like 100-hectare site — a rolling rise of land above the confluence of the Coquitlam and Fraser rivers.
Most mentally ill people can be integrated into the community, he says. But for others, the chaos, dysfunction and drug-dealing of Vancouver’s Downtown Eastside is poison.
Sullivan serves on a provincial task force on homelessness, mental illness and addiction. He says the government is supportive of using Riverview as part of a larger strategy.
Indeed, Premier Gordon Campbell mused in a speech last fall about reopening parts of the site, first purchased by the province in 1904. It shrank from a peak patient population of 4,600 in 1951 to about 300 today.
Campbell called “de-institutionalization” — the policy that began emptying psychiatric wards across North America starting in the 1960s — “a failed experiment.” On that point, Sullivan disagrees.
He was rendered a quadriplegic after a skiing accident as a young man. “If it hadn’t been for de-institutionalization,” Sullivan says, “I would be living in some hospital ward.”
Still, a place like Riverview is the best alternative for some, he says. “They need a more compassionate and supportive environment.”
The notion of reinventing the asylum is gaining currency as governments seek to balance personal freedoms and medical advances with the public dismay over the growing legions of urban street people.
In Toronto, the Centre for Addiction and Mental Health (CAMH) began construction last fall of a revolutionary “mixed use urban village” on the downtown 11-hectare site of what began in 1850 as the first Provincial Lunatic Asylum.
The walled institution morphed over time into a campus-style setting. Services for addiction, psychiatric disorders and forensics are scattered throughout the city.
The intent of the redevelopment is to incorporate those services on the Queen Street West site — and to integrate the village into the surrounding community, says Chris Edey, communications and urban planning manager for the project.
The plan calls for extending city streets into the once-isolated site and mixing some 600 patient residential and treatment beds with leased shops, restaurants, offices and apartments. Still, it faces significant challenges.
By the CAMH’s own estimates, 40 per cent of its Toronto “clients” have both mental and addiction problems.
Nowhere are such concurrent problems more acute than in Vancouver’s Downtown Eastside, a blighted zone of welfare hotels, dank bars, and vice-filled alleys.
Clinical psychiatrist and researcher Dr. Bill MacEwan estimates 60 to 70 per cent of the mentally ill treated at nearby St. Paul’s Hospital have multiple addictions.
MacEwan, also the director of the schizophrenia program at the University of British Columbia, makes regular rounds of the area’s squalid single-room occupancy (SRO) welfare hotels.
He estimates 2,500 people there “are homeless or living in an SRO, have serious psychological problems, serious medical problems, are substance abusers and are not getting any kind of meaningful care.”
They overwhelm hospital facilities. One woman had more than 100 “contacts” with St. Paul’s in a two-year period due to drug-fuelled psychological relapses. Another used at least $700,000 worth of hospital services over two years.
“These are very poor, very expensive health care utilizations.”
MacEwan supports using Riverview, where he worked in the late 1980s. “The asylum model, the old British model where you put something out in the hinterlands where it’s quiet, is a decent model for some patients,” he says.
Still, he cautions, it’s a different world. A vulnerable population there today would attract the same predators who push drugs in the Downtown Eastside.
The residents would need both freedom of movement and protection, a delicate balance, he says.
As for reopening the giant old wards on the site, forget it. They housed as many as 12 psychotic patients to a room. “The old days at Riverview weren’t good old days,” he says.
Few doubt Riverview would have been razed for redevelopment if not for several advocacy groups — some protecting the patients, and others the world-class collection of trees and plants left from the era when it was also a working farm and a botanical gardens.
Ludy Moysiuk joined the Riverview Preservation Society to protect the interests of two schizophrenic nieces who are residents there. Even now, services are pared back, and residents and their families worry the site could close.
“They’re forgetting that they’re people,” Moysiuk says. “That’s their home, and the people around them, that’s their family.”
If Sullivan’s initiative is motivated by a pre-Olympic cleanup, so what, she says. “If that’s what it takes to bring Riverview back as a community for the mentally ill, that’s okay.”
If there is a polar opposite to the Downtown Eastside it is Finnies Garden, a 1.2-hectare series of wild terraced gardens climbing an isolated hillside on the Riverview grounds.
The gardens were planted and the stone walls laid by patients in the early 1950s, an era when work was considered therapy and not a human rights abuse.
As the patient population dropped, the gardens fell into neglect, until volunteers like Don Gillespie and his wife, Norma, of the Riverview Horticultural Centre Society, began the slow process of restoration. Norma, a former psychiatric nurse, trained and lived on the Riverview site as a young student in the 1950s.
She retired from a much-diminished Riverview in 1997. She understands better than most what was lost here, and what may yet be saved.
She walks the gardens, pointing out the lilacs, roses, peonies and rhododendrons planted by former patients. She shows where creeping foliage was pruned to create bright open spaces.
“That’s what the mentally ill need,” she says. “They need uplifting.”
She takes a visitor on a driving tour of Riverview’s narrow, winding roads, past lovely small cottages, the former nurses’ quarters and doctors’ residences, and the other fine buildings that could still be put to good use.
She points out a gnarled walnut tree, two giant firs and a magnificent weeping beech — also part of what makes this place special. Strip away the underbrush of fear and stigma and remember the true definition of asylum, she says.
“It means sanctuary.”