The Last Asylums Exhibit

By L. Baker, L. Beckman, M. Davies, C. Dooley, and E. Dyck

With the development of community-based mental health in the 1960s, Canada’s large long-stay mental hospitals were repurposed as smaller, mainly short-stay facilities.  This path-breaking, bilingual exhibit charts the pace, scale, and shape of this institutional adaptation and the evolving patient and staff experience.  Tasked with the work of creating a national overview of deinstitutionalization, researchers from across Canada mined public records and institutional histories to create these communiqués to stimulate further work on this important subject.

Surveying this research, we observe varying, and sometimes dramatic rates of institutional depopulation in different parts of the country.  But it is clear that the umbrella term deinstitutionalization encompasses more than just changes to patient demographics and staffing configurations.  Profound, life-altering changes for institutionalized patients, practitioners, administrators, and support staff lie behind the statistics, legislative initiatives, and policy documents that we have gathered.

Inside the old mental hospitals, evolving therapeutics fostered new professional configurations, and work therapy was replaced by job and life skills training intended to prepare clients for community living.  A reinterpretation of the patient as “person” was reflected in shifting institutional policies and new recreational options for residents.  Aging institutions took on new roles and developed programs undreamed of in the era of the long-stay mental hospital.  Some facilities closed their doors entirely, becoming playgrounds for movie makers and urban explorers, or were torn down and erased from the physical landscape.

The central premise—and promise—of the shift away from the use of large mental health institutions was the integration of former patients into the life of the broader society.  But in spite of the benign motives of the professional pioneers in community mental health, the marginalization of people with psychiatric labels continued, and it took new forms. Trans-institutionalization, where patients were redistributed across a series of smaller institutionalized settings—including boarding houses, group and foster homes, and nursing homes, and even jails—emerged as a new pattern, and may in fact be the most useful way of understanding these sweeping changes to mental health provision.  Even those whose circumstances allowed them to live independently often found their lives closely managed by social workers and community care teams.  Others fell between the cracks as, by the late 1970s, cost-containment increasingly took precedent over the social integration of former patients as the driver of deinstitutionalization.

In the post-asylum era, continuity of care has been replaced by a patchwork system of treatment by private practice physicians and local mental health teams, back-stopped by crisis intervention in general hospital psychiatric wards.  Social isolation, a deeply stigmatized identity, exclusion from the work force, persistent poverty, and even homelessness, often frame the lived experience of former patients. It is easy for the imaginative eye to see the ghost-like walls of the old asylum standing among the programs that make up today’s community mental health system.