Hamilton

 

 

 

 

Name(s) of Institution:

Hamilton Asylum (1875)

Hamilton Asylum for the Insane

Hamilton Psychiatric Hospital (1968)

Opened:

1875

Location:

100 West 5th Street, Hamilton, Ontario (current address)

Period of Deinstitutionalization:

1965-2001

Patient Demographic:

YEAR	MALE	FEMALE	TOTAL	YEAR	MALE	FEMALE	TOTAL
1876*			30	1960			1,750
1876**			202	1965	682	661	1,510
1884	270	297	567	1967	740	676	1,416
1887			624	1970			858
1888			822	1971			720
1893			950	1975			700
1919***			1,300	1981			430

* Opening.     ** End of year.     ***In 1924, bed capacity increased to 1,299.

Deinstitutionalization:

The Hamilton Asylum was founded in response to nineteenth-century Ontario temperance activism. Petitions in 1867 requested a place of detention for the “inebriates of the province,” and six years later, the provincial government responded, purchasing a hundred acres of land overlooking the city of Hamilton. The location was considered ideal as “the asylum itself was isolated as if it were many miles away.” Along with many other asylums and penal institutions in Ontario, Hamilton Asylum’s creation was largely due to the actions of Ontario’s first premier, John Sandfield Macdonald. In 1868, he enacted the Prison and Asylum Inspection Act of 1868, beginning a campaign of reform that expanded the number of large, publicly funded institutions and brought them under the watchful eye of the Inspector of Prisons, Asylums, and Public Charities of Ontario.

Due to the high number of mentally ill persons needing care and the pressure already placed upon other provincial asylums, Inspector of Asylums J.W. Langmuir recommended that the government convert the Hamilton building into a facility for the maintenance of the province’s “demented minds and lunatics.” Thus, on January 1, 1876, the asylum was deemed the Hamilton Asylum for the Insane, with Dr. Richard Maurice Bucke as its superintendent. Bucke, who would later become a prominent asylum caretaker and author, spent only one year in Hamilton before being appointed as superintendent to the provincial asylum in London, whereupon he was replaced by Dr. James M. Wallace, who remained as Hamilton Asylum’s superintendent until 1887.

During his grand tour of the asylums of the United States and Canada in the mid-1880s, prominent British physician Daniel Hack Tuke stated that the Hamilton Asylum was “beautifully situated, overlooking Lake Ontario at the point of Burlington Bay.” Nonetheless, Hack Tuke believed the location was “inconveniently near a precipitous descent” and the approach to the building “troublesomely steep.” Overall, though, he praised the conversion of the asylum from one for inebriates to one for the insane, since “the needs of the insane were justly deemed more pressing and practical than those of dipsomaniacs [alcoholics].”

Although the main treatment was moral therapy, asylum Superintendent Dr. James M. Wallace, who replaced Bucke after a year, informed Hack Tuke that, when it was deemed necessary, hospital staff employed restraint on patients, using leather muffs for troublesome men and “the camisole” for women. Custodial care remained the primary form of treatment until the 1950s, when new drug therapies, electroconvulsive therapies, and psychotherapy took over as the main form of therapy.

From 1965 to 1975, the in-patient population at the Hamilton Psychiatric Hospital (HPH) plummeted from 1,750 to 700 largely due to the implementation of community care.

Nevertheless, in November, 1976, after several years of de-institutionalization, Medical Director Marcel Lemieux circulated a program to the hospital staff that demonstrated the continued need for some in-patient care, despite the success of psychopharmacology and community care in decreasing the number of chronic patients. He suggested that, due to a large group of patients who were unaffected by the new treatments and community care, “the existence of psychiatric hospitals are needed, not as an asylum anymore, but rather, as a specialized psychiatric institution that is prepared to deal with the field that we will call psychological oncology, acting as the backup service for the primary and secondary care level of psychiatric services that are existing in the community.” Lemieux’s view, in line with that of many of his contemporaries, was that the hospital “should play an important role in the total spectrum of psychiatric services.”

By 1985, the in-patient population had dropped to 368, and by 1995, to 211. The population ultimately fell to just under 200 by 2001. The hospital’s work continues today on the same grounds in a newly built facility, with only one of the original buildings, Century Manor, still standing. In February 2014, a new state-of-the-art hospital was opened under the name The Margaret and Charles Juravinski Centre for Integrated Health and administered by St. Joseph’s Healthcare Hamilton.

Transinstitutionalization:

Community psychiatric outreach began in the 1960s. In 1976, on the hospital’s centenary, Superintendent Frank F. Morin outlined the prevailing philosophy of care: to treat patients with the aim of returning them to the community. by the 1970s, follow-up care included several outpatient clinics. Morin suggested that “prolonged and unnecessary hospitalization can develop in some patients an ‘institutionalized dependence’ which can be extremely detrimental to patients’ rehabilitation.”

Funding for HPH community outreach was secured in 1988, and involved a partnership with community mental health service providers alongside HPH-initiated sponsorships for community service and outreach programs. For example, HPH developed community partnerships with St. Joseph’s Hospital, Community Outreach and Support Team program of Hamilton, Adult Mental Health Services, Hamilton Public Health Bridge to Discharge program, Niagara Mood Disorders Satellite Clinic, Wellington Psychiatric Outreach Program, and the CMHA.

Work Therapy into Occupational Therapy:

As Ontario asylums filled to capacity and beyond during the late nineteenth century, superintendents increasingly relied on unpaid patient labour for running the asylum inexpensively. As elsewhere, Hamilton Asylum patients often did work in and around the institution, including everything from the asylum laundry to road maintenance. Perhaps expectedly, labour was often divided based on late-nineteenth-century Anglo-American gender norms, with women working in the laundry, kitchen, and sewing room while their male counterparts engaged in activities such as masonry, quarrying, and farming. Patient labour provided an unpaid resource for the asylum, and superintendents justified it as therapeutic.

Marg Clark, a ward supervisor in the hospital during the 1940s, recalled that she worked alone during day shifts, caring for as many as eighty-one patients at one time in an all-female ward. Clark trained the patients to do housekeeping chores and other duties typically assigned to nursing staff. She considered this to be a form of occupational therapy, stating that “the girls gained a sense of responsibility, a sense of achievement, and a sense of worth” (HPH, Horizon).

By the second half of the twentieth century, a sophisticated occupational therapy department existed within the hospital, as well as a “community extension team,” established in 1968, whose purpose was to assist with treatment inside the hospital and to help the community utilize the hospital’s services more effectively. The role of the Occupational Therapist was to act as a consultant, coordinator, and sometimes liaison between the hospital and community treatment teams. The department considered this a vital role that should be continued in the community setting, as ex-patients were likely to require this service.

Occupational therapy at the hospital in the 1950s and beyond differed somewhat from the work therapy of the early era, with the goal now being to provide patients with occupational skills that would be useful for employment within the community. Thus, by the 1960s, the hospital’s occupational therapy department contained a typing unit to provide patients with office skills, a domestic service training course to provide women with job opportunities in the domestic field, and an industrial workshop to teach men how to use light machinery and tools. Occupational therapy also took the form of more traditional activities such as woodworking and weaving. This emphasis on building individual skills reflected the shift in mentality that occurred amongst the hospital’s administration during the deinstitutionalization period. Justification shifted from patient labour to serve the needs of the institution to skills-based training to ease transition into the community and ultimately, into paid work outside the hospital.

Patient into Person:

Community care was developed throughout the late 1960s and early 1970s. After testing a community-care program on a small scale in 1969, hospital administrators felt that the results were encouraging enough to significantly expand the program in 1970. Administrators decided that patients who did not require hospital care but were unready to live on their own would be boarded out with families within the city. Ed Luterback, Director of the hospital’s social and vocational rehabilitation unit at the time, indicated that the program was designed for both long-term patients and as an alternative to hospital admission for those who could no longer cope with living at home.

Families who boarded patients were paid five dollars a day for the patient’s room and board, which was ten dollars more per week than the going rate for room and board in Hamilton during that period.  This “premium” rate given to families was meant to be an added incentive for them to “become involved in a friendly, family way with the patient, without trying to control his life.” The ultimate aim of the program was to provide patients with a proper temporary shelter as well as a social and mental adjustment period to aid them in their move from the hospital to their own independent living arrangements.

In 1974, legal aid became available to hospital in-patients.  Lawyers visited twice monthly to help with divorces, wills, estates, and financial affairs.

Staffing in the Deinstitutionalization Era:

In 1925, hospital staff consisted of the Medical Superintendent, Assistant Superintendent, and two physicians. The facility also housed a psychiatric nursing program, founded ca. 1902 and accredited in 1924. The program graduated its first students in 1928. By training nurses in psychiatric care, the program helped to alleviate some of the burden on the physicians and attendants who, by the 1920s, were in charge of over 1,000 patients. As one of the first of its kind in Canada, the program trained nurses for psychiatric work not only in the Hamilton Asylum, but also in the city’s general hospitals. Also during this period, the large infirmary was built. By 1929, the facility was known as the best asylum in Ontario.

Throughout the war years, there were severe staff shortages in the Hamilton Asylym, as in most Ontario hospitals, as nurses were recruited by the armed forces. The postwar period saw the twilight of the nurse training program, which graduated its last class of nurses in 1953. By the late 1960s, the increased use of psychotropic medications, a decreasing patient population, and improved surgical facilities at other Hamilton hospitals all created less need for surgical facilities in Hamilton Psychiatric Hospital. Thus, by 1967, major surgeries were no longer performed within the hospital.

Staffing and structural changes in the Hamilton hospital during the deinstitutionalization era reflected both a decreasing patient population and the shifting of psychiatric patient care from nurses, attendants, and physicians to, in many cases, occupational therapists, community outreach liaisons and care centres, and boarding families. As the hospital ceased to be the only site of care and became one part of a larger spectrum of psychiatric services within the city and province, the hospital’s staff and facilities changed accordingly.

Sources:

Collins, Brianne M. “Ontario’s Leucotomy Program: The Roles of Patient, Physician, and Profession.” MSc dissertation, University of Calgary, 2012.

Forchuck, Cheryl, and Donna Tweedell. “Celebrating Our Past: The History of Hamilton Psychiatric Hospital.” Journal of Psychosocial Nursing and Mental Health Services, October 2001: 16–24.

Hamilton Psychiatric Hospital (HPH). “Community Outreach.” Hamilton Psychiatric Hospital. https://weblady.ca/HPH/programs/community.html.

Hamilton Psychiatric Hospital (HPH). “Hamilton Psychiatric Hospital Occupational Therapy Department.” Circa 1970s. Hamilton Museum of Mental Health Care.

Hamilton Psychiatric Hospital (HPH). Horizon  5, no. 48 (1981).

Hamilton Psychiatric Hospital (HPH), File 720. 100 Years of Service. CAMH Archives.

The Hamilton Spectator, date unknown, 1970. Hamilton Museum of Mental Health Care.

Ontario Department of Health. Ontario Department of Health Annual Reports–Mental Health Division. Toronto: Archives of Ontario. 1867, 1965, 1967, 1970.

Reaume, Geoffrey. “Patients at Work: Insane Asylum Inmate Labour in Ontario, 1841–1900.” In Mental Health and Canadian Society: Historical Perpectives. Montréal–Kingston: McGill–Queen’s University Press, 2006.

Tuke, D. Hack. The Insane in the United States and Canada. London: H. K. Lewis, 1885.