History of Psychiatric Institutions

nurses 1900 stanley royd

Sources: BC Metal Health & Addiction services and National Alliance on Metal Illness (NAMI)

1247: Bethlehem Hospital (aka ‘Bedlam’) opens in London to house ‘distraught and lunatic people.’

1566: The New World’s first mental hospital is established in Mexico City.

1774: The Act for Regulating Madhouses, Licensing, and Inspection is passed in England. The law forbade a person’s commitment to a madhouse without a physician’s certification of that individual’s insanity.

1790: A Quaker called William Turke opens the York Retreat near York, England, an asylum for the mentally ill. The Retreat favoured humane treatment; physical restraints were not used and patients were comfortably housed.

French physician Phillipe Pinel begins working at the Bicêntre and Salpêtrière asylums where he develops ‘traitement morale,’ a form of treatment that focused on the mental origins of madness. His kind treatment of his patients brought about recovery for many.

1817: Quakers in Philadelphia open the first asylum in America based on the principles of moral treatment.

1841: Dorothea Dix, a schoolteacher from Cambridge Massachusetts, becomes inspired to take up the cause of the mentally ill. She travels to several states where she lobbies state legislatures to better their treatment of the mentally ill. Over thirty state mental hospitals were opened as a result of her efforts.

1850: British Columbia’s first recorded case of insanity: shortly after arriving in Victoria, a deranged Scottish immigrant allegedly assaults J.S. Helmcken, the jail doctor. The “maniac” is placed on the next ship back to Scotland.

1864: An infirmary for women is opened in Victoria, and includes a handful of female “lunatics” among its patients. However, treatment for mental illness is non-existent. Most mentally ill people are left to fend for themselves or, if deemed dangerous or troublesome, are locked in the crowded city jails of Victoria and New Westminster.

1867: The Packard Law passes in Illinois. Named for Eliza Packard, a woman committed against her will by her husband after a property dispute, the law required that a patient’s insanity be determined by a jury before he or she could be sent to an institution.

1872: BC’s first asylum for the insane opens: Royal Hospital, a converted cottage that previously served as Victoria’s quarantine hospital, is re-converted to house the mentally ill.

1873: The Insane Asylums Act is passed, BC’s first legislation addressing mental illness.

1878: The overcrowded Victoria asylum is closed and its 36 residents are moved to the newly-built Provincial Asylum for the Insane in New Westminster.

1883: Work therapy is introduced; asylum residents are put to work in the gardens.

1897: The legislature passes the Hospitals for the Insane Act, stipulating that mentally ill persons could be committed to hospital under an Urgency Order, which required two medical certificates. The asylum in New Westminster is renamed the Provincial Hospital for the Insane (PHI).

1899: PHI population surpasses 300. In the absence of social services, the hospital is housing developmentally disabled people and unwanted, physically handicapped children along with psychiatric patients. Complaints are heard of serious overcrowding, poor hygiene and living conditions, and inadequate care.

1901: The psychiatric literature lists the principal causes of insanity as heredity, intemperance, syphilis and masturbation.

1904: To relieve overcrowding, 48 male patients are transferred to a small asylum in Vernon, and the BC government purchases 1,000 acres in rural Coquitlam as the site for a new mental hospital – the beginning of Riverview Hospital.

1905: Using mostly patient labour, housed on-site in temporary buildings, the Coquitlam site is cleared and diked, and Colony Farm is established to grow food for the PHI.

1909: Construction begins on the new “Hospital for the Mind” on the slopes above Colony Farm; the locale would become known as Essondale, in honour of Dr. Henry Esson Young, the cabinet minister who advocated the new hospital.

1912: John Davidson, Provincial Botanist, establishes western Canada’s first botanical garden and arboretum on the Essondale grounds. Davidson would move the garden to the new UBC campus in 1916, but the unique collection of trees remains to this day. Meanwhile Colony Farm gains a reputation as the best farm in Western Canada, employing the latest in farming techniques to produce over 700 tons of crops and 20,000 gallons of milk in a year.

1913: The Hospital for the Mind is officially opened, taking 300 of the most seriously ill patients (all male) from the overcrowded New Westminster facility. The new building is widely considered the state of the art in psychiatric hospitals of the time. It would later be renamed the Male Chronic Building — and in 1950, West Lawn.

1919: BC’s first forensic psychiatric facility opens: the Provincial Mental Home for the Criminally Insane, at Colquitz (Saanich District) on Vancouver Island, with an initial intake of nine patients transferred from PHI. By year’s end Colquitz would house 99 inmates, all male.

1920: Two permanent dormitories are added to the growing complex at Colony Farm, providing 75 beds for patients working on the farm.

1924: The Acute Psychopathic Unit (later called Centre Lawn) opens at Essondale, originally used for testing and recommending treatments for new admissions.

1927: The US Supreme Court rules in Buck v. Bell that the forced sterilization of ‘defectives,’ including the mentally ill, is constitutional.

1930: The 675-bed Female Chronic Unit (later called East Lawn) opens, allowing most of the female residents of PHI to transfer to Essondale. BC’s first training school for psychiatric nurses is established in the new building. The hospital’s first occupational therapist is hired, followed a year later by the first social worker.

1932: The first graduates from BC’s school of psychiatric nursing receive their diplomas.

1934: The Veterans’ Unit (the first section of what would later become Crease Clinic) opens at Essondale.

1936: The former Boys’ Industrial School (built in 1920) is converted to the Essondale Home for the Aged, later known as Valleyview.

1940: BC’s Mental Hospital Act is amended, deleting all references to “lunatic” and “insane”; this year also sees the first male graduates from the nursing school.

1942: Electro-convulsive therapy (ECT) is introduced, followed soon after by sulfa drugs, then psychosurgery; all of BC’s mental health facilities are reported to be seriously overcrowded.

1946: The first female physician is hired at Essondale; however, the hospital will remain gender-segregated until the early 1960s.

1949: Crease Clinic of Psychological Medicine opens, after the second half of the building is constructed (a mirror image of the first half, built in 1934). At Colony Farm, the Veterans Unit (Riverside Building) opens, the forerunner of today’s Forensic Psychiatric Hospital.

1950: Provincial Mental Health Services are amalgamated; New Westminster’s Provincial Hospital for the Insane is renamed Woodlands School, re-purposed as a residential facility for the developmentally disabled.

1951: Essondale reaches its peak population of 4,630 patients. Pennington Hall opens, providing recreational services to patients.

1954: The Durham Rule is established by the US Court of Appeals for the District of Columbia. It states that a person accused of a crime is not responsible if the criminal act “was the product of a mental disease or a mental defect.” It was later rejected due to problems defining ‘mental disease’ and ‘product.’

1955: 230-bed Tuberculosis Unit (now called North Lawn) opens at Essondale. The introduction of improved medications, along with the opening of community mental health centres, boarding homes, and general hospital psychiatric wards, results in the start of a decline in Essondale’s patient population.

1959: Essondale’s last major patient residence, Valleyview 300, opens. The former Tranquille provincial tuberculosis sanitarium in Kamloops is converted to a residential facility for the developmentally disabled.

1963: Congress passes the Community Mental Health Centers Act. This leads to the closure of many large state psychiatric hospitals.

1964: The Colquitz forensic psychiatric hospital is closed and its patients transferred to Riverside Unit at Colony Farm. In the 1980s, Colquitz was renovated to become the Wilkinson Road Jail.

1965: The BC Mental Health Act is introduced, bringing a number of administrative changes.

1966: Lake v. Cameron, a case of the US Court of Appeals for the District of Columbia Circuit , declares that patients in psychiatric hospitals have the right to receive treatment in the setting that is least restrictive.

Essondale is renamed Riverview Hospital, although Valleyview continues to operate independently until 1986.

1972: The BC School of Psychiatric Nursing moves from Riverview to the BC Institute of Technology. The following year sees the last graduating class from the Riverview program.

1974: BC’s Forensic Psychiatry Act is enacted, creating the Forensic Psychiatric Services Commission (FPSC) to provide mental health services for persons in conflict with the law. Over the next two years Riverside Unit at Colony Farm is transformed into the Forensic Psychiatric Hospital. FPSC opens its Vancouver clinic, the first of what would later become a province-wide network of regional clinics.

1975: US Senate holds hearings about the use of neuroleptics (antipsychotic drugs such as Thorazine) in juvenile jails and homes for the developmentally disabled.

1979: NAMI is founded.

1983: With Riverview’s population continuing to fall, West Lawn is permanently closed. Farming operations at Colony Farm are discontinued.

1985: Signalling a nationwide trend to de-institutionalizing the developmentally disabled, Tranquille is closed; Woodlands will close in 1996.

1988: The Fair Housing Amendments Act prohibits housing discrimination against people with disabilities, including mental disabilities.

The BC Mental Health Society is established and takes over management of Riverview; the society’s provincially-appointed trustees are replaced by a community-based board of governors in 1992.

1990: The Americans with Disabilities Act is passed. It prohibits discrimination against people with physical or mental disabilities.

The Mental Health Initiative introduces a comprehensive plan for the development of mental health services throughout the province. It focuses on replacing Riverview with smaller, more specialized regional facilities.

1992: The Crease Clinic becomes the second large Riverview building to close; the building will later embark on a second career as a filming location.

1994: Riverview establishes Canada’s first Charter of Patient Rights. After investigating patient complaints, the BC Ombudsman releases a report titled “Listening – A Review of Riverview Hospital”. The two events signal a change in Riverview’s relationship with its patients and family members.

1997: A new state-of-the-art Forensic Psychiatric Hospital opens at 70 Colony Farm Road in Port Coquitlam, replacing the original Riverside Unit.

1998: The Ministry of Health releases a new Mental Health Plan for BC, to be implemented over seven years. The plan envisions a health care system where people with mental illness have access to necessary care as easily as to physical health care, with priority for specialized services based on medical risk or extent of disability.

2001: The BC government announces a new administrative structure for health services, comprising five geographically-based regional health authorities plus the Provincial Health Services Authority (PHSA), which is responsible for specialized, province-wide services. Riverview and the Forensic Psychiatric Services Commission are among the agencies placed under PHSA.

2002: The Riverview Redevelopment Project is announced. The ageing institutional buildings at Riverview are to be gradually phased out, replaced by new smaller tertiary care facilities located in each of the five geographic regions of BC. Riverview patients will be transferred to facilities within those health regions in a carefully planned “bed for bed” transfer process.

2004: DuPage County begins the Mental Illness Court Alternative Program (MICAP.)

2005: With patient transfers to new regional facilities continuing to reduce Riverview’s population, the 75-year-old East Lawn building is closed.

2007: As part of the Riverview Redevelopment Project, patients and support services housed at the 52-year-old NorthLawn Building are re-located to other facilities, and the building is decommissioned in March. Three months later, the building is temporarily reopened to accommodate patients from the Forensic Psychiatric Hospital at Colony Farm, briefly relocated due to the threat of Fraser River flooding.

2008: Congress passes the Mental Health Parity and Addictions Equity Act. It requires that any limits to insurance coverage for mental illness be no more restrictive than those for physical health issues.

2010: Williams v. Quinn, a case heard by U.S. District Court for the Northern District of Illinois, rules that Illinois residents with mental illnesses living in nursing homes and other ‘institutions for mental diseases’ (IMDs) have the right to live in integrated settings in the community.

2012: The agreement in Colbert v. Quinn, signed today by Judge Lefkow, for the first time will give Medicaid-eligible nursing home residents in Cook County a meaningful choice about where they wish to live, affording them the opportunity to live in their own homes and participate in the community.

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