Is Deinstitutionalization a ‘Failed Experiment’?

Abstract

"For the last 40 years British Columbia has pursued a general policy of deinstitutionalizing patients from its one large psychiatric hospital, Riverview Hospital (RVH), to a variety of alternative, community-based living and care-giving arrangements. This policy has not unfolded in a systematic, linear fashion, but rather it has been punctuated by interruptions and delays as policy makers and mental health care managers have tried to balance public fears and misperceptions that mental illnesses are linked to violence and the growth in homelessness, with the need to provide shelter and treatment to people with mental illnesses while maintaining their civil liberties. Currently, the province is in the midst of implementing a major plan to close RVH, replacing it with various other facilities and services, and establishing a full spectrum of care across the province in a newly-decentralized health care system. Ironically, this process is being challenged even as it enters its final phases. As evidence is beginning to emerge about the successes of deinstitutionalization in the province (Lesage, Groden, Ohana, Goldner, 2006) and the processes related to downsizing RVH (Morrow, Pederson, Jamer, Battersby, Josewski & Smith, 2009), the political tide has changed due to pressures related to the visibility of homelessness, addictions and poverty in downtown Vancouver, and the link between these social problems and psychiatric deinstitutionalization in the public and popular imagination. The result has been increased calls for re-institutionalization, particularly from some key community leaders. Using BC as an illustration, this paper reflects upon some of the current ethical issues arising from calls for the re institutionalization of people with chronic and persistent mental health challenges. [...]", p. 1