Tuesday, December 16, 2008

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Monday, December 15, 2008

History of Tranquille













Jordan Keats
March 31/ 2008


From the Inside Out: A Brief History of Tranquille



From 1970 to 1984, the City of Kamloops, in British Columbia, underwent an economic bust. Its boom started with the completion of the Trans Canada Highway in 1964, and was enhanced by completion of the Yellowhead Highway in 1970. These highways, alongside the firmly established C.N. and C. P. rail lines, turned Kamloops in a major transportation hub. Therefore, immigration, and secondary industries, increased and turned Kamloops into B.C.’s third largest city. The success of Kamloops stems from secure jobs in the public sector, such as the Royal Inland Hospital and School District #73. However, the economic recession, of the late 1970s and early 1980’s, stifled primary industries, such as mining and forestry.

As an economic strategy, investing in commodities can be risky, whereas investments in Health Services are reliable and secure. This investment strategy is evident in the history of the institution at Tranquille, because of its ability to adapt and survive economic fluctuations for almost a century. However, this essay will argue how Tranquille affected those in the Kamloops region, or at least capture a part of the legacy institutions have had on our province.
Tranquille, first opened its doors as a sanatorium for sufferers of tuberculosis in November of 1907, under the management of the British Columbia Anti-Tuberculosis League and the direction of Doctor Charles Fagan, the Province’s first permanent Medical Health Officer.The so-called “White Plague”, was a “wet” disease, and the most commonly perceived treatment was to avoid damp air and polluted cities. The Secretary of the Ontario Provincial Board of Health, Peter Bryce, said that “Kamloops was the best location in Canada, if not the whole of North America.” With much criticism, in regards to the placement of a sanatorium within the vicinity of Kamloops, a site was purchased thirteen miles from town. Much of this “Nimbyism”, an acronym of Not In My Back Yard, was advocated by the Anti-Sanitarium (in Kamloops) League, and their chairman, M.S. Wade, with members ranging from Kamloops mayor J.R. Michell, MP George McCormick, and Senator Hewitt Bostock, to name a few. Nonetheless, Dr. Fagan continued his campaign, despite the A.S.L’s petitions and the hostile stance take by the Kamloops Standard, to see a fully operational sanatorium open and transform into, what a Sun reporter, Elmore Philpott, called a “Whole Little City Within Itself”.

By 1950, the sanatorium’s 191 acre, lake-side site consisted of forty buildings, four of them designated as hospitals. These hospitals would come to be known as the Main building, the Greaves building, the infirmary and two large Pavilions, referred to as East and West. Amongst the remaining buildings were cottages that came to house doctors, but were also the original sanatorium’s housing, a fire hall, a kitchen (capable of feeding over a thousand people), a laundry, farm buildings and dairy barn, nurse’s buildings, and halls. However, the gardens were perhaps the most enduring feature of the site, as the Tranquillian wrote:

What was waste ground with nothing but weeds flourishing on it [sic] in front of the west pavilion is now a sunken garden and is in the opinion of some visitors from Vancouver Island, the equal of anything to be seen in the famous Butchart Gardens.

Beneath these grounds were access tunnels, used for transferring food and laundry, now infamous in ghost-stories and local folklore. The main aspect to note is the self-sufficiency of the compound. Cattle, pork, and honey, were produced to a surplus, allowing sales and trade with other local producers. Therefore, with numerous other factors, such as becoming a tourist destination and support from the provincial governmental, Tranquille survived and even benefited in the post- WWI and WWII years. Many infected returning soldiers, although significantly fewer than WWI, were institutionalized, yet by 1946 there were eighty-five veterans in residence, becoming a quarter of the housed population.

Staffing difficulties, wage cuts, and structural upkeep plagued the institution in the 1930s. In the end, it was scientific advancements, more specifically in surgery and drug therapy, that made the need for such a large-scale institution irrelevant. However, approaching its closure, in the late 1940s and early 1950s, Tranquille had become completely modernized, with large scale laundry facilities and central air-conditioning.

Before its decline, from 1952-58, Tranquille housed over six hundred patients and staff combined, but the occurrence of new cases of T.B. had declined sharply, making the institution and its extravagance, obsolete.

After the last patients had been transferred to Vancouver, at the behest of the Health Minister Dr. Eric Martin, Tranquille became, for a brief period, 1957-58, a functioning school, but once again it had become a “political football”. After much debate and political hesitation, a Social-Credit MLA, Phil Gaglardi, announced that the Tranquille facility would reopen, under the Department of Mental Health, as a relief for the overcrowded facilities of Essondale and Woodlands, the first mental health patients would arrive in July 1959.

What came to be known as Woodlands School, operated from 1896-1996, housed adults, children and the “mentally ill”, who were considered to be wards of the State.While in operation, Woodlands was a “White Elephant” for British Columbians. Looming over the city of New Westminster, the Public Hospital for the Insane housed over 1600 people, until 1950 when the Provincial government separated the disabled children from the adult “lunatics”, and the latter were moved to the Essondale institution.

The adoption of the name Woodlands School was somewhat misleading. In fact, there were only twelve teachers, out of 1200 staff for the resident population of 800 in the 1970s. Those who were amongst the population were the province’s unwanted, such as abandoned babies, epileptics, hyperactive individuals, intellectually and physically challenged persons, orphans, and wards of the state. Although they were referred to as the “unwanted” there are reports of coercion from parents saying that not one of them willingly gave their children to the institution.

Woodlands was not a school students graduated from, those who were not transferred to other institutions, like Tranquille, lived there for their remaining years, with a possibility of being moved into community care. The need for relief was due to the conditions at Woodlands, such that a visiting University of British Columbia professor, Dr. Gunnar Dybwad, said, “[c]onditions at Woodlands School for the Mentally Handicapped are so bad, the school would be closed down and fined if it were a non-governmental organization”. The topics of treatment and living conditions will be further discussed in following paragraphs.

Those transfers, from 1958 -1984, of patients to Tranquille overlapped an era of economic transcendence from Fordism, the systematic assembly line approach to business management, to Taylorism, whereby flexibility of production was introduced, and increasing specialization amongst workers. The passing of the Mental Health Act of 1964 encouraged localized mental health services and created mental health societies. This act serves a touchstone for the end of Fordist practices, which modernized much of the Tranquille Sanatorium, to more efficient Taylorist- style practices, because it exemplifies the economic centralization of big business, organized labour, and the state. Unions and mental health societies demanded higher standards in hiring practices, which meant a shortfall of skilled and educated workers in the mental health sector.

British registered nurses, with specialized training, were actively recruited by the B.C. Provincial Government’s Public Service Commission: one of these recruits was Peter Smith.

In 1974, Peter was hired as a Charge Nurse, or Nurse Three, and had his airfare from London to Kamloops paid for by the province. When asked about his emigration to British Columbia, Smith said, “I was required to work for a certain period of time in BC and also to take out Canadian citizenship as soon as I was eligible (3 years at that time). Beyond that the calling was to the West Coast region which had a strong appeal through much literature I had read”. Smith recalled that seven out of eight of those employed in the Nurse Three position were immigrants, and all others were locals. His initial reaction to Tranquille, contributes integral context for how mental health institutions were functioning globally:

Favourable, but let me provide some personal context for that. I trained at an institution north of London that had 2,300 residents, most of those living in two three-storey buildings. Horrendous! Among its saving graces was a radical Physician Superintendant who invited the BBC to do a documentary on the place with total freedom to film where- and whenever. Within a few years the place was closed down. Soon after graduating I moved to a small facility in Devon. This place had about 300 residents in several individual villas in a lovely rural setting. Tranquille was very similar in size, layout and beauty of surroundings.


The large-scale British institution, Smith referred to, resembles descriptions of the Woodlands School, yet Woodlands had half the population.


What were considered “inmates”, “students”, or “patients”, had no control of their day-to-day activities and were completely reliant on those who operated the institution.

The Fordist model of operation compounded their disabilities, and was varied in its successes. In Smith’s experience, at Tranquille:

The standards of personal care were quite good. The food was of good quality. The standard of emotional support varied a lot: way better than at the institutions in England & at Woodlands. Even so, the living conditions on most wards did provide poor standards in terms of respect for privacy and the dignity of individuals. The quality of interpersonal communications between staff and clients was wildly variable, with some staff conversing well and reinforcing clients’ efforts while others were plain rude and negative. I would say the majority were in the former group. There were generally too few activities available, especially for the more disabled folk
This reporting defines how Fordist processing, in the case of this particular institution, depersonalized both staff and patients. A term used to describe this phenomenon is “total institution”, where the binding nature of regulations defines the lives of workers and patients alike.

In 1972, unionization swept the Government Employees Association, and increased worker’s ties to the institution by way of benefits and job security. Results of this unionization vary. Complaints arose that there was a lack of accountability and disciplinary measures for staff, yet wages became secure and training resources readily available. The sense of division between workers and residents was exacerbated as in Smith’s description of rude and negative communications and treatment, but he also said:

I found the staff dedicated and caring for the most part. The Charge Nurse on my first ward was a particularly compassionate woman. The Director of nursing was very clear on his zero tolerance attitude toward abuse. The definition of abuse can, of course, be quite porous but overt physical or sexual abuse meant instant dismissal, by policy. I found, surprisingly, that nurses did not have much knowledge of the syndromes of developmental disability (DD) or of positive behavioural teaching methods and staff in general did not fully understand aggressive
behaviours as a way of communicating for non-verbal people.

The topic of abuse is far too broad, and not the focus of this essay; however, this dynamic provides insight into conditions that shaped the institutional setting. Hence, two relevant observations by Smith will provide some context for institutional abuse.

The first relates to the abuse of the institution itself, “At Tranquille I was directly aware of very little abuse, beyond the systemic abuse of housing so many people with such intense needs into dormitories within the institutional care model”. The second pertains to the collective lack of knowledge of the era, “I was part of a blinkered vision that could not see how some clients would benefit from living in homes in the community, or could not see how it could be accomplished properly without astronomical costs”. Further, the Canadian Human Rights Act of 1977 established the right for all people to live without stipulation or oppression, and defined those with physical and/or mental handicaps within its parameters. This was a signal that the “blinkered vision” was on its way to being corrected and that Tranquille would soon be irrelevant once again.

Although, from 1971- 1983, Tranquille had transferred over 400 people into community living another 400, more severely handicapped people, were transferred in, furthering the strain on services. There was a shift in specialized care, into preparation and training for community living; however, the Restraint Budget of 1983 provided economic motivations for closure. Pressure from the Social Credit Government, figure-headed by Grace McCarthy, Minister of Human Resources, demanded a reduction of the public service. McCarthy said that 1984 will be, “the most aggressive year of deinstitutionalization that probably this province has ever seen or will see, and we should be proud of the fact that we can do it in this time.” Proud, was not the way the people of Kamloops felt.

Facing another economic recession, unemployment in the region was close to twenty per cent, and the closure of the third largest employer, with the multiplying effect, affected an estimated 2000 to 2500 people. Once again, Tranquille reassumed its role as a controversial “football”. In this instance, the British Columbian Government and Service Employees’ Union found themselves fighting for their collective agreement, hostilely occupying the institution for twenty-one days, and in supporting the institutional model of care. As for the staff, Smith recalls, “some relocated to Glendale on Vancouver Island, many took positions in group homes and continued caring for the people in the new system, some changed careers altogether. Several Tranquille staff opened and managed group homes under contract to the Ministry”. Thus, many people benefited from the privatization of mental health services, despite many concerns with the community care model.

In April 1984, Smith, and two others, opened New Horizons Support Services, an agency that assisted the Ministry in selecting of suitable homes, training ministry and group home staff in the challenges faced by this population, in positive teaching methods and development of staff skills. Peter Smith still resides in Kamloops, and represents an era of humanitarian and economic transformation.

In conclusion, the Tranquille institution provided nearly a century of uninterrupted employment, from 1907 to 1983. If anything, this institution’s political and economic legacy deserves of further research. My experience, attempting to access information from the BC Archives, and from the NDP Health Critic, Adrian Dix, encountered one major roadblock: time. After painstakingly searching for relevant files at the BC Archives and requesting access, I found out that every file of interest was either deemed “Undetermined” or “Restricted”. Shortly thereafter, I was made aware of the process for retrieval of documents, a twelve page document requiring an up to date resume, three personal references, a finalized list of requested items, and an outline of the research papers’ intentions. After submitting the request, I received an email from an Analyst, Charlene Gregg, on behalf of Mac Calhum, saying that Mr. Calham was on vacation for the next ten days, and my request would be processed some time after his return. Also, Gregg brought to my attention that each requested item must go through a Youth Court Judge, due to the sensitive nature of the material and stipulation of the Youth Criminal Justice Act, a process that can take over six weeks to complete. Then, seventeen days later, Mr. Callum emailed, asking if I still wanted to go through with my application, although he was saying now that it would take over three months to be processed through the system. Panic stricken, and relatively frustrated, I emailed the offices of the NDP Health Critic, Adrian Dix, believing that he would have relevant information that had already been processed. Two further emails, and an unreturned phone-call later, I came to the realization that both a provincial and a federal budget had been released within that same week. Before that realization, I believed that he had refused to comment because of the NDP’s connection to the BCGEU, and their precarious role in the closure of Tranquille. After all these attempts, I was beginning to believe Mr. Calhum when he said that if I had chose highways as a research topic there would have been no problem. However, I could not abandon this topic, as someone whose family came to Kamloops directly because of Tranquille’s closure; I was insulted by the bureaucracy that prevented me from finding my family’s history. For future historians, I will provide a list of the restricted items requested, (GR-0118, GR-0133, GR-0379, and GR-0960), to encourage further research and promote the exploration of this topic. My compassion extends to those, residents, families, and advocates, who are trying to understand and learn from the “Awkward Legacy” Tranquille left behind.




Bibliography
British Columbia, Mental Health Services Branch, Department of Health Services and
Hospital Insurance, Annual Report for the Twelve Months Ended March 31, 1964,
Victoria: The Branch, 1964.
Calhum, Mac, E-mail message to Jordan Keats. 03/ 06/ 2008.
Charlene Gregg, E-mail message to Jordan Keats. 2 /21/ 2008.
Gregory, Roxanne. Woodlands justice in doubt. The Straight.com. 23 March 2006
http://www.straight.com/article/woodlands-justice-in-doubt
Hayter, Roger and Trevor Barnes, The Restructuring of British Colombia’s Coastal
Forest Sector: Flexibility Perspectives, February 1995. p.10. Reprinted for
Clarence Bolt, History 214, all sections, Supplementary Readings, Camosun College 2008.
History of Kamloops, News Room Profile, City of Kamloops.
http://www.kamloops.ca/news/cityhistory.shtml
Inland Sentinel, 28 February 1896.
Kamloops Sentinel, 24 September 1958; 30 July 1958.
Lord, John and Cheryl Hearn. Return to the Community: The Process of Closing
an Institution. Kitchener Ontario: Centre for Research& Education in Human
Services. 1987.
McCallum, Dulcie. The need to know: administrative review of the Woodlands
School. Victoria, B.C.: Ministry of Children and Family Development, 2001.
http://www.mcf.gov.bc.ca/media_site/pdfs?Woodlands_review.pdf
News Room Profile, Demographics of Kamloops, City of Kamloops.
http://www.kamloops.ca/news/demographics.shtml
Norton, Wayne. A Whole Little City by Itself. Kamloops: Plateau Press, 1999.
Roeher Institute. Disability, Community and Society: Exploring the Links. North
York, Ont.: The Roeher Institute.1996. Reprinted 1977 with changes and
corrections.
Philpott, Elmore. Vancouver Sun, 14 June 1958.
Roeher Institute, Disability, Community, and Society: Exploring the Links, North York,
Ont: The Roeher Institute, 1996. Reprinted 1977 with changes and corrections.
Smith, Peter John. E-mail message to Jordan Keats, 3/ 17/ 2008.
http://jordan-keats.blogspot.com/
The Tranquillian, August 1931
The Vancouver Sun, 27 July 2007.
1984 Legislative Session: 2nd Session, 33rd Parliament. HANSARD.
http://www.leg.bc.ca/hansard/33rd2nd/33p_02s_840308p.htm#03717

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Monday, March 31, 2008

Peter Smith Interview: Tranquille Essay

The Full interview with Peter Smith

Hi Peter,

First off, thanks for providing your experience to my project. For your info, the thesis is the human element of institutions such as Tranquille, and to a lesser extent Woodlands. Yet, I want more than the aspect of abuse to be focused upon, because of the lack of availability to primary sources. Perhaps Jim told you about my dealings with the BC archives, and their lack of cooperation with me, but the restricted information factor has been a major obstacle for me. So, the paper will in no doubt bring the government’s, and the opposition’s, integrity into question; but to be fair to the NDP Health Critic, and his non-compliance, will be scrutinized as well. In Adrian Dix’s defense, I must have picked the worst time to email him, between a Provincial and Federal budget. As for your participation, if you could speak on your relationship with Tranquille, and how it affected your life, perhaps that could reflect how mental health institutions impacted the community at large.

Attached are some general questions, if you can think of other pertinent aspects, by all means, feel free to add them. Once again: Thank you for your contribution!

J.

On to the formalities:

May I ask your name, date of birth, and professional title?

Peter John Smith. February 6 1947. Now or then? I was a Charge Nurse (Nurse 3) at Tranquille; am currently a part-time Nurse Consultant.

What brought you, from England, to BC; or more specifically, to the Thompson region?

Specifically to work at Tranquille. B.C. Provincial Government’s Public Service Commission were recruiting registered psychiatric nurses in Britain. The Province paid our air fare to Kamloops. I was required to work for a certain period of time in BC and also to take out Canadian citizenship as soon as I was eligible (3 years at that time). Beyond that the calling was to the West Coast region which had a strong appeal through much literature I had read. I emigrated in November 1974.

How many other health professionals came to Kamloops, approximately?

I don’t know the number for that particular recruitment drive (the aim seemed mostly to hire nurses for the large institutions, Woodlands and Essondale). In case it’s useful I can give you an idea of how many immigrant nurses and Canadian born nurses there were from the position of Director to Nurse 3 level. (This is based on memory, full accuracy not guaranteed.)

Position

Canadian

Immigrant

Director

0

1

Assistant Director

1

0

Nurse 5

2

1

Nurse 4

1

3

Nurse 3

8

7

One immigrant was from Singapore, but trained in Britain, and the remainder were British.

To what extent were others trained? /Was there much hiring of unskilled, or unqualified, persons?

Nursing Assistants, during my time at Tranquille, became required to take a Human Service Workers Course at the local College. Tranquille, as a major employer in town, was able to help initiate the course. If your question is about immigrants, I’m not aware of recruitment of non-professionals. I assume non-professional immigrants could apply for positions and gain employment if no citizens applied.

What was your initial reaction to the Tranquille facility?

Favourable, but let me provide some personal context for that. I trained at an institution north of London that had 2,300 residents, most of those living in two three-storey buildings. Horrendous! Among its saving graces was a radical Physician Superintendant who invited the BBC to do a documentary on the place with total freedom to film where- and whenever. Within a few years the place was closed down. Soon after graduating I moved to a small facility in Devon. This place had about 300 residents in several individual villas in a lovely rural setting. Tranquille was very similar in size, layout and beauty of surroundings.

I found the staff dedicated and caring for the most part. The Charge Nurse on my first ward was a particularly compassionate woman. The Director of nursing was very clear on his zero tolerance attitude toward abuse. The definition of abuse can, of course, be quite porous but overt physical or sexual abuse meant instant dismissal, by policy.

I found, surprisingly, that nurses did not have much knowledge of the syndromes of developmental disability (DD) or of positive behavioural teaching methods and staff in general did not fully understand aggressive behaviours as a way of communicating for non-verbal people.

Would you say that it resembled the British system?

In management structure, very much so. Within nursing, though, there were two strong differences. Firstly the nurse training – in Britain nursing DD was a 3 year training course that was separate from nursing the mentally ill. A nurse who was laready registered as a General or Mental Health Nurse could take an extra year to qualify in nursing the DD, while in BC the DD specialism was a short component of psychiatric nurse training. Secondly, in Britain membership in the Nursing Union was optional whereas in BC it was, and still is, mandatory.

Overall, how was your tenure there?

Good, insofar as I think I was able to contribute some additional knowledge that helped in understanding clients’ challenges better and offered some positive teaching methods. I would say, poor insofar as I was part of a blinkered vision that could not see how some clients would benefit from living in homes in the community, or could not see how it could be accomplished properly without astronomical costs.

What is your opinion on the documented, and the alleged, abuses at Tranquille?

I haven’t seen the documentation. Re specific issues I only had one case of physical abuse brought to me: one worker witnessed her co-worker physically abuse a young client. I spent time settling her down and it took an hour to get her to put her statement in writing. He was dismissed.

Since starting to reflect deeply on my working life in institutions (which lasted 15 years after graduating and was in 3 different institutions) I’ve noted that I spoke out against abuse and the system more freely in England (risking my job on more than one occasion) but did not do so in BC. This partly reflects the better living conditions for residents at Tranquille than in the places I’d worked at in England, but also, I suspect, my status as an immigrant may have made me less bold here. Hmmm, not sure now – I remember that since Tranquille closed I had direct involvement in recommending the closure of two of the group homes we felt were not providing adequte support or were abusive in their methods of interaction.

At Tranquille I was directly aware of very little abuse, beyond the systemic abuse of housing so many people with such intense needs into dormitories within the institutional care model. That, however, is a huge issue. A paradox of the system was that, in addition to severe restrictions on people’s movements and often knee-jerk punitive reactions by staff (especially the “loss of privileges”) there was too much freedom for residents to behave in bizarre ways that would be a barrier to acceptance by the community. This was partly due to staff shortages but also to the attitude “Oh, that’s just the way he is” and a belief that the behaviours couldn’t be changed.

An effect of the close confinement of people who had poor coping skills and often very reactive defensive styles was the significant overuse of psychotropic medications. A very poignant story is told by a resident’s mother in Transitions Spring/Summer 2007, pp 5,6 (on-line at TransSprSumm07web.pdf) of the effects of the crowded conditions and medications used as a consequence of that.

In short: Tranquille was in itself an abuse, significantly less so than Woodlands. It was an abuse sustained by society’s ignorance of what daily life was like. An active volunteer department did help make connections to the town community, but on the whole “society”, while it had sanctioned the institutional treatment of DD people was unaware of the real conditions and, with the exception of some remartkable advocates, not interested in finding out. Ultimately, society had greater difficulty back in the 1960s to 1984 in knowing what to do with this population, how to interact etc Although, on the evidence of the way the group name given to this population changes every few years (develpmentally disabled, intellectually challenged etc) society is still quite at a loss. (*further discussion & attempted analysis below)

How about the allegations of sterilization?

During my time at Tranquille (1974 – 1984 )I am aware of two young women who had tubal ligations and I believe that the decisions were made with the knowledge and consent of family & a trustee. I understand that the practice had been followed at Woodlands & it was terminated in the early 1970s.

Sterilization clearly removes a natural right and was, when used as standard practice, an abuse.

How would you evaluate the standard of care you witnessed?

The standards of personal care were quite good. The food was of good quality. The standard of emotional support varied a lot: way better than at the institutions in England & at Woodlands Even so, the living conditions on most wards did provide poor standards in terms of respect for privacy and the dignity of individuals. The quality of interpersonal communications between staff and clients was wildly variable, with some staff conversing well and reinforcing clients’ efforts while others were plain rude and negative. I would say the majority were in the former group. There were generally too few activities available, especially for the more disabled folk – however that remains an on-going problem in the community living model & is partly a function of the degree of cognitive disability.

Who was responsible for oversight, bureaucratic or local?

Within Resident Care, the nursing supervisors were responsible for overseeing policies and practices. They reported to the Director of the department who reported to the Manager of the Institution who, in turn, reported directly to the Deputy Minister of the Ministry whose-name-changed-every-few-years-to-confuse-the-already-confused.

When the Mental Health Act of 1964 was introduced, were there immediate affects at Tranquille?

Sorry, I arrived in 1974.

Where did the employees go after Woodlands, Essondale, but more specifically, Tranquille, were shut down?

Essondale is still open, I believe. Staff at Tranquille – some relocated to Glendale on Vancouver Island, many took positions in group homes and continued caring for the people in the new system, some changed careers altogether. Several Tranquille staff opened and managed group homes under contract to the Ministry. One of those oganizations is now quite large.

What role did you play in the move to community?

With a nursing colleague and a social worker/psychologist we started an agency, New Horizons Support Services in April 1984. Our initial role was assisting the Ministry in the selection of suitable homes, training ministry staff and group home staff in the challenges faced by this population, in positive teaching methods, developing staff skills and knowledge of epilepsy, psychotropic medications etc. In 1985 we opened a crisis intervention unit and stabilised actng-out individuals in that home and worked with staff on their return home. There were two beds for clients in a large family home and clients were included, as far as possible, in regular daily activities. I lived in that setting for about 4 years. From 1991 to 2007 I worked on a team, DDMH (Developmental Disability Mental Health services), assessing mental health issues of the clients and helping access appropriate psychiatric supports and interventions. An increasingly strong advocacy role has developed over the years.

How do you feel about the BC Institutional Legacy Trust Fund’s $510 one-time payment, to all previous residents?

It sounds like an insult. Some former residents who are able to articulate grievances might have been better served by individual legal action. Meanwhile I guess it does acknowledge some bureaucratic guilt & conscience at work.

Do you think community living has better served former residents?

I’ve had the opportunity to follow the lives of many former residents and don’t know of one who isn’t better off on the measures of improved privacy and reduced frustration caused by overcrowding. For those people at the more profound level of cognitive disability, the aims of community inclusion have not been met and probably cannot be. Even within the confines of a family who have chosen to keep their child at home and never used institutional care they can find themselves very isolated because of people’s inability to know how to relate to their profoundly disabled child. CBC and Globe & Mail reporter, Ian Brown, recently spoke of the “invisible veil” he and his wife have experienced raising their son, Walker, who was born with a rare genetic disorder causing severe handicaps.

http://www.theglobeandmail.com/boyinthemoon

It is a profoundly honest and moving article.

Many people who fall within the cognitive criteria for Developmental Disability have simple needs that can easily be met within the current model. Others need the total dedication of the Browns to be able to move forward. The vast majority of community people interested in providing care in their homes request someone who is “not too demanding of difficult”. In our local community, there have been exclusions by community living agencies from “day programs” of a few people who have presented with aggressive &/or disruptive behaviours. This has left an isolated caregiver with 24/7 responsibility for the person. The change in the agency reflected a change in philosophy, but insofar as it has resulted in exclusions and increased stress for some outside of that agency’s purview it has failed some people.

Individual’s needs ought to steer the ship: philosophical & political agendas are icebergs.

Any final thoughts?

The non-verbal population is vulnerable & a target for abuse wherever they live – institutions, group homes, supported apartment living, or with natural families. CLBC & Provincial Government owe it to these people to have some sort of watchdog in place: random inspections at the preventative level & an ombudsman to deal with allegations afterwards are the minimum needed.

Community inclusion works well in some places – we need to examine the characteristics of those commnities and try to replicate them.

The IQ criterion for getting access to support funding has to be reconsidered. A model my wife, Lyn Richards R. Psych, and I have tried to use looks at executive function measures (impulse control, motivation, ability to monitor oneself, organize time, activities etc, -- in short how much help a person needs in getting going, keeping going in the right direction, handling frustrations when things go wrong) and adaptive functioning as more vital measures than what a person scores on formal intelligence tests. This would be particularly pertinent in planning support needs for adults with an Autistic Spectrum Disorder, such as Asperger’s.

The support staff who work directly with the clients are the most crucial people in their lives. For clients who have a history of abuse and suffer PTSD in consequence or are very volatile with little or no ability to soothe themselves it is important that close support people have well developed personalities and characters. They will need to be able to help the client settle and will not do that well if they are themselves defensive and overreactive.

Woodlands and Tranqille are chapters in an on-going story: where sadness, anger, compassion, care, outrage, abuse, guilt, heroic enterprises, mingle in various ways. Fear of ‘difference’ seems hard-wired (in animal studies, South African farmers threw white paint over a baboon to scare it off their frtuit trees, when it ran to its group in its fear, they all ran away from it) and the physical appearance of many of these people crosses a line that makes others afraid &/or uncomfortable. Arguably their dependence on others, inability to meet deep-rooted cultural ideals (Calvinist??) of competence and cognitive excellence also contributes to the societal treatment they receive.

Re: impact on my own life. The institution is dehumanizing primarily for the residents, but can also be so in very significant ways for staff. For myself anyway, I had to consciously work on keeping cynicism at bay and buoying up optimism. Co-workers in all settings have been a constant source of hope in showing their creativity in reaching people and the clients have been remarkable teachers. Humanity stretches way further down & up than I’d have ever dreamed if I’d wandered into the Salesman’s course or become a Hotel Manager (what a misfit! – my mum tried to get me to go there).

one further question that I thought of, Jim already named chlopronazine, and phenothyzines, but can you think of any other meds that were given?

A whole range of psychotropic medications were given – the phenothiazines is a name for a group of these & chlorpromazine is one of the phenothiazines. Also used were trifluopreazine, thioridazine, haloperidol and chloral hydrate. Such medications are primarily anti-psychotics (1) and useful in reducing the positive symptoms of schizophrenia. When Tranquille was still open mental illness was rarely diagnosed in this population: one rationale was that below a certain cognitive level depression, schizophrenia, bipolar disorder etc didn’t affect a person. So, for the most part, the anti-psychotics were used primarily for their sedative effect. Benzodiazepams were another family of drugs used. These drugs are anti-anxiety (2) medications, but also have a sedative effect. Diazepam and lorazepam were two of the most most commonly used. Anti-convulsants (3) were used for residents with epileptic seizure conditions. Phenobarb and Dilantin were two older drugs in this group and Carbamazepine and Valproic Acid were more recent drugs of that type. This group of drugs was used exclusively to reduce seizure frequency, although we later learned that the last two mentioned were helpful for people with bipolar disorder.

The use of medications in mental illness can make a huge impact on the quality of a person’s life – imagine being plagued by hallucinations, delusions, deep suicidal wishes – and the same goes for people with epilepsy. So, some residents who were actively psychotic benefited from type 1 medications: some who suffered anxiety conditions such as PTSD (Post-Traumatic Stress Disorder), benefited from type 2; and those with seizure conditions, of course, benefited from type 3. {these ‘types’ are just my way of categorizing them for this answer} Sadly, the type 1 meds were often used to suppress disruptive behaviours by sedation: effects included (apart from the physiological side-effects which sometimes developed into a full-blown neurological condition, tardive dyskinesia, or Parkinson’s disorder) slowing down the ability to process speech, thus making them even more “non-compliant”, which was often the reason they were prescribed the medication, and increasing the frequency of seizures. Type 2 were addictive and often resulted in a rebound effect – about 4 hours after taking the medication the original agitated behaviors would return with increased intensity. Both effects described for 1 & 2 could result in an increase in the dosage of the medication & a spiral effect.

Also, can you recall the segregation of patients, or who was grouped together, and what the criteria was for living arrangements? From what I understand there were various levels of partitioning, but if you had any further info it would be helpful!

By gender, in the ambulatory wards, and by degree of physical need in the non-ambulatory wards. By degree of independence in terms of which building the person would live in (Sage Building housed the more profound ansd acting-out ambulatory residents; Main Building housed less disruptive and generally more independent folk). There was a cottage program which prepared residents to move to community homes & that was of mixed gender. The social work department at Tranquille moved about 200 people into the community in the late 1960s and early 1970s. The criteria for such moves, as well as for the cottage program, the resident’s competence and ability to regulate his or her behaviour.

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