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!


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.)







Assistant Director



Nurse 5



Nurse 4



Nurse 3



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.

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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