At the present time there is very little informational data available relating to the adult psychiatric day treatment centers in the province of British Columbia. In recent years the trend in psychiatric care has been to treat people within their family and community setting. Within the past five years, four new day care centers have been established at various hospitals throughout the province of British Columbia. The purpose of this descriptive survey was to provide a composite picture of the currently functioning adult psychiatric day care centers. A total of five official and two unofficial day care programs were surveyed and 290 patient records were examined. The specific areas of interest in day care functioning centered around; the family and community involvement in the treatment program, the types of treatment that were used, the type of role the staff carried out, the total program evaluation and a profile of the patients who were treated by this modality. To collect the data, the researcher used; a questionnaire which was answered in a taped interview, observational visits to each center, and an examination of the patients' records. The results of the questionnaire indicated that family involvement in the total day program was generally limited, group methods of treatment were used which gave the patients a sense of community, and patients were followed-up either by the day care center or by the referral source. Referral of patients to these centers were mainly from in-patient wards, other psychiatrists and psychiatric clinics. The criteria that was used to terminate a patient's treatment was on the basis of his actual performance in the program and his level of functioning at home and in the community. This was also the prevalent method used to evaluate the effectiveness of the total treatment program. Staff in these day care centers were both permanent and rotating with their role function being both specific and generalized. An examination of the patients' records revealed that the average patient was 33 years old, generally female, single, diagnosed as being depressed, above Grade 11 in education and presently unemployed. Seventy-seven per cent of the patients had previously received psychiatric treatment and the length of stay in the treatment program was 54 days. Findings from this study indicated that a wide variety of patients were treated in day care, which, had these centers not been available, would have been admitted to an in-patient ward. Day care is not only an alternative to hospitalization, but it may be the choice method of treatment for many patients. / Applied Science, Faculty of / Nursing, School of / Graduate

The chronically mentally disabled need to be defined as a special needs group in order to receive the social and health services they require for community survival. Their needs can be identified by reviewing the relationships between chronic mental disability and schizophrenia, poor social margin, long term use of treatment facilities, and poor social and vocational functioning. Before the 1950's, services to the chronic patient were provided mainly within the asylum system. Although some innovations in psychiatric services were developed earlier, these were directed to patient groups other than the chronically mentally disabled. This tradition of attention to other patient groups has influenced the community mental health movement of the last 25 years. This movement was expected to provide for the needs of the chronically disabled in the community as the mental hospitals were reduced in population. Recognizing that community centered care of the former asylum populations is a technically feasible goal, the National Institute of Mental Health (N.I.M.H.) has proposed a model community system of services for this patient group. This model addresses their special needs, but its application requires a concerted and coordinated effort by several separate agencies. Recent changes in Canadian health care financing allows a realistic look at the American model. This paper uses Vancouver Island, British Columbia, as a planning area for services to the chronically mentally disabled. The population of the area is 441,000. The mental health services available to these patients are reviewed in order to determine the extent of this availability. Criticisms of community services in other jurisdictions were found to be relevant in the planning region. Recommendations are made based on the model service system developed by N.I.M.H. A comparison of the costs of the existing services to chronic patients and the ideal system shows that the required improvements could be made with little extra cost. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

The provision of health care and preventive services that has evolved in Canada was based on the concept of equality. Within any one province all but a few selected groups pay equal prepaid insurance premiums or tax and are given the same benefit; payment of the provider for services rendered. The concept of Distributive Justice suggests that those with special needs should receive special services but selective provision of care or services may give rise to feelings of Relative Deprivation in non-recipients. For a health service to be equitable and perceived as "fair" there must be maximal distributive justice and minimal relative deprivation. During a research project in the Kitimat-Stikine Regional District during the summer of 19 75, it was found that northern British Columbians viewed their health services as unfair. They believed they subsidized the care and services used by southern British Columbia residents. This study investigates the factors in the health service system which affect the utilization and provision of health services and compares the utilization of hospital services of the Kitimat-Stikine Regional District with three other regional districts; Cowichan Valley, North Okanagan and East Kootenay and with British Columbia as a whole province. The comparative regional districts were chosen on the basis of demography, lifestyle, industrial, ethnic and geographic similarities and differences. Statistical tools used were Frequency Distribution, Simple and Multiple Regression. Determinants of access to care are discussed; the perception of illness, convenience costs, financial costs, availability of manpower, programmes and facilities, social and geographic isolation. An examination is made of the distribution of power in the health system and the use that is made of it by political decision makers, government administrators and planners, professional organizations, educators and pressure groups. The health services in the Kitimat-Stikine Regional District are described with emphasis given to missing programmes. The regional district has a high facilities-population ratio and a low manpower-population ratio. The expectations of the residents of northern British Columbia for provision of health care are presented, noting a concentration of expectation on access to acute health care. The planner's expectations, arising from elements in the health system are delineated. Manpower, facility and hospital utilization data were obtained for the four regional districts and the province. The hospital utilization data, separations by disease of residents from hospitals within and without their domiciliary regional district are subjected to statistical testing to determine whether access to care is reduced in the remote regional districts. The data are adjusted for the age and sex composition of the populations of each region-.and the province. There is no indication from the examination of hospital utilization data that the barriers to access to care that exist are effective in reducing the access gained. In each of the four regional districts, the numbers of separations are higher than expected based on the age and sex composition of the populations. A breakdown of the data on the 186 diseases into disease grouping indicates that hospital utilization is significantly high in some regions for particular groups of diseases. The results indicate a need to examine lifestyle and environmental factors in the four regional districts that may be influencing hospital use for these diseases. There are implications for policy formulation and for health planning activities. There is a need for regional districts to broaden their area of concern to include health services other than hospitals, to control environmental health hazards of industries, agencies and homes within their boundaries and to educate the residents about their personal responsibility for their health status, the special needs of some groups of people, the services required to meet those needs and why some services cannot be offered locally but require referral outside the regional district. The health system which has developed, based on the concept of equality does not provide northerners with a perception of equity or fairness. There is a need to obtain innovative services to meet special needs and to ensure the people excluded from the extra benefit are aware of the special needs of those for whom it is provided. Services which provide a high degree of distributive justice and minimize relative deprivation would result in an equitable and unequal service that could be perceived as fair by all. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

This study is, in part, a product of the efforts of the Kitimat-Stikine Regional District Health Care Research Project (1975). During the course of this project interviews with representatives of local health care organizations were held in order to inventory the kinds and numbers of health care services in the Kitimat-Stikine Regional District. In assessing the roles of health care organizations in Kitimat and Terrace, British Columbia it became apparent that a number of community mental health organizations in these two centres were experiencing varying degrees of success and/or frustrations in attempting to meet their organizational goals. In attempting to analyse these experiences it became evident that they were frequently described in terms of the activities and decisions of other organizations. It was also considered that individual organizations had unique characteristics of an internal nature which were also seen to affect the relative success they had in meeting their goals. The question then arose as to the possibility of analysing community mental health services in Kitimat and Terrace in terms of the interrelationships of the organizations which were providing these services. This was seen to be a reasonable approach to the problem of analysis in that the specific intent of the research project from which this study emanated was to provide an inventory of local health care services. In considering the methodology for the analysis of these inter-organizational relationships a review of the literature showed that there had been three basic approaches to organizational research used to analyse organizational behaviour. These approaches were, in order of their development, analysis of an organization as a single unit in terms of its internal characteristics; analysis of an organization in terms of its relationships with other organizations and, analysis, as a unit, of a group of organizations which have recurrent interactions with one another. It was determined that each of these forms of analysis could be utilized in the context of the community mental health organizations located in Kitimat and Terrace. This approach has important implications from a planning point of view in that it affords analyses of benefit to planners and administrators of individual organizations within the context of their own organization's internal framework and within the context of the overall activities of other organizations with which they interact. Further more, it provides an advantageous perspective to authorities in central planning organizations as they attempt to coordinate activities of organizations under their jurisdiction. Five specific variables were selected to facilitate the analysis of inter-organizational relationships at each of the three levels. These variables were: resources; power, organizational autonomy; domain consensus; and inter-organizational coordination. The analyses showed that each of the three levels offer unique opportunities to view the interrelationships between and/or among organizations. It was also illustrated that the third level of analysis was an abstract concept that required further development before it could be clearly differentiated from the other levels. The five variables selected to analyse the interrelationships at each level exhibited varying degrees of relevance to the analysis. The main observation was that, although there was some overlap in their application to specific issues which were discussed, the five variables were able to satisfactorily address any factors which were seen to affect inter-organizational relationships at each of the three levels. Overall, the three level approach to analysis of organizational exchange relationships was suggested to be an appropriate method for central planning agencies to better coordinate the activities of organizations under their jurisdiction. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Unknown

The voices and experiences of immigrant and refugee women in Canada have been conspicuously absent from policy issues, programme planning, and mental health literature. However, more immigrant and refugee women than men, from traditional cultures, are considered to have mental health needs, because of risk factors such as stress at the time of migration, and because of Canadian policies and programmes which disadvantage them. This study explores from the consumers perspective the reasons for disparate mental health service utilization between South Asian and Latin American women in Vancouver. Using a cross-sectional, exploratory, case study approach, and a feminist perspective, ten South Asian and ten Latin American women who have used mental health services were interviewed in depth. Sixty percent of the participants were survivors of violence and torture. Five Latin American women were survivors of pre-migration catastrophic stress. Their mental health needs were characterised by traumatic experiences, grieving and depression. Except for the three who were married, they had no traditional support networks. In contrast with the South Asian group they appeared to have less shame and covert behaviour. Mental illness, considered a ‘house secret’, carries great stigma in the South Asian community, and has serious ramifications for the immediate as well as the extended family. Among South Asian participants seven had been subjected to wife battering, and four of their spouses had a substance abuse problem. Their mental health needs were also triggered by traumatic experiences, grieving and depression. The more established South Asian women had extended family living in Vancouver, yet social support was still lacking. Having ‘no one to turn to’ was a pervasive theme across both groups of women; their experiences characterised by loss. Analysis of data exploring the decision to use services illustrates stages in a process of recovery from experienced violence. Post migration domestic violence and pre-migration violence have devastating, life-shattering consequences which require culturally sensitive interventions by social workers and other health care professionals. An obligatory stage in the clinical intervention process is to explore the issue of violence. Finally, policy decisions which impact upon women from ethnocultural communities in Canada must embrace a philosophy which considers well-trained, culturally-sensitive, linguistically—competent workers a priority.

A contemporary view of health and health care has arisen, out of the broadened social understandings of the later half of this century, which recognizes the individual as a whole person (rather than a clinical object), and which recognizes the local community as the preferable locus of care. The community health center model has emerged as a response to this contemporary view. It is a community-specific model of health care delivery, health promotion, and community action. Its services cover a full range of primary health care needs (from social work to urgent care), utilizing a multi-disciplinary team approach. While the response of facility planning and programming to the contemporary view of health and health care has been explored to great depth over the past twenty five years, the response of architecture has not. The intent of this thesis was, therefore, to create an architectural design that may serve as a model of the multiservice community health center, and as a source of architectural ideas which respond to the contemporary view of health and health care. A rural site was selected as the most appropriate setting for a new purpose-built facility. The design solution specifically sought to countermand the alienation, stress, loss of sense of personal control, unfamiliarity, sterility, and institutional qualities of the common medical environment - particularly, from the experiential viewpoint of the client. The design also sought to stand on its own as a legitimate work of architecture. Towards these ends, the building was bound to the community via prominence, accessibility and familiarity in the activities of daily life. A concept of democratic space sought to extend the public realm and a sense of public ownership into the facility. A marketplace vocabulary and communitycontrolled space contributed towards this end. The building was bound to place via architectural expression and explorations of processional qualities; responding to the nature of its island place, to the forest environment, and to local vernacular architecture. The design sought to establish a relationship with nature, or natural order, via an interstitial relationship with the forest, the use of natural materials, a truthful structural expression, a presence of natural light, and, at the conceptual level, an interplay between order and aggregation. As a representation of health care architecture, the design sought to express the notion of a community of services, rather than that of an untouchable institution. It also sought to achieve all of this in accord with efficient functioning and way-finding, and to achieve it at costs comparable to existing facilities (if not less expensive), via strategic choices regarding systems and construction.

The voices and experiences of immigrant and refugee women in Canada have been conspicuously absent from policy issues, programme planning, and mental health literature. However, more immigrant and refugee women than men, from traditional cultures, are considered to have mental health needs, because of risk factors such as stress at the time of migration, and because of Canadian policies and programmes which disadvantage them. This study explores from the consumers perspective the reasons for disparate mental health service utilization between South Asian and Latin American women in Vancouver. Using a cross-sectional, exploratory, case study approach, and a feminist perspective, ten South Asian and ten Latin American women who have used mental health services were interviewed in depth. Sixty percent of the participants were survivors of violence and torture. Five Latin American women were survivors of pre-migration catastrophic stress. Their mental health needs were characterised by traumatic experiences, grieving and depression. Except for the three who were married, they had no traditional support networks. In contrast with the South Asian group they appeared to have less shame and covert behaviour. Mental illness, considered a ‘house secret’, carries great stigma in the South Asian community, and has serious ramifications for the immediate as well as the extended family. Among South Asian participants seven had been subjected to wife battering, and four of their spouses had a substance abuse problem. Their mental health needs were also triggered by traumatic experiences, grieving and depression. The more established South Asian women had extended family living in Vancouver, yet social support was still lacking. Having ‘no one to turn to’ was a pervasive theme across both groups of women; their experiences characterised by loss. Analysis of data exploring the decision to use services illustrates stages in a process of recovery from experienced violence. Post migration domestic violence and pre-migration violence have devastating, life-shattering consequences which require culturally sensitive interventions by social workers and other health care professionals. An obligatory stage in the clinical intervention process is to explore the issue of violence. Finally, policy decisions which impact upon women from ethnocultural communities in Canada must embrace a philosophy which considers well-trained, culturally-sensitive, linguistically—competent workers a priority. / Arts, Faculty of / Social Work, School of / Graduate

A contemporary view of health and health care has arisen, out of the broadened social understandings of the later half of this century, which recognizes the individual as a whole person (rather than a clinical object), and which recognizes the local community as the preferable locus of care. The community health center model has emerged as a response to this contemporary view. It is a community-specific model of health care delivery, health promotion, and community action. Its services cover a full range of primary health care needs (from social work to urgent care), utilizing a multi-disciplinary team approach. While the response of facility planning and programming to the contemporary view of health and health care has been explored to great depth over the past twenty five years, the response of architecture has not. The intent of this thesis was, therefore, to create an architectural design that may serve as a model of the multiservice community health center, and as a source of architectural ideas which respond to the contemporary view of health and health care. A rural site was selected as the most appropriate setting for a new purpose-built facility. The design solution specifically sought to countermand the alienation, stress, loss of sense of personal control, unfamiliarity, sterility, and institutional qualities of the common medical environment - particularly, from the experiential viewpoint of the client. The design also sought to stand on its own as a legitimate work of architecture. Towards these ends, the building was bound to the community via prominence, accessibility and familiarity in the activities of daily life. A concept of democratic space sought to extend the public realm and a sense of public ownership into the facility. A marketplace vocabulary and communitycontrolled space contributed towards this end. The building was bound to place via architectural expression and explorations of processional qualities; responding to the nature of its island place, to the forest environment, and to local vernacular architecture. The design sought to establish a relationship with nature, or natural order, via an interstitial relationship with the forest, the use of natural materials, a truthful structural expression, a presence of natural light, and, at the conceptual level, an interplay between order and aggregation. As a representation of health care architecture, the design sought to express the notion of a community of services, rather than that of an untouchable institution. It also sought to achieve all of this in accord with efficient functioning and way-finding, and to achieve it at costs comparable to existing facilities (if not less expensive), via strategic choices regarding systems and construction. / Applied Science, Faculty of / Architecture and Landscape Architecture (SALA), School of / Graduate

The study was undertaken when St. Bartholomew's Hospital, in Lytton, B.C., a 27 bed facility, was experiencing under-utilization and the threat of closure. This study examines the health and social services of the area, and suggests alternatives for the hospital. Three methods of investigation were used, involving survey methods, documentary analysis, and oral histories. Two survey instruments were prepared by the researcher and applied to a stratified sample of key informants from the community. The respondents in these surveys were divided into either provider or consumer categories, and stratified within each of these as to the degree of contact with the local hospital. Twenty-five such interviews were held with each major category for a total of fifty completed interviews. A comparative questionnaire was also given to patients of St. Bartholomew's Hospital, asking for specific comparison between that hospital and any other with which the patient may have had personal contact. Documentary analysis involved examination of data from three major sources. The hospital maintained records were examined to present utilization rates according to age, sex, diagnosis, residence location and ethnic origin of patients for specified years. Information from British Columbia Hospital Plan was relied on to provide similar information for the school district of South Cariboo, and for the Thompson-Nicola Regional District, for comparison with local rates. The Medical Services Commission of British Columbia was approached to supply information on the volume of physician visits in the local community for selected years. Oral histories were prepared from various persons in the local health field, and from many other individuals in the community. The purpose of these oral histories was to substantiate the factual material, and to generate new and different information not available from the data. The results of this study indicate that Lytton is probably not going to change much in the next decade, but that patterns of health care delivery, and modes of demand for health services are experiencing a significant change at the present time. The result is that the local hospital has become less favoured, and therefore less used by the local people in satisfying their health service wants. Five alternatives for this hospital were examined in some detail. Alternative A involved no change in the present system. From medical, economic and political viewpoints this alternative is not acceptable. Alternative B suggests a reduction in the present inpatient capacity of the hospital, a restructuring of the governing body, the attraction of a second primary health care worker to the area, and the placement of the present doctor and the additional primary care person within the hospital setting. The additional primary care worker could be either a nurse-practitioner, or a physician on salary to the hospital. This alternative has many strengths, but attempts to facilitate change in the hospital in isolation with little regard to the other health and social agencies in the area. Alternative C has all of the attributes of B but goes one step beyond to house the primary health care workers in a Community Clinic built adjacent to the hospital, and include most of the other health and social services available to this community. This alternative requires substantial initial capital, but represents the optimum for the people of Lytton. Alternative D suggests the closing of the inpatient services, and the creation of a comprehensive Diagnostic and Treatment Centre housing most of the health and social services. Alternative E would be for the hospital to close its doors, offer no services, and make no effort to meet the community's health care requirements. Similar to A, this alternative is deemed unacceptable. The last alternative suggests that the University of British Columbia Faculty of Medicine might take over the hospital as a teaching hospital providing rural exposure to a rotation of resident physicians as part of their formal education. The final report was presented to the Board of Directors of St. Bartholomew's Hospital for their consideration. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate