There has been a recent and widespread interest in developing new methods of assisting the mental hospital patient in becoming a self-supporting member of society. A new concept, that of "the therapeutic community", has provided insight as to the significance of both physical surroundings and the staff interaction upon the patient's potential for return to the community. Many mental hospital patients become sufficiently free of symptoms to be able to leave hospital, but require further assistance before being able to do so. It is in this context that various kinds of transitional facilities are now being established. The present study examines one such facility, the "halfway house", and attempts by a comparative survey an "operational definition" of its distinguishing features. The several areas requiring descriptive data were assembled in a questionnaire, which was then sent to all centres which could be located from available references on the subject. Responses were received from twelve examples in the United States, to which are added two from British Columbia. A brief reference only is included for "hostels" which are of comparable character in Britain. The introductory chapter reviews the perspective of these institutions. This points up rehabilitation as a process that involves many elements, such as the removal of disabilities incurred as a result of being a mental hospital patient, the necessity of providing for gradual reintegration of the patient into the community, the development of new resources to help accomplish this goal, and the changing attitude developed by service personnel in both the large institution and the transitional facility, so that the patient will be able to receive the encouragement and assistance required. The core material, compiled from the questionnaire, is analyzed under the headings of (a) the new features of this social agency, (b) sponsorship and finance, (c) physical facilities, (d) the nature of staff and facilities, (e) eligibility (Chapter II). Dynamically, the "halfway house" is assessed as a therapeutic community, covering (a) staff functions, (b) the residents' progression, (d) special services, (e) discharge criteria (Chapter III). The conclusions are that the "halfway house" is a new type of social agency that has developed within the last decade. Although it has some similarities with boarding homes, it also retains some of the characteristics of mental hospitals with which it is usually linked. All but one of the examples stress the movement of individuals or clients into the community, and in order to accomplish this, a team of personnel has developed: the houseparent, social worker, and psychiatrist. The makeup of the team is analogous to the mental hospital treatment team of nurse, social worker, psychiatrist. Two elements remain unclear: (a) the policy with regard to eligibility or selection and discharge, and (b) the function of the houseparent. With regard to the former, such matters as high cost of service to the client or policy limiting who is accepted may limit the service. In some cases it is not clear why persons are admitted, except on the basis of unclearly stated need. Some facilities have a clearer view of purpose; i.e., to remove dependency upon the mental hospital or to teach the former patient the social skills required for living in the community. But many houseparents, lacking professional education, are nevertheless responsible for the physical order of the facility and for setting a therapeutic tone. Some suggested areas for further study are better definitions of the hospital disabilities removed by a stay at the agency, and closer examination of how social interaction amongst clients and staff, as well as the use of community resources, brings this about. / Arts, Faculty of / Social Work, School of / Graduate

Today much emphasis is placed on the rehabilitation of the mentally ill. This study undertakes a survey of the values of foster home care as a therapeutic resource in the rehabilitation of such patients. The programs presently in operation in Maryland, U.S.A. and Ontario have been examined to determine their effectiveness in meeting needs evinced by recidivist patients at the Provincial Mental Hospital, Essondale, B.C. A sample group of twenty-one patients was obtained by taking all recidivist patients returning to the hospital from probation between July 1, 1959 and December 31, 1959, who had been active with the social service department during the previous admission. Patients who met these criteria were assessed primarily through the use of rating scales based on information contained in the files. An examination of the needs and resources of these patients indicated that the average patient was unmarried, returning for his fourth admission, without family resources, and limited in social, vocational and educational skills. Previous to this readmission one out of every two had become the client of public welfare agencies, drawing social assistance. The study suggests that patients' needs may be adequately met through a foster care program which provides emotional support, thus helping to stabilize and aid the patient in his adjustment to the community. The use of this system is also indicated for the care of chronic patients whose symptoms of illness are controlled, yet who are unable to accept full responsibility for their own care. The program could also be adapted to provide care for the geriatric patients who today swell the population of mental hospitals. Considering the program under three headings: general policy, required facilities and type of patients, methods of implementing foster home care in the community are indicated. Research would be of value in developing methods of selecting patients who would derive optimum benefit from the program, and in assessing the progress made in the new setting. Foster home care, which has as its goal the placing, of patient's in family settings in the community, is in line with the current emphasis on decentralization of large mental institutions, and, as such, provides a suitable therapeutic resource in the rehabilitation of the mentally ill. / Arts, Faculty of / Social Work, School of / Graduate

The Sustaining Clinic is a recently-added service provided by the Mental Health Centre in British Columbia for a selected group of patients who are unable, for a variety of reasons, to benefit from more intensive therapy than a monthly interview. This study reviews the contribution of the therapeutic team at the Sustaining Clinic (of which the social worker is a part), toward the rehabilitation of a difficult group of mentally-ill patients, most of whom require long-term follow-up care. To emphasize the focus on the appropriate type of patients, the method is to review (1) the problems of a sample group of these patients, and (2) the treatment services given to them; thus, establishing how far this meets their needs. Treatment is evaluated with the aid of three rating scales assessing the patient's functioning at the time of referral and at the time of discharge. The evidence is that (1) The enormous disability associated with these patients is to a large extent imposed, preventable, and treatable. Disability originates particularly from parental rejection, and is later magnified by the rejection mechanisms stemming from cultural attitudes. (2) The treatment provided by the Sustaining Clinic is effective because it is related to the needs of the patient and to the specific conditions surrounding his illness. Therapeutic contributions include regulation of medication, support in cases of stress, limit-setting, information-giving, manipulation of the environment, and providing a figure for identification. (3) More resources than the Clinic can provide will be needed, because of the deep-seated personal and social handicaps of these patients. This study itself can be helpful only if coordinated with others which examine other "halfway house" programs, and the social worker's participation in them. / Arts, Faculty of / Social Work, School of / Graduate

The goal of treatment is the restoration of the mental patient to the community. This study has sought to show that family care is a useful device for rehabilitation, both for the person for whom return to independent living is expected, and as a means of providing a more satisfactory way of life than the hospital environment for the person who will continue to need supervision. The method used was to survey the development of family care in Europe, Canada and the United States, and to compare various characteristics of U. S. programs in New Jersey, Wisconsin, Michigan, California, Idaho, Maryland, Kentucky and Minnesota. A report of the Veterans Administration, Washington, D. C. was examined, and a study was also made of special features of foster care programs in the Veterans Administration Hospital at Bedford, Massachusetts, and St. Cloud, Minnesota. A general assessment was made of existing arrangements for boarding home care of mental patients in British Columbia, with special reference to community resources available, in order to determine the relative merits of boarding home placement versus family care. In this connection the files of all patients placed in boarding home care by one full-time social worker at the Provincial Mental Hospital, Essondale, B. C., between July 1, 1959 and August 31, 1960 (comprising 20 patients in all) were closely examined to establish the main characteristics of the group and their community adjustment. In the concluding chapter, as a result of the various comparisons made, it was possible to draw up a check list of criteria which could serve as a guide in setting up and developing future family care programs. The check list in summary comprises the following points: (1) orientation of hospital employees and the community to the program; (2) preparation of the patient; (3) sufficient number of social workers to operate the program; (4) sponsors suited to the task of caring for patients; (5) adequate physical standards in the home; (6) provision of medical services for patients; (7) provision of clothing and money for incidental expenses and comforts allowance for patients without means; (8) encouragement of appropriate social activities; (9) homes of varying sizes to meet the needs of different patients; (10) location of the home within access of community facilities for the benefit of patients. The broad conclusion is that the provision of adequate services will ultimately depend on the assumption by the community of the responsibility for the rehabilitation of the mentally ill. / Arts, Faculty of / Social Work, School of / Graduate

As a short-term psychiatric centre, Crease Clinic was designed for the treatment of adults. In common with many other adult mental institutions in North America, however, it has increasingly been asked to assume responsibility for the care of adolescents, because of the lack of more appropriate resources for young people. Conscious of the fact that the younger patients need a type of treatment different from that of adults, the Clinic has, at various times, tried to introduce modifications within its main psychiatric programme for the benefit of this age-group. Nevertheless, adolescent patients have continued to pose problems to both the hospital and community, and there are serious questions on both sides as to what legitimate achievements can be expected from their treatment in the Clinic. Accordingly, this study surveys the problems and needs of a selected group of adolescent patients, namely, those suffering from behaviour disorders. In the light of dynamic knowledge of their personality structures, it seeks to evaluate the degree to which the Clinic is meeting the needs, and the directions in which its programme might be strengthened or modified. The group of adolescents, those thirteen to nineteen years of age who were admitted to Crease Clinic in the period 1956 - 1958, numbers forty-four in all. Information derived from the clinical records covers the problems they presented, their family backgrounds, and their living circumstances at the time of admission. The clinical treatment programme is examined in its basic aspects of: (1) "milieu" and activity programmes; (2) psychotherapy and somatic therapies; (3) participation of parents; (4) the role of social service. Data were obtained on this portion of the study from the files of the sample group of patients, from interviews with staff members, and from the writer's personal experience as a social worker in Crease Clinic. The main conclusion reached is that there is a clear need for a specific unit for the treatment of adolescents, whether it be attached to the mental hospital, or established separately within the community. The treatment currently available within the Clinic for these young patients is not adequate to meet their needs; some of the primary deficits appear to be: (1) the limit upon the period of residence in the Clinic; (2) insufficient structuring and coordination of the various therapeutic programmes, and (3) the lack of individually planned treatment related to each patient's particular needs and problems. There is evidence that Crease Clinic can offer this type of patient limited service as an emergency resource for suicidal or assaultive youngsters, as a diagnostic resource for those needing immediate assessment or a period of observation, and as a treatment unit for the minimally-disturbed adolescent whose "acting-out" seems to stem from current situational stresses. However, to effect permanent treatment gains for this group of disturbed adolescents, an appropriately-staffed In-patient resource, designed specifically to meet their needs, is essential. / Arts, Faculty of / Social Work, School of / Graduate

This study deals with that minority segment of the German immigration population which, as evidenced by hospitalization for mental illness, has failed to make a satisfactory adjustment in Canada. Heavy environmental demands of a new country, or personal and social inadequacies, or a combination of both factors, have been held responsible for such failures. This exploratory study seeks to throw light on either interpretation. It examines clinical information, and suggests ways of analyzing case histories so that environmental and personal factors contributing to mental illness, can be more closely investigated. For the purpose of intensive study, ten case records of German immigrants were carefully selected, and were compared with those of twenty Canadian-born patients chosen on the same basis of elimination. The material available was analyzed, and classified with a view to underlining the correlating or diverging factors in the functioning of both groups. The extracted findings led to an assessment scheme in the areas of economic and work capacities, social and personal factors, applicable to individual patients and to comparable groups. A rating scale was designed which could become a measuring tool for present or future functional capacities. In spite of the small numbers used and of the analytical limitations, this attempt resulted in some well-marked similarities and deviations. To supplement this method, two composite examples of patients, reflecting causative influences in the social diagnosis, are presented. The outstanding result of this study is the emergence of similarities rather than differences between the German and Canadian patient groups. This suggests that the impact of immigration stress cannot be solely responsible for mental illness in the German group. Migration to a completely unfamiliar country, it is assumed, renders certain dormant inadequacies, for example in social relations, more prominent than a pattern of mobility or instability in one's native country would do. However, in both groups there is also the indication of low-grade functioning in economic, social and personal areas, and evidence that personal, as well as precipitating situational forces, could be accountable for mental illness in both. This experimental study strongly suggests the need for further research in this field along the same lines. However, some social work implications can be, and have been drawn from the study. / Arts, Faculty of / Social Work, School of / Graduate

This study surveys the personal circumstances and situations upon discharge, of young women who have been in the Provincial Mental Hospital a number of years, and have no home to which to return* It was found that nine out of ten patients without usable family resources have problems of such a nature on discharge as to require the services of a social worker. Their problems include obtaining work or maintenance to meet their basic needs of food, clothing, and shelter. They also need personal assistance and encouragement in obtaining employment, making new friends and acquaintances, and participating in recreational activities. The method used was to compile pertinent information from the hospital files of patients aged thirty-five and under, who left on "probationary discharge to self" during a given one-year period (actually, July 1, 1957 "to June 50, 1958). Eighteen patients were found to meet this criteria, whose cases could be studied extensively. The findings suggest that the average patient without family resources has come from a home in which there has been much stress, and is limited in educational, vocational, and social skills (e.g., lack of friends and acquaintances, relationships with the opposite sex, etc.). Social workers, both at the hospital and in welfare agencies throughout British Columbia, were active in helping approximately 90 percent of these patients meet their needs. Such help included making arrangements for finances, job finding, accommodation finding, transportation, and providing emotional support. Only 56 percent of these patients were able to make an adjustment that did not result in re-admission to the hospital: which suggests that follow-up, and after-care programs should be strengthened to include more extensive use of hostels (such as the Vista in Vancouver), and of family care programs. The possibility of smaller local centres for psychiatric care is another idea that merits consideration, to avoid prolonged separation from the community in which the patient is to return. / Arts, Faculty of / Social Work, School of / Graduate

This thesis is a study of the care of the mentally ill in British Columbia from the early days of the pioneers to the present time. It is hoped that this study will be of value to those charged with the care of the unfortunate persons among us who suffer from some form of mental illness. It is also hoped that this work will help to clear up some of the misconceptions surrounding the whole topic of mental hygiene. The study begins in the early years of the nineteenth century. The so-called insane were at first sent to an asylum in California but later were placed in the gaol in Victoria. Later the Royal Hospital in that city was used to house them up until the first asylum was built in New Westminster. After the turn of the century many new ideas regarding the care of the mentally ill began to spread throughout the civilized world, and had a profound affect on the administration of the mental hospitals in British Columbia. After World War I psychiatry developed very rapidly and scientific treatment began to replace simple custodial care in the mental hospitals. The findings of a survey made by the Canadian National committee for Mental Hygiene in 1919 and the recommendations of a Royal Commission in 1927 greatly influenced the government in providing better facilities throughout the province. The first social worker came to hospital at Essondale in 1932, and later that year the Child Guidance Clinic was opened. It has done excellent work but it has been successful in helping only the children who need urgent attention. Shock therapy is used extensively at Essondale and the results have been very encouraging. Other modern forms of therapy are used including organized recreation, handicrafts, and cosmetherapy. Neither psychoanalysis nor group psychotherapy is practised at the hospital. There has been a gradual development in British Columbia from simple custodial care to modern treatment procedures. In spite of present day knowledge, however, the mentally ill in this province are not getting the full benefit of all the techniques for curing them. Overcrowding has always been, and still is, a major problem. Lack of trained personnel, of adequate methods of after-care, of satisfactory preventive services are all problems which need more attention. / Arts, Faculty of / Social Work, School of / Graduate

The pioneer study of A. B. Hollingshead and F. C. Redlich, recorded in their book, Social Class and Mental Illness, indicates that social class is related to a number of factors pertaining to mental illness. Subsequent studies prompted by this work have examined some of these factors. All of these investigations were carried out in the United States in various mental health settings. It became our purpose to examine the relevance of these factors in a Canadian mental hospital setting. Three hypotheses were postulated. First, that social class would be related to the type of treatment received in the hospital. Second, that the duration of stay in the hospital would be related to social class. And, third, that the patient's level of improvement upon discharge from the hospital would be related to social class. Routinely collected data from Riverview Provincial Mental Hospital were used to test these hypotheses. No statistically significant relationships were found between social class and of the three dependent variables. However, it was noted that the higher social class levels of psychotics, as measured by the educational index, seemed to receive more electro-convulsive therapy and group therapy than was the case with any other diagnostic category. Possibly this trend could be persued in subsequent studies. Also, duration of stay was not considered to be an important variable because of the relatively short stay of the majority of all persons admitted to the hospital. It was concluded that the definition of treatment was too narrow. Electroconvulsive therapy and group therapy were the most amenable to statistical examination. However, it is widely recognized that milieu therapy is a major form of treatment in Riverview Hospital and therefore, should be included in any consideration of treatment in subsequent studies. / Arts, Faculty of / Social Work, School of / [Other authors, Allan Lloyd Failing Mary Louise Ferguson Pamela Dawn Gaudette Roberta Miriam Jauck Gordon Edward McLeod] / Graduate

The topic of disability within counselling is one that has received relatively little attention, despite counselling’s focus on multicultural competencies. Some scholars argue that mental illness can be conceptualized as a disability, and that viewing it as such can provide important insight and empowerment to individuals dealing with these issues. In particular, exploring mental illness as psychological disability can provide a framework for understanding the impacts of both internal and external experiences of disability on the individual. This research draws on critical disability studies theory to frame psychological disability within a social-relational model, examining the potential impact of ableism and sanism on counselling clients with psychological disabilities. Three participants were interviewed using a semi-structured protocol to explore their experiences with counselling and psychological disability. Using interpretive phenomenological analysis, six main themes emerged: Embodied Difference, Meaning and Disability, Intersections of Identity, Emotional Labour, Language, and The Therapeutic Alliance. Implications for research, training, and practice include further exploration of intersectional identities such as gender and physical disability, and incorporating an understanding of the psycho-emotional dimensions of disability, including emotional labour, into counsellor education and practice.