Policy into Practice

Module Artefacts

  • Historical documents that mapped out deinstitutionalization in Canada with contemporary audio commentaries;
  • Audio testimony, documents and researcher reflections on the difficult history of Greenacres, Ontario’s first purpose-built dementia care facility
  • Skits that explore past, present, and desired future mental health systems
  • A contemporary article documenting one woman’s journey of recovery

Module Takeaways

  • Relate policy formation and implementation to the lived experience of service users and practitioners.
  • Formulate an opinion about the history of deinstitutionalization which takes into account its impacts, both intended and unintended

Module Assessment

Have your students write a 250-word letter as a progressive policy-maker of today acknowledging 3 essential lessons that they have learnt from the artefact(s) which they examined and propose a way to insure that policy is both responsive and proactive. Address your letter to one of the following people featured in this module:

  • Jayne Whyte
  • Lucy Costa
  • Ralph Buckley
  • A resident of Greenacres
  • A staff-person at Greenacres
  • Margo Robinson
  • branwen Willow
  • Cat Omura

Module Learning Lens

As governments change and priorities shift, so too do state policies and programs. There have been major new Canadian policy initiatives over the last fifty years that have aimed to improve the lives of individuals experiencing mental health difficulties. One such policy is deinstitutionalization–the closing down of long-stay institutions that provided treatment for mental health patients. This module considers the policies of deinstitutionalization and the impact of these policies on the lives of people receiving psychiatric services. It also includes recent research on Ontario’s first purpose-built dementia facility, created during this transitional time and an illustration of trans-institutionalization, a pattern of patient redistribution that is an often-unacknowledged result of deinstitutionalization.

Speaking to the History: Deinstitutionalization Policy Formation

Takeaways: 

  • Understand the circumstances and ideas that informed deinstitutionalization policies and how they shaped day-to-day practice and the lives of service users
  • Identify the ways in which restrictions and discipline characteristic of the earlier long stay mental health hospitals have been reproduced in the bureaucratized mental health and social welfare systems of the deinstitutionalization era/ that constitute community mental health
  • Recognize the negative impacts of deinstitutionalization including economic and social exclusion, inadequate housing and homelessness, stigma and discrimination

Learning Lens: 

Dessin d'un architecte des petits chalets dans un cadre aux allures de parc

 Early Saskatchewan architectural design for cottage groups, 1950s.

The historical documents and commentaries presented in this lesson illuminate Canada’s shift from institutional to community mental health, and can be presented in lecture format by instructors or explored independently by students.  Why look to the past to educate future practitioners? As anyone working in the field or using services will tell you, the merit of community mental health continues to be a topic of fervent and contentious debate.  Yet this deeply contested history is largely unknown to historians, practitioners, and policymakers alike. Few know what values the original architects of community mental health saw as central to the new system, or which policy innovations were abandoned in the formative years of community mental health.

Artefacts in Context: 

Arguably the most significant social policy in late 20th century Canada, the deinstitutionalization project saw nearly 50,000 beds closed in aging institutions across the country between 1965 and 1980, and thousands more have been closed in the quarter century since. Rippling through all sectors of Canadian society, deinstitutionalization affected the economy, the workforce, public health, social planning, education and human rights. The impact of this shift has been profound: therapeutic and professional contours of care have been re-shaped, new networks among service users have been created, and the social landscape of Canadian communities has been transformed in ways never imagined by the original architects of community mental health.

Evaluating the Artefacts:

Speaking to History - Saskatchewan: Self-guided Learning

Timing: 
20 minutes

The following texts and sets of audio commentaries and primary historical documents allow students to investigate the ideas behind deinstitutionalization in Saskatchewan. These self-guided resources are well suited for flipped classroom use with an in-class or online discussion or learning activity.  Working in class or online, instructors and learners can select resources that suit the time available and a geographical and topical focus that is of interest.

Ask students to use the following themes to guide their exploration of these artefacts:

  • Shift from institutional to community mental health
  • Economic and social marginalization
  • Relevance and impact of cost-reduction policies
  • Underdeveloped community mental health supports
  • Paternalism, power inequalities, professional hierarchies
  • Psychiatric survivor movement
  • Community engagement and input
  • Policy developed by service users
une photo en buste de Jayne Whyte

Jayne Whyte, Saskatchewan writer, historian, activist and service user.

Jayne Whyte is a historian, a writer, an activist with the Canadian Mental Health Association, and a long-term user of mental health services in Saskatchewan. Saskatchewan began exploring the idea of community mental health under Premier Tommy Douglas in the 1950s, when Jayne Whyte was a teenager. The Saskatchewan Plan, as the first of these linked articles details, proposed to divide the province into eight administrative regions, with the intention that each would develop a comprehensive set of local mental health centers and supports. Fiscal concerns about the cost of the old mental health institutions are mentioned, but more space is given to presenting a set of core values about decreasing the stigma surrounding mental health and the psycho-social rehabilitation of mental health patients.

The second linked article was written by three Regina-based architects tasked with the work of envisioning how such reforms would take physical form.

The Saskatchewan Plan is a tale of promising mental health policy that was abandoned before it could become practice.  Abandoned when it became clear that neither the federal government nor the medical community would support a model based on care by salaried physicians working in government facilities, the prairie province instead followed an aggressive policy of deinstitutionalization and cost-reduction in mental health services.  From 1963 to 1970, under this agenda, the patient population at the province’s two large psychiatric hospitals plummeted, but much of the community supports envisioned by the creators of the original plan remained undeveloped.

Jayne Whyte reflects on the early plans and what actually took place on the ground.

1 minutes

Listen to Jayne Whyte consider the gap between the promise of early policy initiatives in community mental health in the prairie province and the harsher realities of the system that she has encountered as a mental health patient.

5 minutes

Speaking to History - Toronto: Self-guided Learning

Timing: 
40 minutes

The following texts and sets of audio commentaries and primary historical documents allow students to investigate the ideas and policies behind deinstitutionalization in Ontario, with a particular focus on Toronto. These self-guided resources are well suited for flipped classroom use with an in-class or online discussion or learning activity. Working in class or online, instructors and learners can select resources that suit the time available and a geographical and topical focus that is of interest.

Ask students to use the following themes to guide their exploration of these artefacts: 

  • Shift from institutional to community mental health
  • Economic and social marginalization
  • Relevance and impact of cost-reduction policies
  • Underdeveloped community mental health supports
  • Paternalism, power inequalities, professional hierarchies 
  • Psychiatric survivor movement
  • Community engagement and input
  • Policy developed by service user
Health and shoulders photograph of Lucy Costa

Lucy Costa. Toronto advocate, activist and former service user.

An advocate with the client Empowerment Council at Toronto’s CAMH and a graduate student at Osgoode Law School, Lucy Costa is a former service user and a long-time patient advocate and community activist. Costa’s careful reflections on the three documents that we gave her remind us that the paternalism and power inequalities inherent in the asylum have lingered in public policy, even as the walls of the institutions dissolved.

In Ontario, deinstitutionalization led to the closure of almost 80% of psychiatric hospitals beds in the 1950s and 60s. The push for change is evident in Dr. C.A. Roberts’ 1963 Report on Ontario Mental Health Services.

Lucy Costa locates similar language in recent mental health reports and sets the 1963 document alongside the emergence of pharmacology as the dominant therapeutic and mental health legislation of the period. 

 Lucy Costa situates the 1963 report within the legal and professional landscape of the period. 

3 minutes

Fifteen years later, on the eve of the closure of Western Toronto’s Lakeshore Psychiatric Hospital, bureaucrats at the Queen Street Mental Health Centre (now CAMH) created the following Fact Sheet detailing the institutional restructuring. Focusing primarily on the fiscal aspects of the closure and the fate of current patients and staff, only two paragraphs in the 4-page memo speak to the shape and scope of future community mental health services.

Picking up on a mood of energy in the document, Lucy Costa notes that fiscal imperatives are reframed as positive policy changes, and inserts the story of an emerging psychiatric survivor movement, located just off-stage in downtown Toronto.

Lucy Costa shares reflections on the closure of the Lakeshore Psychiatric Hospital, deinstitutionalization and the rise of the psychiatric survivor movement.

5 minutes

Toronto psychologist Dr. Reva Gerstein’s 1983 Mayor’s “Action” Task Force Report on Discharged Psychiatric Patients, known as The Gerstein Report, is a very different document.

In fact, because she had been a mental health practitioner for 30 years, Gerstein’s text can be read as a professional report card on the policy initiatives set out in the earlier Ontario documents. Writing of the failure of community mental health services to allow former patients a life of dignity, Gerstein acknowledges that, “neither my former colleagues nor I ever fully appreciated the need for a comprehensive range of aftercare support services.”

Listen to Lucy Costa argue that we are still walking through the same mental health landscape today.

4 minutes

 

Speaking to History - Vancouver: Self-guided Learning

Timing: 
40 minutes

The following texts and sets of audio commentaries and primary historical documents allow students to investigate the ideas behind deinstitutionalization in Vancouver, BC.  These self-guided resources are well suited for flipped classroom use with an in-class or online discussion or learning activity.  Working in class or online, instructors and learners can select resources that suit the time available and a geographical and topical focus that is of interest.

Ask students to use the following themes to guide their exploration of these artefacts: 

  • Shift from institutional to community mental health
  • Economic and social marginalization
  • Relevance and impact of cost-reduction policies
  • Underdeveloped community mental health supports
  • Paternalism, power inequalities, professional hierarchies 
  • Psychiatric survivor movement
  • Community engagement and input
  • Policy developed by service user
Head and shoulders photograph of Ralph Buckley

Ralph Buckley, retired Vancouver social worker.

Ralph Buckley is a retired Vancouver social worker who graduated from the University of British Columbia in 1970, launching his career in the new world of community mental health. Decades of experience in Vancouver’s community mental health centres and on St Paul Hospital’s psychiatric ward provide a frontline perspective on documents from the era in which these services were being established.

Formulated by the same John Cumming who had led community mental health experiments in the 1950s that had helped shape the original Saskatchewan Plan, the 1972 Vancouver Plan, proposed a range of locally-based professional services for people with serious mental health difficulties, coordinated by Greater Vancouver Mental Health Service (GVMHS) teams. The care pathway set out in Cumming’s plan was designed so that a specific staff person would work with each patient, coordinating care, offering therapy, and serving as an advocate and friend.

Emphasizing the mix of humanitarian spirit and economy that underpinned the plan, Ralph Buckley provides a historical context for Cumming’s proposal.

Ralph Buckley describes the Vancouver Plan of 1972 and subsequent initiatives in the city.

2 minutes

Psychiatrist Hugh Parfitt, the first director of Vancouver’s Kitsilano Mental Health team, shared two documents with us from this period of his professional life. The first was this brilliant orange brochure which details services offered by one of the GVMHS teams which Cummings had proposed.

By 1974 there were nine multidisciplinary GVMHS teams across Vancouver and the nearby suburb of Richmond, working in facilities close to public transit routes and offering drop-in services, free coffee, and opportunities for building basic life skills. Commenting on the brochure, Buckley sketches out scope of work done by the care team, presenting a rebuttal to those who use the term “tyranny of the acute” to critique the current focus on clients with serious mental health difficulties.

Ralph Buckley discusses the Mount Pleasant brochure and the subsequent history of community mental health in Vancouver.

3 minutes

Mental Health Team Comes to Kitsilano: What does it mean to you? [INSERT: Doc #3 MH Team Comes to Kits.pdf], the third document in this series, is another from Parfitt’s cache.

Somewhat unorthodox, the GVMHS teams of the 1970s worked with community groups like Coast Foundation and the radical MPA (Mental Patients Association), and offered after-hours emergency service and a suicide prevention program.  In Kitsilano, a 1973 effort led by the MPA to flatten professional hierarchies and facilitate community input into Vancouver’s new mental health system was thwarted by the provincial government. Citizens committees were held as the model in the new GVMHS, addressing psychiatrist John Cumming’s emphasis on bringing local communities on board in his 1972 “Vancouver Plan.” As Ralph Buckley notes, the language about mental health used in this document is different than that used by mental health professionals, offering a rare historical perspective on policy from people who were using early community mental health services [LINK: R Buckley 3].

Learning from History / Using History #1

Timing: 
30 minutes

Students often find policy difficult to understand and can struggle to comprehend how it directly impacts their day-to-day practice. The short set of historical documents and 2 audio commentaries in Speaking to History – Saskatchewan can help them work through these issues.

Shape your group discussion with prompts. First, ask your students to orally reflect on what they have learned from the historical documents and the audio commentaries. How do the historical documents make them revise their understandings of the current mental health systems or practices? Do the “speaking to history” commentaries by Jayne Whyte prompt them to come up with further revisions?

After your students have explored what they have learned about the history of deinstitutionalization from Jayne and the Saskatchewan documents, ask them to think about how they can use these points of learning in a practice setting today. Encourage your students to move from abstract ideas to specific practice examples. This can be done online using discussion board.

Timing does not include working through the artefacts.

Learning Activity Type: 

Learning from History / Using History #2

Timing: 
40 minutes

Students often find policy difficult to understand and can struggle comprehending how it directly impacts their day-to-day practice. The combination of historical documents and audio commentaries in this lesson can help them work through these questions.

Shape your group discussion with prompts. First ask your students to orally reflect on what they have learned from the historical documents and the audio commentaries. How do the historical documents make them revise their understandings of the current mental health systems or practices? Do the “speaking to history” commentaries by Jayne Whyte, Lucy Costa and Ralph Buckley prompt them to come up with further revisions? Make sure to write down their responses so that the students can refer back to this early discussion as you move onto the next part.  

After your students have explored what they have learned, ask them to think about how they can use these points of learning in a practice setting today. Encourage your students to move from abstract ideas to specific practice examples. This can be done online using discussion board.

Learning Activity Type: 

Speaking to History: Taking a Stance from History

Timing: 
40 minutes

None of the roles of our three Speaking to History respondents existed before deinstitutionalization.  Mental health patients like Jayne Whyte did not live independently and take active roles in consumer organizations.  Service users like Lucy Costa did not go on to become paid patient advocates and law students.  And social workers specializing in mental health did not find employment in the community.

Read the text and documents and listen to the audio clips for Speaking to History. Then taking on the role of Jayne Whyte, Lucy Costa or Ralph Buckley and, using their language, propose a solution to a current social or health issue that incorporates the lessons of deinstitutionalization. Learners should identify the problem, propose a solution, and explain what aspects of Whyte, Costa or Buckley’s personal/ professional stance informed their approach and the language they used.  

Have learners record their monologue on a cell phone or device and share it with the class by uploading it to the course website. Instructors can use the monologues as a starting point for a class discussion.

Learning Activity Type: 

Designing Dementia Care: A Case Study of Greenacres

Takeaways: 

  • Recognize that the inherent ageism in our society permeates policy and practice
  • Appreciate the need to create residential care facilities that afford full and dignified lives for older adults with cognitive or physical limitations 
  • Understand that in an institutional setting, the conditions of care and the conditions of work are fundamentally connected, and that good policy takes this into account
  • Recognize that the deinstitutionalization era as a complex historical period which included trans-institutionalization for client groups who didn’t fit the primary policy directive

Learning Lens: 

Photograph of elderly woman in wheel chair in institutional corridor

Greenacres resident, 1981, negotiating some of the facility’s 3.5 miles of corridors.

Jim Struthers is a noted Canadian historian of aging, dementia and social policy and a team member of the multi-disciplinary Re-Imagining Long Term Care Project, an international study of promising practices in residential care for the elderly funded by the Social Science and Humanities Research Council of Canada. Four years ago he discovered a forgotten archival file dealing with Metro Toronto’s Greenacres Home for the Aged, a set of historical documents which told a scandalous story of vulnerable old people, fiscal cost-cutting, and disturbing conditions of life and work in a home for seniors with dementia. Greenacres had opened with public fanfare in 1956, part of program of functionalist modernization that resulted in the creation of Metropolitan Toronto. Yet as Struthers makes clear, Greenacres was not a progressive institution inspired by new ideas about dementia care and the needs of an aging population, but a warehouse for people who were not wanted in other facilities. By the 1970s Greenacres was drawing media attention due to crowded conditions and poor care, then in November 1981 a political storm broke when the Canadian Union of Public Employees (CUPE) Local 79 made public a damning report detailing dreadful conditions at the public institution.

Artefacts in Context: 

Canadians have complicated thoughts and feelings about long-term residential care for our aged. Many of us – particularly if we are women and from minority communities – find work in these institutions. Or perhaps we find ourselves faced with the difficult decision of entering such a place, or experience ambivalence and as sense of failure as we struggle to find suitable accommodation for a beloved family elder. Like other Canadians, we regard media reports of violence and excessive drug use in eldercare facilities with horror.

Evaluating the Artefacts:

Designing Dementia Care: Self-Guided Learning

Timing: 
65 minutes
Grand front entrace of institution with landscaping

Greenacres Home for the Aged on show: the public face of the new institution.

The video footage, audio excerpts and historical photographs and documents in this unit take learners within the walls of Ontario first purpose-built dementia care facility in the late twentieth century.  These self-guided resources are well suited for flipped classroom use with an in-class or online discussion or learning activity.  Instructors can use the entire guided learning section or select themes and topics that are most relevant to their teaching.

Elderly woman walking through doorway with uniformed woman holding her arm

Greenacres resident and caregiver, 1981.

Ask students to use the following themes to guide their exploration of these artefacts:

  • The relationship between conditions of care and conditions of work
  • Ageism and stigmatizing attitudes about mental health as reflected in policy and practice
  • Impact of bureaucratic efficiencies and cost-reduction policies
  • Transinstitutionalization as an unintended consequence of deinstitutionalization
  • The need for long term care practice models which meet the requirements of residents

The findings of the Re-Imagining Long Term Care project, which has conducted in-depth studies of nearly two dozen institutions across Europe and North America, have repeatedly demonstrated the critical interrelationship between the conditions of care and the conditions of work at residential facilities for the aged. As lead historian on the Re-Imagining team, Jim Struthers looked for precedents for today’s system of care homes and found a cautionary tale in the history of Greenacres Home for the Aged. The Newmarket, Ontario institution was heralded as “unique” and “ideal” at the time of its 1956 opening, but when union officials visited the facility in 1981 they found that the high needs of residents and a lack of basic tools and training had entirely outstripped the capability of workers to offer good care. Residents were subjected to assembly line care and were poorly fed and inadequately clothed. Many were physically restrained for extended periods of time.

Listen to a woman who worked as a nursing attendant at Greenacres in the 1980s describe conditions of work and care at the institution.

4 minutes

Compassion for the residents is evident in her narrative, but so too are the limitations to good care created by unbending institutional routines and high patient numbers.  

Jim Struthers elaborates on what he discovered about life and work at Greenacres.

Jim Struthers was shocked to learn of conditions at the home, which seemed to undermine the fundamental rights and dignity of the frail aged with cognitive impairments, a particularly vulnerable group in Canadian society. Some of the factors he sees as central to the failure of Greenacres were: a poor choice of location, overcrowding, understaffing and bad institutional design. In the following video clip, Struthers elaborates on what he discovered about life and work at Greenacres.

Read sections of the CUPE report that caught Struthers’ attention and which echo points raised by both Struthers and the former nursing attendant.

Eager to learn more about the origins of the CUPE report and the impact it had on residential care policy and practice, Struthers interviewed Jeff Rose, president of CUPE Local 79 in 1981 and Lynn Spink, the woman who researched and wrote the publication that served as a catalyst for institutional reform. In the fall of 1981 Spink and Rose were working on comprehensive study of conditions at all seven public Metro Toronto homes for the aged. But when workers at the Newmarket facility told Spink that there weren’t enough staff assigned to care for the residents and that they lacked basic supplies such as washcloths, bedding and clothing for the residents, the two colleagues agreed that getting action on Greenaces had to be a priority. Read Spink’s article about what happened next as the union moved to make the shocking story public.

Struthers comments on the impact of the Greenacres scandal within homes for the elderly

Scandals are a kind of backwards policy catalyst, fuelling public fears and pushing politicians and bureaucrats into action. Before the Committee at City Hall had finished questioning Rose about the union’s report, Metro Chairman Paul Godfrey announced that he had just stepped out of the meeting and asked Sam Ruth, President of the Baycrest Foundation, to investigate conditions at Greenaces. Ruth’s report recommended hiring additional staff, purchasing equipment, furniture and supplies, and implementing new cleaning procedures and a system for replacing absent workers. In the following video clip, Struthers reflects on the reoccurring phenomena of nursing home scandals in Ontario and our failure to learn from history.

Jim Struthers knew that Greenacres had been built in the 1950s, when provincial funding was available to build new 100 to 200-bed public and non-profit homes for the aged. Tracing backward in time from the 1981 CUPE report to learn more about the original idea behind Greenacres’ creation, he came across a 1956 memo from city officials explaining why they created a facility three times the recommended size for  a home for the aged and 60 kilometers distant from the City of Toronto.

Map of Metro Toronto visually locating Greenacres Home for the Aged

Greenacres was part of a network of Metro Toronto eldercare facilities.

Struthers talks about Greenacres as an illustration of transinstitutionalization

Prompted by his engagement with current ideas about meeting the complex needs of the aged with cognitive impairment, Struthers thought he might find that Greenacres, operating in an era of increasing recognition of Canada’s aging population, was a site of research and innovation in dementia care. But this was far from being the case. No psychiatrist ever visited the facility, and no research was ever conducted on the premises.  Dammed by the double negative of being labeled mentally ill and aged, Greenacres residents were misfits in the post-Second World War policy world that sought to discard the mental health hospital and recreate the old age home as an attractive locale for senior citizens needing minimal assistance. As Struthers understands it, the creation of Greenacres is an illustration of trans-institutionalization, a functionalist measure to remove a problem population from other facilities. In the following video, he expands on these ideas.

Struthers reflections on best practice in long term care today

Academics and community partners from the Re-Imagining Long Term Care project stress that the 21st century residential old age home is still trying to overcome many of the problems Jim Struthers found at Greenacres three or more decades earlier. Functionalist economies have been replaced by “charting for dollars”, which burden nurses with more administration and takes them away from the critical work of building caring relationships with residents. Worrying reports of increased anti-psychotic drug use amongst the institutionalized elderly vy for media attention alongside tragic tales of institutional violence. Residents are entering homes older and in poorer health, many with complex care needs and dementia-related concerns. Re-Imagining researchers appreciate that medical issues are important amongst this increasingly frail population, but question whether the current Canadian system is capable of nurturing the social and the emotional lives of residents. In every facility studied by the Re-Imagining team, residents, workers, and family have spoken of the need for empathy, dignity and respect for all who cohabit the world of the residential facility.  What we need, one doctor on the team pointed out recently, is cultural change.

Jim Struthers has spent four years gathering data on current promising practices in European and North American residential care facilities but, as one of the project historians, he continues to regard the present through the rear-view mirror of history. In the following video clip, he shares his vision of a future long term care facility informed by the lessons of the past.

Designing Dementia Care: Perspective Taking

Timing: 
30 minutes

Making specific references to events described in the artefacts used in this unit, students take the perspective of a 1981 Greenacres worker, resident or a family member and write a 250 word letter to the Chairman of Metro Toronto (the 1981 equal of today’s mayor) saying how the system has failed them.

Learning Activity Type: 

Designing for Dementia-care (architectural planning)

Use a free software design program or paper and pencils, have students create an annotated architectural design plan for a new state-of-the-art dementia care unit. Annotations explain the rationale behind design choices and serve as critical reflections to demonstrate lessons learned from the Greenacres unit. This activity can be done independently or in groups. It also works well as a graded assignment.

Instructors can build a second step to this activity by having students share their plans and discuss the rationale for their design choices.

Learning Activity Type: 

Tools for Recovery: Margo's Story

Takeaways: 

Middle aged woman smiling, wearing beautiful red hat

Community Expert, Margo Robinson.

  • Recognize the importance of peer support in developing coping strategies and new skill sets
  • Value creativity and community engagement as pathways to confidence and wellbeing 
  • Acknowledge systemic barriers to recovery

Learning Lens: 

Community expert Margo Robinson contributed a 3-page recovery memoir to the History in Practice project, documenting one woman's journey from serious mental health difficulties to wellbeing. This personal reflection explores the role of medications, peer support, and community involvement. It recounts what Margo regarded as critical gaps in care and also what worked for her. Students can read Margo’s memoir below. 

Evaluating the Artefacts:

Margo's Recovery: Group Think Tank

Timing: 
30 minutes

Ask your students to reflect on Margo’s recovery story and collectively make a list of the different tools that Margo found helpful. Next, have your students brainstorm other practices that would be helpful in the process of recovery and consider how the community, mental health professionals, and policy makers could support these tools.

Using a black board or similar aid, pull these ideas into a collective mind map or infogram.  This activity can also be conducted online by having students create and upload their list contributions to the discussion board.

Learning Activity Type: 

Past, Present and Future: 3 Skits about Policy and Practice

Takeaways: 

  • Appreciate system user perspectives on mental health policy
  • Understand relations of power in the mental health system (patient/doctor/nurse/staff)

Learning Lens: 

These short 1-3 minute skits by project community experts branwen Willow and Cat Omura present past, present and desired future mental health systems from the perspective of a community expert. They can be used as audio recordings for classroom use or as scripts to be enacted by students.

Evaluating the Artefacts:

Past, Present and Future - 3 Plays

Timing: 
45 minutes

Have students read and act out their play scripts. Online, students can listen to the audio recordings of the plays prepared by branwen Willow and Cat Omura. Use the questions below, which were carefully developed by these community experts, to generate class discussion about the plays. Online, students can upload their contributions to a discussion board.

"And now we know better" (Past) skit audio by Cat Omura and Branwen Willow.

5 minutes

Past:

  1. Did you have trouble accepting this scenario as an account of something that actually happened?
  2. What might be some of the results (negative or positive) of the large scale de-institutionalization that took place in BC in the 90s and is happening in other countries currently today?
  3. How could the release of patients who have previously been institutionalized be better managed?
  4. How could families and communities be better prepared and educated?

"How do you feel?" (Present) skit audio by Cat Omura and Branwen Willow.

1 minutes

Present:

  1. How do you feel about the interaction you’ve just witnessed?
  2. What do you think about the two people in this scenario?
  3. Do you think the interaction went as well as it could have? Why or why not?
  4. Why might the staff not be addressing all Eliza’s concerns?
  5. What barriers, formal or informal might be in place in this setting?
  6. What is the disconnection between this patient’s expectations and the care being provided?
  7. How could the situation be improved?

"Breaking down barriers" (Future) skit audio by Cat Omura and Branwen Willow.

1 minutes

Future:

  1. Did you have any preconceptions when you first read that the cast had mental health issues?  Did your view of the cast change during or after this scenario?
  2. How did you relate to their discussion?
  3. What barriers might be overcome when people living with mental illness partake fully in education about mental illness?
  4. What do you think the interests of the various members of the community might include?
  5. What did you think about the kind of services being talked about?
  6. What are your feelings about people with mental illness?
  7. What would your reaction be if a co-worker told you that they lived with a mental illness? What issues of trust and responsibility might you face if some one confided this to you?

 

Learning Activity Type: 

Past, Present or Future - 1 Play

Timing: 
20 minutes

Select one of the plays prepared by Branwen Willow and Cat Omura and have students read the parts in a large discussion group. Then use the corresponding set of questions, which were carefully developed by these community experts, to generate discussion about the play. Online, students can listen to the audio recordings of the play prepared by branwen Willow and Cat Omura. Use the questions below, which were carefully developed by these community experts, to generate class discussion about the play. Online, students can upload their contributions to a discussion board.

Past:

  1. Did you have trouble accepting this scenario as an account of something that actually happened?
  2. What might be some of the results (negative or positive) of the large scale de-institutionalization that took place in BC in the 90s and is happening in other countries currently today?
  3. How could the release of patients who have previously been institutionalized be better managed?
  4. How could families and communities be better prepared and educated?

Present:

  1. How do you feel about the interaction you’ve just witnessed?
  2. What do you think about the two people in this scenario?
  3. Do you think the interaction went as well as it could have? Why or why not?
  4. Why might the staff not be addressing all Eliza’s concerns?
  5. What barriers, formal or informal might be in place in this setting?
  6. What is the disconnection between this patient’s expectations and the care being provided?
  7. How could the situation be improved?

Future:

  1. Did you have any preconceptions when you first read that the cast had mental health issues? Did your view of the cast change during or after this scenario?
  2. How did you relate to their discussion?
  3. What barriers might be overcome when people living with mental illness partake fully in education about mental illness?
  4. What do you think the interests of the various members of the community might include?
  5. What did you think about the kind of services being talked about?
  6. What are your feelings about people with mental illness?
  7. What would your reaction be if a co-worker told you that they lived with a mental illness? What issues of trust and responsibility might you face if someone confided this to you?
Learning Activity Type: