Models of Practice: Spaces of Hope

Module Artefacts

  • A unit introducing students to the world of Toronto’s PARC, born in 1980 as a drop-in offering basic services to former psychiatric patients, but recognized today as a “living room to thousands” and an important civic institution.
  • The story of Edmond Yu, a chronicle of inadequate social supports and poor policing with a hopeful postscript – the creation of supportive housing for marginalized people.
  • Video footage – past and present – telling the surprising story of pioneering dementia care innovations at BC’s Valleyview Hospital in the late 1978s and 1980s.
  • A 10-minute documentary that explores the inner workings of Unity Housing, an innovative community housing run by and for service users.

Module Takeaways

  • Appreciate the importance of shared power, stakeholder engagement and inclusive practice in organizational design and function
  • Recognize the critical need for daily necessities, community connections and/ or opportunities for creative self-expression in mental health supports
  • Discuss the characteristics and values of best practice as reflected in this module
  • Recognize the value of innovative and non-medical practice models directed by those who use or provide services

Module Assessment

Ask your students to write a 250-word letter about hope and promising mental health practice, incorporating characteristics and values of best practice that they have gained from their examination of module artefacts. Students should address their letter to one of the following people featured in this module:

  • a PARC member
  • Edmond Yu
  • Moyra Jones
  • John Hatfull or Alex Verkade
  • Karen Ward

Module Learning Lens

In the mental health world the notion of a “space of hope” speaks to a wish for asylum - a place of refuge, support and healing, where the judgments that often surround emotional distress and mental difference are suspended. Indeed, popular memories of “disappeared” spaces of hope, such as BC’s early MPA and the Vancouver Emotional Emergency Centre, live on within local communities of people who have mental health histories.

While it is easy to dismiss these reminiscences as nostalgic dreams, the utopian perspective is always an important marker of best practice. Our community partners were clear about what they considered best practice in mental health, emphasizing shared power and decision-making and programs that incorporated pathways to empowerment, community, and wellbeing. Their “utopian” vocabulary included the following descriptors: friendly/enabling interventions, sharing of knowledge, self-determination, developing community, connectedness, peer support. Researchers have generally focused on the last item on this wish list, pointing to the long history of successful peer models in alternative residential treatment centres and housing programs. But some critics warn that recent moves to integrate trained peer-support workers into mainstream services replicates the power imbalances found in professional-patient relationships, creating divisions within the larger “peer” community.

A Living Room to Thousands: Wellbeing at PARC

Takeaways: 

  • Appreciate that healthy living includes access to safe egalitarian spaces where sociability, privacy, creative self-expression, and the necessities of daily living are available to people as citizens
  • Understand the importance of the drop-in style, member-driven programming, and self-directed services in community services
  • Appreciate the therapeutic role of using personal voice and storytelling through art and writing in fostering positive identity, social inclusion, and intellectual and political engagement
  • Describe best practice in community mental health

Learning Lens: 

When PARC (Parkdale Activity Recreation Centre) was founded in 1980, it was envisioned as a haven, a sanctuary from the outside world for those who needed it most: deinstitutionalized psychiatric patients who were not welcomed elsewhere in Toronto’s Parkdale neighbourhood. More than forty years on, PARC remains a space of hope and wellbeing for many, but it is also recognized as a vital civic institution, part of the fabric that makes Parkdale a unique Toronto community.

Artefacts in Context: 

Parkdale, once a thriving and trendy middle-class Toronto neighbourhood, became a place of boarding houses and bachelorettes in the years following World War Two. By 1979 Lakeshore Psychiatric Hospital, about twelve kilometers west, had closed its doors and the nearby Queen Street Mental Health Centre had drastically reduced in-patient beds. Sandwiched midway between these two facilities, and a first destination for many former patients seeking housing, Parkdale was heavily impacted by the push to deinstitutionalize mental health care.

Contrary to claims made by advocates of community care, Parkdale did not ‘make room’ for those set adrift from the big hospitals, or provide them with safe, adequate, or healthy ways of living. Former patients found themselves trying to make do with inadequate welfare payments and poor levels of outside support. Their often-obvious poverty, marginal living situations, and psychiatric diagnoses bred suspicion and distrust among Parkdale’s middle-class. The media fuelled these fears with stories of decreasing property values, dangerous streets, and the emergence of Parkdale as a “Psychiatric Ghetto” or a “Dumping ground for social misfits.”

Evaluating the Artefacts:

Please Note: We have tried to identify individuals in the PARC photos used on this exhibit and ask them for permission to post their image on the History in Practice website, but we know that this has been an imperfect process. If you can help us identify unnamed individuals, or if there is a photo of you that you would like to have removed from this site, please let us know and we will make the necessary changes.

Art and Writing at PARC Self-Guided Learning

Timing: 
10 minutes
Man sitting writing at a table with "Creative Writing Class '85" written below.

 A 1986 poster for PARC's Writing Class.

Art and art-making is an inside/outside phenomenon at PARC, referencing past and present, and making publicly visible the many social and expressional activities that the organization facilitates. Colourful works of art hang all over the walls of PARC Drop-In and the corridors that snake through the upper floors of the building. Art spills outside onto the streets of PARC in celebratory pageants, street theatre and banners used in political marches. Members’ prose was first made public in the PARC newsletter, and later in two published compilations: Kiss Me You Mad Fool (1991), and Let’s Face It (2011), taking the personal views and histories of members well beyond the walls of PARC.

The PARC Writing Group, another one of the organization’s oldest group activities – provides a strong source of documentation and exemplifies how members of the PARC community came to appreciate the politics of giving voice and a sense of citizenship to marginalized peoples. Formal art groups have existed at PARC since the 1990s, but art in various forms was produced at PARC since the very beginning. Creative self-expression enriches the lives of PARC members, allowing them to make a personal or political statement about their lives and to express their identity through creativity.

From very early on, PARC staff and members recognized the importance of art for members’ confidence, self-esteem and social skills. Read this early report on art groups at PARC:

Hand-written poster announcing 1982 PARC creative writing contest with suggestions for writing about life outside the hospital or about the societal fears about ex-patients living in the community.

From the early days writing at PARC was about politics and identity

Coffee, cigarettes and chocolate bars from the grocery store across the street have fuelled the PARC writing group for over 25 years. After a few false starts in the early years, Hume Cronyn, the founder of the group, questioned its purpose:

What use is writing once a week for an hour when many of our members suffer from deplorable living conditions; where meals in the boarding houses where most of our members live consist of cornflakes with hot water for breakfast, jam sandwiches for dinner or cold noodles with mashed potatoes; where they are harassed, beaten up, taunted by landlords, shopkeepers, school children; where they have no winter coat for sub-zero weather; where years and years of medication causes constant headaches, twitching, unbearable itchiness; where voices from the past and the future, fears, and anxieties create havoc in the head? It was my view there were so many problems from which our members suffered, that it was only when these problems were solved, then maybe a writing workshop had a place.

But at the urging of PARC members, the writing group continued to meet after Friday at 3 o’clock, after PARC’s weekly Friday meal was served.  Anywhere between six to fifteen people turned out each week, and the group became a place of friendship, trust and good humour. Workshops focused on a specific theme or topic each week. After twenty minutes to an hour of writing, writers shared their work with the group, to receive criticism and spark discussion. Political themes emerged early in the writing of PARC members, as this early poster makes clear.

When Kiss Me You Mad Fool was published in 1991, Cronyn boldly proclaimed that the collection was a call for solidarity with the broader community in a struggle for a better mental health system and a more equitable society.

Art at PARC has taken a similar path from the personal to the political. Beginning in 2008, Making Room Community Arts has found a home at PARC under the leadership of artistic director, Michael Burtt. Making Room Community Arts describes itself as “a radically inclusive, multi-disciplinary arts company in long-term residence at the Parkdale Activity Recreation Centre. We create celebrations and ceremonies, large and small out of the ground of everyday life.” 

Photo d'été coloré à l'extérieur devant l'entrée de la communauté PARC. Des percussionnistes et musiciens forment un cercle.

Music, art and community at a PARC Pageant

Winter photos of whimsical iron bike stand outside the front of PARC

Bike racks: Function art at PARC.

Photos d'un support à vélo fait d'acier à figure farfelu devant PARC

 Bike racks: Function art at PARC

Much of the art produced under the leadership of Burtt helps members situate their personal histories within the history of Parkdale. One example was the Parkdale Pageant and boat launch of June 2012. Hundreds of PARC and community members came together to build a raft and a canoe, and to carry both via a lively parade through the streets of Parkdale to Lake Ontario for launch on the water, thus reclaiming Lake Ontario for the community, for PARC membership, and for Parkdale. The raft project is one of many examples of the ways that the art produced at PARC makes its way back out into the community of Parkdale and beyond.  Other PARC-produced art has been printed on mugs or postcards and sold. Another art project saw PARC members help shape Parkdale’s streetscape, when they designed bicycle rack sculptures that were installed by the City of Toronto.

PARC Writing and Art Sampler

Art and poetry produced by PARC community members are set alongside photographs to create Creativity and Well-being at PARC – A Sampler for educators and learners. Forming their inquiry around the potential of creativity through writing as a force for the personal empowerment, sociability, and political engagement, instructors can direct students to read and reflect on one or more of these artefacts.

Items from the Sampler can be used as the basis for shared reflections or the Sixty Second Sound Bite learning activity from this unit. Learners headed for practitioner careers in mental health will benefit from Whose Story is This? by PARC community worker Bob Rose and the accompanying Thinking About Best Practices learning activity.

Students can work through this material online or in class in preparation for a discussion or learning activity. Have students use the following themes to guide their viewing of the Art and Writing at PARC artefacts:

  • Creativity as self-expression
  • Creativity as a political act
  • Creativity as self-improvement
  • Creativity as social engagement
  • Community art practices

PARC: The Sixty Second Sound Bite

Timing: 
15 minutes

This learning activity can be used as an entry point into a larger class discussion on the themes you have highlighted within your lecture. It can be modified for online through the discussion board feature of a learning management system.

Begin this exercise by having your students break up into pairs and assign a piece of writing for each pair. Within the group of two, the students will take turns playing the role of the “interviewer” and the “interviewee.” Prep the students with interview questions such as: “Which writing or art piece was most memorable to you and why?” or “Tell me about something unexpected that you learned from the writing/ art samples.” Feel free to encourage your students to think up their own questions. Next, have each interviewee talk without interruption for sixty seconds (to their partner). Once both partners have been interviewed, invite some students to share their “sixty second sound bite” with the whole class.  

Learning Activity Type: 

PARC: Multi-Purpose

Timing: 
30 minutes

PARC’s mission statement is: “A community where people rebuild their lives.” The PARC model of practice positions members as citizens (as opposed to mental health patients) and the organization serves the very necessary function of providing a positive space for healthy living and community formation.

Use PARC’s mission statement alongside the Learning Lens and Artefacts In Context sections of this unit as the basis for a focused 5-minute lecture or have students work through this material independently. Consider using the characteristics that our community partners used to describe desirable qualities of mental health services as the basis for discussion: friendly/enabling interventions, sharing of knowledge, self-determination, developing community, connectedness, peer support. Have students prepare for the in-class learning activity by viewing the Creativity and Wellbeing at PARC – A Sampler before class. Students can then work in small groups using the PARC mission statement and the Creativity and Wellbeing at PARC Slideshow to explore art as a member-directed approach to wellbeing. This activity closes with a five-point reflection which students can present in class or post to an online discussion board.

Learning Activity Type: 

Food at PARC: Self-Guided Learning

Timing: 
2 minutes

Hunger and lack of good food are a daily reality for many PARC members, for few have access to cooking facilities at home and many cannot buy a month’s groceries on limited disability payments. Thus it is no surprise that food has been central to PARC from the beginning, and has always consumed a large proportion of the organization’s operational budget. Relying on the Daily Bread Food Bank and Second Harvest programs, PARC provides between 50 and 250 meals a day for its members. In 2012, PARC served 77,000 meals.

Equally important at PARC are the community-building and social features of food. The kitchen runs primarily on member-volunteers’ labour. Volunteers get together to prepare and serve meals and help to run the food bank. But PARC views the preparation of food as a basic survival skill as well, a perspective that helped to launch a cooking group in the 1990s, where members learnt how to prepare and cook nutritional and economical meals for themselves. Celebratory communal meals mark special occasions and the passage of the seasons at PARC. In dusty boxes in the PARC archives, photographs of food preparation, eating, and special holiday meals abound, testifying to the important role food plays in the lives of members who walk through PARC doors each day.

Educators and learners can use these artefacts to explore the different ways in which food enriches the lives of PARC members. Students can work through the artefacts online or in class in preparation for a discussion or learning activity. Have students use the following themes to guide their viewing of the Making Food and Making Community at PARC artefacts:

  • Hunger
  • Access to food
  • Access to cooking facilities
  • Community building
  • Social engagement

 

Learning Activity Type: 

Food at PARC: Multi-Purpose

Timing: 
30 minutes

PARC’s mission statement is: “A community where people rebuild their lives.” Their model of practice positions members as citizens (as opposed to mental health patients) and serves the very necessary function of providing a positive space for healthy living and community formation.

Use PARC’s mission statement and Learning Lens and Artefacts In Context sections of this unit as the basis for a short, focused lecture or have students work through this material independently. Have students prepare for the in-class learning activity by viewing the Food at PARC Slideshow before class. Students can then work in small groups using the PARC mission statement and the Food at PARC Slideshow to explore how making and sharing food at PARC simultaneously fosters physical wellbeing and community. This activity closes with a five-point reflection which students can present in class or post to an online discussion board.

Learning Activity Type: 

Hanging out at PARC: Self-Guided Learning

Timing: 
6 minutes

“Hanging out” at PARC means something different every day. Whether members chose to play a game of pool, indulge in bingo, come together for movie night, or participate in sing-alongs, drumming circles or dances, PARC provides a space for both casual recreation and more organized community activities. When the drop-in centre was first proposed in Parkdale, it was designed specifically to address the lack of affordable and healthy activities in the area, all the more important for those who have little or no space or opportunity for recreation or activities in whatever type of housing they had. Coming to PARC to “hang out” was as important as some of the more purposeful and organized self-improvement activities.

Educators and learners can use these artefacts to explore the different facets daily life at the PARC Drop-in, past and present. Students can work through the Hanging Out at PARC Slideshow online or in class in preparation for a class discussion.  Have students use the following themes to guide their viewing of the Hanging Out at PARC artefacts:

  • Casual Recreation
  • Organized community activities
  • Poverty and affordable activities

Lenette Powell-Flowers’ 1991 “At First Glance” takes us right into PARC of that era, evoking the smells, the sounds, and the emotions of early years in the “living room to thousands.”

Excerpts from other PARC writings and PARC photographs from across the years demonstrate what PARC means to its members.

 

Learning Activity Type: 

Hanging out at PARC: Slideshow Discussion

Timing: 
15 minutes

PARC considers everyone and anyone who enters its doors to be a member, and in so doing fosters a sense of member-identity rather than a mental health client or service user-identity.  Using the Hanging Out at PARC Slideshow, teachers and learners can share a discussion of how member identity is illustrated in the slideshow images and text.  For online use ask students to view the slides and post a short statement about what it means to be a PARC member rather than a client to the discussion board.

Learning Activity Type: 

PARC: Five Minute Paper

Timing: 
15 minutes

Use the Learning Lens and Artefacts In Context sections of this unit as the basis for a focused 5-minute lecture to introduce your student to the importance of developing a “living room” approach as a model of practice for PARC with potential applications within the broader mental health system.

Either in class or online, have students work through the thematic slideshows depicting daily events at the PARC drop-in and then focus on one of the core facets (creativity, food, hanging out). Then have students write a “five minute paper” that compares and contrasts mental health practice that views the service user as a citizen versus mental health practice that views the service user as a patient.  With some modification, this exercise can also be used as a graded assessment.

Learning Activity Type: 

'Because of Edmond': A Place of Safety and Hope

Takeaways: 

Sketch d'Edmond Yu, vue de haut, une chandelle à la main

Sketch of Edmond Yu by PARC member Heinz Klein.

  • Acknowledge that people living with mental health difficulties deserve dignified access to the fundamental necessities of life, i.e. housing, food
  • Understand the critical connections between mental wellbeing and safe, supportive, affordable housing
  • Recognize that crisis interventions with people in emotional distress require empathy, adherence to basic human rights principles, and a strategic understanding of social exclusion

Learning Lens: 

The history of Edmond Yu’s life and unnecessary death is a tragedy, a tale of inadequate social supports and poor policing that took place in Toronto in the 1990s, but has been recast and replayed in other Canadian cities. Yu’s heartbreaking story had an encouraging postscript when his community of PARC (Parkdale Activity Recreation Centre responded to the death of one of their own by creating supportive housing for marginalized people, especially those with psychiatric diagnoses.  It is the nexus of these two tales – one heartbreaking and one hopeful – that make the story of Yu’s life, death, and legacy such a powerful teaching tool.

Artefacts in Context: 

Like Canadians across the country in similar circumstances, PARC members have always faced enormous barriers to safe shelter and affordable housing. Homelessness is not just about not having a home. It is about spending more than 50% of your income on rent. It is about sleeping on a friend’s couch or in a shelter, for weeks or months at a time. It is about sleeping rough, in the park or wrapped in a blanket on a hot air vent. This description is all about place, but homelessness is also about emotional dislocation, loss of individual property and threats to personal health and safety.

Evaluating the Artefacts:

"Because of Edmond": Self-Guided Learning

Timing: 
40 minutes

Supported by the Learning Lens and Artefacts in Context, these artefacts and accompanying text provide instructors with the basic components for a lecture on Edmond Yu, PARC, and the challenges of providing good housing and social supports for people with mental health difficulties. Artefacts include the 24 recommendations made by the Coroner investigating Yu’s death and insightful audio selections by two individuals closely connected to the story of Yu and PARC.

For flipped classroom use, students need to work with the Values Line learning activity (see below), working through artefacts in advance of the lecture and the in-class discussion. Instructors need to have learners take their position (agree, neutral or disagree) for the Values Line activity before they are exposed to the contents of the lecture. Learners can work through this material independently or listen to an in-class lecture. Learners working at a higher level can use the inquest recommendations as a platform for an extended inquiry into human rights and best practice in community mental health.

Photo de Bob Ros, assis dehors en mangant un hamburger

 Bob Rose, a central figure at PARC, circa 1990s.

Bob Rose, an outreach worker with PARC, met Edmond at the end of 1996, standing outside the rooming house from which he was being evicted. Though reluctant at first to make a connection with Bob and with PARC, Edmond slowly opened up to allow them to help.

 Bob Rose speaks about Edmond Yu becoming homeless.

3 minutes

Able to secure a short-term crisis bed for Edmond at Toronto’s Gerstein Crisis Centre, Bob hoped this would buy him some time to find Edmond secure long-term accommodation, but on February 20, 1997, one week after his Gerstein placement, Edmond was killed. Shortly after Edmond’s death, Bob Rose summarized the tragedy in PARC’s 1996-1997 annual report as “what happens when the world chooses to make war on poor people instead of making war on poverty.”

Bob Rose speaks about the impact of Edmond Yu's death on the PARC community.

3 minutes
Photo de Victor Willis dans son bureau à PARC

Victor Willis, longtime executive director at PARC, 2014.

Victor Willis, then working at the Gerstein Crisis Centre and a PARC Board Member, remembers meeting Edmond the day before he was killed. He also frames Edmond Yu’s death within a larger story about the limitations of the mental health system.

PARC Director Victor Willis speaks about meeting Edmond Yu and how his death demonstrates the failure of the mental health system.

4 minutes

Edmond’s death further mobilized PARC staff and members to advocate for social justice, supportive housing, and a better mental health system. A coroner’s inquest resulted in 24 recommendations, one of which was that more funding should be given to support the establishment of safe-houses and other forms of housing for consumer-survivors in Toronto. Read the 24 recommendations here. 

PARC’s very establishment in 1980 was a response to an inadequate community mental health system that left psychiatric survivor/consumers without viable housing options.

 Victor Willis speaks about deinstitutionalization and the Parkdale neighbourhood.

6 minutes
À l'intérieur de l'appartment d'Edmond avec vue de sa chambre à coucher et de la salle à manger. Un bel endroit où vivre.

Edmond Place, 2011.

Throughout the whole process of planning and lobbying for Edmund Place, one of the tests that PARC applied to its ideas was to ask themselves “could Edmond have lived here?” In the following audio clip Victor Willis describes the housing on the 3rd floor of PARC, and some of the principles behind Edmond Place.

Victor Willis speaks about PARC's supportive housing.

4 minutes
À l'intérieur de l'appartment d'Edmond avec vue de sa cuisine. Un bel endroit où vivre.

Edmond Place, 2011.

Read PARC’s rationale for naming the building after Edmond Yu.

Despite Edmond Place being widely recognized as a success, there are reminders everywhere that more needs to be done to provide safe housing for vulnerable members of our society. Listen to Bob Rose reflect on the fact that Edmond Place represents many tenants’ first real form of housing.

Edmond Yu's death was tragic and unnecessary. It had a large impact on the PARC community, as described here by PARC worker Bob Rose.

1 minutes
Learning Activity Type: 

“Because of Edmond": Values Line

Timing: 
30 minutes

The different aspects of this set of resources (the text, the audio clips and the documents) all speak to the importance of housing for people with psychiatric diagnoses and the role that it played in the life and death of Edmond Yu.

At the beginning of the lecture, before your students have been exposed to the content of the module, divide your classroom into three separate areas: agree, neutral and disagree. Pose a value statement to your class such as: “decent housing is a fundamental determinant of mental health” and ask your students to move to the area that corresponds with their view (agree, neutral or disagree). Online, use polling software to gather these responses. Ask one or more students from response group to explain why they have positioned themselves where they have. Then deliver your lecture or have students work through the material independently. Once the students have been exposed to the story of Edmond Yu, ask your students to reflect on whether their opinion has changed.

Learning Activity Type: 

“Because of Edmond": Evaluating Recommendations for Change

Timing: 
30 minutes

The coroner’s inquest that followed Edmond Yu’s death resulted in 24 recommendations aimed at preventing such a tragedy from reoccurring. After explaining to your students the role of such inquests and recommendations, use this document (the jury recommendations begin on page 4) as a basis for further investigation into the contentious question of police responses to people experiencing mental health difficulties. The 2003 film Crisis Call (Skyworks), available in many institutional libraries, is another useful tool for exploring this topic.

After a careful review of the inquest recommendations, ask your students to write a critique of the recommendations using the following questions as guidelines:

  • What are the strengths and limitations of relying on police, mental health professionals and policy-makers to address stigmatized attitudes and practices toward persons in mental distress?
  • As community experts, what list of recommendations might a group of PARC members have drawn up?
Learning Activity Type: 

Moyra Jones at Valleyview: Early Dementia Care Innovation

Takeaways: 

  • Consider the diverse factors, stakeholders and processes that engender helpful innovations in mental health practice.
  • Appreciate the potential of a relational dementia care model that fosters service user identity, purpose and dignity by positioning the practitioner as ally and integrating multidisciplinary rehabilitation and health care interventions
  • Understand the importance of incorporating new knowledges and practices outside professional and institutional circles, allowing emergent promising mental health research and practice models to have a broad societal impact

Learning Lens: 

Artefacts in Context: 

3 women standing together around a table filled with stacks of open library books

 Moyra Jones (right) with colleagues, George Derby, circa 1977.

The arc of Moyra Jones’ career spanned a vast evolution in the field of aging and mental health.  In the 1950s and 1960s there was limited interest in the elderly as a social group. When the attention of Canada’s health professionals and policy analysts focused on older citizens – as the federal Senate Special Committee on Aging did in 1963 - it was to highlight the deficits of an expanding population cohort seen as largely redundant in post-World War Two Canadian society. The elderly were regarded as economically marginal individuals whose work skills were irrelevant in a modern industrial age. With an increasingly mobile population, family supports for elderly members were seen as lacking.  Indeed, many health professionals considered aged grandparents to be unhealthy individuals whose brains disposed them to senility, as psychologically problematic additions to the nuclear family. The elderly psyche was regarded as similarly problematic, marked by a heightened sensitivity to loneliness, diminished self-esteem and feelings of redundancy.

Evaluating the Artefacts:

Moyra Jones: Self-guided Learning

Timing: 
60 minutes

Innovation is a process that involves taking a new idea and giving it value, but it is also about recognizing moments and situations where change is possible, and working with established components to give them additional worth. Successful innovation involves delivering a product that is both helpful and meaningful to the people who will use it, a process often engages multiple actors and organizations. In order for innovation to bear fruit stakeholders need to have a shared creative mindset and an acceptance of the potential of change. Today, with concerns about delivering care to a growing population of aging Canadians, the notion of innovation in dementia care is particularly timely.

Ideas about innovation are most often employed in creating business models, but this unit tells the story of an innovation that gave new value, not to a cell phone app, but to the lives of elderly people with dementia and the practitioners who worked with them. Moyra Jones (1936-2015) was an important Canadian innovator in dementia care and rehabilitation therapy. Most well-known for the GentleCare approach to dementia care that she developed and marketed across North America and Europe, Jones began her work in Vancouver in the 1970s. As the video artefacts presented in this lesson explain, Jones led a team of practitioners at Valleyview Hospital, BC’s provincial geriatric mental health facility, in the creation of an innovative model of treatment that brought together medicine, rehabilitation and the creative arts.

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 focus that fits teaching requirements. Ask students to use the following questions to guide their exploration of these artefacts:

  • What was Jones’ vision of best practice in dementia care, and how did her commitment to “making life happen” support a paradigm shift in the field?
  • Innovation is about vision and strategy.  What does it mean to support innovation as a leader, and what are the key personal and professional strategies that Jones employed?
  • How did Jones’s social location and her professional credentials and experience in the health care system give her creditability to innovate at Valleyview?
  • What does the Valleyview story tell us about innovation as a process (sometimes difficult and challenging) and about seeing opportunity in crisis?

How the story began...

Joy Fera, recreational therapist at George Derby, describes how Jones brought her on board with Jones’ plans for George Derby and their move to Port Coquitlam’s Valleyview Mental Hospital.

Cluster of institutional buildings on wooded hillside with mountains in the background

Valleyview Buildings with older Home for the Aged in foreground

In 1974, when Moyra Jones took the position of head of rehabilitation services at the George Derby veterans’ rehabilitation facility in Burnaby, BC, gerontology was a marginal field of study. In mental health terms, the aging brain and the elderly psyche were regarded as weak, the former in danger of succumbing to what was then known as senility, the latter prone to loneliness, lowered self-esteem, loss of self-confidence and feelings of redundancy.

Doreen Alexander describes the first efforts to create integrated mental health teams that would bring together medical and rehabilitation staff

Faced with a residential population of elderly men, the majority of whom had worked in BC’s remote forests and mines, Jones understood that standard recreation and rehabilitation activities like woodwork, painting, bingo and sing-songs were unlikely to be successful. Instead, she set in place a rehabilitation program that aimed to match the life histories and personal identities of George Derby’s residents, taking retired pilots to the annual Abbotsford Airshow and bringing in mineral samples for former prospectors to classify and sort. Highly organized and energetic, Jones used funding from local branches of the Canadian Legion to buy equipment and the voluntary labour of legion members to run an ambitious program of institution-community special events and resident outings.

Doreen Alexander describes Valleyview and Moyra Jones

Jones was adept at locating and inspiring like-minded allies in the workplace.  Listen to Joy Fera, recreational therapist at George Derby, describe how Jones brought her on board with Jones’ plans for George Derby and their move to Port Coquitlam’s Valleyview Mental Hospital.

As Fera describes, in 1978 Jones was hired as Director of Rehabilitation Services at Valleyview Hospital, a large geriatric unit on the site of the province’s Riverview Hospital in Coquitlam.

Kerry Burke describes the first efforts to create integrated mental health teams that would bring together medical and rehabilitation staff

Upgraded and modernized following World War Two, Valleyview’s operations were spread over eight buildings on the hillside facing southwest toward the Fraser river, and included an infirmary and admitting building with four wards for acute and chronic cases. Administratively separate from Riverview’s general wards and out-patient services, from the mid-1960s Valleyview administrators and staff were guided by broader trends toward psychiatric deinstitutionalization, attempting to use patient assessment, rehabilitation therapy, social work techniques and new “tranquillizing medications” to provide early treatment and discharge for patients who would formerly have become chronic, long term residents.

Joyce Wright describes how Moyra Jones convinced her to come on board and build the volunteer program at the institution into a large workforce that provided important links to the larger community

Music therapist Doreen Alexander, the first in her field to work at Valleyview, came to Valleyview shortly before Jones took up her new position.  Listen to Alexander describe Valleyview and Moyra Jones:

Kerry Burke explains the care philosophy of Moyra Jones

Elements of the program that Jones would spearhead at Valleyview were in place when she arrived, but this was nevertheless a unique career opportunity in geriatric mental health. No other North American psychiatric facility had specific institutional provision for aged patients or an interest in creating an active psychosocial treatment program for this client group. The next decade would bring the “discovery” of Alzheimer’s disease as a major medical and social catastrophe and the creation of local and regional Alzheimer societies, but dementia care was still in its infancy in 1978. Jones was invited to lead a rehabilitation team that would work alongside the medical professionals as equal partners in delivering geriatric mental health care.

Doreen Alexander recounts how the changes in attitudes and practices that took place at Valleyview still stand out clearly in her memory

Multidisciplinarity and shared authority were at the heart of Jones’ vision for Valleyview.  In her new treatment model, rehabilitation would encompass the standard rehabilitation therapies of occupational and physiotherapy – long established at Valleyview - but also the barber and the beautician, the chaplain, and a new group of re-recreation and music therapists. Importantly, it was decided that members of Jones’ rehabilitation team and Valleyview medical staff would have formal input in determining patient treatment plans. But there was resistance to this change. Jones’ tactics for dealing with opposition included educating medical staff with demonstrations and in-service training and, on occasion, terminating rehabilitation services on wards with intractable old-guard medical staff. Listen to Doreen Alexander and fellow music therapist Kerry Burke describe the first challenging efforts to create integrated mental health teams that would bring together medical staff and rehabilitation staff:

Liz Moffit explains the background and orientation of the Capilano program in Music Therapy, and the importance of the link with Valleyview

A charismatic personality, Jones was an excellent recruiter.  She soon began broadening the scope of the Valleyview program, bringing in new music therapists, a volunteer coordinator, and her friend and former George Derby colleague Joy Fera.  Jones courted colleagues with educational credentials who could match her breadth of vision and commitment to the work underway at Valleyview.  Joyce Wright, who became a lifelong colleague and friend, describes how Jones convinced her to come on board and build the volunteer program at the institution into a large workforce that provided important links to the larger community.  Why do you think Joyce Wright ended up saying yes to Moyra Jones?

Liz Moffit speaks to Moyra Jones' role in opening up a practice space for music therapy at Valleyview

For Moyra Jones, rehabilitation therapy offered elderly people quality of life and a sense of affirmation and personhood in a society that devalues its older citizens. Coming out of professional training at the University of Toronto’s joint Occupational Therapy/ Physiotherapy program likely gave Jones an affinity with multi-disciplinary approaches to rehabilitation and healing. And by the time she reached Valleyview Jones also held a fervent belief that the rehabilitation professions were fundamental to good mental health treatment and care – not just for the elderly, but across the life cycle. As Kerry Burke explains, this was about seeing the social as potentially more important than the medical, a radical view indeed, and one that he sees at work in best practice elder care facilities today:

Doreen Alexander explains some of the elements of therapeutic practice in music therapy at Valleyview

But positioning the social as equal to the medical in a care model for dementia care, continues to be a matter of debate in the field. Many researchers stress that focusing family caregiver stressors, or on a search for “the cure” to Alzheimer’s disease, means that the needs of people with dementia are being ignored. At Valleyview in the 1970s and 1980s psychiatric nurses trained in a medical model of mental health care and treatment found it difficult to accept the new and promising practice of music therapy. Innovation requires demonstrating the value of new ideas and new methods, particularly in field of dementia care where ageism and our cultural fetish with cognition devalues elderly patients. Yet as Doreen Alexander recounts, changes in attitudes and practices did take place at Valleyview, and pivotal “breakthrough” moments at Valleyview still stand out clearly in her memory. What is Alexander’s “breakthrough” moment, and where can we still see inherent professional ageism in her account?

Kerry Burke describes one of his most successful Valleyview music therapy ventures

Jones had studied music seriously as a child and young adult in Ontario, so music therapy spoke to her as a treatment option in her work. Serendipitously, North Vancouver’s Capilano College (now Capilano University) graduated its first class of music therapists from a new diploma program in 1976, two years before Jones started at Valleyview. The Lower Mainland, with its substantial population of elderly people, was an excellent location for developing professional opportunities in music therapy for the aged. Over time, Moyra Jones came to believe that music therapy was the most promising practice for elderly dementia patients, and Valleyview became the model of best practice in geriatric music therapy in the province. The relationship between Capilano’s music therapy program and the aspirations of Jones and her rehabilitation team at Valleyview demonstrates the importance of recognizing and acting upon good timing, but also appreciating the potential of inter-institutional synergies. Listen to Liz Moffit, an early Capilano graduate and longtime instructor in the program, explain the background and orientation of the BC program and the importance of the link with Valleyview:

Joy Fera describes memories of Moyra Jones as a visionary colleague and community builder

What makes music therapy such a promising practice in dementia care? Practitioners have long identified the role of music in fostering memory, movement and sociability, but recent studies also demonstrate that critical role which music can play in facilitating the activities of daily living for people with cognitive difficulties, arguing that music should be fully integrated into the fundamental routines of long term care facilities, for instance. By opening up a practice space for music therapy at Valleyview and by using her professional authority to promote the work more broadly, Moyra Jones helped demonstrate its utility in geriatric mental health when music therapy was still a marginal rehabilitation profession in English Canada. Liz Moffit speaks to her role in doing this:

Music therapists at Valleyview were therefore working on the frontlines of promising practices in dementia care, using the creative arts to craft a model of care that cast the practitioner as a friendly ally rather than a figure of authority and allowed patients to re-member the contours of their lives personhood to emerge. Listen to Doreen Alexander explain some of the elements of therapeutic practice in music therapy at Valleyview:

Joyce Wright describes memories of Moyra Jones as a visionary colleague and community builder

There is a professional politic to institutional innovation, where change needs to work in the interests of all stakeholders. Kerry Burke found that his most successful Valleyview music therapy venture was a cumulative sing-along. Nursing staff supported this activity because it fit with demands of their work and linked back to established institutional practice.

Liz Moffit describes memories of Moyra Jones as a visionary colleague and community builder

Moyra Jones talks about her vision of good dementia care after 25 years in the field

What was it about Moyra Jones that inspired others to work with her?  Former colleagues describe Moyra Jones as kind, fun and ferocious, a visionary mentor, and a person who pulled you into her plan but let you run with your own ideas. Operating in an old-guard health care institution in an era when middle class women were still maneuvering their way into the professional workforce, Jones set high standards for her team. But she also got to know them as people, helped them develop as practitioners, and shielded them against the judgments of the hospital administration. Listen to Joy Fera, Joyce Wright and Liz Moffit sketch out their memories of Jones as a visionary colleague and community builder, a professional role model and a mentor:

Moyra Jones talks about her vision of good dementia care after 25 years in the field

Sometimes history lets you get lucky. Joyce Wright shared more than her own memories. She retrieved a box of old video tapes from her basement, giving us access to footage of Moyra Jones leading a 1990s workshop. At Valleyview and in the decades that followed, Jones worked on the frontiers of dementia care, in Canada and internationally. She was a leader and an innovator, passionately engaged in psychosocial gerontology and committed to creating humane and helpful models of dementia care. Listen to Jones talk about her vision of good dementia care after 25 years in the field. Then reflect on comments by Joyce Wright and Liz Moffit about Jones’s contributions to more informed and compassionate attitudes and practices in the field. What does Jones’ presentation tell us about using self-knowledge and self-awareness to select a career path or field that challenges us to be our best professional selves?

Liz Moffit comments on Jones’s contributions to more informed and compassionate attitudes and practices in the field

Joyce Wright comments on Jones’s contributions to more informed and compassionate attitudes and practices in the field

Learning Activity Type: 

Dementia Selfie

Timing: 
20 minutes

An adaptation of an exercise that Moyra Jones used in her 1990s workshop, this learning activity helps participants situate themselves in the position of a person with dementia. Have students either draw a self-portrait with their non-dominant hand or take a photo of themselves with their cell phone. Then ask students to tear a portion of their “selfie” portrait away (physically or using a photo editing tool) in the response to each the following “loss” prompts, all of which Jones identified as deficits experienced by people with cognitive challenges:

  • Loss of significant friendship or romantic partnership
  • Loss of memory
  • Loss of home
  • Loss of ability to communicate effectively
  • Loss of decision-making
  • Loss of privacy

Employ Moyra Jones’ exercise to as the basis for a class discussion (online or in class) or have students write a short reflection piece. Jones’ useful questions for generating verbal or written reflections include:

  • What kind of a person are you going to be?
  • How does that make you feel?
  • What loss bothered you the most?
  • How would you want family, friends and health care practitioners to care for you when you are that little piece of yourself?
Learning Activity Type: 

Visualizing the Valleyview Legacy

Timing: 
25 minutes

Introduce this exercise by asking learners to decide on 3 words that best describe Moyra Jones. Then have students make a mind map or infographic that visually depicts core values embedded within the ideas and practices of Moyra Jones and her Valleyview colleagues. Once learners have identified the core values and placed them on their mind map, then have them add a written or spoken “legacy of how to innovate” statement to each core value. This exercise can be completed in class or online, and can also be used as the basis for a group discussion or completed independently as graded assignment.

This unit invites comparison with Designing Dementia Care: A Case Study of Greenacres, another History in Practice instructional unit located in our Policy into Practice Module. Instructors may wish to have learners use material from both units to deepen their understanding of systemic and professional ageism and of the importance of acknowledging and treating the whole person.

Learning Activity Type: 

Unity Housing: Model of Best Practice/ Space of Hope

Takeaways: 

  • Recognize the vital roles that safe and supportive housing play in wellbeing
  • Discuss the characteristics and values of best practice as reflected in this module
  • Recognize the value of stakeholder engagement and flexibility in a successful supportive housing model

Learning Lens: 

Still photograph of Alex Verkade sitting at his desk at Unity Housing

Community Expert Alex Verkade

What would happen if people with psychiatric diagnoses got to design and run their own housing programs? History in Practice Community Expert Alex Verkade had some good answers to this question because he helped create Unity housing, a Vancouver-based housing organization. His 10-minute documentary, created with the help of UBC film student Alex Poutianinen, shows the inner workings of an innovative and successful model of community housing run by and for people with mental health difficulties. The film helps future mental health practitioners understand how stakeholder engagement makes a difference and underscores the value of the system that provides clear expectations and flexible solutions to help tenants remain housed.

Verkade also sat down with senior project research assistant Christie Wall to talk about his involvement with History in Practice and his hopes for his film.

Artefacts in Context: 

This artefact illuminates secondary benefits of good practice models.

Housing as a social, cultural and economic right was recognized in the 1948 United Nations Universal Declaration of Human Rights and the 1976 International Covenant on Economic, Social and Cultural Rights. Canada voted in favour of these proclamations, but it does not currently have a national housing strategy. At present, most Canadian housing policy is not based on the idea that adequate housing is a human right, nor does it take into account the profound personal importance of having, not a house, but a home. Given their social and economic marginalization, it not surprising that housing deficits disproportionately impact Canadians living with mental health difficulties.

Evaluating the Artefacts:

Unity Housing: A Better Way

Unity Housing: Create a Commercial

Timing: 
30 minutes

Before your students watch the video on Unity Housing, split them up into small groups and assign each group a theme to gather insights about:

  • Supportive housing models with democratic processes 
  • Members as workers/staff
  • Limitations of low levels of staff
  • Peer support
  • Voluntary participation 
  • Isolation and social exclusion
  • Poverty
  • Barriers to education and employment 

After they have viewed the video, have groups summarize their insights in bullet points on flip charts or class blackboards, then have each group use these insights as resources for creating a 2-minute commercial for Unity Housing. Instructors should insure that insights reflect unit takeaways and consider including a classroom discussion before students begin work on their “commercials”.

This activity can be done as an actual video, as a storyboard for a video, or as a “pitch” for a proposed video. Have each group present their commercials to the class in order to compare and contrast what the different groups took away from the Unity Housing video. This activity can also be done as flipped classroom or an assessment, with students doing some of the tasks independently or online.

Learning Activity Type: 

Unity Housing: Locating Themes and Content Analysis

Timing: 
20 minutes

Write these themes on small pieces of paper: 

  • Supportive housing models with democratic processes 
  • Members as workers/staff
  • Limitations of low levels of staff
  • Peer support
  • Voluntary participation 
  • Isolation and social exclusion
  • Poverty
  • Barriers to education and employment 

Then distribute these pieces of paper to the class so that each student/ small group holds one. Ask students to locate their theme in the video as they watch it, and have them share this with the rest of the class through board work or discussion. This can be done online by assigning each student a theme and having them post their reflections on the course discussion board.

Learning Activity Type: 

Unity Housing: Role Play on Community Engagement

Timing: 
20 minutes

These teaching resources have been co-created by academics and “community experts”, people who have used mental health services. Community experts contributed ideas but also made their own artefacts, of which the Unity Housing: A Better Way video is one.

It isn’t always easy to draw community partners into projects like creating these teaching resources, but Alex Verkade and the Unity Housing video demonstrate a successful model of academic-community partnership where the whole is more than the sum of both parts. Have 2 students take on the roles of Alex Verkade and Christie Wall and read the text of their interview for the class. Then bring the whole class into the exercise, encouraging shared ideas about how to facilitate service user engagement in initiatives that impact their lives. It might be useful to have the two readers continue to take the roles of Verkade and Wall in the larger discussion to encourage awareness of different perspectives on community engagement. What did your students learn from Alex’s testimony that might not have occurred to them otherwise?

Learning Activity Type: 

Doing Well Through Art at the Gallery Gachet

Takeaways: 

  • Appreciate the connection between art and healing
  • Acknowledge the benefit of stakeholder engagement that fosters meaningful identity and clarity of purpose
  • Value art as social and political engagement

Learning Lens: 

A well established artist-run centre located in Vancouver’s Downtown Eastside, Gallery Gachet is named the after artist Vincent Van Gogh’s homeopathic doctor. Starting small with one annual exhibit in a basement studio in 1993, Gachet now hosts up to 12 exhibits per year and is a vibrant local hub for talks, workshops, symposia and special projects and events. Collective Members determine the programming and direction of Gachet, positioning the facility at the intersection between art and healing, and mounting shows and events that challenge attitudes and practices relating to mental health and marginalization. Gachet is about art and culture, but it is also about meaningful work, decent housing, human rights and social and economic justice.

Karen Ward is a writer, artist, activist and longtime Collective Member who believes that Gachet exemplifies best practice in community mental health programming. Educators and students will find her thoughtful – and personal – reflections an excellent entrée into a broader discussion of the merits of creative expression, community engagement, and personal and collective empowerment.

Evaluating the Artefacts:

Artist and Gachet collective member Karen Ward talks about how the gallery fosters mental wellbeing through creating positive identity, community engagement and meaningful work.

Doing Well by Art

Timing: 
15 minutes

In September 2015, the Gallery Gachet Collective learned that their primary source of operational funding, the Vancouver Coastal Health Authority (the regional health) cutting all financial assistance to the organization. After students have viewed the Gachet video, share news of this decision with them and ask them to prepare a compelling letter or a powerful verbal testimony to persuade the Board of Directors of Vancouver Coastal Health to reconsider their decision. Students should visit the Gallery Gachet website to prepare their submission. They may also find it useful to study Winnipeg’s dynamic and successful ArtBeat, another community-based art studio directed by service users.

Learning Activity Type: