By Jayne Melville Whyte, B.A., independent researcher

Summary

Deinstitutionalization promised to integrate discharged patients into the community. The Saskatchewan branch of Canadian Mental Health Association created White Cross Centres to help these newly minted citizens build a social life and gain skills for daily living. This exhibit charts this history, and provides a compelling – and personal – illustration of the inadequacies of an underfunded and underdeveloped community mental health system. Jayne Whyte takes us inside the precarious new world of community mental health.

A 1950s Pilot Project

A thick white cross is surrounded by a dark gray circle. Text within the circle reads "The White Cross for Mental Health"

The White Cross logo

Beginning in the 1950s, Saskatchewan was the first Canadian province to implement deinstitutionalization. The Saskatchewan division of the Canadian Mental Health Association (CMHA) played an important role in this. The CMHA, which had a history of advocating for improvements in the conditions of mental hospitals, now stepped forward to take on the role of providing community resources for mental health clients.

Assuming that discharged patients would be fully integrated into the community as employed people with active social lives, CMHA Saskatchewan developed a pilot project for rehabilitation services in the mid-1950s. Called White Cross Centres, these local facilities aimed to integrate patients into the community and help them relearn skills for daily living. Yet right from the start, support services were scaled back in a misguided push for economy. As was the case across Canada, a limited notion of the concept of rehabilitation and insufficient resources undermined the possibility of successful community living.

The funds saved as the large hospitals closed were not reinvested in the people who lived with mental illness, their families, community mental health services and non-profit organizations like CMHA in ways that empowered full citizenship and human rights.

This exhibit is based on a chapter from Pivot Points: A Fragmented History of Mental Health in Saskatchewan published by CMHA Saskatchewan (2012). The author has needed the community mental health system for most of her life. This may be your story too.

Rehabilitation Through Community Living

ink sketches of people doing activities: typing, dancing, making baskets

Living for years and even decades in residential facilities, many former patients had lost family support and the skills necessary to establish themselves in the world outside the institution. In addition, post-World War Two farming communities no longer used hired hands and female servants and the prairie economy of the 1950s also limited employment opportunities elsewhere.

In Saskatchewan, the CMHA adopted the concept of rehabilitation as central to their new mandate. (The term “rehabilitation” might now seem to have an old-fashioned ring and is often replaced by the term “recovery”.) Pioneered by New York’s Fountain House, rehabilitation held that people with emotional and physical impairments can learn practical and skills that will enable them to live as full members of the broader community.

According to William Anthony, a professor in rehabilitation services from Boston University, Mass.,

Deinstitutionalization focused on how buildings function; rehabilitation focuses on how people function. Deinstitutionalization focused on closing buildings; rehabilitation focuses on opening lives. Deinstitutionalization focused on getting rid of patient restraints; rehabilitation focuses on getting hold of person supports.

A 1956 Saskatchewan’s CMHA brief to the provincial government argued that rehabilitation was one of the most neglected areas of community mental health work in the province.

Provincial president Mrs. N. M. Toombs and executive director George Rohn described the Association’s role in rehabilitation programs as experimental, and as a pilot project created with the expectation that government would take on the task once its value had been proved. At a time when social programs were being created for survivors of the polio epidemic, CMHA lobbied for services for people with mental illness:

We commend the Government for appointing a consultant in the field of rehabilitation and we sincerely hope that expansion of the program will take place in the near future. It might be well to explore ways and means for the use of the Federal Rehabilitation Grants in the rehabilitation of the mentally ill.

The First Centre

ink sketch of building front with "White Cross Centre" sign and people waiting to enter

The first CMHA White Cross Centre opened in Regina in November 1955 with Mr. A. S. Mayotte as rehabilitation director. In the early days, organizers expected ex-patients to get jobs and attend a White Cross Centre for rehabilitation and recreation during evenings and weekends.

Regina’s Scarth Street White Cross Centre was designed as a one-stop resource for former patients. It was a place to go during the transition from hospital to community. Help was provided in finding housing and employment and gaining or regaining skills for daily living such as shopping and budget planning. The White Cross Centre “club” offered a large room where participants could dance to records and play table tennis and board games, and a small kitchenette where coffee and sandwiches could be made. A staff person and community volunteers managed the Centre under the direction of the CMHA Saskatchewan board.

Members of the White Cross Centre Club discovered that they formed a natural community and the CMHA recognized this as well. The centres were safe, de-stigmatized places where people with mental health difficulties living outside institutions could and did find supportive community among their peers.

At first, membership was small. But not for long. Ex-patients found that they could come and be themselves “without people looking at me as though I had two heads.” They could be with others who had problems similar to theirs.

…Here you could bring your fears, your anger, your need for a friend. Here, too, friendships were made, romances begun. Club members could rejoice, disagree and sympathize with one another, without someone standing in judgment of their behaviour.(SAB R1265 II.A. Kahan, Irwin “Somewhere to Go”)

Former patients looked out for one another and created lasting friendships. They monitored each other for signs of difficulty that might indicate a need for more help. When a member returned from another hospital stay, the members welcomed the person back.

The services were well used, and by 1956 centres had opened in Saskatoon, Regina and Weyburn. They offered programs for patients discharged from the large mental hospitals in Weyburn and North Battleford as well as new patients released from psychiatric wards on the Regina General Hospital and the Grey Nuns Hospital (now the Pasqua).

Not only patients, but also employers, wives, husbands and friends turned to the White Cross Centres, phoning from across the province for assistance and advice. Parents would enquire whether their son or daughter might attend. Spouses would call to see where their partner might get help.

Often families phone and say, “My son or daughter has nowhere to go, can she come to your club?” … Just as often, [parents] phone to say, “My son (or daughter) is easier to get along with since coming to the club.”

From its primary function of providing a safe and accepting place for patients and ex-patients, the Centre has become a place where one faces many of one’s problems. It is also a place where one can get advice. A husband may come in to say that the wife seems ill and incapable of looking after the children. (SAB R1265 II.A. Kahan, Irwin “Somewhere to Go”)

From Volunteers to Professionals

ink sketch of 4 "society ladies" wearing 1950s clothing

Montage of society ladies from Jayne's book & early 60s professional women.

ink sketch of 3 professional women wearing nursing uniforms, 1950s style

Montage of society ladies from Jayne's book & early 60s professional women.

The first White Cross centres were run by lay women who previously visited with patients at Weyburn and North Battleford provincial mental hospitals. These volunteers entertained former patients in their homes, which might surprise some people, and encouraged people living in group homes to get together at the White Cross Centres for fun and conversation in the evenings.

While volunteers continued to be important in CMHA rehabilitation efforts, professional social workers and psychologists soon moved in to direct the White Cross programs. By 1958, the Saskatoon Centre had expanded to employ a full-time social worker, as more patients from Saskatchewan Hospital in North Battleford needed help finding a job and a place to live.

A social worker or psychologist focused on restoring a person to a “full and satisfying life” by assessing the needs and problems of the person’s health, social and life circumstances, as well as perceived emotional or psychological problems.

The social worker would interview the patient to determine the patient’s motivation, interpret the illness to family, employer and others directly concerned. The social worker would help the patient make use of available treatment and vocational adjustment along with personal and social adjustment. The patient should do as much as he [or she] is capable of.

With the ultimate goal of finding mainstream employment for people returning to the community, the social worker evaluated this process: “Vocational help and job finding were necessary, but one of the more difficult functions.” It was very difficult for former patients to find their way into the labour force and. employers were reluctant to take a risk on someone for whom occupational programs in hospital were their previous “work experience.”

The social worker acted as a liaison with the hospital. Hospital psychiatrists provided discharge information to assist in follow-up, though some were reluctant to do so. The social worker was expected to know the community resources including the Department of Welfare, and to foster relationships with potential employers.

Reflecting a change of emphasis from pilot project to permanent CMHA program, the new director, Joyce Harman, staffed the Regina White Cross Centre, managed the clubs in Saskatoon, Swift Current and Weyburn, and was expected to expand the program to North Battleford and Prince Albert. Her complex duties included guidance and leadership for volunteers, liaison with mental hospitals, professionals and clubs, public speaking, public education and working with the media.

Expansion and Erosion

ink sketch of old town street with Empress Theatre depicted
ink sketch of modern 1960s low rise business building

By 1960 the Saskatchewan White Cross Centres were no longer focussing to integrate former patients into the labour force, shifting its emphasis to social programs. Activities and member attendance was growing at all the centres and CMHA board and staff were aware that the clientele of White Cross Centres had shifted to include people from the community referred by clergy and general practitioners. But a voluntary organization could not sustain the full range of services necessary to help people find housing and jobs, nor provide education and support to people running housing services. Tragically, no other organization or government body picked up the range of employment, education and housing services that the CMHA no longer offered.

Gradually, CMHA realized that if they were to continue to run the programs, they needed annual grants. The 1960 CMHA annual meeting discussed the respective roles of government and CMHA in provision and funding of rehabilitation services and the board requested and received a $10,000 rehabilitation grant from the provincial government.

This program funding moved White Cross Centres from an innovative experiment in services which CMHA believed the government would eventually provide, to direct services through a voluntary, non-profit organization. The Scientific Planning Committee developed a divisional policy regarding function, membership, evaluation, and job descriptions.

The role of the wider community sector was critical in the ongoing activities of White Cross Centres. In Regina, the Centre hosted a field program for student nurses to further the role of the nurse in social rehabilitation and benefited from financial and transportation assistance from the local Rotary Club. In Swift Current, the Kinsmen Club provided transportation to bring members to the White Cross Centre and to the Saturday Club for children with developmental disabilities. With the help of community organizations, CMHA North Battleford rented the Empress Theatre for the White Cross Centre in 1961 and hired the Supervisor at $90 per month for keeping the Centre open three days a week. As the programs expanded, the supervisors in the various cities requested pay increases.

When it became obvious that some centre clients were not ready for mainstream employment and few prospective employers ready to hire them, the White Cross Centre took on the role of “sheltered workshops”, with money from contracts to dismantle, sort or make items contributing to keeping their doors open. Into the 1970s, former patients took apart telephones, power meters and other equipment for recycling. One crew assembled plastic bags with a fork, napkin, and condiments for a fast food chain. A participant remembers turning countless strips of coloured plastic into “flowers” used to decorate parade floats and wedding cars. Members stuffed envelopes or shredded documents for CMHA and businesses that contracted for this service. Workers were paid a small honorarium, a few dollars a month, to ensure that their “earned income” was under the maximum allowed for people on Income Assistance.

CMHA was a member of the coordinating council that produced the 1960 provincial Special Report on Rehabilitation of Handicapped Persons in Saskatchewan. This report, never fully implemented, argued that a full range of employment, income, education, and social supports was needed if community mental health was to take real responsibility for people it was meant to serve. While the report recommended comprehensive planning and coordination of rehabilitation services through government departments of health, education and welfare, it also that acknowledged these might be limited in scope:

Ideally, it can be argued that for any disability, injury, or illness that occurs, restoration of every person towards optimum function is desirable. The rehabilitation process cannot, therefore, be divorced from the regular health, welfare, and education services of the community … For practical purposes, it becomes necessary to consider the rehabilitation process …more narrowly…, recognizing such realistic limits as finances, facilities, personnel supply, public demand and potential recovery of the individual in relation to the effort expended. [SAB R1265 IV.A.53 Special Report on Rehabilitation of Handicapped Persons in Saskatchewan, 1960]

In other words, the public, and organizations representing persons with disabilities, could not expect unlimited resources to meet their needs. Instead of the earlier ideal of “optimum function” or what CMHA had called “a full and satisfying life”, the new standard was more modest, “a functional goal would seem to be the restoration of handicapped persons to a level adequate for them to maintain their place in society with minimal dependence on others.”81

A complete range of services is, in a sense, a minimum requirement. For instance, the benefits of existing medical and psychiatric restorative services are diminished or dissipated without the complementary support (psychological, social, educational and vocational) required by the disabled to achieve maximum independence. Successful treatment of persons suffering from psychosis, for example, is of questionable value without sufficient skilled social and vocational staff to rehabilitate the patient into the community. (SAB R1265 IV.A.53 Special Report on Rehabilitation of Handicapped Persons in Saskatchewan, 1960)

Saskatchewan’s White Cross Centres were just one of many early plans for a comprehensive system of community mental health services that were never truly implemented. Doctors, hospitals, and mental health clinics focused on the medical needs of persons with chronic and acute mental illness. Income, employment, housing, education and other supports were not integrated into a system of mental health care. Psychologists and other counselors are often not covered under Medicare. The new population of persons who received counselling and treatment for mental disorders might never have been hospitalized, but that did not mean that their illnesses were less severe and disabling. As a voluntary agency based in the cities, CMHA could not meet the serious psychological, social, educational and vocational needs of people living with mental illness throughout the province. They and their families continued to fall between the cracks, without comprehensive and co-ordinated programs and supports in community mental health services.