Name(s) of Institution:
Hospital for Mental and Nervous Diseases (HMND) Waterford Hospital (renamed 1972)
St. John’s, Newfoundland
Period of Deinstitutionalization:
In 1969, Barbara Patterson compiled statistics based on a random sample of 61 out of 139 patients at HMND (36 female, 25 male). The average age of female patients was 34.9 and of male patients, 36.8. Psychogenetic reaction was the most common diagnosis in females and males of 18 and 12 respectively. Source: Patterson, Population of the Day Centre.
Following the Second World War, the hospital began intensive training at all levels with a focus on modern nursing concepts and practices in occupational and recreational therapy. The prevailing theory was that the “total patient” had to be treated. At this time, it also became obvious that many patients would benefit from family therapy. By 1946, outpatient day services had been initiated, which allowed patients to receive treatment without being institutionalized.
When Newfoundland entered Confederation on March 31, 1949, it became eligible for federal health grants. This also meant a reorganization of provincial health services as the hospital now fell under the jurisdiction of the provincial Department of Health, distinct from the Department of Public Welfare. Between 1949 and 1953, 80 percent of HMND’s federal grant was spent on equipment and staff. With the increase of proper staff and facilities, occupational and recreational therapy became a reality. Patients could attend adult educational classes, and there was now enough space for patients to assemble for weekly dances, movies twice a week, and Sunday church services.
In 1951, the Mental Hospital Service Centre, a combination of an outpatient department and day care unit, was opened. There was a particular emphasis placed on treating early psychoses and non-psychotic conditions. The centre offered several advantages: patients could retain family contact and, if possible, the family could be involved in treatment. The centre also allowed patients to avoid becoming institutionalized and served as a bridge for former in-patients. In addition, it was a treatment option for patients who otherwise may have been unwilling to receive treatment. The typical length of stay was reduced and its cost was a half to a third as much as that of full hospitalization. By 1952, the hospital had opened the first two day centers in Canada.
From 1958 to 1959, patients who demonstrated the ability to handle responsibility were given more freedom and began to live on open wards. By 1969, the hospital had 220 patients with these privileges. In 1962, an eighteen-bed rehabilitation unit for female patients was opened and administered by the nursing department. It was a household management unit designed to build independence and self-reliance. The program initially focused on household tasks, but expanded to encompass workplace situations. Between 1962 and 1967, 800 female patients passed through the unit, with 600 going on to become gainfully employed (usually in the fields of domestic, laundry, or catering services) or moving into boarding care and independent living situations. By 1972, about 300 former in-patients lived in thirty boarding homes outside the hospital in the Conception Bay area. The HMND and the government jointly administered these homes.
In 1949, the hospital established the Family Care Programme for patients who did not have relatives or a place to live, but were considered capable of living in the community. In order to free up hospital beds, these patients were discharged to boarding houses. The Department of Public Welfare provided housing, clothing, and pocket money, while the HMND was responsible for supervision and care. By December of 1956, the program had five homes caring for twenty-nine patients. In 1969, 864 patients were placed in homes. Of this group, 529 were readmitted to the hospital while 143 left the program and moved into independent living situations.
In 1961, the Mental Health Services Division, headed by Clarence Pottle, was established by the Department of Health to coordinate services in the province’s general hospital system. The division was created in response to the logistical difficulties faced by patients who required care outside of the St. John’s area. This division also oversaw the HMND.
In 1965, as part of a commission to study the future of health care in the province, Lord Brain held hearings to address the concerns raised by the provincial Canadian Mental Health Association that found that the HMND’s ability to deliver adequate services was negatively affected because of gross overcrowding due to a lack of institutions in the province. In response to the 1966 Royal Commission on Health report, Newfoundland began to decentralize its health services. For mental health services, this move to regionalization meant the establishment of integrated psychiatric services in general hospitals. In 1970, general hospitals had 1,200 admissions compared to the HMND’s 998.
The idea was that hospitals would provide the bulk of short-term care while the HMND would provide specialized referral services, allowing it to concentrate on issues such as creating de-institutionalization programs for long-term patients. HMND staff argued that distance, transportation, and communication presented unique problems for mental health care in Newfoundland. These problems were minimized by providing physicians serving outlying communities with comprehensive discharge reports to help them with patients’ aftercare. In 1979, the Community Care Recreation & Activities Centre in Long Pond became fully operational. The centre provided programs and opportunities for patients and was an important point of contact between patients and the community.
Work Therapy into Occupational Therapy:
In 1952, HMND began its first adult education classes. In 1955, the occupational therapy department produced the first issue of the hospital’s newsletter, The Echo. The newsletter received contributions from staff and patients. The 1957 edition of The Echo discussed the exhibition “Occupational Therapy as an Aid to the Rehabilitation of the Psychiatric Patient” for Mental Health Week. This therapy was a program of activity designed to give patients full and normal workdays made up of a mixture of domestic work, creative activities or jobs, recreation, social activity, and exercise. It emphasizeds that the ultimate goal was a patient who got better; the resulting craftwork that often went on sale was merely a by-product. In 1969, Rehabilitation Services, which had previously existed only for female patients, was expanded to include male patients. This included the “Caribou Workshop” (special assessment and treatment centre) for short- and long-term patients, which employed diverse forms of work to assess abilities and provide opportunities to patients. The workshop included pottery, art therapy, carpentry, preparation of driftwood, painting, weaving, sewing, and laundry service, while the Occupational Therapy Program used more traditional activities such as leather craft and basket making. Funds from the sale of finished goods were used to provide patients with benefits, including day trips. Out of the 175 patients referred to the Caribou program in 1969, 77 were discharged into the community.
Patient into Person:
In 1954, CBC radio aired a program spotlighting the HMND’s Caribou group. The group was active in many patient programs, including establishing two canteens, the Caribou Workshop, the Patient’s Welfare Fund, and an art fund. They headed activities such as dances, birthday parties, bingo, concerts, movies, sporting events, and picnics. In 1964, an article in the Psychiatric Nursing Digest, which was published for graduate nurses at the HMND, stated that doctors, nurses, social workers, occupational therapists, and recreation workers must now take a group approach to patient cases. This involved discussing the details of a patient’s life in order to develop a tailored approach to diagnosis and therapy. This problem-solving approach reflected the growing interest in treating the whole person and emphasized motivation and goal seeking in potential solutions. The recreational therapy program involved sports, music, and dance as a way to help individuals with their interpersonal relationships. The article stated, “This method is based on respect for every human being, regardless not only of race, color, and creed, but also of age, sex, and emotional, mental, or physical handicaps.” In May 1964, the Psychiatric Nursing Digest discussed the benefits of the “Remotivation” technique, a simple group interaction used by psychiatric aides. It was described as “a structured activity, which enables him to reach his patients in a meaningful and constructive way, over and above the daily custodial care.” By 1969, the HMND had established a patient council with an elected executive. This was based on the principle that the patients should have maximum participation in and control of their environment. The council’s main task was to handle the practical details on the ward, such as the activities schedule. Patterson’s 1969 report stated that the hospital’s philosophy emphasized psychotherapy, therapeutic milieu, resocialization, and the earliest possible return to living in the community. The HMND’s goal was to treat patients with their families and not in isolation. Group psychotherapy sessions were also initiated in an effort to develop social skills and renew patients’ interest in social relations.
Staffing in the Deinstitutionalization Era:
A full-time dentist was appointed to the hospital around 1950. Three years later, a prosthetics laboratory was established with federal funding. A physiotherapy department was established in 1952–1953. All patients were treated yearly, with 84 percent of them requiring immediate treatment.
In 1952, the position of mental-health education officer was created by the hospital through a federal health grant and filled by Charles Strong. He was responsible for establishing contact between public and private agencies working in the mental health field. He was also tasked with fostering a positive public awareness of mental illness.
In February 1964, the first issue of Psychiatric Nursing Digest was published for graduate nurses at the HMND. The hospital believed this was an important publication since it was becoming more common for nurses to be employed in the field of mental health. As well, the publication was an acknowledgement that nurses played a leading role in care, supervision, and the administration of extended community care programs.
In 1964, Psychiatric Nursing Digest said that there was an urgent need for graduate nurses with special training in general psychiatric nursing, clinical supervision, teaching, and administration. Potential candidates could receive bursaries for university beginning at $160 permonth, but a service commitment was required after graduation. In 1969, the Day Care Centre at HMND was under the direction of Dr. Bishwarp Bhattacharya. The staff consisted of one other psychiatrist, a social worker, a full-time graduate nurse, three nursing assistants, an occupational therapist, physiotherapy staff, and administration staff. In 1972, the hospital, now called Waterford Hospital, formally affiliated its residency program with the new Department of Psychiatry at Memorial University.
Government of Newfoundland. “New Nurses’ Home at Mental Hospital Opened in March.” Newfoundland Government Bulletin, March/April 1952, 26. Hospital for Mental and Nervous Diseases (HMND).
“Concepts in Mental Hospital Treatments.” Hospital for Mental and Nervous Diseases Report. 1969. Joseph R. Smallwood Collection, Centre for Newfoundland Studies. Hospital for Mental and Nervous Diseases (HMND).
“Home Care Programme.” Hospital for Mental and Nervous Diseases Report. 1969. Joseph R. Smallwood Collection, Centre for Newfoundland Studies. Hospital for Mental and Nervous Diseases (HMND).
“Patient Care.” Hospital for Mental and Nervous Diseases Report. 1969. Joseph R. Smallwood Collection, Centre for Newfoundland Studies. Hospital for Mental and Nervous Disease (HMND).
“Further Notes on Remotivation.” Psychiatric Nursing Digest vol. 1, issue 4 (May 1964). Hospital for Mental and Nervous Disease (HMND).
“New Preparation for New Roles.” Psychiatric Nursing Digest vol. 1, issue 2 (March 1964). Hospital for Mental and Nervous Disease (HMND).
“Opportunities for Graduate Nurses in Mental Health Programmes.” Psychiatric Nursing Digest vol. 1, issue 3 (April 1964). Hospital for Mental and Nervous Disease (HMND).
“The Psychiatric Head Nurse.” Psychiatric Nursing Digest vol. 1, issue 2 (March 1964). Hospital for Mental and Nervous Disease (HMND). Psychiatric Nursing Digest vol. 1, issue 1 (February 1964). Hospital for Mental and Nervous Disease (HMND).
“Guest Editorial.” The Echo vol. 2, issue 4 (April 1957). O’Brien, P. Out of Mind, Out of Sight: A History of the Waterford Hospital. St. John’s: Breakwater, 1989.
Patterson, B. Characteristics of the Population of the Day Centre of the Hospital for Mental and Nervous Diseases. St. John’s: Memorial University of Newfoundland, 1971.
Smallwood, Joey, editor. “Hospitals.” In Encyclopedia of Newfoundland and Labrador, Vol. 2, 1074. St. John’s: Newfoundland Book Publishers, 1981–1994.
Tancock, T. “Sidelights of Recreational Therapy.” Psychiatric Nursing Digest vol. 1, issue 3 (April 1964). Waterford Hospital.
“Medical Director’s Report.” Fourth Annual Meeting of the Waterford Hospital Report. November, 1977.
Waterford Hospital. “Proceedings of the Waterford Hospital Seventh Annual Meeting.” Seventh Annual Meeting of the Waterford Hospital Report. October, 1980.