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Constructing consent : the emergence of corporatism within the Vancouver mental health system Burnell, Thomas 1992

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CONSTRUCTING CONSENT: THE EMERGENCE OF CORPORATISM WITHIN THEVANCOUVER MENTAL HEALTH SYSTEMBYTHOMAS BURNELLB.A. (Hons.), University of British Columbia, 1981A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FORTHE DEGREE OF MASTER OF ARTSinTHE FACULTY OF GRADUATE STUDIES(Department of Anthropology and Sociology)We accept this thesis as conforming to the required standardTHE UNIVERSITY OF BRITISH COLUMBIADecember 1992© Thomas Burnell, 1992In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature Department of Anthropology & SociologyThe University of British ColumbiaVancouver, CanadaDate December 29, 1992DE-6 (2/88)ABSTRACTAn examination of developments between 1970-1990 demonstratea substantial restructuring of relations between the state andnonprofit societies within Vancouver's mental health system.While helping to establish and support the growth of nonprofitsocieties, the state, during the 1970's, maintained a "hands off"relationship with the nonprofit sector. Throughout the 1980's andearly 1990's, state intervention into the affairs and aspirationsof nonprofit societies dramatically increased, primarily throughthe establishment of corporatist arrangements. Such arrangementsnecessitated the establishment of non-aligned intermediaryorganizations to regulate and monitor activities within thenonprofit sector.The establishment and development of nonprofit societiesand the subsequent restructuring of relations between the stateand nonprofit societies is explored through an examination ofcorporatism. This examination includes a detailed case study oftwo nonprofit societies operating in the city of Vancouverbetween 1972 to the present, the Coast Foundation Society and TheGreater Vancouver Mental Health Services Society. The methodologyutilized includes analysis of secondary data, archival anddocumentary materials, and personal interviews with a number ofkey informants previously or currently employed within the mentalhealth system. Analytic themes from the literature on pluralismand corporatism, along with Claus Offe's theoretical examinationof state-interest group relations, are used to explain theconstruction of corporatism during this period.While the inquiry provides a detailed account ofiidevelopments within Vancouver's mental health system through acase study approach, broader issues are also explored. The impactof macro economic changes, especially the effect of therecessionary period during the 1970's, is crucial inunderstanding changing state priorities and the subsequentconstruction of corporatism. An understanding, therefore, of theway in which corporatism relates to the broader reconstruction ofconsensus within late capitalist societies is an important focusof this study.iiiTABLE OF CONTENTSABSTRACT i iLIST OF TABLESACKNOWLEDGEMENTSviviiCHAPTER 1: INTRODUCTION  ^1THEORETICAL PERSPECTIVES ON STATE-INTEREST GROUPRELATIONS  ^6CORPORATIST THEORY: AN ALTERNATIVE TO PLURALISM .^8THE STATE, CLAUS OFFE AND CORPORATISM ^ 10CHANGING POLITICAL RATIONALITY ^  13CORPORATISM AND THE POLITICAL SYSTEM  16TRIPARTISM: A FORM OF CORPORATISM  17OFFE: A CRITIQUE ^  19CORPORATIST ELEMENTS  22CORPORATISM AND LEGITIMACY ^  23THE NONPROFIT SECTOR: A DEFINITION ^  26THE NONPROFIT SECTOR AND CORPORATISM  30SUMMARY ^  33ENDNOTES  36CHAPTER II-THE EVOLUTION OF VANCOUVER'S MENTAL HEALTH SYSTEMFROM 1972 TO 1992: A CASE STUDY IN CORPORATISM ^ 38ONE OF THE ANCILLARY SERVICES: THE EMERGENCE OF COASTFOUNDATION ^  48THE CENTRALIZATION OF SOCIAL SERVICES AND THE STATE . ^ 58CENTRALIZATION AND THE VANCOUVER MENTAL HEALTH SYSTEM ^ 62THE HOUSING CRISIS OF 1979-1980: THE RAPID EXPANSION OFCOAST FOUNDATION ^  64RECESSION AND RESTRAINT: TOWARDS CORPORATISM ^ 68RECESSION AND RESTRAINT: THE RIVERVIEW PROBLEM  72RECESSION AND RESTRAINT: DEVOLVING STATE AUTHORITY TOGVMHSS ^  81THE CONSTRUCTION OF CONSENT: GVMHSS'S SUPPORT OF THENONPROFIT SECTOR ^  86TACTICS OF AGGRESSION: THE ENCROACHMENT OF THECOMMUNITY RESIDENTIAL SECTOR ^  90COAST FOUNDATION-1985-1991: FROM INTERNAL STRIFE TOCORPORATE STRUCTURE ^  95ENDNOTES ^  104ivCHAPTER 3- CORPORATISM: TOWARDS AN EMPIRICAL AND THEORETICALUNDERSTANDING OF STATE-INTEREST RELATIONS INVANCOUVER'S MENTAL HEALTH SYSTEM104THE CONSTRUCTION OF CONSENT IN POST-1945 CANADA . . . ^ 106THE EMERGENCE OF THE NONPROFIT SECTOR IN VANCOUVER'SMENTAL HEALTH^ SYSTEM ^ 110CENTRALIZATION, CRISES, AND THE EMERGENCE OFCORPORATISM  116ENDNOTES ^  138BIBLIOGRAPHY  145APPENDIX A .^  151APPENDIX B: GLOSSARY OF TERMS ^  155VLIST OF TABLESTABLE I: HISTORICAL TRENDS AFFECTING THE DEVELOPMENT OFNONPROFIT SOCIETIES IN BRITISH COLUMBIA'S MENTALHEALTH SECTOR. ^TABLE II: CHRONOLOGICAL DEVELOPMENT OF COAST FOUNDATION AND THEGREATER VANCOUVER MENTAL HEALTH SERVICES SOCIETY . 47viACKNOWLEDGEMENTSThe research for and preparation of this thesis would nothave been possible without the guidance, support, and assistanceof many people. I am indebted to my senior supervisor - Dr. BobRatner -for his patience, constructive criticism, and unremittingfaith in this thesis. The various drafts of this thesis havereceived helpful criticism and support from Dr. John O'Connor andDr. Nancy Waxler-Morrison. To all three of these people I am verygrateful.Other forms of assistance were provided by a great number ofpeople. I would like to thank Ms. Lucie Hanson, from the GreaterVancouver Mental Health Services Society, for her openness andassistance in providing valuable written material and inidentifying many of the key people interviewed throughout thisinquiry. Mr. Peter Tomlinson provided a wealth of information onthe early days of Coast Foundation.To my work colleagues, my thanks for your understandingduring the times that I became obsessed with getting this studyfinished. To my children, Aaron and Tristan, thank you for yoursupport, and to Janet Burnell a special thanks for yourassistance and patience during the formative stages of thisthesis.viiCHAPTER 1: INTRODUCTIONThe "peace formula", or compromise, worked out between capitaland labour after World War II led to the unprecedented expansion ofthe welfare state in western democratic societies. The stateassumed responsibility for providing universal social service,especially in the areas of health, welfare and education (Joppke,1987: 237). "Universal" social services equates with the provisionof services for all citizens, such as public education for allchildren. The post-war economic boom, which generated additionalrevenues for governments through increased taxation, funded theexpansion of welfare services.The emergence of the welfare state created unparalleledexpectations and demands. Having obtained universal services andrights, specific interest organizations lobbied the state foradditional resources and legislation protecting minority rights.One of the minority groups that received considerable attentionthroughout the 1960's and 1970's was the mentally ill. Maintainingthe mentally ill in segregative, isolated institutions conflictedwith the state's new role as provider of fundamentally"reasonable" and humane standards of living. The state, therefore,had to respond to demands for the closing down of mental hospitals.Such demands were strongly forwarded by the psychiatric profession,who wanted to be integrated into the medical mainstream, by civillibertarians, who advocated basic civil rights for the mentallyill, and by social scientists, who criticized the deplorableconditions of the total institution(Busfield, 1986). Theconvergence of these reform forces with the growing belief withingovernment circles that "community care was more economical than1institutional care", resulted in the adoption ofdeinstitutionalization policies, beginning in the late 1950's, bymost levels of government in the United States and Canada (Ayre,1986: 89).In British Columbia, despite the creation of some alternativeresources in the 1960's, the dramatic reduction in hospital bedsleft many of the mentally ill homeless and without adequateclinical support, a situation exacerbated by the complete absenceof resources in the city in which the majority of the mentally illresided, Vancouver.By 1972, the lack of services in Vancouver was resoundlycriticized by psychiatrists, municipal officials, and the press.Responding to pressure from these groups, the provincial governmentcontracted with different societies, private and nonprofit, toprovide clinical, residential, and rehabilitation services. By theearly 1980's, the two prominent societies within Vancouver's mentalhealth system were the Greater Vancouver Mental Health ServicesSociety (GVMHSS) and Coast Foundation Society 1 .During the 1970's, the relationship between the state andVancouver's nonprofit societies can be characterized as reactionaryand passive. Responding to escalating demands, the state annuallyincreased its financial support to nonprofit societies. Yet,despite considerable state funding, the nonprofit sector wassubject to only minimum reporting requirements. By 1985, therelationship between the state and nonprofit societies had changeddramatically. The state introduced a number of measures to ensureaccountability and to regulate the nonprofit sector, such asenforcement of licensing requirements, introduction of care2standards, and implementation of a contracting system which clearlyoutlined contractual requirements and obligations.The shift towards greater accountability and regulation wasaccentuated by the economic recession of the late 1970's. Facedwith restricted funding, the state was cognizant of the need toensure that public monies were efficiently and effectively spent.As well, funding limitations restricted the state's ability tosatisfy the escalating number of demands emanating from Vancouver'snonprofit sector.Paradoxically, while state officials were faced with the taskof curtailing and regulating Vancouver's nonprofit societies, theywere aware that the imposition of new institutional arrangementswas politically hazardous. The plight of the mentally ill was apublicly sensitive issue and nonprofit societies were capable ofgalvanizing support in any potential conflict with the state. Thechallenge facing the provincial state throughout the 1980's,therefore, was the implementation of new institutional arrangementswithout engendering widespread conflict. Table I outlines some ofthe major historical developments which affected developmentswithin Vancouver's mental health system.TABLE I: HISTORICAL TRENDS AFFECTING THE DEVELOPMENT OF NONPROFITSOCIETIES IN BRITISH COLUMBIA'S MENTAL HEALTH SECTOR.StateAfter 1945, emergence of thewelfare state at the federallevel leads to the developmentuniversal services.By^1970,^administrativeresponsibility for welfareprograms is transferred to theprovincial state. Funding forsocial programs is jointlyMental HealthProvincial government pursuesactive policy o fdeinstitutionalizationbeginning in the late 1950's.Marginal^development^ofresources for the mentally illprior to 1970.Legal changes throughout the3In 1972, beginning with the NDPgovernment and continued by thesucceeding Social Creditgovernment, the state supportsthe rapid expansion ofnonprofit societies inproviding social services tospecific targeted populations.By 1980, the provincial statecentralizes policy-making andsocial service administrationwithin the provincial state.By 1980, issues of systemcoordination, rationalizationof multiple funding, andmonitoring of nonprofitsocieties are discussed at theprovincial level.In 1983, the provincialgovernment introduces restraintmeasures. Such measures meetwith considerable resistance.In efforts to depoliticizesensitive issues, theprovincial state utilizes anarray of consultative processesto generate consensus.While maintaining authority forpolicy development, theprovincial state decentralizesadministration of socialservice programs to the locallevel.Responding to public criticism,the state, throughout the1970's, conducts a series ofstudies evaluating provincialmental health services.Responding to an escalatingcrisis, the provincial statehires a consultant to design aplan for the development of newservices in Vancouver. Theplan, calling for servicedelivery based upon catchmentareas, is implemented duringthe early 1970's.In 1982, in response to thehousing crisis and imminentprovincial cuts a number oforganizations form anorganization called TheAdvocacy Group. The AdvocacyGroup becomes the Inter-AgencyMental Health Council. CoastFoundation and GVMHS acceptleadership roles within thecouncil.In 1985, faced with increasingpressure to cut backexpenditures, Mental HealthServices turns its attention toclosing down RiverviewHospital. Recognizing thatclosure of Riverview is apolitically sensitive subject,the provincial state begins anexhaustive consultationprocess.In 1987, the provincialgovernment releases the resultsof the consultation processthrough a document called theMental Health ConsultationReport.In 1987, the provincialgovernment delegatesresponsibility for monitoringnonprofit societies to localadministrators.shared by the federal andprovincial states.1960's aimed at protecting thementally ill while residing inthe community.4In 1991, the provincialgovernment takes the firststeps towards closing downRiverview hospital.This thesis will examine the ways in which the state was ableto forge new institutional arrangements with Vancouver nonprofitsocieties after 1980. The restructuring of relations between thestate and the nonprofit sector will be described as a complexprocess which required the state to devolve some of its power tointermediary organizations in order to construct a new consensus.The impact of new institutional arrangements on two specificnonprofit societies, Coast Foundation Society and the GreaterVancouver Mental Health Services Society (GVMHSS) will beinvestigated extensively. Note: As many of the acronyms are usedcontinually throughout this thesis, the reader may want to refer tothe glossary of terms in Appendix II.The remainder of this first chapter provides the theoreticalunderpinnings of the thesis. Specifically, the chapter will examinethe theoretical literature on state-interest group relations. Afterreviewing pluralist and corporatist theories, this inquiry willexamine the merit of Claus Offe's argument on corporatism inexplaining the shift in relations between the state and nonprofitsocieties after 1980.The second chapter empirically traces the emergence ofVancouver's nonprofit societies during the 1970's, examines theimpact of socio-economic forces upon the state, describes therestructuring of state priorities in the 1980's and explores theimpact of new state priorities upon state-nonprofit relations.5Chapter three evaluates empirical developments in light of Offe'stheoretical perspective, and offers observations on likely futuredevelopments within Vancouver's mental health system.THEORETICAL PERSPECTIVES ON STATE-INTEREST GROUP RELATIONSUntil the early 1970's the dominant paradigm analyzing state-interest group politics was pluralism (Williamson, 1989: 49).Pluralist theory argues that society can be viewed as anaggregation of "...individuals who can be seen to behavecollectively" (op cit: 51). Individuals will come together ingroups, or organizations, to lobby the state for resources orfavourable policy initiatives. Groups organized around certaininterests will be in direct competition with other groups. Forexample, while farmers and farm workers collectively lobby thegovernment for agricultural subsidies, teachers, at the same time,are also lobbying for more favourable conditions.In the pluralist paradigm, ...influence is widely, notequally, dispersed" (op cit: 52). Consequently, while some groups,i.e. capital, have an unequal access to resources, their influenceis held in check by the presence of numerous other groups.Polyarchy, a central concept within pluralism, emphasizes "...ruleby minorities rather than rule by a majority" (op cit: 53).Another way in which interest group power is held in check isthrough the state. For pluralists, the state is the arena intowhich interest groups bring their issues for mediation. In actingas an impartial umpire between competing groups, the state seeks toensure "...a degree of fairness in the balance of influence amongdifferent organized interests" (op cit: 55). The poor and thedisorganized turn to the state to act on their behalf against more6organized and powerful interest groups.The pluralist paradigm has been criticized from many differentangles. Citing Alan Cawson, Peter Williamson writes:"Pluralism has proven to be deficient because of itsunderlying assumptions of a competitive political marketplace,its voluntarism and methodological individualism in itsimplicit theory of interests, and especially in its portrayalof a neutral state which is disengaged from interest conflictsas the same time as it preserves an institutional andideological boundary between public and private spheres" (opcit: 57).The primary criticism of the pluralist model is its portrayalof the state. Indeed, Williamson argues that the state in thepluralist paradigm is completely "non grata"(op cit: 55).Essentially, the state is the arena in which group politics is"...brought to bear. In this schema the state mirrors society,being shaped in its decisions and structure by outside pressures"(op cit: 55). By viewing the state as a reflection of society,pluralism is unable to conceptualize the state as an actor in itsown right capable of setting the political agenda and exercisingpower to develop its own organizational structures (Albo andJensen, 1989: 200).The pluralists narrow definition of the state further reducesthe importance of the state in their studies. The state is oftendefined simply as a democratically elected and accountablegovernment. State institutions, such as the bureaucracy, are oftenexcluded in the pluralist examination of state-interest grouprelations. Yet, with the emergence of the welfare state, and theenlargement of the bureaucracy thereupon, a theory of state-interest group relations requires an adequate understanding of therole state institutions play in determining government policies and7in monitoring state funded interest groups.CORPORATIST THEORY: AN ALTERNATIVE TO PLURALISMResponding to growing disenchantment with pluralism,Philippe Schmitter, in 1974, wrote an essay, "Still The CenturyOf Corporatism", in a attempt to offer an alternate understandingof the development of state-interest group relations withinsociety (Williamson, 1989: 9). Schmitter begins his essay byproviding a clear definition of corporatism:Corporatism can be defined as a system of interestrepresentation in which the constituent units areorganised into a limited number of singular,compulsory, noncompetitive, hierarchically ordered andfunctionally differentiated categories, recognised orlicensed (if not created) by the state and granted adeliberate representational monopoly within theirrespective categories in exchange for observing certaincontrols on their selection of leaders and articulationof demands and supports (op cit: 10)Schmitter's definition is diametrically opposed to pluralistpropositions. Schmitter recognizes that interest groups aredependent, not independent, upon the state for sanctioning orstatus 2 . He also recognizes that interest groups often worktogether, as opposed to being in perpetual competition with eachother, and are often represented by a specific association ororganization.Unlike previous studies of corporatism, which emphasized theincorporation of interest groups in the formulation of publicpolicy, Schmitter's definition treats corporatism as aninstitutional structure. As such, corporatism is viewed as asystem which structurally restricts competition and opennessamong organized interests.Corporatist theory has undergone considerable development8since 1974. The first revision to Schmitter's initial treatmentof the subject occurred during the late 1970's. At this time,Schmitter to discusses corporatism as a system of interestintermediation rather than interest representation (op cit: 14).The distinction is important. Interest intermediation recognizesthat "...interests associations could also perform a regulatoryfunction over their members in a quasi-public manner" (op cit).Instead of simply representing an interest sector, intermediaryorganizations act as intermediaries between the state and otherinterest organizations. As well, intermediary organizations areable to exercise power in regulating and sanctioning otherinterest organizations within a given sector.Given the importance of intermediary organizations tocorporatist arrangements, a greater understanding of theseorganizations has been the central focus of the corporatistparadigm since 1985. A new dimension to the corporatistliterature was added when a number of empirical studiesdemonstrated that the state since the late 1970's wasincreasingly willing to devolve power to organizations known asprivate interest governments, or PIGs. Schmitter offers thefollowing definition of PIGs:"A private interest government exists where a non-stateassociation allocates goods, services or status that aremonopolistic in nature and indispensable for members; it istherefore capable of affecting and potentially controllingtheir behaviour, and does so with the specificencouragement, license or subsidisation of the state, thusimposing certain public standards and responsibilities onthe behaviour of the association" (Schmitter, 1985: 47)PIGs, therefore, are accorded the equivalent of state power overa particular interest sector.9The definition of a PIG excludes organizations such assecret societies, business corporations, cartels and QUANGOS. Allthese organizations either do not "...have members in the samesense as an interest association, or they do not represent ageneric social category, and/or they have not received a mandatefor exercising public functions (op cit: 47).Whereas corporatist literature has been effective inadvancing an understanding of state-interest group relations, forclearly defining the term corporatism, and for advancing anunderstanding of the role of intermediary organizations in theestablishment of corporatist arrangements, a number of problemsremain with the corporatist literature. First, despite theimportance of the state to the corporatist paradigm, the stateremains theoretically underdeveloped within the literature.Second, in narrowly studying institutional arrangements,corporatist literature has ignored the interconnection betweensocial-economic and political developments and the emergence ofcorporatism within society. To date, corporatist theorists haverelied upon Marxist historical and theoretical studies, mostnotably those of Claus Offe, to offset deficiencies within thecorporatist paradigm.THE STATE, CLAUS OFFE AND CORPORATISMInstead of portraying the state as a neutral arbitrator, thestate, for Marxist state theorists, is structurally andinstitutionally committed to protecting and advancing the long-term interest of capital 3 . Structurally, Marxists argue that thecapitalist state "depends upon revenue from privately organizedmaterial production" to sustain its many social services (Joppke,1 01987: 239). Its reliance upon a healthy economy requires thestate to ensure favourable conditions exist for capitalaccumulation. Instead of acting as neutral umpire, the capitaliststate reflects a strong class bias and enacts policies thatenables capital to maintain a distinct advantage over otherinterest groups.While the capitalist state is intricately connected tocapital interests, there are critical differences betweencapitalist arrangements in non-democratic and democraticsocieties. In non-democratic societies, the state's coerciveinstitutions (the police, judiciary and the military) are oftenutilized to protect and advance capital interests. Fascist andthe military regimes of Latin America are often cited as examplesof non-democratic capitalist states.While the democratic state in capitalist societiesmaintains a large coercive apparatus, it relies upon "consent" tomaintain the social conditions favourable for capitalaccumulation. In other words, the state relies upon support fromall classes for its policies and activities. The state willinduce organizations to voluntarily comply with policies thatclearly enhance capital interests. Conversely, to ensure thelong-term viability of capitalism, the state will enact policiesdetrimental to the short-term interests of capital. As Joppkeargues, the post-war enactment of labour and factory legislationand the exponential growth of the state in the areas of socialexpenditures (subsidized health care and housing), resulted in astrengthening of organized labour vis-a-vis capital(op cit: 237).In turning his attention to the question of state-interest11group relations, Claus Offe argues that the basis of consent, priorto 1970, relied upon the state's ability "...to serve as many ofthe specific demand inputs as possible, given the limitations offiscal and other resources, so as to satisfy a maximum of specialinterests"(Offe, 1985: 224). In other words, the state recognizedthat increasing demands emanating from civil society were a given,and the state's prime objective was to satisfy as many demands aspossible.In satisfying demands, the state was required to expand , orencroach, into areas of civil society previously autonomous fromits domain. Despite expansion, however, the state, as portrayed byOffe, remained passive and reactionary: "Again, the standard ofrationality is to make 'adequate' responses to problems that areaccepted as they emerge"(op cit: 225). Indeed, the state exercisedminimal control over the burgeoning interest groups and theirdemands. As Offe contends, policy makers were not interested incontrolling the "intensity and content of specific demands that arebeing made in the political process, nor over the number andidentity of organized collectives by which such demands are beingmade" (op cit: 223).Despite the proliferation of interest groups since 1945, thestate, for Offe, retains its class bias throughout. Theeffectiveness of an interest group to access state policy makersincreases the likelihood that its demands are heard and satisfied.As empirical studies by Panitch, Miliband, Clement havedemonstrated, relations between business interests and stateofficials in a capitalist society are interconnected(see Panitch,1977; Miliband, 1969; Clement, 1975). The close association between12business and the state ensures business demands are considered andgiven priority. Therefore, capital interests have an advantage overother interest groups in getting their demands fulfilled.Changing Political RationalityEconomic expansion throughout the 1950's and 1960's enabledthe state to sustain increasing levels of social investmentsnecessary for capital accumulation-urban infrastructure, researchand development, education and training, etc- and socialexpenditures necessary for legitimation(Joppke, 1987: 239). Withthe onset of the recessionary period after the mid-1970's the statefound itself under pressure to stimulate the economy by reducingsocial expenditures and increasing social investments. Of course,reductions in social expenditures threaten to undermine the veryfoundation upon which the welfare state was built: "The basis ofthe capital-labour accord- a "positive-sum" growth economy-vanished, and the instrument of class compromise itself became theobject of intense social and political struggle(op cit: 244)."In response to the "economic and institutional crises" of themid-1970's, the state shifted from one type of politicalrationality to another. Offe is quite vague as to what he means byeconomic and institutional crises. However, one assumes Offe isreferring to the "fiscal crisis" that confronted most westerncountries in the early 1970's(see O'Connor, 1973).Politically, the state could no longer fulfil the insatiabledemands stemming from civil society. Demands needed to bechannelled into something more manageable, and interest groupsneeded to be contained and monitored. One feature of the newrationality, the channelling of demands, required the state to13become more active in shaping political priorities. No longer couldthe state simply respond to demands as they emerged. The state hadto assume an active role in establishing the political agenda andgenerating consensus for that agenda.The "new political problematic" facing the state was to createconsensus in an era when conditions were conducive to civil strife:to ensure long term survival, interest groups vying for decliningstate resources are inclined to political action to obtain theirdemands. Thus, the political objective of the state is to curb thepower of, "Shortsighted, narrow-minded, irresponsible, andillegitimate mass organizations" while generating agreement onpublic policy and priorities(Offe, 1985: 230).Ironically, at the same time that the state is concerned withcurbing interest group power, it recognizes that such organizationsare ,increasingly, indispensable for the formation of publicpolicy. Offe cites two reasons for this development. First, withthe emergence of the new political rationality, the state becomesreliant upon interest group expertise in the construction of publicpolicy.Offe does not offer any insight into the reasons why interestgroups are important information agents. However, an argument canbe constructed to support Offe's claim. In an era of restraint, thestate must assess the urgency of services, both in social andpolitical terms, and establish priorities accordingly. In advancedcapitalist states, in which information and specialization ischanging rapidly, it is impossible for state officials tounderstand the complexity and political ramifications of issues,especially at the local level; thus, the need to rely upon interest14groups to provide information and direction.Securing acceptance for controversial public policies is thesecond reason why interest groups are indispensable to publicpolicy:" The advantage of corporatist modes of interestrepresentation over democratic representative ones resides inthe potential of the former for depoliticizing conflict, thatis, in restricting both the scope of the participants inconflict and the scope of strategies and tactics that arepermitted in the pursuit of conflictinginterests...Traditional channels of the democratic policy leadto 'over-participation' or an 'overload' of unresolvedissues(Offe, 1985: 242)."Although Offe, at times, refers to interest groups inpluralistic terms, i.e. there are many interest groups solicitingstate favours, one also gets the sense that different groups can berepresented to the state by a singular organization. Indeed, forcorporatism to be effective it is important for a singularorganization to be selected as a representative of otherorganizations. The state, after all, relies upon a representativeorganization to secure compliance and commitment among divergentand vocal groups.Grant further develops this argument by referring tocorporatism as a"...process of interest intermediation which involves thenegotiation of policy between state agencies and interestorganisations arising from the division of labour in society,where the policy agreements are implemented through thecollaboration of the interest organisations and theirwillingness and ability to secure the compliance of theirmembers(Grant, 1985: 3-4).Like Offe, Grant acknowledges that one of the essential componentsof corporatism is the^...importance of groups engaged incorporatist bargaining being able to discipline and control their15members to comply with agreements negotiated with the state orother parties"(op cit: 21). Certainly, interest groups that arediversified and have the ability to act in a "relativelyautonomous" manner are unpredictable and potentially obstruct aconflict-free resolution to policy crises. The ability of aninterest sector to control "possible mavericks" is one of the"enabling conditions" that influences the state's decision to enterinto corporatist arrangements.Of course, one of the difficulties facing the state isdeciding which group should be selected as the representativeorganization:"At the same time, however, it is a source of weakness becauseno one is able to justify and legitimate (other than on an adhoc basis) which groups are entitled to what kind of status,and for what reasons"(Offe, 1985: 236).After 1970, the task confronting the state in North America isto utilize the positive attributes of interest organizations whilecurbing the dysfunctional tendencies of those very same groups. Thedevelopment of corporatist arrangements is the primary method bywhich the state accomplishes this delicate balance.Corporatism And The Political SystemSince the late 1970's, reliance upon corporatist arrangementsto generate consensus has increased. One of the reasons for thisdevelopment is the inability of the present political system toreach agreement on controversial policies. Intra-party and inter-party deliberations hinder the government's ability to act:"In fact, there is presently not one major issue of domestic-policy making on which one party opposes another party morestrongly than factions oppose each other within one and thesame party. It is hardly an exaggeration to argue that theparty as a political institution has ceased to perform thefunction of formulating and securing agreement on programmatic16policy guidelines"(op cit: 243) .Frustrated by political paralysis, state and politicalofficials turn to alternate solutions to engender consensus. Thefirst option open to the state is to offer inducements to producedesired compliance. Often, however, organizations do not respond toincentives, or the state must continually increase the incentive togain ongoing cooperation.The second method of political control is to create aframework of conditions so "... that individual actors cannotescape even if they wanted to"(op cit: 245). Reliance upon coercion, however, often leads to active resistance and increased conflict,thereby, defeating the purpose of the new political rationality.The third, and, in Offe's opinion, the most effective form ofpolitical control, is incorporation of interest groups into thepolitical process:"What remains is the political method of absorbing potentiallyobstructive political resistance by granting 'voice' optionsto those who are, due to the second method, deprived of someof their 'exit' options in order to prevent them from exertingtheir veto power on policies"(op cit: 246).Given the failure of current political practices, state andgovernment officials are inclined to choose corporatism over thestatus quo.Tripartism: A Form Of CorporatismHaving argued that the state gains many advantages throughcorporatism(i.e. consensus, reduction of potential conflict,discipline of local groups, needed expertise), Offe turns hisattention to the impact of the new political order upon classrelations within capitalist societies. His point of departure is toexamine the most prevalent form of macro-level corporatism,17Tripartism: the arrangement by which the state, capital and labourenter into discussions on economic policies.The rhetoric associated with Tripartism claims that the newpolitical arrangement is a major achievement for labour. After all,tripartism enables labour to participate in the development ofstate economic policies. Despite appearances, however, Tripartismfavours capital.Labour's participation in tripartite relationships ismandatory. As previously argued, labour, as with other interestgroups, is reliant upon the state for political and legal status.Such status can be easily withdrawn. To avoid the loss of status,labour must demonstrate an openness to work with the state indeveloping policies. Moreover, labour leaders are expected toensure their members act responsibly and are bound by commitmentsreached through tripartism.While labour's relationship with the state is asymmetrical,the state's relationship with capital is equally unbalanced. Thestate is dependent upon capital for economic growth and taxrevenues. Capital, therefore, is not compelled to participate intripartite discussions. Often the state has to offer inducements topersuade capital to attend conferences on economic policies.Moreover, there is no expectation upon business leaders to ensuremember compliance: "The traffic runs in one direction, because theviewpoint of organized capital can be transmitted to the politicalsystem but the spokesmen of these groups can make no bindingcommitments "(op cit: 252).In the final analysis, corporatism, for Offe, greatly benefitsthe state, is not binding upon capital, and curtails the disruptive18tendencies of labour, and, indeed, all interest groups.Offe: A CritiqueThe "relative autonomy of the state" continues to remain acentral problem for Marxist and neo-Marxist theorists. 4 In arguingthe capitalist state has "real autonomy" and has the capacity"...to implement policy preferences and shape the structure ofsociety according to their own interests", Marxist analyses areprone to constructing a monolithic, omnipotent state(Albo & Jansen,1989: 182-183). In many instances, Offe's analysis reinforces thestate-centric perspective. Through corporatism, the state controlsinterest group demands and actions. Interest groups are unable toresist state encroachment or corporatist strategies.By focusing exclusively upon the state, Offe is silent on theimpact of corporatism on interest groups. He fails to develop anadequate understanding of the benefits interest groups obtain fromcorporatism. One is mystified as to the process by which the statechooses one interest group over others to represent a particularinterest sector. Finally, Offe's analysis does not offer insight asto how a chosen interest group acquires legitimacy for its newrole.Offe is not alone in minimizing the role of interest groups.Recently, in her neo-Marxist treatise on non-governmentorganizations, Vogel writes: "Voluntary organizations such asdevelopment NGOs interact with the state at a relatively low pointin the hierarchy and, as a result, have little power to shape thenature of state policy"(Vogel, 1989: 63). In criticizing liberaland conservative state theorists (Nisbet, Kerrine, and Nehaus),Salamon warns:19"Taken together, the overall result has been to stress theexpansion of the state, to convey an impression of governmentdominance of societal problem-solving and service-provision,and to leave little conceptual room for a vibrant nonprofitsector"(Salamon, 1987: 34).Any theory of state-interest relations must take into considerationthe role and influence of interest groups in shaping state policiesand actions; otherwise, one is left with a top-down analysis whichvirtually excludes interest groups from the analysis.The final problem with Offe's analysis is his view thatcorporatism is inherently logical and, in the final analysis, theonly remaining option open for the state to alleviate interestgroup pressure and conflict. Contrary to the state-centricperspective, Schmitter argues that corporatism does not come aboutthrough "...deliberate, grandiose efforts of politicaldesign"(Schmitter, 1985: 37). Corporatism is neither a logical nordesirable alternative to resolving state-interest group conflicts.With the exception of Belgium and the Netherlands, neo-corporatistarrangements have not been sustainable at the macro (national)level(op cit: 37). Moreover, the emergence of neo-corporatistarrangements are often the result of the state's and interestgroup's inability to resolve policy crises:"..they [corporatist arrangements] have been the unintendedoutcome of a series of disparate interest conflicts and policycrises in which none of the class or state actors involved wascapable of imposing its preferred solution upon the others"(opcit).Such arrangements begin "...as second-best compromises which no onereally wanted or defended openly..." and which really does notfully satisfy anybody but does contain enough elements to partiallysatisfy everybody(op cit).Nations in which state-interest group relations are20adversarial in nature often rely upon the use of physical and legalcoercion to resolve political and economic crises. The rise of the"exceptional" state in Britain is testament to this phenomena.However, the reliance upon coercion is, in the long-run, a poorstrategy for the state to pursue:"This is backed ultimately by the resource which, at least intheory, it is supposed to monopolise-physical coercion-but ifthis were to be relied upon too frequently the 'economy' ofthe state form of political organization would diminishgreatly(op cit: 42).The effectiveness of corporatism relies upon extracting "voluntarycompliance" from interest groups to resolve crises. By findingcompromises without resorting to violence, the state is moreeffective in maintaining "...credibility of its symbolic status asa unique social institution which embodies and protects the publicinterest..."(op cit: 43). Thus, through corporatism, the state'sallegiance to capitalist interests, which is manifested clearlywhen the state exercises coercion, remains "fraudently" hidden(opcit).Whereas corporatism has difficulty maintaining support at themacro and micro (firm) levels, it flourishes at the meso (industry)level. In many ways, this development is not surprising. With theexception of capital and labour, the ability of interest groups,such as nonprofit societies, to effect state policy at the macrolevel is limited. As Schmitter argues, however, it is at the mesolevel, where the division of labour between the state and interestgroups intersect, that the state relies upon interest groups forexpertise, and critically, for policy implementation: "...but thestructural point of departure lies at the meso level in anarrangement of mutual convenience between representatives of21interest associations and representatives of state authority"(opcit: 44).Given corporatism's value as a method of interestintermediation at the meso level, corporatist theory is consideredby some as a middle-range theory:Neo-corporatism offers us a middle range theory of interestintermediation. As explained by Merton, middle range theorylies between all-inclusive general theories of social systemsthat are too remote from social reality to account for what isobserved, and detailed descriptions of particular phenomenathat are not generalised at all. Middle range theory doesinvolve abstractions, but they are close enough to what isobserved to facilitate empirical testing(op cit: 26).Corporatist ElementsOffe's treatment of corporatism relies upon a macro analysis.He traces the effects of broad historical developments on theconstruction of corporatist arrangements. So while Offe's analysisprovides a comprehensive overview, corporatist theorists, such asSchmitter and Grant, provide a more detailed analysis of thestructural elements of corporatism.Wyn Grant argues that two other enabling conditions must existbefore corporatist arrangements can come into existence. First,there must exist, paradoxically, a strong and simultaneously weakstate:"It must be, on the one hand, autonomous enough in thepolicy arena at issue not to be 'colonisable' by theinterest or interests involved, and credible enough tothreaten these interests with a worse possible outcome-usually direct regulation- if they do not agree torespect the 'public-regarding' provisions it imposes. Onthe other hand, the state must be weak enough torecognize that the costs of implementing a given policyauthoritatively will exceed its likely benefits, andwilling enough to devolve some of its most distinctiveresource-legitimate coercion- to organisations which itdoes not administratively control"(op cit: 26).22Second, an interest sector must be willing to take on theresponsibility for organizing a given sector, profession or class.Unlike Offe, Grant argues that interest sectors always have theoption of refusing corporatism:"Affected groups may refuse to organize themselvesappropriately; targeted associations can turn down theinvitation to participate; incorporated associations candefect if they find the costs of collaborating too high"(op cit: 35).Organizations will join corporatist arrangements if there is aprospect of benefiting from such a partnership. The devolution ofstate power to certain interest organizations enables thoseinterest organizations to gain greater control over their owndevelopment and direction. As well, such interest groups gaincontrol over other organizations within a given class, sector orprofession. In short, organizations that acquire state powerthrough corporatism, achieve power and status in relation to theirown internal structure and in relation to external organizationswithin their interest sector.Corporatism and LegitimacyAs a process of interest intermediation, corporatism andprivate interest governments in particular,"...require legitimation if they are to function effectivelyand durably. Their actions must stand a high probability ofbeing obeyed voluntarily (but not necessarilyenthusiastically) by those affected by them, as well as bythose participating in them"(op cit: 59)Since corporatist arrangements endure at the meso level, they arerelatively unknown to the public: "Not only are their allocativemechanisms kept secret, but the very existence of private interestgovernments is often not known to the large public"(op cit: 60).Ostensibly, the norms and procedures of political democracy require23state institutions to be held accountable to public scrutiny andsubject to public ratification. Yet, the corporatism and PIGs'spower is founded upon exactly the opposite premise to politicaldemocracy: "Indeed, much of the power of PIGs, especially of thesegmental or selective sort, depends on such invisibility andignorance"(op cit: 60). It is difficult to ascertain whethercorporatist arrangements, if publicly known, could achieveacceptance in democratic societies.According to Schmitter, to date, corporatism "...has been sofar a consumer, not a producer, of legitimacy, and that itssupplier has largely been the state"(op cit: 61). Schmitter'sargument is problematic, however. Certainly, in the initial stagesof the new arrangement, the state must confer power to PIGs. Yet,if corporatist arrangements are to be of value to the state, PIGsmust be proficient, over the long-run, in ensuring compliance forpolicy issues and implementation strategies, and be able to controlthe actions of potentially troublesome interest groups. Failure byPIGs to sustain favourable results would compel the state to re-evaluate and adopt different strategies in dealing with state-interest group intermediation. Thus, PIGs need to generate support,or legitimacy, from different interest groups if they are to retaintheir status and power.Given that PIGs derive status and power from their ability tosatisfy state requirements, PIGs are cognizant of the need toemploy different strategies in securing compromises and compliancewithin an interest sector. Such negotiated compromises may be"...less of a problem for those categories of interest whereindividual actors are very weak and dispersed, e.g. farmers,unskilled workers, the petty bourgeois, but it could pose a24serious challenge in those categories where 'going it alone'through market power or state influence is a real alternative,e.g. capitalists and privileged professions"(op cit: 57).Logically, therefore, PIGs are compelled to pursue two strategiessimultaneously. First, PIGs must endeavour to weaken those agencieswhich have the capacity to 'go it alone' and be disruptive. Second,PIGs need to create an environment which will entice privilegedinterest groups to avoid the "...temptation to exploit momentarypositional advantages to the maximum, and the fate of landing inthe worst possible outcome in which all lose"(op cit: 58).Minimising risk and maximising predictability is the raison d'etreunderlying all negotiated compromises between PIGs and constituentmembers within an interest sector.Once the roles, responsibilities and legitimacy of PIGs arefirmly entrenched, it is very difficult for interest organizationsto disassociate themselves from corporatist arrangements:"Moreover, whatever their precise legal status, 'Corporatistinstitutions, once established, make it difficult for theconstituent parts to regain their previous autonomy'"(Grant, 1985:13). From this observation, one can conclude that during theinitial stages of any corporatist arrangement, PIGs are required tofocus their energies upon solidifying their base of power inrelation to constituent members within an interest sector. Oncepower is attained, corporatist arrangements are unlikely to besusceptible to challenges from within an interest sector. In thelong run, therefore, the vulnerability of corporatism lies in thetenuous relationship between PIGs and the state, not between PIGsand their constituent members.One of the central problems with the theoretical literature to25date is its exclusive reliance upon studying corporatistarrangements between the state-capital/labour interests. Indeed,the dual-state thesis, proposed by Alan Cawson, argues that it isonly in the realm of "production" that corporatist arrangementswill emerge(Williamson, 1989: 178). In production politics, thestate "...has only influence, not control over what changes theintervention might bring about and, therefore, over its directionand success"(op cit: 170). Consequently, since there is a mutuallydependent relationship between the state and capital and/or labour,corporatist arrangements will emerge in this sector. Conversely, itis unlikely, so the argument goes, that consumer or clients, ornonprofit societies, are capable of organizing themselves to thepoint that a dependent relationship could emerge. Within thisrealm, corporatism is not perceived as a viable strategy. Thus,state-class interests are conducive to corporatism, while state-non-class interests are conducive to pluralist arrangements inwhich the state directly controls the relationship.In studying state-nonprofit relations within Vancouver'smental health system, this thesis will demonstrate that corporatistarrangements can and do evolve between state and non-class interestgroups, and will offer some possible explanations to account forthis phenomenon beyond what is currently available in theliterature.The Nonprofit Sector: A DefinitionWhile Claus Offe focuses his analysis at the macro level, andcorporatist theorists focus their studies on a better understandingof the genesis and development of intermediary organizations, thetheoretical literature has neglected to develop an understanding of26those interest organizations which are affected by corporatistarrangements but do not possess the power of the state or anintermediary organization to develop and shape the nature ofcorporatist arrangements. To adequately understand the constructionof corporatism, it is necessary to include all affected interestorganizations into the analysis. Why do interest organizations,such as nonprofit societies, accept a subordinate role in the newinstitutional arrangements? How can such organizations affect thedecisions of the state and intermediary organizations? What is thelong term prospect for interest organizations under corporatism?These questions, along with others, will be explored in subsequentchapters. However, before turning attention to these issues, it isfirst necessary to review the nonprofit literature to ascertain itsrelevance to an understanding of corporatism.Ralph Kramer describes nonprofit societies as being...essentially bureaucratic in structure, governed by anelected volunteer board of directors, employing professionalor volunteer staff to provide a continuing social service toa clientele in the community"(Kramer, 1981: 9).Despite common features, nonprofit agencies vary considerably.For example, some nonprofit societies allow clients, or consumers,to sit on their board of directors; others do not. Furthermore,nonprofit societies perform different roles.Functions can be divided into direct services...which include residential care and community-basedprograms, and indirect functions, of which advocacy, supportof medical research, and public education are the most common.Organizations that provide direct rather than indirectservices have the largest staff... and those sponsoringvarious forms of residential care employ the largest numberand most diverse types of employees(op cit: 105).Finally, nonprofit societies vary in their dependency upon the27government for funding. Some societies, usually smaller in size,are able to muster sufficient funds from corporate and individualdonations. Other larger agencies are almost totally dependent upongovernment funds.Nonprofit societies are distinguished from state, orstatutory, agencies in a number of ways. Unlike state agencies,which provide universal and comprehensive services, nonprofitagencies provide "...specialization in a problem, a group ofpeople, or a method of intervention"(op cit: 258). Similarly,nonprofit societies are organized on the basis of a particularclientele, while statutory agencies are organized along functionallines(op cit: 43). Finally, there is usually a vast difference inthe "size, bureaucratization, complexity and professionalization"between nonprofit and statutory agencies(op cit).While it is not unusual for government bureaucracies to employthousands of people and have budgets into the tens of millions,nonprofit societies typically employ between 10 to 150 staff andhave budgets ranging from $50,000 to a few million dollars perannum. Of course, the modest size of nonprofit societies gives thema "special advantage" over statutory agencies: they are able toprovide "...greater accessibility, less stigma, higher standards,or a more qualified, complete, or personalized service"(op cit:245)Nonprofit societies are distinguished from private proprietorsin that"...they do not have as one of their primary goals theproduction of profits for a limited set of owners. There canbe profit, but that excess revenue must remain with theorganization and any decision about profitability is secondaryto other goals of such organizations"(Gibbs, 1990: 1).28As nonprofit societies are smaller than statutory agencies butlarger than proprietary agencies, they tend to occupy the middleground between state and proprietary organizations(Young, 1986:171).Organizationally, most nonprofit societies follow a typicalevolutionary pattern. Nonprofit societies often emerge as the"...sole providers of services to controversial, stigmatized, ordeviant groups, for whom the government has not acceptedresponsibility"(Kramer, 1981: 235). In their formative years,nonprofit societies begin as "...freewheeling, pioneering, andloose..." organizations (op cit: 107). Over time, however, nonprofitsocieties lose their pioneering spirit and becomeinstitutionalized, i.e. more bureaucratic and professional. Indeed,as Hall suggests, professional staff come to dominate and propelnonprofit societies: "Professional managers define their long-termcareer interests in terms of the profession. Thus, they would shapethe organization's interests in how those activities are viewed...by the profession"(Hall, 1987: 15).The shift from a grass-roots to a professionally drivenorganization significantly alters the nature of nonprofitsocieties. As agencies become more professional and bureaucratic,they begin to resemble "mini-state bureaucracies". The advantagenonprofit societies enjoy over statutory agencies begins todiminish. Furthermore, as professional managers define their long-term career interests in terms of their success (success beingdefined as the ability to generate additional funds for programsand staff), nonprofit agencies cannot help but become expansionaryin nature.29The Nonprofit Sector And CorporatismUnlike the state and the nonprofit sector, the "...phenomenonof government-nonprofit interaction has been largely ignored inboth public debate and scholarly inquiry..."(Salamon, 1987: 30).The result of such neglect is the absence of a valid theory toexplain why nonprofit societies emerge, flourish, and change, andto explain the changing nature of relations between nonprofit andgovernment agencies.In addressing the problem of why nonprofit societies emerge,Lester Salamon examines two conflicting theories: 1)Market/Government Failure Theory and 2) Voluntary Failure Theory.With respect to the Market/Government Failure hypothesis, Salamonargues that as the welfare state focuses upon producing a range ofcollective goods that "...command community support", there willalways be some "...unsatisfied demand on the part of segments ofthe political community that feel a need for a range of collectivegoods but cannot convince a majority of the community to goalong"(op cit: 35). In this context, governments are apt to turnto the nonprofit sector to provide specialized services.A variation on this Market/Government failure theme arguesthat where governments are providing services to minority groups,their size and inflexibility hinders their ability to respond tothe changing needs of a particular clientele. Once again, thefailure of statutory agencies to provide responsive servicescompels governments to contract out services to nonprofitsocieties.Salamon argues, however, that the Market/Government failurehypothesis has little theoretical value in explaining the emergence30of nonprofit agencies in capitalist societies. Assuming governmentswant to provide for some unsatisfied needs, they are not restrictedto using nonprofit societies to supply additional services.Governments could contract out services to private proprietors orthey could give funds to the clients themselves to purchase theirown services. The fact remains, however, that nonprofit agencies doflourish in capitalist societies(op cit: 36).A second theoretical explanation turns the market/governmentfailure on its head. In the normal course of events, individualswith a particular need approach governments for funding. Asnonprofit societies are viewed by government officials as "akin tothose of government", and as nonprofit societies enable governmentsto establish "experimental" projects without creating a "monstrouspublic bureaucracy", governments are usually willing to providemoney for innovative, pilot programs(op cit: 38).Experimental nonprofit agencies, after a while, assume a lifeof their own, and they become expansionary. At some point in theirevolution, nonprofit societies begin to be viewed by governmentofficials as failing to fulfil their stated mandates, i.e.nonprofit societies become too large and, therefore, toobureaucratic, less accessible and too costly. Once nonprofitagencies are perceived as having "failed", they are subject to avariety of government actions. Such actions include:A. Take-over, or nationalization, by the government sector.B. State administration of nonprofit societies. Nonprofitsretain their legal status but are subject to firm rulesand regulations which usually includes having governmentrepresentatives sit on their board of directors.31C. Reprivatization, or contracting out, of services.Annually, government contracts are tendered out forcompetition.D. Pragmatic partnership. This strategy requires both thegovernment and nonprofit societies to negotiate aworkable compromise. Both sectors recognize the strategicvalue of the other in providing social welfare services.(Kramer, 1981: 273-290).To date, studies derived from the nonprofit literature aregenerally descriptive in nature or focus upon understanding theorigins of nonprofit societies at a particular moment in time. 5Even when examining the origins of nonprofit societies, theoristsmaintain a narrow focus of inquiry. Nonprofit societies emerge asa response to a particular need: the failure of government ormarkets to respond to the needs of particular groups leads to thecreation of nonprofit societies, or disenfranchised groups createtheir own nonprofit societies to address particular needs. Theseanalyses are not "...situated within a broader theoreticalunderstanding of the relationship between state and society"(Grant,1985: 18). In Salamon's opinion, a theoretical understanding ofstate-nonprofit interaction is in the earliest stages ofdevelopment.Given the lack of theory regarding nonprofit societies, it isnot surprising that the study of state-nonprofit interactionswithin the mental health field have focused upon pragmatic,empirical problems. Specifically, report after report has examinedways in which to devise a more effective, accountable andresponsive system. While such studies are valuable, they disregard32broader theoretical questions. As a result, problems such as theeffect of state encroachment and control through corporatistarrangements upon the nonprofit sector, are ignored. Certainly, thestrategies governments will pursue in handling expansionarynonprofit societies will depend upon the political and economiccontext in which they operate. Offe's understanding of thepoliticization of nonprofit-state relations in advanced capitalistsocieties provides a way to theoretically understand changes withinthe mental health field and a way to embed the literature onnonprofit societies in a wider theoretical context.SUMMARYThe starting point of any contemporary inquiry into state-interest group relations begins with an examination of the welfarestate. Neo-Marxist, liberal, and conservative theorists agree thewelfare state represents...a gigantic enlargement of the apparatus of government-particularly the national government-at the expense of socialinstitutions, among them private nonprofit groups. The centralimage has been that of a large bureaucratic state, hierarchicin structure and monolithic in form, taking on socialfunctions performed by other social institutions (Salamon,1987: 33-34).The equation of a monolithic state and declining nonprofit sectoris not supported by reality, however. Whereas it is true that thewelfare state did take on many of the functions performed byinstitutions such as the family and the church, it is equally truethat state expansion led to the phenomenal growth of ancillaryinstitutions.The growth of the welfare state and supplementary institutionshave given rise to a particular division of labour in capitalist33society. To ensure a "safety net" remains in existence, the welfarestate provides universal social (medical, education, housing) andwelfare (income assistance, family allowances, old age, invalidityand survivors' pensions) services for all citizens(Gough, 1979: 2).Conversely, interest groups provide services to specificclass/sectoral interests(Schmitter, 1985: 40). Through thisdivision of labour, the state is able to maintain its universalityand claim to nonpartisanship while providing additional resourcesto specific groups.The following chapter will examine the establishment anddevelopment of Vancouver's community mental health system, withparticular emphasis given to the development of two societies: theCoast Foundation Society and the Greater Vancouver Mental HealthSociety. The emergence of these two organizations coincided withthe expansion of the provincial welfare state. However, as shall bedemonstrated, benevolence was not the major factor behind thestate's support of the development of nonprofit societies. Onlywhen nonprofit societies were able to secure a monopoly position inthe provision of specific services did the state provide financialsupport.In accordance with Offe and other corporatist theorists,chapter two will demonstrate that the B.C. provincial stateinitially established few restrictions on interest group demands oractions. By the beginning of the 1980's, however, state officialsbegan contemplating the introduction of regulations to monitornonprofit societies. With the onset of the recession, the statebegan its restructuring of nonprofit societies through theestablishment of corporatist arrangements. Such arrangements were34designed to curb demands emanating from the nonprofit sectorwithout creating widespread conflict. As well, corporatism, itshall be argued, enabled the state to implement long discussedregulatory measures.The following chapter will also show that corporatistarrangements in Vancouver led to a mutually dependent relationshipbetween the state and GVMHSS, and that these arrangements emergedin the social service sector and not in the arena of production. Apossible explanation for this development is offered in chapterthree.Finally, the following chapter will examine the ways in whichthe GVMHSS, as the intermediary organization between the state andother interest groups, was able to legitimate its new role whileencroaching upon the aspirations and activities of anothernonprofit organizations, the Coast Foundation Society.35Endnotes1. While private boarding home operators were instrumental inproviding residential services, it will suffice to focusanalysis on the relationship between the state and the majornonprofit societies, since Vancouver's nonprofit societieswere responsible for providing clinical, rehabilitation andresidential services.2. For Claus Offe, the attribution of status to interestorganizations refers to: resource status- allocation ofstate resources to interest groups; representation status-the extent to which the state permits organizations torepresent a potential membership (unions are often cited asan example of representative status); and organizationalstatus-the extent to which internal relations are controlledby the state (Offe, 1985).3.^The re-examination of the state by neo-Marxist theorists wasin direct response to the inadequacies of the pluralistparadigm. Neo-Marxist's writers accept a much broaderdefinition of the state and state functions. However, withinthe Marxist paradigm, defining the term "state" is morecomplicated than first appears. Nicos Poulantzas defines thestate as being composed of... several apparatuses or institutions of whichcertain have a principally repressive role, in thestrong sense, and others a principally ideologicalrole. The former constituted the repressive apparatusof the State, that is to say the State apparatus in theclassical Marxist sense of the term (government, army,police, tribunals and administration). The latterconstitute the ideological apparatuses of the State,such as the Church, the political parties, theunions..., the schools, the mass media..., and from acertain point of view, the family (Poulantzas, 1972:251).The fascist state is often cited as an example whereinpolitical and civil society are compressed into one. Withinliberal-democratic states, civil and political society areperceived as being separate. Consequently, a morerestrictive definition is needed to define the state.Following Ralph Miliband, Leo Panitch defines the state asthe,...complex of institutions, including government, butalso including the bureaucracy (embodied in the civilservice as well as in public corporations, centralbanks, regulatory commissions, etc), the military, thejudiciary, representative assemblies, and (veryimportantly for Canada) what Miliband calls the sub-central levels of government, that is, provincialexecutives, legislatures, and bureaucracies (Panitch,1977: 6).36Panitch's definition is noteworthy for two reasons. First, anumber of important institutions, such as the family, thechurch, unions, corporations, and community nonprofitsocieties are not included in the definition. Theseinstitutions are said to be located within civil society.Second, Panitch's definition does include the "sub-centrallevels of government". For Canada, this inclusion isparticularly relevant. Social welfare services, for example,are the responsibility of both the federal and provinciallevels of government.The state performs its social and economic activities "inany of three ways: provision, subsidy, and regulation."(Papadakis, 1987: 31; Gough, 1979: 3-4). Provision refers towhen state employees directly provide social services. Suchservices include "social security, education and training,health and housing", to people in need. "Rent benefits andmortgage interest relief," are examples of state subsidies.Regulation refers to social legislation (Factory Acts),policies controlling access to service (licensing, socialhousing eligibility, etc), and policies governing servicestandards (Papadakis, 1987: 31).In western democratic societies, the reliance upon the stateto provide services varies tremendously. England has a longhistory of "statism". Central and local governments provideservices; nonprofit societies are largely underdeveloped andpoorly funded. In the Netherlands, on the other hand, theprovision of social services is achieved almost exclusivelythrough the utilization of nonprofit, voluntary agencies.In the Netherlands, therefore, nonprofit societies are wellestablished, largely bureaucratic, and well funded. They arealso subject to external demands for reporting, budgeting,management control and other forms of accountability(Kramer, 1981: 108).A reduction in any one of the three state activities maylead to an increase in any of the other two activities. Inprivatising social services, for example, the state, mayincrease its regulatory functions to ensure that privateagencies maintain minimal levels of care.4. For an excellent discussion on the relative autonomy of thestate as it relates to Canada see Gregory Albo's and JaneJenson's "A Contested Concept: The Relative Autonomy of theState" in Glen Williams's and Wallace Clement's The Canadian Political Economy Montreal: Queen's University Press, 19895. See Kramer, Ralph Voluntary Agencies In The Welfare State Berkeley: University of California Press, 1981; Salamon,Lester, 1987, Gibbs, Barrie "The Nonprofit Sector"Unpublished Paper, 1990.37Chapter II-The Evolution of Vancouver's Mental Health System From1972 To 1992: A Case Study In CorporatismThe post 1945 welfare "safety net" created by the federalstate provided the mentally ill with the means to survive outsidethe hospital. Once the mentally ill were able to live in thecommunity, provincial governments began to dramatically downsizemental hospitals. 1 Despite access to welfare services, however,many of the mentally ill found themselves unable to cope in a non-institutional setting. Many were homeless or resided in substandardboarding homes. Clinical support, emergency response units, andservices facilitating community adjustment (recreation, leisure,and specialized education) were all lacking. While local, ormunicipal governments, acknowledged that resources were needed,they received little financial support from the provincial state todevelop such resources.Until 1970, Vancouver's mental health system, as elsewhere inNorth America, was also lacking in resources. Except for theBroadway Clinic, which operated as an out-patient service forRiverview hospital, Vancouver had no clinical services; moreover,there were no support services (social and recreational facilitiesor sheltered workshops) (Seager, 1973: 61). Of all Vancouverhospitals, only the Vancouver General Hospital (VGH) reserved anypsychiatric beds. Yet, although 41 psychiatric beds were availablethrough VGH, the hospital had no emergency psychiatric resources.People in need of immediate psychiatric help were assessed throughnormal emergency procedures. 2 Furthermore, it was estimated inearly 1972 that, given adequate resources, VGH could process inexcess of 120 referrals per month. Needless to say, 41 beds were38inadequate to meet the current needs of the Vancouver system. 3Responding to this state of affairs, the University of BritishColumbia's Department of Psychiatry sponsored a retreat in early1972 specifically to examine the "crisis" within Vancouver's mentalhealth system(op cit: 63).Hospitals were not the only institutions concerned about thelack of resources. The media printed a number of critical articles.One article claimed the "fragmented non-system...had produced achaotic situation in an area which has exceedingly high rates ofattempted suicides, heroin and alcohol addiction, and otherindicators of high pathology"(Ayre, 1986: 104). In 1971, MentalHealth professionals within Vancouver's metropolitan health units,through their Medical Health Officers, expressed their concern forthe lack of mental health services for every age group. 4One of the curious aspects of the Vancouver situation is thatunlike the rest of the province, Vancouver's "Incorporation Act"rendered the municipality responsible for "...all city matters ofpublic health", including mental health services. 5 Consequently,city officials clearly believed that it was their responsibilityfor providing a wide range of services for the mentally ill. Fundedthrough the Vancouver School Board, the municipality, however, wasrestricted in the services it could sustain. Indeed, the city'sDepartment of Mental Health Services focused its efforts onproviding education and consultation on general mental healthissues. As early as March 22, 1972, Dr. Bonham, the city's ChiefMedical Officer, and Dr. R.J. McQueen, Director of Vancouver'sMental Health Services, approached the provincial government foradditional funding so that it could expand city services for the39mentally ill. 6The growing distress over the lack of resources, combined withthe realization that the provincial government was quite concernedabout the imminent provincial election, galvanized the differentinterest groups into action. On July 12, 1972, the MetropolitanBoard of Health of Greater Vancouver...authorized the creation of a Mental Health Planning &Advisory Committee to work on the coordination of mentalhealth services in the Metropolitan Health Service areas andto undertake planning activities for the improvement of suchservices." 7Not surprisingly, this committee consisted of representatives fromthe city's Health departments, the hospitals with psychiatricservices, the Department of Psychiatry, University of BritishColumbia, the Alcoholism Foundation and the Narcotic AddictionFoundation, representation from private psychiatrists and theGreater Vancouver Hospital District. Throughout its deliberationsthe committee maintained close contact with the provincialgovernment and senior administrators from Riverview.On October 6, 1972, the committee presented itsrecommendations to the Metropolitan Board of Health of GreaterVancouver. The recommendations called for an equal partnershipbetween provincial, municipal, and private agencies for thedevelopment of mental health services in Vancouver. Moreimportantly, the committee echoed a familiar theme when it urgedthe provincial government to provide the city with monies foradditional staff so that planning for a coordinated mental healthsystem could immediately occur. Such planning would not be carriedout in isolation from hospital and community services. Indeed, thehospital sector was to play a major part in developing resources in40their local areas. In contrast to this vision of a decentralizedmulti-service system, the report warned against the formation of a"...single agency to achieve on a monolithic basis a viable mentalhealth service." 8Reacting to public pressure and the increasing demands fromthe city, the provincial government, in early 1972, appointed itsown consultant, Dr. John Cumming, to look into the Vancouversituation. Dr. Cumming came to British Columbia highly regarded. Heserved as Assistant Director at New York State Hospital, and hewas the primary person responsible for deinstitutionalizationwithin that state. 9 Just two and a half weeks after the city'sMental Health and Planning Advisory Committee presented itsrecommendations, Dr. Cumming presented his "Plan For Vancouver" tothe Metropolitan Board of Health on October 25, 1972.While Dr. Cumming agreed with some of the city'srecommendations, i.e the need for decentralized services based uponclearly defined geographical areas and an immediate focus uponproviding services to the most seriously ill population, herejected the recommendations that suggested the city becomeresponsible for the provision of direct services through theirhealth departments, as well as the suggestion that the cityadminister the planning of Vancouver's mental health services.Instead, he recommended the creation of an alternative systemfocused around the creation of multi-disciplinary Community CareTeams. Each team would be located in a catchment area whosepopulation ranged from 50-100,000 people. 10 Although Dr. Cummingenvisioned that the teams would be responsive to local needs and,therefore, largely autonomous, he did recommend that one41coordinating body be responsible for establishing the communitycare teams.Although Dr. Cumming's proposal highlighted the need todevelop localized community care teams, he also made a number ofother recommendations. First, he believed that for a mental healthsystem to be effective, it needed to develop a number of ancillaryservices. In particular, Dr. Cumming called for the development ofhostel housing and for the creation of agencies to provide basic(food and medical care), and rehabilitation services (social skillsand vocational sheltered workshops). One assumes that Dr. Cumming'sbelieved that the organization responsible for developing the teamswould also accept responsibility for developing these ancillaryservices. Finally, given the substantial reduction in hospital bedsover the previous 15 years, Dr. Cumming's recommended therestructuring of Riverview into a regional hospital.Dr. Cumming's "Plan" created a dilemma for the newly electedprovincial New Democratic government. Clearly, the city and thehospital sector wanted control over the development of mentalhealth services in Vancouver, but Dr. Cumming's had recommended theestablishment of a separate body overseeing the creation ofVancouver's mental health system. A political compromise wasreached in late 1972 when an Executive Committee was established toadminister what it called the Greater Vancouver Mental HealthProject. This executive committee was to consist of five members:two from the city's Mental Health Planning & Advisory Committee,two from the Community Care Services Society and one member chosenby the four members of the executive committee. 11The Community Care Services Society was an interesting42organization. Essentially, it was a society in name only.Officially, this society was known as the Community Care ServicesSociety of the Provincial Department of Health, Community HealthPrograms-Mental Health. 12 Its membership consisted of senior levelbureaucrats from the different provincial ministries, consultantssuch as Dr. Cumming, and researchers. This society acceptedproposals and budget submissions and made recommendations forfunding. Although it had no legal mandate, it enabled theprovincial government to maintain a significant presence inVancouver.Surprisingly, on May 1, 1973, the provincial government,having obtained a compromise, turned over the administration of theGreater Vancouver Mental Health Project to the Metropolitan Boardof Health of Greater Vancouver. It is unknown why the governmentchose to transfer responsibility for the newly formed project tothe Metropolitan Board of Health. Perhaps the provincial governmentwanted to ease longstanding tensions between the provincialgovernment and the city. Another factor may have been therecognition by all those involved that the NDP governmentpresented a window of opportunity for social service agencies.While the previous Social Credit government parsimoniouslycontrolled funds for social service programs- in the 1971-72 fiscalyear the Social Credit government spent $148.5 million on socialservices- and the new NDP government was committed to financingmuch needed social services in this area. In the 1974-1975 fiscalyear, the NDP government more than doubled the budget for socialservice to $367.4 million dollars(McDonald, 1984: 5). In 1973,therefore, many believed that the opportunity which existed might43disappear with a change of government. Certainly, a sense ofurgency prevailed throughout the system to get things done. Giventhis urgency, it is likely that all parties believed a longprotracted struggle over who controlled the G.V.M.H. project wouldbe counterproductive.Events occurred rapidly after 1973. Dr. John Kyle wasappointed Executive Director of the project on June 1, 1973. ByJanuary of 1974, six Community Care Teams had been established.On June 1, 1974, the G.V.M.H. Project officially become the GreaterVancouver Mental Health Service (GVMHS). By the beginning of 1975,the Broadway Clinic, Venture (a 16 bed short stay crisis residence)and Vista (an 11 bed facility, half for women) were all secondedfrom Riverview to GVMHS. As well, the Maples Family & Children'sClinic was seconded to GVMHS from the Burnaby Mental Health system. 13By 1975, GVMHSS employed a total of 87 staff. Except for asmall clerical component, most of GVMHS employees possessed"professional credentials." Typically, a Community Care Teamincluded a consulting psychiatrist, nursing staff, an occupationaltherapist, Master's level clinicians and clerical support. Despitethe fact that many of GVMHS's employees were seconded fromRiverview Hospital, and were, therefore, provincial employees,GVMHS assumed responsibility for bargaining with employeesassociations.Almost overnight, GVMHS had become a major force withinVancouver's mental health community. With the development andsecondment of a number of impressive resources, and with itsprofessional staff, GVMHS unquestionably commanded the respect ofcity officials and professional medical practitioners. Needless to44say, a central office was required to administer the vast resourcesplaced under GVMHS's jurisdiction. Early in 1973, Dr. Kyleestablished such an office on West Broadway.Early on, Dr. Kyle was cognizant of the need to downplay therole of the central office in the affairs of GVMHS. As he stated inhis 1973 Annual Report, the central office's role was simply todevelop policies and procedures for the Community Teams, to engagein research and evaluation, and to provide short term and long termplans. 14In the first year, each Care Team looked to the newly createdCitizens' Advisory Committees for guidance. Although central officewas responsible for screening suitable candidates, the local areacitizens' committees were responsible for making the finaldecisions regarding the hiring of each Team Director. Given thateach Citizens' Advisory Committee's mandate involved hiring theTeam Director and participating in identifying local needs andassisting in the development of services in meeting those needs, itis not surprising that each Team Director was quite responsive tolocal concerns rather than the wishes of central office.Dr. Kyle was astutely aware that GVMHS's acceptance as a"legitimate" organization in Vancouver's mental health systemrequired him to develop excellent relations with all externalagencies. In his 1973 report, Dr. Kyle was lavish in his praise forthe role played by the Citizens' Advisory Committees in helpingselect Team Directors and in helping find suitable locations forthe Teams. His correspondence with R.J. McQueen, the city'sdirector of Mental Health Services, indicates that each person heldthe other in deep respect. Dr. Kyle recognized the complementary45nature of services provided by the city and the G.V.M.H. project.Most importantly, Dr. Kyle expressed a keen willingness to workclosely with the hospitals to develop comprehensive services forVancouver.With the rapid rise of GVMHS as a leading organization inVancouver's mental health system, Dr. Kyle's cautionary style wasdiscarded after only a year. Instead of praising the Citizens'Advisory Committees, he stated his concern that the "...committeeshave not maintained their interest since the Teams were establishedand that alternate ways of ensuring community support wererequired". 15 Another development was the appointment of Mr. JohnSeager as Supervisor of Patient Services. Each Team Director was toreport to this new position. Ostensibly, Mr. Seager was to...provide more direct leadership to the operating centres". 16Both of Dr. Kyle's statements indicates that he was not happy withthe lack of direction provided by the Citizens' committees and thatcentral office would need to take a much more active role inadministering the Teams. Dr. Kyle was careful not to completelytransfer power to the centre. He made it clear that the TeamDirector was responsible for the "quality of decisions andimplementation". 17 By the end of 1974, however, there was a definiteshift in focus from responding to the needs of the local communityto responding to the direction established by central office.Throughout the early years, GVMHS was preoccupied withdeveloping its own internal operating structure and systems.However, Dr. Kyle did not lose sight of the fact that theorganization needed to maintain a prominent profile withinpolitical circles. Indeed, one of the most important roles GVMHS46performed throughout the early years was to act as an intermediarybetween the city and the province. While reporting to the municipalMetropolitan Board of Health, Dr. Kyle actively participated, as aninvitee of the provincial Ministry of Health, on the RegionalManager's committee in Victoria. GVMHS was to keep Victoriainformed on local issues and emergent problems.Besides his relationship with Victoria, Dr. Kyle acted as aconsultant to the Community Care Services Society. Upon hisrecommendation, the society made decisions regarding fundingallocations. However, except for providing letters of support andrecommending funding for agencies, GVMHS, as an organization, didnot actively help support the development of ancillary services inVancouver. One proviso to the preceding note: there wereindividuals within GVMHS who, on their own time, did help establisha number of community agencies, most notably Ms. Helga Hicks andDr. Hugh Parfitt.The chronicle of major events for both organizations can becharted as follows:TABLE II: CHRONOLOGICAL DEVELOPMENT OF COAST FOUNDATION AND THEGREATER VANCOUVER MENTAL HEALTH SERVICES SOCIETYGVMHSSIn 1973, the Greater VancouverMental Project was establishedto oversee the development ofcommunity based mental healthteams.In 1974, the Greater VancouverMental Health Services (GVMHS)replaced the GVMH Project.Although reporting to theVancouver Metropolitan Board ofHealth, GVMHS also maintainedclose relations with theprovincial state.COAST FOUNDATIONJanuary^1972,^the MentalPatients' Boarding Home projectwas established. The same year,the project was incorporated asCoast Foundation Society. Theorganization's democratic rootswere firmly established duringthis period.In 1974, Coast constructed anew apartment block. Enteringthe housing field enables Coastto secure a niche withinVancouver's mental health47In 1978, GVMHS assumedresponsibility for coordinatingthe Mental Health Liaisonprogram. Coordinating part ofthe mental health systemrequired GVMHS to become moreexternally focused.In 1985, GVMHS incorporated asa nonprofit society. Theorganization's new name is theGreater Vancouver Mental HealthServices Society (GVMHSS).In 1987, GVMHSS acceptedresponsibility f o radministration of Vancouver' snonprofit societies. In thesame year, GVMHSS requirednonprofit societies to signlegally binding contracts.In 1989, GVMHSS helpedestablish the Katherine SanfordSociety. Between 1989-1992, thenew society purchased a numberof community residentialfacilities.system.In 1978, Coast began its shifttowards a hierarchialorganizational structure withthe establishment of aManagement Council.In 1981, Coast hired its firstExecutive Director.In 1981, Coast purchased fourcommunity homes. The purchaseof the homes substantiallyincreased Coast's size andscope. Expansion required Coastto adopt a hierarchialdecision-making structure.Between 1981-1990, Coast waspreoccupied by internal strifeand is unable to effectivelychallenge GVMHSS's increasedregulation of the nonprofitsector.In^1989,^GVMHSS^assumedresponsibility for enforcingstandards of residentialservices.In 1990, GVMHSS established aconsultative^process^toestablish^priorities^forallocating funding .One Of The Ancillary Services: The Emergence of Coast FoundationGVMHS was not the only organization to emerge as a majorplayer during the early 1970's. Other community based nonprofitsocieties, most notably Coast Foundation Society, came intoexistence.In late 1971 a group of unemployed teachers banded together48,found a sponsoring agency -the Unemployed Teachers' Association-and applied to the Federal government for a grant under the LocalInitiatives Program. Upon receiving the grant in January 1972, theMental Patients' Boarding Home Project was established. Initially,the project "...was apparently intended as an activator group andremedial education program for the residents of psychiatricboarding houses". 19 At the time there were 26 boarding homes inVancouver, housing approximately 200 residents. 19 Very early in theproject, it became clear to all those involved that "remedialeducation" was not a practical goal. Many of the people housed inthe boarding homes were heavily sedated and had beeninstitutionalized for over 20 years. The goal of teaching was soonreplaced by more practical concerns: housing, helping dischargedpatients find work and obtain unemployment benefits, and, mostimportantly, providing residents with activities so that they couldincrease their mobility and motivation.In March of 1972, the project obtained a grant from the cityand purchased a twenty-four passenger bus. The project then begantaking residents from the boarding homes to activities in the city.Originally, the project utilized the city's Community Centres asits base of operations. However, in April 1972, the project leaseda house in East Vancouver to serve as an activity centre and as acentral office. Those operating the society were very concernedwith making the house as non-institutional as possible:East End House, as it came to be known, was restored to acondition of appearance as much as possible like that which itoriginally was in some fifty years ago. Bright but traditionalcolor schemes, period wallpapers, and comfortable but archaicfurniture were used, to create an intimate, reassuring,environment in which the boarder participants in projectprograms (most of whom are in their middle or later years)49could feel entirely at home. Greater care was taken that notthe minutest object--not a coffee mug, not an ashtray--shouldbe reminiscent of the past institutional experiences of theboarders, many of whom spent lengthy periods in Riverview orother large hospitals. 20With the acquisition of a permanent facility, the projectbegan attracting a core group of "ex-psychiatric patients" to itsnew residence. These ex-patients were attracted to the project'sliberal ideals. Besides their anti-institutional biases, staffbelieved in the importance of soliciting input from the project'sparticipants about the programs and activities they would like tosee developed. As well, all decisions were reached by a democraticvote of all those employed by the project. Finally, project staffwere firmly committed to maintaining its grass-root origins; theydid not want to become too rigid and bureaucratic.Despite the project's progressive views, it derived itsideological beliefs from a liberal, rather than a radical,tradition. As early as 1973, there were discussions between theSocial Service Department of the Vancouver General Hospital and theproject for joint programming. In comparison, the Mental Patient'sAssociation (M.P.A.), an organization which began as a self-helpgroup of ex-psychiatric patients and which gave equal voting rightsto all its members (staff and participants alike), was stronglyvocal in its opposition to the psychiatric and legal professions.The M.P.A.'s twenty year anti-psychiatry crusades are well known.Certainly, in 1972/73, M.P.A. would never entertain the idea ofjoint programming with medical professionals.Despite the project's early successes in obtaining a permanentresidence and a bus, the first year of operation was unstable.50Project staff had to reapply every six months for renewal of itsfederal grant. Often staff were not paid due to administrativedelays in receiving money: "A skeleton crew of volunteers workedfor three months receiving only token honorariums paid out ofSociety funds to cover expenses." 21The hand-to-mouth existence experienced by the project led tothe constant threat of expropriation by another agency. In 1973,VGH expressed a willingness to "absorb" Coast's programs into itssocial service department. More pointedly,...an established recreational agency (which had apparentlymade a commitment to City Council some two years ago to dosomething for the boarding house dwellers in the way ofrecreation), attempted an administrative takeover andabsorption of our operations, in order to capitalize on ourmethods and established rapport". 22Not surprisingly, the precarious financial position createdcontinual anxiety for all those associated with the project.In 1972, two events occurred which impacted upon the project'stenuous situation. First, on July 10, 1972, the project wasincorporated under the Societies' Act. Coast Foundation Societybecame the name of the new organization. By registering under theSocieties' Act, Coast no longer needed to rely upon the goodwill ofa sponsoring agency to apply for funds. Coast could apply for moneyon its own behalf. The second event was the hiring of PeterTomlinson as the organization's "Research Planner". Essentially,the Research Planner acted as spokesperson for the organization. Hewas also responsible for writing funding proposals and acquiringfunds for the organization. Although this position constituted manyof the responsibilities of an Executive Director, theorganization's anti-hierarchial bias precluded any individual51assuming the title of Executive Director.In his first year, Tomlinson focused his energies oncultivating relations with a number of different agencies. He wasan active participant on the Citizens' Advisory Committees. Heinvited Dr. Kyle and members of the Community Care Services Societyto visit the organization's activity centre. He established a closerapport with Dr. Cumming. 23 Most important, Tomlinson establishedgood relations with VGH and with the city's Director of MentalHealth Services, Dr. R. J. McQueen. 24Tomlinson realized that while contacts were critical, in thelong term, the organizations's survival also depended upon itsability to carve out a niche within Vancouver's mental healthsystem. In 1973, changes occurring elsewhere presented Tomlinsonwith the opportunity he was seeking. During 1973,"...the Federal Department of Urban Affairs had just recentlyamended the National Housing Act to provide 100 per centmortgage financing in addition to project start-up funds, tononprofit agencies sponsoring housing for special needsgroups"(Tomlinson, 1976: 25).Later that year, Jackie Hooper, a social worker, who had beenrejected by the M.P.A., approached Tomlinson with the idea ofconstructing a twenty-six apartment block in Vancouver's west end.The idea of developing an apartment block caused considerabletrepidation. Nobody in the organization had any experience workingwith realtors, contractors, and the Central Mortgage and HousingCorporation (C.M.H.C.). The business (developing sophisticatedaccounting systems) of administering a mortgage in excess of$300,000 and maintaining accurate government records evoked fearsof impending bureaucratization. Many within Coast were vehemently52opposed to entering the housing field. On the positive side, thenew NDP government was firmly committed to financing new socialservice resources, so it was likely that ongoing operatingexpenditures for the apartment block would be financed by theprovincial government. Indeed, in 1973, upon the recommendation ofDr. Kyle and Dr. Cumming, the Community Care Services Societypromised to provide an annual grant of $17,000 to cover operatingexpenditures. 25 Tomlinson and others decided to forge ahead withthe new project.Within Coast, the split over the proposed new housing projectcame to a head in early 1974. For Coast to secure funding fromC.M.H.C., the organization was required to change its by-laws.Incorporated within Coast Foundation's by-laws was a clause statingthat upon dissolution of the organization, all assets would revertto the general membership. C.M.H.C. required Coast to include aclause in its by-laws to state that upon dissolution of theorganization, assets funded by the housing corporation would revertback to that corporation. For many within Coast, C.M.H.C.'sinsistence on this clause provided a perfect example of howexpansion would lead to outsiders determining what Coast could orcould not do.Tomlinson and his supporters carried the day. On June 22,1974, the original society was dissolved and a new society, withnew by-laws, was created --the Coast Foundation Society (1974).The acquisition of an apartment block created two separatedivisions within the organization: the Research/Planning andHousing division and the Recreation and Resocialization division(Activity Centre). As well, the administration of just under two5 3million dollars in assets required a level of expertise previouslyabsent in the organization.In spite of the changes, however, the events of 1974 did notcause a permanent rift within Coast Foundation. Between 1975-1981,Coast remained a medium sized nonprofit organization. During thisperiod, Coast did construct two new apartment blocks (1977 and1979). 26 However, the organization's operating expendituresremained relatively modest: for the year 1980, Coast operatingexpenditures were $625,250, of which $372,930 was associated withthe Housing Division. 27 In 1979, the organization employed 14staff, only two more than in 1974.Coast's moderate size enabled the organization to maintain itsdecision-making structure. In 1974, each division was "...comprisedof one co-ordinator and a work team, the size of the team to bedetermined by the board of directors on the recommendations of theteams involved". 28 The work teams interviewed and hired their owncoordinators. Hiring decisions were finalized by a democratic voteof all division staff, and the term of office for the coordinatorwas one year. Theoretically, the coordinator was responsible to theBoard of Directors.Both the coordinator and the work team had the right to callmeetings. All issues affecting the divisions were decided by ademocratic vote of all staff. Despite the presence of "GeneralStaff Meetings", in which staff from all divisions and the Board ofDirectors participated, each division operated autonomously fromall others and from the Board of Directors. The Board of Directors,five in number, consisted of staff, former staff and clientmembers.54Coast's experience in developing its first apartment blockgreatly enhanced the organization's reputation. Overnight, Coasthad become a leader in providing "innovative" housing. Only M.P.A.offered any other housing (four group homes) and that organizationseemed unwilling to actively pursue any additional housingprojects. As well, 26 psychiatric boarding homes also operated inVancouver.Peter Tomlinson's hard work and the organization's newlyearned reputation impressed government officials. By 1974, Coastenjoyed a reversal of its funding situation. In 1973, Coastreceived $73,561 from its federal L.I.P grants and $16, 510 fromthe Province of British Columbia. In 1974, Coast received $30,695from the federal government and $72,818 from the Province ofBritish Columbia. Unlike federal funding, provincial monies wereguaranteed annually. Moreover, given Victoria's commitment to theVancouver Plan, provincial funds were not expected to disappearovernight. No longer did the society have to worry about dailysurvival or a "hostile" take-over.In 1975, Peter Tomlinson left Coast to work with Dr. Cummingat the Community Care Service Society. Although Tomlinson's visionwas missed by Coast, it was fortuitous for Coast that he joined theCommunity Care Service Society, since over the next eight years,Tomlinson remained a strong advocate for Coast while withingovernment circles.Gary Forsgren replaced Tomlinson as Research/Planner in 1975.Unlike Tomlinson, who valued decentralization, Forsgren favoured amore traditional management structure, where roles andresponsibilities are defined, policies and procedures entrenched,55rational planning processes implemented, and critical decisionsenacted by those individuals ultimately responsible. If anythingwent awry, government officials would hold the organization'ssigning officials accountable. Despite Forsgren's bias towardstraditional management practices, he inherited an organizationquite resistant to change, especially in this direction.Internal pressures began to erode the organization'sdemocratic orientation. The first group to experience the strain ofmanaging a demanding organization was the Board of Directors. Thefive member Board found itself continuously involved in theorganization's daily operations and in resolving ongoing personaldisputes. Often, decisions made by the Board were unpopular withstaff. Consequently, many of the long-standing Board members wereexhausted after four years of tension. By 1978, the organizationexperienced difficulty in retaining board members.Upon the Board's request, the organization's first ManagementCouncil was established in 1978. The council was to be a decision-making body, provide information and make recommendations to theBoard, and provide a channel for appeals in case of dismissals. 29Each division coordinator participated on the Council and couldexercise one vote in making decisions. Although Gary Forsgren waschairperson of the council, he could not vote.By 1979, therefore, the Board received direction from theManagement Council, not vice versa:"Sid drew to the attention of the meeting that the Boardrelies heavily on the Management Council for its direction,since the Council is closely involved in the Society's day-to-day operations, and the Board will act in response to theCouncil's recommendations." 3056Between 1979-1981, Management Council acquired increasingresponsibility for making executive decisions. Moreover, thedivision coordinators also acquired executive powers. For example,in 1979, during the development of the Recreation andResocialization coordinator's job description, the coordinator wasno longer responsible for reporting to the Board of Directors;instead, the coordinator was to report directly to the ManagementCouncil. Furthermore, the new job description granted the divisioncoordinator powers to hire and fire staff:"Re hiring and firing, etc, the manager must have the finalsay for recommendation to Management Council. If a manager isresponsible for operation of a team and he/she doesn't haveultimate responsibility for hiring and firing, he/she will beineffective as manager." 31With the shift towards a more traditional managementstructure, Forsgren, once again, initiated a number ofcorresponding changes. In 1979, the Board adopted a committeestructure: personnel, fundraising and nominating committees wereestablished. That same year, the Board began its first Long RangePlanning process. In 1980, the organization's localized regime(each division had their own practices) was replaced by uniformpolicy and procedures. Job descriptions were written for all staff,and a system was developed to consistently review salaries andbenefits.Forgren resigned in 1980, and in 1981 the organization hiredits first Executive Director, Dianne Weldon.By 1981, Coast was an organization in transition. Theorganization's grass-roots orientation was being replaced by a morehierarchial, bureaucratic structure. Management's vision for theorganization conflicted with many of the staff who had been with57Coast since 1974. With Coast's second major expansion after 1981,tensions grew throughout the organization.The Centralization Of Social Services And The StateBetween 1975-1984, political and economic changes withinBritish Columbia substantially impacted GVMHS and Coast FoundationSociety. The first of these changes was the centralization ofsocial services by the provincial state.In December 1975, the New Democratic Party was defeatedand the Social Credit party returned to power. For many socialworkers, the NDP years are fondly remembered as a time "...when thegovernment introduced a new system of decentralized social servicedelivery by means of community resource boards"(McDonald, 1984: 7).In reality, however, the changes introduced by the NDP began theshift towards a more centralized social service system. Thecreation of the provincial resource boards shifted responsibilityfor the administration of social services from local agencies andthe city to the province: "...the Vancouver Resources Board, whichhad been formed from the amalgamation of two children's aidsocieties and the City Welfare department..." (op cit). The resourceboards did, however, solicit input and generated citizen interestin the social service system.The succeeding Social Credit government continued the processtowards centralization. In 1976, the government dissolved theVancouver Resource Boards and the Citizens's Advisory Committees,and transferred the Boards' responsibilities to the newly createdMinistry of Human Resources (MHR). As McDonald writes,"By mid-1977 policy-making in social welfare services wassolidly concentrated in the hands of the Minister and aheadquarters staff of senior bureaucrats. Increasing58reliance was placed on uniform policy directives prepared inVictoria and administered in each region of the Province"(opcit: 8).Despite fears to the contrary, the Social Credit governmentdid not dismantle the social service system established by the NDP.Indeed, in most areas the government maintained and expandedservices, and in the area of child welfare, the government createdtwo new programs.' In one of the programs over 200 positions wereadded to the Ministry of Human Resources to "...provide intensivehome based counselling services for families with children atrisk"(op cit). Grants to community-based agencies were alsomaintained. During the Social Credit's previous term, thegovernment spent a total of $242,678 on community grants; in 1982-83, the Social Credit government provided $6.78 million tocommunity agencies(op cit: 6).Along with the shift towards centralization, the provincialstate began to examine more rational methods of allocating andadministrating funds. To accomplish this goal, provincialministries contemplated two initiatives to rationalize funding: theconsolidation of multi-ministry funding into one ministry, andcontracting:"Similarly, efforts have been made to relieve the policycoordination problems and administrative duplications createdby multi-ministry funding of a large number of quangos. In anumber of multi-ministry funding instances, it has beenproposed that the ministry representing the largest fundingsource undertake the budgeting, monitoring and evaluationfunctions.""Contracts are replacing the variety of other funding vehiclesused in the past. From the government's perspective, annual ormulti-year contracts provide a much better instrument forestablishing agency mandates, specifying the type, quantityand quality of the goods or service to be provided and theconditions under which changes will be acceptable,establishing procedures and indicators for evaluation, and59agreeing upon the ongoing information requirements of bothparties" (Langford, 1983: 570).Within the Ministry of Health, the call for a rationaldelivery of services, which included financial and serviceaccountability, were not new themes for those working in the mentalhealth field. In 1979, for example, the government had commissionedDr. Cumming to examine the delivery of mental health servicesthroughout British Columbia. As Zoe Ayre describes: "Towards theend of the 1970's, the government again felt it necessary to assessthe functioning of existing services so as to improve theefficiency and effectiveness of the system of mental healthcare"(Ayre, 1986: 105). Whereas Dr. Cumming praised Vancouver'smental health services, he delivered a devastating indictment onthe province's Boarding Home system, and, once again, recommendedthe decentralization and redistribution of Riverview.With regards to the consolidation of funding, the state madea number of changes that were to affect provincial mental healthservices. In 1979, the Ministry of Human Resources (MHR) providedfunding to seventy-four "Achievement Centres" throughout theProvince of British Columbia. 33 As well, the MHR funded allcommunity residential homes, including homes caring for thementally ill, throughout the province. While the MHR allocatedfunds, it was the Ministry of Health which was responsible forensuring agencies were accountable for the funds they received. Theprocess of funding allocation was disconnected from the process offunding administration and monitoring. Many people in Victoriabelieved that such a system was counterproductive. As the Ministryof Health did not distribute funds, it did not possess any leverage60to demand certain standards and performance levels from agencies.Consequently, by 1984, achievement centre and community residentialfunding was transferred from the MHR to the Ministry of Health.Note: although Mental Health Services assumed responsibility foradministration of budgets and funds in the community residentialfield, the MHR continued to pay a portion of the per diem ratesreceived by each boarding home.By 1984, Mental Health Services in Victoria had assumedresponsibility for both the development of mental health policy andthe allocation and administration of all provincial funds to mentalhealth agencies.Contracting was the second initiative aimed at rationalizingthe delivery of services within the nonprofit sector. The shiftfrom per diem funding to contracting, was, once again, a naturaloutcome of internal developments in Victoria. Prior to 1980,"QUANGOS, or quasi-autonomous non-governmental organizations-private organizations delivering public policy for government"received little scrutiny from provincial ministries(Langford, 1983:564). Governments assumed a "see no evil, hear no evil" approachwhen dealing with nonprofit societies:"The general criterion of satisfactory policy performance wasthe silence of agency clients and the acquiescence of boardand advisory committee members associated with the variousagencies. Formal ex ante or ex post evaluations were virtuallyunknown" (op cit: 569).By the early 1980's, government complacency regarding QUANGOSchanged. With the onset of the government restraint policy, QUANGOSwere quite vocal in their criticism of government policy. Ifacquiescence reflected performance, then QUANGOS, by beingoutspoken, were performing poorly.61Centralization And The Vancouver Mental Health SystemWithin Vancouver's mental health system, the thrust towardscentralization and rationalization is best exemplified by changeswithin the residential community care field. In 1976, considerablepressure was exerted upon the provincial government to resolve thechaotic situation within the community care system. At the time,all "personal, intermediate, and extended" care homes in Vancouver,and throughout the province, came under the same licensingrequirements covering personal care homes. As such a number ofclient groups were assimilated within the system: the elderly, thementally handicapped and the psychiatric population all came underthe jurisdiction of personal care.By the late 1970's, a number of problems existed with theresidential care system. First, as people were becoming older andas more people were being deinstitutionalized (from Riverview andWoodlands), many within the field demanded a more efficient system.For example, the scarcity of beds required a better system formonitoring bed availability. 34 Another problem with the system wasthe assessment criteria for residents. People were accepted intohomes based upon financial need, not upon levels of care required.It was quite possible, therefore, for homes to consist of a mixtureof people needing different levels of care. Moreover, boarding homeoperators were notorious for demanding docile residents: "...manyboarding home operators, who are private entrepreneurs, demanddocile, easy to care for clients, since this maximizes profits." 35Finally, the residential community care system lacked a LicensingAct which defined adequate standards of care and building andnutritional requirements.62In 1978, the provincial government reorganized the communitycare system. First, people wishing to be placed into residenceswere assessed on the basis of health, not need. Different levels ofcare received different per diem rates. Consequently, it no longerpaid for boarding home operators to take the most docile clients.Another change was the separation ,both in terms of assessment andadministration, of the elderly from the mentally ill. Of course, individing the two populations, two organizations were required toadminister each system. Finally, the Community Care Facilities Actwas enacted in 1979. This act clearly defined levels of care andresponsibilities of boarding home operators.The changes introducedby the provincial government were designed to develop acentralized, rational and efficient system.With the exception of Vancouver, the administration of thisnew system was taken over by the province. In Vancouver,responsibility for administering the city's community carefacilities was transferred to the Metropolitan Board of Health. InJuly 1978, the Metropolitan Board of Health transferredresponsibility to GVMHS: to manage its new responsibilities, GVMHScreated the Mental Health Liaison program (MHLP). Since GVMHS wasthe only community agency with the capacity to provide psychiatricassessments and contained the bureaucratic structure capable ofmonitoring placements, it was the logical choice for coordinatingand administering the new system.Due to its new responsibilities, GVMHS's mandate expanded. Aswell as providing direct clinical services and acting as anintermediary between the city and the province, GVMHS was nowresponsible for directly coordinating an important part of63Vancouver's mental health system. Moreover, if GVMHS chose toenforce all the clauses associated with the Community CareFacilities Act, it, potentially, could assume responsibility for"regulating" Vancouver's boarding homes.In developing a close working relationship with the communityresidential system, GVMHS was required to become more externallyfocused. In 1982, GVMHS further expanded its external orientationby establishing, within its senior management structure, a supportservices component. This component was, and is, responsible forenhancing” ... program-oriented ties with the management of public,private and nonprofit organizations involved in housing,vocational rehabilitation, social-recreational programs andemergency services...The support Service's mandate is thedevelopment of inter-agency agreements in order to activelycreate a climate which will increase patient access toexisting community resources and to gain support for thedevelopment of additional resources." 36Ostensibly, therefore, GVMHS's support services component wasfirmly committed to collaborating with all community agencies.Between 1979-84, two new resources came under GVMHS's jurisdiction.In 1979, an after-hours emergency resource was established. In1982, GVMHS was requested by S.A.F.E.R. (Suicide Attempt Follow-Up,Education and Research), for financial reasons, to be incorporatedwithin GVMHS's apparatus. Besides the addition of these newresources, GVMHS remained relatively stable throughout the nineyear period.The Housing Crisis of 1979-1980: The Rapid Expansion of CoastFoundationThe second major event that affected developments withinVancouver's mental health system was the housing crisis of 1979-641980. During that year, spiralling housing prices and changes tothe Long Term Care system enticed many boarding home operators tosell their properties: two hundred and thirty-nine beds were lostto the elderly and to the psychiatric populations(Albach, 1985:56). Of these 239 beds, 97 were beds for psychiatric residents. 37Without question adequate housing had become the number onepriority within Vancouver's mental health system.Faced with the devastating prospect of losing 97 beds, Ms.Helga Hicks, GVMHS's Director of Support Services, and officials ofLong Term Care, approached Coast in 1981 to ascertain whether theorganization would be interested in purchasing four communityhomes. For G.V.M.H.S, Coast was an attractive alternative toprivate operators. Coast was not motivated by profits; therefore,Coast would not be likely to sell property during upsurges in thereal estate market. Moreover, Coast had developed a track record ofbeing able to finance and operate housing projects. 38With little debate, the Coast Board of Directors approved thepurchase of four new homes in 1981. The purchase of the four homesled to the creation of a new division (Community Homes Division),to the hiring of 26 new staff, and to an increase in the operatingbudget from approximately $650,000 to $2.2 million dollarsannually. In addition to the four homes, in 1981 Coast constructeda new apartment block, and in 1982 and 1983 acquired two largefederally funded grants. These grants required the organization tofind jobs for its clients (members).Expansion left its mark on Coast in a number of differentways. First, with the increase from 14 to 50 staff, and with theimplementation of different supervisory levels, it was no longer65feasible to have a decentralized decision-making structure. It wasnot possible for 50 staff to continuously come together to makedecisions on specific program issues. As well, due to fundingrequirements, Coast could no longer develop programs in isolationfrom external constraints. External authorities required thatsomeone be responsible for ensuring that legal and contractualobligations were achieved. Consequently, both internal and externalchanges required Coast's management staff to assume ultimateresponsibility for all programs and policies.The acquisition of the new homes also impacted upon Coast'sphilosophical orientation. The new Community Homes Manager wasprofessionally trained in providing care for the mentally ill, andindeed, the primary focus of the Community Home Division is to"care" and "help" residents in their daily lives. s9 homeresidents require 24 hour supervision. The concept of "caring" foran individual creates a distinction between staff and members:acting as "caring" professionals, staff are required to maintainappropriate boundaries. The concept of "care" also requires staff,managerial and program staff, to be accountable. Standards andlicensing requirements must be implemented, programs are developedto provide therapeutic value, and staff must be well trained inproviding mental health care. 90 acquisition of the new homes,therefore, introduced a new source of tension within theorganization, between the professional orientation of the CommunityHomes Division and the grass-roots, non-professional orientation ofthe Housing and Resocialization divisions.Like GVMHS, Coast's expansion required it to assume a moreexternal orientation. Coast's Community Home Division was required66to interact with GVMHS's Mental Health Liaison Program; theResocialization and Recreation Division was required to workclosely with the federal civil service. Each year, to ensurefunding renewal, the Resocialization Division was required toprovide an extensive written submission, with a detailed budget, toa federal review board. As well, the division was required todocument all employment statistics. Demonstrating success wascritical if Coast wanted its funding renewed.Nonprofit agencies within Vancouver's mental health systemviewed Coast's emergence as a major player with trepidation. On theone hand, there was a general expectation that Coast would assumea leadership role in promoting mental health issues. On the otherhand, Coast's size generated apprehension. A brief description ofVancouver's nonprofit sector is required to understand why othernonprofit societies were anxious with regards to Coast's newstature.Between 1975-1980 many different nonprofit societies wereestablished in Vancouver. In the housing field, the Lower MainlandSociety for Rehabilitation for Young Adults (LMSRYA) operated"rehabilitation" group homes for 22 young adults(Finch, 1978: 20).Look-out, a short-term emergency resource, located in Gastown,provided valuable services for the hard-to-house. The ArbutusVocational Rehabilitation Society (AVRS) and the Vancouver andBurnaby branches of the Canadian Mental Health Association (CMHA)operated "sheltered workshops" for people interested in gainingwork experience. Finally, the Kettle Friendship Society, joined MPAand Coast Foundation as organizations providing social andrecreational activities.67For all these agencies, simply surviving preoccupied theirdaily existence. In 1979, the Kettle, for example, existed on abudget of $65,000 per year. The only way it could survive wasthrough the acquisition of short-term federal grants. 41 In 1978,CMHA closed down one of its workshops for financial reasons (op cit:7). The LMSRYA was under constant threat of absorption becausetheir facilities were considered too expensive.Many agencies believed that Coast, if the conditions wereright, would not hesitate in "absorbing" these fledgingorganizations. While casting a wary eye at Coast, it was to GVMHSthat the smaller nonprofit societies turned for support.Recession And Restraint: Towards CorporatismThe final event that affected developments within Vancouver'smental health system was the onset of the recession and theintroduction of the government restraint program. The economicgrowth of the 1970's came to an abrupt halt in the early 1980's:"There was a significant decline in outside demand forB.C. resources, coupled with evidence of seriousdepletion in the forest industry. Corporate profitsplummeted, bankruptcy rates soared, as unemploymentnearly doubled from 6.5 percent to 12.1 percent between1980 and 1982. The time had clearly come for a governmentof the right to unveil tougher measures"(Resnick, 1987:10).In 1982 the recession deepened and in 1983 the provincialgovernment issued a stern warning:"The growth and prosperity which came so easily in the1960's have faltered, with the economic crisis of thepast two years marking the turning-point. No one...should take a return to prosperity for granted...Mostdifficult of all, our expectations must change. 42In 1983, the government called for a 25% reduction in the size ofthe civil service and the "down-sizing" of other social68expenditures; e.g. post-secondary educational institutions were tobe cut back by 5% in 1984 and 1985(op cit: 13-14).The housing crisis of 1979/1980 and the fear of impendingcutbacks created a sense of urgency within the Vancouver mentalhealth system. Representatives from the Kettle, Coast Foundation,CMHA and the Riverview Volunteer Association met, on January 18,1982, to discuss approaches in resolving the current "crisis".These agencies formed a loosely structured organization calledT.A.G. (The Advocacy Group). Since T.A.G. had only a time-limitedmandate, and given the group's belief that an ongoing, coordinatedlobbying effort was essential to maintaining existing services, anew voluntary federation of community agencies was established. Thenew organization was, and is, called the Interagency Mental HealthCouncil (IAMHC).Both Coast Foundation and GVMHS assumed leading roles withinthe IAMHC. Coast Foundation's Paula Farqhuar became the council'sfirst Chairperson. Given GVMHS's close association with theprovincial government, it declined to serve on the council'sexecutive. Still, GVMHS did provide valuable staff resources tostudy gaps within the mental health system, and supportedstrategies for working with the provincial government.Building upon the initial enthusiasm of the first few years,a few members of the IAMHC sought to expand the council's mandatefrom an "information and education focus" to one that also includedresponsibility for "planning and coordination." 43 A proposal wascirculated that recommended that the Service Planning Committee ofthe Interagency Mental Health Council become the official liaisonbetween the Council and the Vancouver Advisory Committee (a69committee comprised of representatives from hospitals, privatepsychiatrists and community treatment). Since the Service PlanningCommittee would be the conduit between the Council and the AdvisoryCommittee, it would be in a strong position to ascertain prioritiesand make recommendations for the Vancouver area. The proposal wassoundly defeated by the larger body of the IAMHC.There are several reasons for the proposal's defeat. First,the proposal was very complex and would have resulted in theproliferation of sub-committees or task forces. Community mentalhealth agencies possessed neither the inclination nor the manpowerto participate on the committees. Second, the community agencieswere, and still are, wary of a committee of their own peers havingthe power to make recommendations regarding service priorities.Would the Service Planning Committee make impartialrecommendations, or would it reflect the priorities of thecommittee membership? Finally, the Service Planning Committee withits IAMHC affiliation were perceived as being too diverse toperform a planning and coordinating role. Agencies from the FraserValley and Vancouver are both represented on the Council. Sincethese two distinct regions compete for funds, the Service PlanningCommittee would have had difficulty reaching consensus. Presumably,each area would protect its own interests.The rejection of the Service Planning Committee's proposalwas, in many ways, a missed opportunity. As community agencies werevoting members on the Council, they could have influenced futuregovernment policy and direction in a time of rapid change throughthe Service Planning Committee. With the defeat of the proposal,the IAMHC remained, primarily, an information-sharing and70networking association.While difficult to document, it is likely the council was veryeffective throughout the 1980's in presenting to Victoria a unitedfront on mental health issues. The government's restraint programled to a "...20% reduction in funding for community-based socialservice quangos...", and in 1984 the government cancelled entirelyseveral social service organizations. In the mental health field,however, Victoria was reluctant to engage in wholesale cuts. Thoseworking in the field were able to ensure that Victoria remainedcommitted to maintaining current levels of funding. Of course,between 1983-1987, agencies did not receive any increase infunding, which effectively resulted in a cutback as funding did notkeep pace with inflation.The onset of the recession and the government restraintprogram gave GVMHS pause to reflect. Internally, GVMHS was underpressure to acquire additional resources. As Bruce Vichert'sstatistics indicate, increasing patient case loads and an increasein the severity of illnesses being treated by the Community CareTeams put significant pressure upon GVMHS to acquire additionalresources:"The number of cases open at the beginning of 1980, plus newcases opened during the year, less the closures, indicates anactive open involvement with 4,796 patients. The same figurefor 1989 is 7,895, an increase of 65%(Vichert, 1990: 1).Faced with increasing demands and a restricted funding base,GVMHS began to examine different options. With the centralizationof mental health services in Victoria, GVMHS's role as anintermediary between the city and the province was not asimportant. Consequently, GVMHS decided, in 1985, that its71relationship with the Vancouver Metropolitan Board of Health wastoo restrictive. The Board was responsible for municipal healthissues and "maintained minimal involvement with GVMHSS". 44 GVMHSS'snew Executive Director, John Russell, wanted a board that could actas a resource and an advocate for the society. Although GVMHSSwanted to maintain its connection with the city, it also wanted theright to pursue its own mandate. As a result, in 1985, GVMHSS wasincorporated, under the British Columbia Society Act, into anonprofit society. 45By becoming a nonprofit society, GVMHSS enlarged its capacityto pursue other interests. As a nonprofit society, GVMHSS couldapply to the federal government for grants, could engage infundraising activity and, most importantly, could enter into thehousing field. The British Columbia Housing Management Commission's(BCHMC) guidelines stated that only nonprofit societies could applyfor social housing units. By becoming a nonprofit society, GVMHSScould now compete with Coast in developing housing. Indeed, in itsConstitution, GVMHSS identifies as one of its purposes:"to operate a charitable institution (without profits to itsmembers) for the purpose of constructing, providing,maintaining, leasing, owning and managing one or more low-rental housing projects for such persons as may be designatedby the Province of British Columbia (where such designationsare required) ul . 46Through incorporation, therefore, GVMHSS was able to expand into anumber of different areas.Recession And Restraint: The Riverview ProblemThe onset of the recession and the government restraintpolicy, resulting in decreased levels of funding for the Ministryof Health, required Victoria to examine the current state of mental72health services throughout British Columbia. The most pressingissue confronting Victoria was Riverview Hospital.Thirteen years after Dr. Cumming recommended the downsizing ofRiverview hospital and the substantial expansion of the communitymental health system, Mr. Brian Copley, Executive Director ofMental Health Services, Ministry of Health, stated, on July 15,1985, that the government would be engaging in a "ConsultativePlanning Process for Improved Mental Health Service System". 47 Theconsultative process was to develop a "...detailed plan to improvethe Province's Mental Health System, including the possiblereplacement of outdated facilities on the Riverview/Valleyviewsite." "As well, the consultative process was to obtain the opinions of avariety of concern groups:"Over the past few months Mental Health Services staff havetalked with literally thousands of British Columbians from allareas of the mental health care system: consumers andproviders, volunteers and professionals, employers andemployees, representing the legitimate concerns of variousindividuals, interest groups, community, hospital andeducational agencies involved".Working from a tight time frame, Copley wanted the consultativeprocess to be completed within six months: a draft plan was to becomplete by November 30, 1985 and the plan was to be submitted tocabinet by January 15, 1986.The consultative process announced by Copley was quiteinteresting for a number of reasons. First, the Ministry of Healthand the Social Credit government were reluctant to initiate theprocess. Between 1972-1985, several reports and many agencysubmissions requested that the government take action. Moreover, inthe early 1980's the problems of Riverview received considerable73discussion within the Ministry itself. However, it was not until1985 that the government decided to take some form of action.The Ministry's reluctance to tackle the Riverview problem wasquite understandable. Previous experience demonstrated that closingdown large institutions garnered few political rewards. The closureof Tranquille, in the late 1970's, a large hospital for thementally handicapped, engendered widespread criticism. Parentsberated the government for closing down the hospital without firstdeveloping community resources. People were being released into thecommunity with nowhere to go. Unions, naturally, were quite upsetthat the closure of Tranquille would result in the loss of severalhundred jobs.Another reason for the Ministry's reluctance stemmed from aconcern over funding. Although it was expected that mental healthwould maintain existing funding levels, the Ministry did not"...anticipate the infusion of substantial new funds into thesystem, at least for the foreseeable future." 49 Thus, funding forthe Riverview closure was expected to come from existing fiscalresources.While the government was reluctant to address the Riverviewquestion, other pressures were pushing the Ministry to take action.As indicated in chapter one, between 1962 and 1979 Riverviewreduced beds from 6328 to 1306 (in 1985, the official bed count was1306 but in actuality there were 1220 beds at Riverview).Certainly, given the reduction in beds the existence of a largeinstitution such as Riverview, with its 73 million dollar budget,no longer made fiscal sense. Moreover, the cost of maintaining aperson in Riverview was approximately $300 a day; in the community,74residential care costs $65 a day. 50 Economically, therefore, therewas increasing pressure to downsize Riverview.Another concern facing the Ministry was the"outdated and often dilapidated building at RiverviewHospital, with limited staffing and program resourcesavailable for effective treatment and rehabilitation, bothwithin the institutions and subsequently in communitysettings." 51Riverview itself was in need of a major restoration if it was to beeffective. Consequently, by 1985, the government faced the choiceof either upgrading Riverview or downsizing the hospital.Instead of bringing out policy directives clearly outlining aplan of action, the Ministry of Health adopted a more cautionaryapproach to the problem by engaging in a consultative process. Theprocess adopted by the Ministry and the government was a naturalextension of internal developments within the public sector. By1985, policy development and fiscal administration were centralizedinto the "political leadership of ministers" andministries(Langford, 1983: 564). As Resnick writes:"At the same time, neo-conservatism, B.C. style, vestedgreater authority in the hands of the provincial government atthe expense of municipal bodies, school boards, college anduniversity boards, and semi-autonomous governmentcommissions"(Resnick, 1987: 14).Policy initiatives as controversial as the downsizing of Riverview,therefore, required cabinet approval.The politicization of "policy development" lends itself tocaution. Senior bureaucrats, whose careers are reliant on thegoodwill of Ministers, and the Ministers, themselves, are reluctantto engage in action without wide-ranging support. To gather supportfor controversial policies, governments engage increasingly inconsensus building processes such as the "Consultative Process".75As Langford argues, the consultative process is only one of manythat governments currently use to generate consensus:"The scope of public sector activity has mushroomed; theprocess of deciding upon the allocation of public resourceshas become increasingly complicated by the development ofpolicy-making and coordinating agencies, regional government,departmental planning branches, task forces and publicparticipation; and a complex network of new vehicles fordelivering policy has evolved(Langford, 1983: 564).The "Mental Health Consultation Report" was finally releasedon September 29th, 1987, almost two years later than expected. Thereport called for the substantial downsizing of Riverview over a 10year period. Specifically, the proposal recommended thatRiverview's 1306 official beds be replaced by 550 medium/long termbeds located in three to four regional hospitals; an additional 310residential beds located in the community; and 60 acute care bedslocated in the general hospital system. Nine hundred and seventybeds were to suffice for the existing 1306 located at Riverview.Beside bed allocations, the report recommended that family(general practitioners, psychiatrists, and case managers) andcommunity (social/recreational; Life Skills/vocational) services beexpanded. Such services were to support patients in theiradjustment to living outside the hospital. 52 Finally, the reportstated that Riverview's current budget of 73 million dollars wouldpay for the proposed initiatives.Recognizing the need to develop community resources prior toscaling down operations at Riverview, the Ministry also providedadditional "new" funding in the following areas:A. $60 million in capital funding for new inpatientfacilities.B. $20 million over a three period to address critical76service shortages.C.^An average of $2.6 million per year for 10 years tofund transition costs, including community educationand staff retraining.The report and the ministry's commitment for additionalfunding received cautious but favourable responses from thoseassociated with the mental health system. Mental healthprofessionals and agency directors were pleased that the governmentwas, finally, committed to remedying the Riverview problem. Whilegenerally favourable, the B.C. Government Employees' Union, whichrepresents over 1200 employees at Riverview remained concerned overthe fate of its members. They strongly suggested that the BCGEU bedirectly involved in "... all phases of implementation to ensure anorderly transition to the alternative system of care". 53 Finally,general hospitals such as VGH, were dismayed that little provisionfor emergency psychiatric beds was made in the report. Thegovernment responded by increasing its commitment from 60 to 170new psychiatric beds in general hospitals.A year and a half after the publication of the Mental HealthConsultation Report, the Minister of Health had yet to bring theplan forward for approval by cabinet. In the spring session of theprovincial legislature, Dr. Tom Perry read letters demonstratingthe public's mounting frustration over the government's reluctanceto take action:Dear Dr. PerryAs parents of a son who suffers schizophrenia, we ask yourassistance in getting the government of B.C. to movepositively to adopt the new Mental Health Act. This documentwas readied-I think they're referring to the mental healthplan- in 1987, with input from many, including parents andfamilies though the Friends of Schizophrenics Society. It was77to be put to cabinet in the spring of 1988, the fall of 1988,the spring of 1989... Delays. Why? Because of the governmentdisrupting, retiring, downsizing and generally gutting thecivil service, key personnel were affected. It's time to geton with this crucial bill." 54The debate between Tom Perry, John Cashore, from the New DemocraticParty (NDP), and Peter Dueck, then Minister of Health, was quiteheated. The NDP was determined to ascertain the status of the Plan.The Minister of Health was determined to offset criticism byrestating the government's commitment to the plan:"The commitment I made in the "Mental Health ConsultationReport" released in 1987 still stands. Riverview Hospital willnot be downsized until cabinet has approved a long-rangemental health plan and community-based services are in place.I made that commitment last year, it still stands." 55Between 1987 and 1989, the rumour mill was bustling withactivity. Several times civil servants working within Mental HealthServices in Victoria announced the Plan was almost dead. Since theywere powerless to comment on government policy, they urged allthose within the system to put pressure upon Copley and theMinister of Health to resurrect the Plan and take it forward tocabinet. GVMHSS, community agencies such as Coast Foundation, theInter-Agency Mental Health Council, and the Friends ofSchizophrenics all sent submissions to the Deputy Minister ofHealth, Mr.Brian Copley, and to the Minister of Health, PeterDueck, arguing for the speedy implementation of the plan. In early1990, cabinet approved the Plan and the first allocation of newmonies was approved for the 1989/90 fiscal year.Since the "Plan's" implementation, $10 million of the $20million "new" money allocated for covering critical shortages hasbeen spent. However, by the end of 1991 transitional funds have yetto be allocated, and plans to construct "regional" hospitals and78community residential facilities to replace Riverview are onlybeginning to get underway.Those within the Ministry and the mental health field werequite sceptical about the government's long-term commitment to theplan. By early 1991, concerns over the introduction of a possiblenew restraint program, and the effect such a program would haveupon the Mental Health Plan, were echoed throughout the system.Several meetings, throughout 1991, with high level civil servantswithin Mental Health Services in Victoria and with the new DeputyMinister have led to the same conclusion: restated commitments fromVictoria with no additional funds. 56While the politics of the Mental Health Plan were unravellingover these past six years, Riverview was quietly reducing beds andincreasing its budget. Between 1985 and 1991, the Riverview bedcount was reduced from 1306 to 1032 official beds (unofficially,the reduction was from 1220 to between 900-920 beds). 57 Riverview'sbudget has increased from $73 million to, depending upon sources,between $90-$100 million. While it is likely the rapid rise inRiverview's budget represents escalating staff salaries and cost ofliving increases, and thus very little expansion of new services,it is almost certain that there have been no staff reductions. Thecomplex and potentially volatile issue of how to "downsize"Riverview's 1654 full-time staff remains unaddressed.At a recent symposium, representatives from Riverview claimedthat the reduction in beds has enabled the hospital to reallocatefunds. Indeed, 16.3 million dollars have been reallocated. However,$9.3 million are designated to cover budget shortfalls incurred byRiverview hospital and GVMHSS. Another $3.7 million will help79"increase" Riverview's ward staff. Finally, $3.3 million aredesignated to develop community programs. However, Riverview staff,in collaboration with other community agencies, are jointlyoperating the new community services. Thus, Riverview stillcontrols how the new community programs are being developed.Between 1985-1991, and especially during the initial stages ofimplementing the Mental Health Plan, key organizations (such asGVMHS in Vancouver, Riverview, Regional Managers associated withthe Provincial Mental Health Services, and the general hospitals)have taken on the responsibility of setting priorities and makingfunding recommendations for their jurisdictions. The transfer ofauthority to these organizations has met with approval fromVictoria. Indeed, it was the Mental Health Services thattransferred authority to these key organizations.The Ministry's track record over the years demonstrates thatit was reluctant to take a leadership role in developing BritishColumbia's mental health services. With key organizations assumingresponsibility for directing change, the Ministry avoids thepolitically dangerous situation of being held accountable forunfavourable responses to new developments. The organizationresponsible for setting priorities will be held accountable fordecisions.At the macro level, the state's strategy in obtainingconsensus through a consultative process may, in the finalanalysis, have the opposite effect. On October 24, 1991, GVMHSS andRiverview co-sponsored a Mental Health Symposium. At thissymposium, Riverview outlined its ten year plan to replace thehospital. According to Riverview's plan, the hospital will be the80major architect in developing mental health services in BritishColumbia. Certainly, Riverview has made a conscious effort over thepast two years to separate itself from government and establishitself as the leader within the mental health field. Indeed, in1990 Riverview was incorporated as a nonprofit society: it is nowcalled the B.C. Mental Health Society. Ironically, Riverview iscurrently given the responsibility for organizing its own demise.At the symposium, GVMHSS, like the B.C. Mental HealthSociety, also presented its vision of the future. Unlike Riverview,however, GVMHSS's vision has the community mental health systemtaking a leading role in developing mental health services inVancouver. The system has yet to hear from the general hospitals orthe Regional Managers as to their vision of who should be theleaders in mental health. Indecisiveness from Victoria and theemergence of powerful blocs could lead to conflict in the future.Recession and Restraint: Devolving State Authority To GVMHSSIn 1985, the Riverview problem was not the only issueconfronting Victoria. A decrease in funding combined withincreasing demands created a zero-sum game. By 1986, ministrypersonnel were being openly criticized for delaying the MentalHealth Consultation Report and for a lack of leadership within themental health area. Community agencies based in Vancouver wereparticularly virulent in their criticism. Vancouver had long becomea thorn in Victoria's side. As one Vancouver mental health officialnoted, Victoria viewed Vancouver as a "Black Hole, 50 miles away".Tight funding created a sense of urgency in Victoria to ensurethat scarce revenues were being utilized effectively. The impetusfor contracting gained momentum after 1986. However, given the81perception that community agencies would resist signing contracts,and the fact that contracting is effective only when locallyadministered, Victoria was reluctant to introduce a contractingsystem.In 1987, Mental Health Services delegated the responsibilityfor managing nonprofit societies to local administrators. InVancouver, they approached GVMHSS to take on the new role ofadministrator.The administration of Vancouver's eight nonprofit societiesrequired GVMHSS to :A. Negotiate^Contracts^Between^GVMHSS^And^TheAgencies.B. Develop Program Standards "upon which programs caneventually be evaluated". 58C. To Monitor Program Performance.D. Plan And Establish Priorities For Vancouver's CommunityMental Health System And Allocate Funds To AgenciesGVMHSS reluctantly accepted its new role as administrator. Inthe words of GVMHSS, "We took this role on as you know, a year anda half ago. We took it on with some trepidation and I think theagencies have accepted it with some trepidation". 59 After havingspent several years fostering trust and cooperation, GVMHSSunderstood that its new role, if mismanaged, could either alienateGVMHSS from other community agencies or alienate its own servicesystem from the central office: in its new role GVMHSS would berequired to decide funding priorities between external agencies andits own internal services. GVMHSS could not please everybody.Finally, the prospect of an increased work load was another factor82contributing to GVMHSS hesitation to take on administrativefunctions. 60Despite its reluctance to accept the new role, GVMHSS believedthat the alternative --the Ministry "setting up shop" in Vancouver-- would benefit neither GVMHSS nor the Vancouver community mentalhealth system. GVMHSS was not interested in sharing its position ofauthority with another agency. More importantly, a local agencywould be able to lobby and advocate on behalf of that particularregion. A Victoria based agency would be required to compromiseVancouver's needs with those of other regions.The theme of "if GVMHSS did not take on the role then a worsealternative would be forced upon Vancouver" was prevalent in 1987(and still exists in 1991). Initially, agencies accepted GVMHSS asadministrator because it was better to go with the "Devil youknow." Certainly, the GVMHSS track record since 1980 indicated thatGVMHSS would be a fair and equitable administrator.Since 1987, GVMHSS has employed a number of differentstrategies, enabling it to successfully implement Victoria- basedinitiatives while maintaining widespread support among thecommunity agencies.GVMHSS's first responsibility as administrator of thenonprofit sector was to implement a contracting system.Prior to 1985, agencies received funding on a per diem basis.Agencies received money for each hour a client attended theirprogram. A cap existed as to the maximum number of hours a programcould claim in any given month. Not surprisingly, agenciesconsistently managed to reach their maximum number of hours.The new funding process required agencies to sign formal83contracts clearly articulating obligations (service, reporting, andfiscal) between contractor and the agency. Part of the contractingprocess required agencies to submit monthly statistics in a numberof different categories. In 1985, GVMHSS signed the first contractwith Victoria.In 1987, GVMHSS required each agency to sign "standard"contracts. The contracts contained two controversial clauses.First, GVMHSS wanted each agency to submit a line-by-line budget.Through this budgeting process, each agency was required to seekpermission from GVMHSS to shift money from one item in the budgetto another. Clearly, such restrictions affect an agency's abilityto plan and make decisions regarding where to allocate resources.A general outcry from several agencies led GVMHSS to reconsiderthis clause. The line-by-line budget process was omitted from thecontracts. The contracts now contain only gross budget figures,i.e. $200,000 for agency X. What the line-by-line controversydemonstrated to the agencies, however, was GVMHSS's willingness tolisten to their concerns and take action on them.A second controversial clause provided GVMHSS with the rightto expropriate any surplus that may accrue to an agency. If anagency wanted to use the surplus, they had to seek permission fromGVMHSS. Once again, several agencies believed this clause to be aninfringement upon an agency's right to decide how and when toutilize surpluses, i.e. to transfer surpluses from one part of theorganization in order to offset deficits in another. To alleviateconcerns, GVMHSS stated that they would not unreasonably refuse anagency's request to utilize their surplus. While this assurance wasacceptable to most agencies, Coast Foundation refused to sign their84contracts for two years. In 1991, GVMHSS insisted that Coast signits contract.While originally exempt for the contracting process, CommunityResidential Facilities will be shifting over to the contract systemin the next few years. 61Besides formal contracts, Mental Health Services was veryinterested in developing program standards and evaluation criteriafor all funded agencies. It was GVMHSS's role to help develop thestandards. Instead of developing standards in isolation from otheragencies, GVMHSS initiated, in 1989, "A Consultative Process ToDevelop Standards for Prevocational and Vocational Programs", andResidential services. The process brought together programdirectors to discuss what standards each agency was willing toobserve. The recommendations from this consultative process wasforwarded to Victoria. In 1989, Victoria released a standardsmanual for residential services; in 1991 a standards manual forrehabilitation services was issued.Interestingly, despite GVMHSS's commitment to establishingstandards, it is likely that comprehensive agency and programevaluations will not follow as quickly as originally intended. Onecan cite several reasons for this probability. First, GVMHSS's ownbias is to evaluate an agency based upon their "motivation" and"commitment" to "caring" for the mentally ill. 62 Subjectivemeasurements are viewed more favourably than objective measures.One result of this orientation is that smaller agencies that areable to maintain a grass-roots "feeling" meet with greater approvalthan larger agencies which concentrate on goals, objectives andresults.85Another factor hindering the development of a comprehensiveevaluation system is cost. Evaluations are expensive, and withinthe social services, money is scarce. Traditional resistance by thenonprofit sector to agency and program evaluations is the finalfactor hindering development in this area. As Langford states:"The movement towards ministry evaluation of agencyperformance has not yet achieved the necessary legitimacyamongst the quango population, and cooperation is limited. Ina well-publicized case, an agency preferred to have itsfunding cut off rather than cooperate in an evaluation of theservice it was providing-despite the fact that the right toevaluate was established in the contract between the quangoand the government(Langford, 1983: 571).Finally, given GVMHSS's present desire to maintain goodwill amongcommunity agencies, it is unlikely that it would pursue a strategythat would precipitate overt resistance. Indeed, within therehabilitation field, GVMHSS has assumed a position of non-interference. There are no current mechanisms in place tosystematically review program performance. As Langford concludes:"Governments have demonstrated little capacity for evendeciding what "product" they want from their quangos, there islittle consensus on the mechanisms required to enforcemandates if they existed, and the political leverage enjoyedby most quangos makes them reluctant partners at best ingovernment efforts to evaluate their effectiveness as policydelivery agents(op cit: 572).The Construction Of Consent: GVMHSS's Support Of The NonprofitSectorA demonstration of how effective the consultation process canbe in averting possible conflict occurred in 1990 when Victoriaannounced that $20 million was being allocated to cover criticalshortages (Vancouver received $1.7 million dollars in 1990, or 1/3of the provincial allocation for that year). Instead of rationallyassessing Vancouver's current needs, and allocating resources toagencies based upon such assessments, GVMHSS decided to engage in86a consultative process to establish priorities for Vancouver. TheExecutive Director from each agency was invited to participate ina day long workshop designed to discuss where the new monies shouldbe spent. During the session each agency presented its proposalsfor funding and then assessed the merits of each other's proposals.Those proposals which received support were recommended forfunding.While agencies did not receive all the enhancements theyrequested, each agency did receive some additional money for theirown organizations. More importantly, each agency came away feelingthat, while not ideal, the process did allow for input, and GVMHSSdid listen to their needs. The solicitation of input was regardedas important. In other regions, input was not sought and regionalmanagers have met considerable resistance to changes they wouldlike to implement.The consultative process required each agency to compromise sothat consensus on priorities could be reached. It is difficult foragencies participating in this process to publicly denounce theresults of the process when they were active participants in thatprocess.The consultative process established priorities for theVancouver area. GVMHSS reviewed the results of the process and madetheir final recommendations to Victoria. Interestingly, of the $1.7million allocated for the Vancouver area, GVMHSS, itself, received62% of the money for its own organization. Thus, the consultationprocess did not hinder GVMHSS from strengthening its own agency.Between 1987-1991, GVMHSS actively supported the aspirationsof small, fledging nonprofit societies. With the exception of Coast87Foundation Society and St. James Society, however, agenciesproviding social, recreational and vocational services remainedrelatively insignificant until 1987. As indicated previously, in1979, the Kettle Friendship Society operated on a budget of $65,000per annum. Ten years later, the Kettle's budget was in excess of$500,000, and in 1991, in excess of $800,000. The major infusion ofmoney has occurred between 1989-1991. 63 Other agencies such as theMental Patient's Society and the Canadian Mental Health Associationin Richmond have experienced similar growth.GVMHSS's concern for the smaller agencies originated in theearly 1980's. At that time, individuals within GVMHSS believed thatsubstantial inequities existed within the mental health system. Onthe one hand, Coast Foundation received millions of dollars; on theother hand, the smaller agencies were just struggling to survive.By 1987, the view of Coast Foundation as the system's "FatCat" was also held within GVMHSS and other community agencies. Thesmaller agencies argued that if they possessed Coast's budget theycould also provide a wide range of services and offer competitivesalaries to their employees. Moreover, given a more substantiveprogram budget, managers would be free to focus their time andenergy in performing management functions, i.e. submitting grantsand proposals for additional funding. Program managers within thesmaller agencies are usually required to serve as "Jack Of AllTrades". They organize and implement programs, supervise staff, andperform management responsibilities.As with the smaller agencies, GVMHSS sought to alleviateinequities between Coast Foundation and other agencies. In theirpaternalistic support of other agencies, GVMHSS, at times, found88themselves hindering Coast's development. In 1987, for example,Coast Foundation applied to BCHMC for the development of two newapartment blocks, one in downtown Vancouver and one in the GreaterVancouver area. At a meeting between Coast and GVMHSS held on July22, 1987, representatives from GVMHSS made it clear that they wouldnot support Coast's application. There were two reasons cited forGVMHSS's lack of support. First, Coast was too big and had reachedoptimum size. Second, Coast's application would "conflict withtheir [GVMHSS] support of MPA's proposal". "Between 1989-1991, GVMHSS's support of the smaller nonprofitsocieties took a different form. Prior to 1989, GVMHSS's focus wasto develop the infrastructure of the smaller agencies. Since 1989,and since 1987 in the case of MPA, GVMHSS has actively supportedinitiatives by the smaller nonprofit societies to enter the housingfield. For example, the Kettle began operations of four group homesin 1989, and in 1991 the Kettle joined Coast in providing satelliteand community residential housing.The presence of other nonprofit societies in the housing fieldsignificantly impacts upon Coast's status within the Vancouvermental health system. Whereas Coast held a virtual monopoly onhousing until 1987, there are now several agencies competing forfunds. In the past four years, funds that would have normally beengiven to Coast went to other agencies.It would be wrong to insinuate that GVMHSS was not supportiveof any Coast issues over the past few years. With the allocation ofnew monies in 1990, Coast, like the other agencies, receivedfunding for innovative housing projects. As well, GVMHSS has beensupportive in representing to Victoria Coast's concerns regarding89the organization's increasing deficit in the Community ResidentialDivision. Of course, the fact that GVMHSS could not afford to losean additional five community homes in the Vancouver area probablycontributed to GVMHSS's support for Coast on this issue. Overall,however, the significance of GVMHSS's support to the smallagencies, to the detriment of Coast Foundation, cannot be ignored.Politically and pragmatically, GVMHSS's strategy of supportingthe smaller agencies has been very effective. Politically, thefocus upon Coast's size has deflected scrutiny away from GVMHSS'sown size and rapid expansion between 1989-1991. In many ways, thesmaller agencies have been quite accommodating in their silence. Asone program director stated, "It is better to criticize Coast thanbite the hand that feeds you."Pragmatically, with the development of the smaller agencies,no one agency, such as Coast Foundation, can monopolize a segmentof the mental health field. In a monopoly scenario, an agency withmaximal resources has the ability to negotiate favourableconditions. Furthermore, regulation of such an agency is verydifficult as that agency can threaten to withdraw its considerableservices. Within a multi-agency system, GVMHSS has more options inbargaining with a truant agency. Thus, through the development ofthe smaller agencies, GVMHSS expanded its control over theVancouver community mental health system.Tactics Of Aggression: The Encroachment of The CommunityResidential SectorUnlike the cautionary style of collaborating with thecommunity agencies, GVMHSS, between 1987-1991, pursued aggressivetactics in relating with Community Residential Facilities (with the90exception of Coast Foundation, all community residential facilitiesin Vancouver until 1989 were privately owned). In 1986, GVMHSS,along with other regional managers, gave notice to community homeoperators that, forthwith, they were required to provide ".5 hoursof professional care per resident per day, seven days a week". 65The person designated as responsible for providing the"professional care" was the Person In Charge (PIC) of the communityhome. Prior to the enforcement of the regulation, PICqualifications were quite diverse. A person with a Bachelor'sdegree and several years experience in the mental health fieldcould qualify as a PIC. The new standard stated that only"professionals" who qualified for licensing, i.e. psychiatricnurses, could assume the job of PIC.GVMHSS's rationale for enforcing this regulation ispersuasive:"We are dealing with a totally different system now, andthat's why we have insisted we have never before been reallyhard on the issue of having professional nursing staff becausethe multiple meds, the side effects, additional physicalillnesses that a lot of them have totally changed the system.It used to be in '78 when long term care came in the bulk ofthe people we had were personal care or just a little bitabove, it's quite different and the number of unusualoccurrences in facilities is rising very dramatically... u 66Consequently, with the increased levels of care required in thecommunity, GVMHSS believed the community home system required"professional" staff.Although GVMHSS "grandfathered" existing personnel who werelicensed but did not qualify under the new standard, it insistedthat new hirings conform to Provincial regulations. In the case ofCoast Foundation, a new employee who possessed over 10 yearsexperience working in the mental health field was rejected as a91PIC. Besides interfering in the hiring practices of an agency,GVMHSS did not take into consideration, or were indifferent to, theeffect the new standards would have upon the existing agencies. In1990, professional nursing staff earned between $35,000-$40,000.Other mental health staff working in community residentialfacilities earned between $20,000-$25,000. Such discrepanciescreate friction and turmoil within staff groups.Acting on direction from Victoria, GVMHSS, in 1991, beganenforcing another previously ignored standard. In the communityhomes it was not unusual for three to four people to share abedroom. Today, only two people can occupy a bedroom. While no onewill argue with the reasonableness or desirability of the newstandard, the lack of consultation regarding the enforcement ofthis standard, and the fiscal hardship the new standard causes(homes will now receive money for only 10 beds rather than 12) havegenerated frustration and anger over GVMHSS's actions.The enforcement of these two previously ignored regulationsdemonstrates the degree to which GVMHSS can exercise power andaffect the operations of a society under its jurisdiction. However,GVMHSS's actions are meeting some resistance. Pricare, anorganization representing private community home operators, iscurrently contemplating action against GVMHSS. The struggle betweenPricare and GVMHSS will test the limits of GVMHSS's power and thedegree to which agencies can act autonomously.GVMHSS's creation of the Katherine Sanford Society has alsoengendered considerable controversy over the past two years. Therapid escalation of real estate prices and the enforcement ofregulations led, in 1989, to three community homes submitting their92notices: "Notice of closure for next year has been given by threefacility owners resulting in the loss of 50 beds". 67 Reacting tothe notices, and fearing a repeat of the 1980 housing crisis,GVMHSS decided to establish the Katherine Sanford Society:"To deal with proposed closures and the inability of newoperators to undertake the expense of property acquisition, anew non-profit housing society (Katherine Sanford HousingSociety) was developed. The Society, with assistance from theB.C. Management Commission, will purchase sites or existingbuildings for residential facility development and will assumeongoing responsibility for property management. 68The Katherine Sanford Society is responsible for purchasing homesand then leasing to private operators.In its first year of operation, two GVMHSS staff were activemembers on the Society's Board of Directors. Over the past year,GVMHSS has distanced itself from the society and is no longerrepresented on the Board. However, there still remains a closeassociation between the two agencies: GVMHSS continues to provideadministrative support to the society.To understand why the Katherine Sanford Society iscontroversial one needs to understand how social housing units areallocated in British Columbia. Each year the province allocates 25%of its housing units to the various ministries. Mental HealthServices negotiates with other ministries for housing units. Uponreceiving their share of the units, Mental Health Servicesallocates units to the various regions. In Vancouver, GVMHSS isresponsible for distributing the units. 69 In the past, CoastFoundation has received units for the construction of theirapartment blocks.With control over the allocation of units, GVMHSS has beenable to rapidly develop the Katherine Sanford Society. In 1990,93Vancouver was allocated 36 units for social housing for thementally ill. Twenty of these units were allocated for theconstruction of a new Venture, a short-stay psychiatric emergencyresidence operated by GVMHSS. Sixteen units were allocated toKatherine Sanford Society. Coast Foundation, along with the otheragencies, received no additional units. 70The separation of ownership and operating functions enablesthe Katherine Sanford Society to control and stabilizedevelopments within the community residential field. If an operatoris not meeting expectations and complying with provincialstandards, the Katherine Sanford Society can replace the operatorwith another without losing the home. As well, being nonprofit, theKatherine Sanford Society is not subject to the lure of the profitmotive. Consequently, in times of a real estate boom, the Societywill not be inclined to sell its property.Many operators in the Vancouver mental health system havevocally criticized GVMHSS's close association with the KatherineSanford Society. They argue that social housing units should not beutilized to subsidize private operators. Moreover, GVMHSS, throughthe new society, is directly competing with operators.It is interesting to note that ten years earlier GVMHSSapproached Coast to help alleviate the housing crisis. This timearound, GVMHSS decided to establish a society which directlycompetes with Coast for unit allocations. Once again, therefore,Coast's ambitions are curtailed.In deciding to create the Katherine Sanford Society, GVMHSStook a calculated risk. It decided the benefits associated with theability to control developments within the community residential94field, in the long run, outweighed the hostility created by the newSociety in the long run.There are indications that GVMHSS's more assertive tendency toactively intervene in the community mental health system is showingup in the rehabilitation field. Just recently, GVMHSS, concernedover the lack of resources for "lower functioning" clients, hasindicated its intention to increase its rehabilitation services.Indeed in 1990, GVMHSS developed a Lifeskills program; at the sametime, Coast Foundation received funding from the federal governmentfor a similar program. Coast Foundation Society, the MPA, theKettle Friendship Society, and the Canadian Mental HealthAssociation-Vancouver and Richmond branches) all providerehabilitation services meeting the needs of a wide spectrum ofclients. The question of which organization, GVMHSS or the fundedagencies, is going to provide the bulk of rehabilitation services,is one of the emerging issues confronting Vancouver's mental healthsystem in the 1990's.GVMHSS's latest foray in providing services may be politicallydangerous. To date, GVMHSS has been careful not to enter theexclusive terrain of the community agencies. If GVMHSS decides toprovide more rehabilitation services, this may affect itsrelationship with the agencies.Coast Foundation-1985-1991: From Internal Strife To CorporateStructureInternal strife and structural changes preoccupied Coast'senergies between 1985-1987. The rift between the organization'sgrass-roots orientation and professionalism of the Community Homesdivision came to a climax during these two years. Coast's first95"official" Executive Director resigned in 1982. Instead ofselecting a replacement from within the Board of Directors, noweleven in number, Coast's Board decided to hire a new ExecutiveDirector from outside the organization. Bearing in mind that 1983was the first year of the Social Credit restraint program, theboard sought a candidate who was both a mental health professionaland a "money man". In late 1984, a new Executive Director washired. As well as possessing a Master's degree in CounsellingPsychology, the new Executive Director was, and still is, acorporate executive in a developing international company.An internal review of the organization's programs, and afunding scandal resulting in the loss of over $100,000 to theorganization, led to the resignation and termination of two ofCoast's three senior managers. Not surprisingly, the two managerswere responsible for the Housing and Recreation and ResocializationDivisions. Reacting to internal developments, three boarddirectors, loyal to the "old guard", resigned in 1986-87.Professionalism had emerged as the dominant orientation withinCoast Foundation.Concern over Coast's internal affairs led GVMHSS to insistthat an outside evaluator, Western Management Consultants, conducta comprehensive review of Coast's operations. In its review,Western Management Consultants made several recommendations. Thereview found:"There is a need for more strategic planning. Managementtechnique does not appear to be strategically oriented. Webelieve that if management focus had been given to improvingthe Board relations or to arguing strongly for financialmanagement, or for dealing with human resource issues in thecollective agreement, then some of the difficulties which hadbeen experienced over the past could have been avoided." 7196Indeed, despite earlier attempts in the late 1970's and early1980's, Coast Foundation, by 1985, did not have a Long Range Plan.Such a plan could have anticipated changes to the externalenvironment and placed Coast in a better position to react todevelopments between 1987-1991.Western Management further found that Coast overemphasized itsmental health orientation to the detriment of its "business"affairs. The review recommended:"With respect to property management, there was no separaterecognition given to their assets in the organization'sstructure even though the organization has properties tomaintain with a value of over $5 million...We noted from thestructure that the management functions in community homes andhousing divisions did not appear to be so different as tonecessitate separate divisions. Both these divisions offerdifferent forms of accommodation and if necessary andappropriate, we would see the consolidation of these twodivisions as a natural thing." 72In accepting this recommendation, the Coast Board of Directors, in1987 amalgamated the two residential divisions (Housing andCommunity Homes) into one division and created a third divisioncalled the "Property And Accounting" Division.During the review, Coast's Executive Director resigned. Inaddressing the issue of replacing the Executive Director, thereview's final recommendation advised the Board of Directors tohire a new person with extensive management skills: "Faced with thechoice, it is essential that the organization choose managementskills and experience in the position of the Executive Directorrather than technical skills". 73 In 1987, the Board of Directorshired a new Executive Director with no mental health experience butwho possessed a Master's degree in Business Administration and tenyears experience operating a large social service agency.97By 1987, therefore, Coast had taken on a corporate structure.The Executive Director and senior managers were experienced andqualified managers who were responsible for strategic planning,grantsmanship, public relations and legal/financial affairs. Theorganization's middle management and supervisory staff possessedprofessional qualifications (occupational therapy, social work ornursing) and/or mental health expertise (counselling, employmenttraining and placement experience, and programming skills). Programstaff possessed generic qualifications (experience working with aspecial needs population and post-secondary education;increasingly, Coast program staff are required to hold degrees) andare concerned with responding to client needs.Coast's evolution into a sizable nonprofit society hasaffected the organization both negatively and positively. Theorganization's varied interest groups generate perpetual internalconflict. For example, there are those within Coast who stronglybelieve that, for rehabilitation purposes, members (clients) shouldparticipate in all facets of the organization. The utilization ofmembers to perform skilled tasks requires a commitment by theorganization to train members and to tolerate mistakes whiletraining occurs; thus, inefficiencies occur. Others within Coastare interested in presenting an efficient, very professional imageto the business community:"We went to this method to involve the members in the "real"work of the clubhouse and with the logic that if we don't takea chance on our members and give them opportunities, who will.The other frustration is that much of our "business" side,fundraising, accounting, personnel, etc. deals with publicswhich may be quite sensitive to the foibles of our currentreception systems." 74The site for conflict between the various interests is the98Board of Directors. Representatives from clients, professionals,and business interests all sit on the Board. Each group championsa particular vision for the society. The organization's seniormanagement team expends considerable energy responding andmediating conflicts that originate at the Board level.Continuous internal strife clearly places Coast at a distinctdisadvantage when dealing with GVMHSS. The coerced review byWestern Management Consultants clearly indicates that GVMHSS andVictoria had lost confidence in Coast Foundation. Consequently,between 1987- 1991, Coast was placed at a distinct disadvantagewhen reacting to GVMHSS encroachment: Coast could only negotiatefrom a position of weakness, not strength.Between 1987-1991, Coast found itself powerless to resistGVMHSS initiatives. Coast was fortunate to build a new communityhome in 1987 (Ananda House) and, after protracted negotiations, anew apartment block in 1989 (Francis Court). Over the past twoyears, however, there has been no new funding from GVMHSS and BCHMCto build new housing, a trend that is likely to continue in theforeseeable future.Despite open and frank conversations between Coast and GVMHSS,regulations requiring Coast to hire "professional" staff for itsCommunity Homes and to reduce the number of beds in each home arenow in effect. Coast has not been able to modify licensingrequirements in these two areas. Interestingly, Coast's fear thatnursing staff would greatly affect the way the homes operate haveproved largely unfounded. However, the infringement upon Coast'sautonomy continues to generate strong negative feelings.Coast's emergence as a sizable corporate entity continues to99generate apprehension among other nonprofit societies withinVancouver's mental health system. While recognizing Coast'simportance to the system, Coast provides similar services to otheragencies and is, therefore, in direct competition with otheragencies for funding. As more and more agencies are now providinghousing, competition is increasing.While agencies are competing with Coast for scarce funds,GVMHSS is viewed as a strong supporter of smaller agencyaspirations. This situation has emerged despite the fact thatGVMHSS has received the lion's share of increased funds between1989-1991. To date, Coast has been ineffective in forming allianceswith other agencies in an effort to offset GVMHSS's encroachment.In tight economic times, Coast's size makes it vulnerable tocutbacks, since it is viewed as being better able to absorb areduction in funding. A reduction of $50,000 in a five milliondollar operating budget is less significant than a $50,000reduction in a $500,000 budget.Despite disadvantages, Coast's size and management expertiseprovides the organization with many benefits. Taking advantage ofits business acumen, Coast, between 1986-1991, successfully raisedfunds to purchase the building which accommodates theorganization's rehabilitation and employment services. The purchaseof the building, in a very expensive real estate market, providesCoast with security for its operations and with increased equity.Other fundraising activities have enabled Coast to fund a number ofcapital projects.In 1992, Coast entered into a joint venture with B.C. Hydro toconstruct housing for the mentally ill. This is the first project100with a major business corporation and may provide the basis forfuture developments with other corporations.During the government's restraint program, Coast neverexperienced a large reduction in any of its funding. With theincreased funding that resulted from partial implementation of theMental Health Plan, Coast received a large grant from GVMHSS for awork program and an outreach worker. Indeed, Coast's CommunityServices Division experienced rapid growth from 1988-1991: thebudget expanded from $600,000 to $1.3 million; staff doubled insize. Such expansion resulted from an influx of both provincial andfederal funds. Thus, Coast's management staff was effective innegotiating increased funding for its rehabilitation services.Unlike the housing area, GVMHSS has been very supportive ofCoast's rehabilitation services. There are several reasons for thissituation. Key personnel within GVMHSS who are responsible forrehabilitation have maintained excellent relations with Coastcounterparts. GVMHSS's and Coast's management staff are verycordial and respectful of each other. More importantly, in aligningitself with the smaller agencies, many of which until 1987 providedonly rehabilitation services, GVMHSS has taken a hands-off approachin the rehabilitation field. As previously indicated, however, thissituation may be changing and conflict between GVMHSS and thecommunity agencies may be imminent.With GVMHSS's entrenchment as funder and administrator,acorporatist arrangement has been firmly established. However, asshall be explored in the following chapter, such arrangements arenot static and are subject to strains and tensions. As we shallsee, it is unclear whether GVMHSS can maintain its role in the face101of macro level developments, i.e. changes within the provincialstate, or from demands being generated from within GVMHSS itself.In summarizing chronological developments within the GVMHSSand Coast Foundation, particularly with regard to theirtransformation along corporatist lines, we may say the following:1. Pluralism best describes Vancouver's mental health systemprior to 1980. During the 1970's a number of prominentorganizations emerged, most notably the GVMHSS and CoastFoundation. Developing themselves as viable organizationspreoccupied the activities of these two societies during thistime. These societies were loosely connected and were notsubject to intensive state intervention.2. With the onset of the economic recession and the provincialgovernment restraint program, state officials sought ways inwhich to contain nonprofit demands while depoliticizingpossible conflict. The establishment of a corporatistarrangement between the provincial state and the GVMHSSprovided the state with the opportunity to achieve itspolitical objective.3. The selection of the GVMHSS as the intermediary agency betweenthe state and other nonprofit societies was a natural outcomeof previous developments. GVMHSS had maintained closerelations with the provincial state throughout the 1970's andhad established a reputation of being able to carry out quasi-public responsibilities. Prior to the devolution of statepower, GVMHSS had established reciprocally dependent relationswith the provincial state.4. Having assumed responsibility for the administration and102monitoring of the nonprofit sector, GVMHSS established itsauthority by securing the support of the smaller nonprofitsocieties and by curbing the aspirations of Coast FoundationSociety. By the beginning of the 1990's, the GVMHSS had firmlyestablished its power. Over the past five years, CoastFoundation has been unable to effectively challenge GVMHSS'sauthority.103EndnotesChapter 3- Corporatism: Towards An Empirical And TheoreticalUnderstanding Of State-Interest Relations In Vancouver's MentalHealth SystemThis concluding chapter will provide an overall assessment ofthe corporatist model in understanding the relationship between thestate and interest organizations in a capitalist society. Toaccomplish this goal, the chapter will be divided into fivesections. The opening section will provide a brief discussion ofthe state's role in capitalist society and the changing nature ofthat role within the Canadian conjuncture. Subsequent sections willanalyze the changing dynamics of state-nonprofit relations in lightof Claus Offe's theoretical argument, and will address theinterpretative limitations of Offe's analysis regarding thenonprofit sector. The final section of the chapter will discusspossible future scenarios for corporatism in theory and inpractice.My purpose in reviewing theoretical and empirical issues isnot merely to reiterate what has been considered previously, but toclarify and develop arguments that have been introduced throughoutthis thesis.In chapter one, the discourse on corporatist theory focusedupon an explication of the ideas articulated by Claus Offe. Tobroaden the critique of corporatist theory, and to thread a numberof relevant themes through this chapter, it is necessary to situateOffe's theoretical argument within a larger theoretical corpusknown as neo-corporatism.Peter Williamson writes that neo-corporatism, as distinguished104from earlier "...forms of corporatist social thought andauthoritarian practice...", emerged as a theoretical model withPhilippe Schmitter's 1974 essay, "Still the Century ofCorporatism"(Williamson, 1989: 3). Today, corporatist theory isrecognized and respected as a "...political theory of interestrepresentation" with, increasingly, sociological and economicimplications(op cit: 16-17).Throughout eighteen years of change and development,corporatism has contributed to the study of state-interestrelations by developing and empirically verifying several keypropositions. First, corporatism is a system of interestintermediation rather than interest representation. Corporatistinstitutions act as intermediary associations between the state andmember associations, and as intermediary associations are criticalfor organizing and controlling conflicting functional interests(opcit: 14). Second, corporatism is being used more and more as aforum "...for making and implementing public policy", especially inthe realm of production politics(op cit: 16). Finally, whilecorporatist theory recognizes that corporatism exists at differentlevels, it has focused most of its attention on examiningcorporatist arrangements at the meso/sectoral level. 1 The lack ofresearch at the macro/national level is due, primarily, to the lackof a "theory of the state".Despite the state's central importance to any discussion ofcorporatism, corporatist theory has largely ignored theorizing onthe effects of macro/national developments and state power oncorporatist structures(op cit: 120). To remedy the absence of atheory of the state, corporatist theorists have, uncritically,105drawn neo-Marxist state theories into their analyses. As shall beargued throughout this chapter, corporatist theory must articulatea comprehensive understanding of the state if it is to maintainrelevance as a viable theory of state-interest relations.The Construction Of Consent In Post-1945 CanadaAs indicated in chapter one, neo-Marxist state theorists haveidentified two major functions that the state must try to fulfil incapitalist societies: accumulation and legitimation. 2 To achieveits accumulation functions the state has to engage in two"...distinct sets of activities, social investment and socialconsumption"(Gough, 1979: 51). Social investment refers to"...projects and services that increase the productivity oflabour"-urban infrastructure, research and development, andeducation(op cit). Social consumption refers to " projects andservices that lower the reproduction costs of labour power"-subsidized health care and housing, social insurance schemes(opcit; see Joppke, 1987: 239). By engaging in these activities thestate is able to contribute, indirectly, to increasing capitalaccumulation.The state and the economy are dialectically related. On theone hand, the state engages in activities that reproduce theconditions necessary for capital accumulation; on the other hand,business provides the state with a continuous flow of revenuethrough taxes. A healthy economy enables the state to engage in"social expense" activities. Social expenses are economicallyunproductive but are required to maintain social harmony "...byhelping to support non-working portions of the population-theelderly, the young, etc"(Joppke, 1987: 239). Social and community106workers, various types of counsellors, police, prison andprobationary staff, and nurses are only a few occupations that fallunder social expense activities. 3 The development of the welfarestate after 1945 was based significantly on the expansion of thestate in the provision of social expenses.The Great Depression created severe disruptions within allwestern capitalist economies which in turn led to widespread socialdisharmony and conflict. Both capital and labour turned to thestate to resolve the economic and social crisis. In constructing anew consensus after 1945, the state increased government spending,guaranteed "...social welfare-the core of Keynesian-increaseddemand and thereby stimulated production, leading to both fullemployment and high profits"(op cit: 240). As well, socialassistance created a "safety net" for those who were displaced bythe increasing industrialization of monopoly capitalism. As aresult of these developments, "...the material interests of bothworkers and capitalist were reconciled"(op cit).In Canada, by 1945 the principles of the welfare state werebegrudgingly accepted by both capital and labour, but "welfarism"was, at best, unevenly implemented throughout the country. Thefederal state under Mackenzie King introduced welfare legislationin 1944(Panitch, 1977: 21). Despite the introduction of acentralized unemployment insurance program, federal acceptance ofwelfare programs was mostly philosophical rather than in the formof practical programs. One of the problems the federal stateencountered in implementing wide-ranging welfare programs was thejurisdictional battle between the federal and provincial statesover what level of government should provide social services.107Throughout the 1950's and 1960's administrative responsibility forhealth, welfare, and education was transferred to the provinces.Some provinces were committed to the development of welfareservices while others were not. Indeed, as late as 1960 mostprovinces were more interested in providing "...functions relatedto capital accumulation, such as hydro-electricity power,transportation, industrial subsidies of various kinds, and, aboveall, education"(Stevenson, 1977: 84).In spite of provincial resistance to introducing welfareservices, especially in conservatively governed provinces such asBritish Columbia, expectations and demands for universal socialservices were unrelenting. Throughout the 1960's and 1970's,therefore, provincial governments found it necessary tosubstantially increase the state apparatus to accommodateincreasing demands. As Armstrong states:"The most striking feature of the enormous growth in thenumbers of government workers is its unevenness by levelof government. In 1946 the federal total was greater thanthe combined provincial and municipal total, but it wassmaller than either of the other two by 1971"(Armstrong,1977: 297).Between 1961-1981, in British Columbia, the growth of thepublic sector was fourfold that of the previous 20 years (1941-1961, the provincial state increased from 1,851 to 10,233employees; 1961-1981, the provincial state increased from 10,233 to43,152 employees). The increase was almost evenly divided between1961 to 1971 and 1971-1981. By the recessionary period of the early1980's, the provincial state employed in excess of 47,000employees(Rosenbluth, 1984: 1-6).Despite the unevenness in development across the country, the108principles and institutions of the welfare state were firmlyentrenched within Canadian society by 1971. State institutions,especially those associated with the provincial state, rapidlyexpanded to implement social service programs. However, given theprovincial government's delay in providing new social services, itis not surprising to find that in 1971 a centralized, rationalsystem to administer the new services did not exist and thatconfusion reigned between the provincial and municipal levels ofgovernment over which level of government was responsible for themanagement of the new social service programs. In any case, theperiod of rapid state expansion was financed by an unprecedentedeconomic boom throughout Canada and by the state's willingness toincur increasing levels of debt.All this signified that the welfare state had been firmlyestablished, both philosophically and structurally, in BritishColumbia by 1971. The importance of this claim is twofold. First,one of the major distinctions between corporatist theory andpluralism is the recognition that the welfare state is a "unifiedentity" founded upon the provision of social services to allcitizens. The state cannot simply be viewed as an "...arena wheregroup pressures are brought to bear", as pluralists contend. Inthis schema the state mirrors society, being shaped in itsdecisions and structure by outside pressure"(Williamson, 1989: 55).The welfare state, however, has its own political orientation(provision of universal social services), its own structure(institutions), and its own political agenda independent fromeconomic and social forces.In direct contrast to the pluralist model, neo-Marxist109theories have tended to reify the state. Often neo-Marxists discussthe state in abstract general terms and as a result fail torecognize that there are different levels of the state, each levelcomprising a multitude of complex institutions. Between and withineach level there are conflicts, negotiations, and compromises, andeach state level may have different perspectives on policies andpriorities. As shall be argued in the subsequent sections, theemergence of the nonprofit sector is intricately linked to thewelfare state. However, in order to understand the way in whichstate-nonprofit relations develop and change over a twenty yearperiod, one has to conceptualize the state in what Gregory Albo andJane Jensen call "neo-institutional" terms-the state as morecomplex and as possessing greater internal conflicts thanpreviously theorized(Albo & Jensen, 1989: 200)The Emergence of The Nonprofit Sector In Vancouver's Mental HealthSystemFollowing from the works of Claus Offe, James O'Connor and IanGough, Christian Joppke argues that the post-war economic boom, andthe return to full-employment led to increasing economic (consumergoods) and political (increased state social services) demands fromall groups and classes within civil society(Joppke, 1987: 141-143).In the context of post-war developments, it was not surprising thatmany interest groups came forward to lobby the state for servicesaddressing the needs of specific interest groups. To maintainsocial harmony, or legitimacy, the state was cognizant of the needto finance those social groups that were potentially politicallydisruptive. As long as the economic boom continued, the state couldafford to finance an increasing number of interest groups. Thus, as110Offe argues, the welfare state's political mandate to maintainsocial harmony through increased expansion of "social expenses" wasachieved without the state having to control the intensity,content, or the number of demands emanating from civil society.Ostensibly, the nonprofit literature (Kramer, 1981; Young,1986; Rose-Ackerman, 1986; Hall, 1987; Salamon, 1987) iscomplementary to Offe's corporatist arguments. The nonprofitliterature argues that groups of individuals representing specificneeds will approach the state for funding. Given that nonprofitsocieties are perceived as being akin to the state, and that suchsocieties can provide cost effective "experimental" services todisenfranchised but politically motivated groups, the state is morethan willing to provide money and support to nonprofit societies.There are a number of events that occurred throughout the1970's which are particularly germane to the emergence of nonprofitsocieties. By 1970, the provincial government had begun expandingits commitment to welfare services. Until 1970, such expansion wasprimarily focused upon the development of its own institutions.Throughout the 1970's both the New Democratic and Social Creditgovernments continued to expand the public service sector and beganfinancing ancillary organizations such as nonprofit societies.The enlargement of the state sector enabled the provincialstate to develop a modern administrative structure to manage itsexpanding responsibilities in the fields of health, welfare andeducation. The centralization of administrative responsibilitieswithin the provincial ministries was a critical part of themodernization process. In centralizing some social service sectors,responsibility for administering social service programs shifted111from the municipal (or local) state to the provincial state. Sucha shift required negotiation and compromise between the two statesectors. Finally, by the early 1980's, the centralization processhad the effect of distancing those individuals responsible forpolicy development and funding allocations from the areas, i.e.Vancouver, in which actual social service programs were beingimplemented. As a result, provincial bureaucrats becameincreasingly dependent upon agencies to provide information andrecommendations needs at the local level.Upon the advice of a provincial consultant, The GreaterVancouver Mental Health Service Society (GVMHSS) was created duringthe early 1970's. On the one hand GVMHSS was created as a communitybased resource to provide direct clinical services to the mentallyill of Vancouver; on the other hand, GVMHSS was created as anorganization that could act as an intermediary between theprovincial and municipal levels of the state. Throughout the1970's and 1980's GVMHSS has maintained a close association withboth levels of government. GVMHSS personnel have a long history ofparticipating on various provincial committees. In the late 1970'sGVMHSS assumed responsibility for coordinating and administratingthe Long Term Care program for Vancouver's mentally ill. Thus, atthe outset GVMHSS was created as a political entity as well as aprovider of direct service.One of several nonprofit societies to emerge during thisperiod was Coast Foundation. After existing on a shoe-string budgetthroughout its first two years of operation, Coast, takingadvantage of changes within the federal social housing program,began developing housing for the mentally ill. The expansion into112housing enabled Coast to attract core funding from the provincialgovernment. The acquisition of core funding stabilized Coast'sprecarious existence. However, despite Coast's reliance upon theprovincial and federal state for funding, the organization was onlyperipherally connected to the state: for the most part, beyondaudited financial statements, the state requested only minimumreporting requirements. Besides being only tangentially connectedwith the state, Coast had no formal connection with other nonprofitagencies within the sector.With the expansion into housing, a split occurred within Coastbetween the organization's grass-roots orientation and its newexpansionary, professional orientation. While the split wasinitially resolved during the mid-1970's, it became a focal pointof contention in the late 1970's and early 1980's.Events and developments throughout the 1970's raise severalissues for corporatist theory. Throughout the 1970's all threeareas under study (the provincial state, GVMHSS, and CoastFoundation) were preoccupied by their own internal developments.Although GVMHSS and the provincial Mental Health Services wereclosely associated, the state maintained only peripheral contactwith nonprofit societies. Langford argues that senior ministrypersonnel within the state were, for the most part, unaware of, ordemonstrated very little interest in, the burgeoning nonprofitsector:"Using British Columbia as an example, funding wasprovided on an annual basis to exiting agencies, risingmore or less each year at the same rate as the rest ofthe particular ministry's estimates...Overall, there waslittle evidence of concerted thought at the centre(either in line ministries or central agencies) about therelevance of the entire cohort of social service quango113activities to the overall social policy goals of thegovernment or the effectiveness of the performance ofindividual agencies on a year-by-year or multi-yearbasis" (Langford, 1983: 569).Besides the lack of connection with the state, nonprofit societiesacted in isolation from one another. In many ways, Vancouver'smental health system exemplified a pluralist system.The existence of pluralism at the meso-level raises thequestion of how one explains such arrangements within corporatist,or indeed, neo-Marxist theory. One possible explanation focusesupon the distinction between the politics of production (class) andconsumption (social services or social expenses). In this argument,corporatist theorists argue that within the realm of the economythe state has only "..influence, not control, over what changes theintervention might bring about and, therefore, over its directionand successes"(Williamson, 1989: 170). Even labour, which islegally dependent upon the state (through legislation, the staterecognizes labour's right to organize and undertake collectiveaction), has the ability to enact "...a range of sanctions,including labour and investments strikes but also a plethora ofminor acts of non-cooperation which could adversely affect, andpossibly render completely ineffectual, the intervention"(op city.The potential power resources of producers stand in direct contrastto that of "...consumers or clients of interventionist policies.For one thing it is probable that consumers, while represented byan organization or organizations, will not organize themselves.Even if they are organized this would not place them on equalfooting with producer interests" (op cit). Consumers do not have thepower to seriously negotiate compromises with the state and are,114therefore, powerless to prevent the state from "...authoritativelyimposing its decisions"(op city. In the context of this argument,there is no need for the state to establish corporatistarrangements within the realm of consumer politics. Such anargument is not supported by empirical developments withinVancouver's mental health system. Consequently, the criticalconcern, and one this chapter will turn to later, is to account forthe existence of a corporatist arrangement within the nonprofitsector.A second explanation for the existence of pluralism argues,that with the emergence of new interest groups, pluralistarrangements are quite common but, over time, such arrangements arereplaced by corporatism. While this is true in the context of thisinquiry, such an explanation is too general. Specific questions areleft unanswered: is corporatism the inevitable result of anevolutionary process between the state and interest groups, or doescorporatism emerge as an effect of changes occurring at the macroeconomic-political level?Within the nonprofit literature, individuals and statebenevolence are cited as important factors leading to the emergenceof nonprofit organizations in industrial society. Empiricaldevelopments in the 1970's call into question the importance ofthese factors. Throughout the 20 years prior to 1970, individualsapproached the state for funding but such applications received nofinancial support. Only with the emergence of the welfare state,and the state's commitment to the development of social services,did individual demands receive support from the provincialgovernment. The nonprofit literature fails to incorporate broader115economic-political developments within their analysis and,consequently, reduces an understanding of state-nonprofit relationsto either descriptive terms or methodological individualism.The state benevolence thesis is also subject to question.Throughout its early years, Coast Foundation struggled to survive.It was only when the organization began developing housing(politically, a high demand resource) that Coast received corefunding from the provincial government. Equally, GVMHSS powerduring the first few years was derived from its political role asan intermediary between the city and the province. The ability ofnonprofit societies, such as Coast and GVMHSS, to secure a nicheand become politically influential within Vancouver's mental healthsystem led directly to state support. Other societies', the Kettle,for example, inability to situate themselves politically accountedfor their marginalized existence throughout the 1970's and early1980's.Centralization, Crises, and The Emergence Of CorporatismIn his treatise on "corporatism", Claus Offe argues that theeconomic/institutional crisis of the early 1970's required thestate to reconstruct a new political rationality. In an era ofdiminishing revenues, the state could no longer afford to fund allthe services being demanded. The dilemma facing governments,however, was that the very foundation of the welfare state wascentered on the state's ability to provide an increasing number ofsocial service programs. Ostensibly, a reduction in social serviceswould create widespread hardship and conflict. The challenge facingall western capitalist governments during the 1980's was to channeldemands into something more manageable, i.e. to reduce the level of116state spending to unproductive interest groups, while containingand depoliticizing conflict.Offe is vague on what he means by the "economic-institutionalcrisis" of the early 1970's. Ian Gough's insightful analysis on thewelfare state provides a better overview of the crisis. Goughargues that the welfare state is inherently contradictory.Thereturn to full employment after 1945 created the conditions for theeconomic boom between 1945-1974: full employment ensures that themajority of workers have money to spend on consumer goods. However,the restructuring of the economy after 1945 resulted in lessreliance on labour and an increasing reliance on technology. Stateexpansion in the social services enabled capitalism to maintainfull employment:"There has taken place a far-reaching structural shift inemployment over these years away from manufacturingindustry and into the services, particularly the publicservices, and within this group particularly the socialservices...Their explanation of this fact is that thesocial services provide a cheap (that is, low-capital)means of maintaining full employment" (Gough, 1979: 106).To sustain state expansion the state has to divert monies, on anincreasing scale, from accumulation to legitimation and to increasetaxes. Both of these conditions, inevitably, affect the economy'scapacity to sustain high rates of growth: "It follows that anyincrease in state expenditure necessarily reduces the quantity ofsurplus value available for re-investment and this slows down therate of capital accumulation and economic growth(op cit: 105).With the onset of the recession in the mid-1970's the economicboom came to an end. To resolve the crisis within capitalism, i.e.to re-establish the conditions for accumulation, the "neo-117conservative coalition (old middle class-shopkeepers, farmers, etcand elements of the new middle class, "...the so called "YoungUrban Professionals", and big business) sought a restructuring ofstate priorities away from nonproductive investment in socialservice expenditures to reinvestment in private capital(Joppke,1987: 251). As a result, the "...instrument of classcompromise...", the welfare state, became the object of intenseclass conflict as the new conservative coalition called for thedownsizing of all social service institutions.In reconstructuring consensus, the state, Claus Offe argues,must rely on corporatist arrangements. After the mid-1970's thestate takes an active role in bringing together representatives ofparticular classes to participate in consensus decision-makingprocesses. Decisions are often required on the allocation of scarcefunds and resources. Chosen representatives must have the mandateto represent a particular sector and be able to secure compliancefrom its membership. By including class representatives in resourceallocation decisions, the state is able to depoliticize andinstitutionalize conflict. In agreeing to compromises, all partiesare responsible for complying with the negotiated agreements.Empirically, there are a number of events which occurredbetween 1980-1986 that relate to the above scenario. In 1980, theprovincial state began to address the issue of "policy coordinationand comprehensive audits" for nonprofit societies in BritishColumbia. During that year, the state adopted"proposals for reform of the B.C. government's financialmanagement system included provision which could havebeen used to develop a more extensive annual review ofagency budgets, to establish the conditions on whichgrants or contracts were arranged, and generally to118increase the quantity and quality of information quangoswould be obliged to provide the government"(Langford,1983: 569).By 1984, Mental Health Services had assumed responsibility forpolicy development and funding authorization for all provincialmental health services. This included responsibility for budgeting,monitoring and evaluation of nonprofit societies.By 1980, the Vancouver mental health system found itselfimmersed in an escalating crisis. Each agency, including GVMHSS andCoast, experienced increasing demands on their services from mentalhealth consumers. In 1979-1980, several private community homesgave notice of closure. Emergency resources were inadequate to meetthe growing needs of the Downtown Eastside. To accentuate theproblem, rumours persisted that the provincial government was aboutto implement restraint measures. Not only was the likelihood ofincreased funding for needed services remote, but there was growingfear that a restraint program could lead to the closing down ofseveral agencies.Reacting to a funding crisis and to a precarious future,agencies within the mental health system formed the Inter-AgencyMental Health Council. The council provides, for the first time, aforum in which agencies can formally meet. During its formativeyears, the council was effective in ensuring mental health issuesremained a priority for the provincial government. However,agencies within the council failed to reach agreement on a mandate(even in 1992, the council's mandate continues to be discussed adinfinitum) which would have given agencies power to makerecommendations for services and funding allocations within119Vancouver's mental health system. Consequently, the council, by1987, had evolved into an information and communication resourcefor mental health agencies.Between 1979-1984, Coast Foundation emerged as one of the twomajor organizations within Vancouver's nonprofit sector. Coast'snew status and power was due to the acquisition of four communityhomes and federal funding for employment training and placementprograms. Coast's expansion caused considerable changes in theorganization's internal and external orientation. Internally, aprofessional, hierarchial administrative structure was establishedto effectively manage the organization's new scope of services. Newtensions emerged within the organization, specifically, between theorganization's professional/program orientation and theorganization's administrative/business requirements.Externally, Coast's community home division is required towork closely with GVMHSS in assessing and coordinating communityhome referrals. As well, the community homes are expected to complywith licensing requirements, to implement standards of care, and toprovide detailed statistical and financial reports. Theorganization's rehabilitation services, however, were not subjectto the same level of scrutiny that existed in the community homes.Externally, Coast's new stature increased expectations fromthose within the mental health system for Coast to take a leadingadvocacy role on behalf of the mentally ill, especially in takinga leading leadership role within the Inter-Agency Mental HealthCouncil. At the same time, Coast's emergence as a multi-milliondollar organization created considerable trepidation among thesmaller agencies which feared Coast's expansionary tendencies.120Like Coast, GVMHSS also experienced considerable changesduring this period. Responding to internal pressures for additionalsources of revenue, GVMHSS became incorporated as a nonprofitsociety. Incorporation enabled GVMHSS to pursue different re-sources, especially federal funding. As well, the organization'snonprofit status distanced GVMHSS from its association with theprovincial state. Throughout the period, GVMHSS becomes an activeparticipant on the Inter-Agency Mental Health Council and an allyof the nonprofit agencies within the mental health system.The provincial government unveiled its restraint program inthe 1983-1983 provincial budget. Restraint measures represented awholesale attack on social service programs within BritishColumbia. The public service was reduced by 25% and there was a 20%reduction in funding to "...community-based social servicequangos," resulting in the financial collapse of a number ofagencies (e.g. seniors' day centers) (op cit: 568).In a climate of reduced funding for all ministries, Riverviewhospital, with its considerable financial base, received newattention. The downsizing of Riverview, potentially, would generateadditional revenues for a financially pressed ministry. Of course,the hospital and the British Columbia Government Employees Unionwere apprehensive and resistant to any proposed downsizing of thehospital. Complicating the matter was the extensive public outcryto the government's restraint measures. As a result, Mental HealthServices was reluctant to initiate any concrete actions to downsizethe hospital. Instead, senior bureaucrats initiated a publicconsultative process to discuss the Riverview problem.As part of its decentralization process, Mental Health121Services in Victoria approached GVMHSS, in 1987, to assumeresponsibility for administration of Vancouver's nonprofit sector.In accepting its new role, GVMHSS assumed responsibility forestablishing a contracting system, developing program standards andevaluation criteria for community agencies, and, most importantly,prioritizing funding requirements for the Vancouver system. By1987, therefore, policy development and provincial budgetallocations were centralized in Victoria while administrativeresponsibilities were decentralized to the local regions.Empirical developments between 1980-1986 raise severalimportant issues. Without question, empirical events support Offe'smajor contention that the economic crises (in British Columbia, theeconomic downturn occurred during the early 1980's), curtailed thestate's capacity to accede to escalating demands from interestorganizations. In a climate of diminishing revenues, the state'sprimary goal, after 1983, was to reduce social service expenditureswhile containing the inevitable conflict that such reductions wouldinduce. Corporatist arrangements, in which intermediaryorganizations are responsible for generating consensus in theallocation of scarce resources, offer the state one method toachieve its political goals. It is not surprising, therefore, thatthe state assumed an active role in the establishment ofcorporatist arrangements.The strength of Offe's analysis is that he identifies theexternal conditions, historical political-economic developments,which impact upon the state's capacity to act. Conversely, thenonprofit literature is conspicuous in its neglect of broader macrodevelopments. While acknowledging the importance of macro122development on meso level arrangements, corporatist literature, todate, does not attempt to systematically explore this connection.Ironically, a strength and weakness of Offe's argument is hisunderstanding of the centrality of the state. In comparison to hisanalysis of the state prior to 1970 as "reactionary and passive"with regard to interest group demands, Offe sees the state, by themid-1970's, as a principal force in galvanizing new corporatistarrangements. Offe is quite correct in advocating a centralposition for the state in understanding the development ofcorporatist arrangements. However, empirical developmentsthroughout the 1980's call into question the image of theunassailable state. The centralization process of the late 1970'sand early 1980's clearly strengthened the provincial state'sability to develop and enact policy initiatives. At the same time,the provincial government's restraint programs weakened its resolveto pursue innovative policies. Schmitter's argument that one of theenabling conditions for the emergence of a corporatist arrangementis, paradoxically, a strong and weak state, represents a closerdepiction of events occurring between 1980-1986.Interestingly, the provincial state support for proposalscalling for greater accountability of nonprofit societies occurredthree years prior to the onset of the government restraint program.It is very likely that the state, regardless of the political-economic environment, would have proceeded with the introduction ofmeasures to control the nonprofit sector.The introduction of the government restraint program affectedthe state's ability to implement accountability measures. On theone hand, the restraint program, which called for leaner and more123efficient civil and social services, provided a perfect ideologicalrationalization for the implementation of measures such asstandardized contracts and levels of care. On the other hand, thestate's reluctance to initiate controversial policies contributedto a very cautious approach in introducing measures such asstandards and evaluation for rehabilitation services.By 1987, a corporatist arrangement had been established withinVancouver's nonprofit sector. Yet, such arrangements areproblematic within neo-Marxist or corporatist theory. PeterWilliamson offers a number of insights to explain the existence ofcorporatism within the realm of the social services.Williamson initiates his understanding of welfare corporatismby arguing that "dependency, rather than negotiation, is the key toany consideration of corporatism"(Williamson, 1989: 171). If sucha proposition is true, then in those circumstances where the stateis dependent upon specific agencies, a corporatist arrangement maydevelop.In developing his argument further, Williamson contends that,within the welfare system, power is generated in two ways. First,professionals working within the welfare system "...enjoy amonopoly position in respect of their right to exercise particularskills based on a body of theoretical knowledge. Second,professions have rights of self-regulation in terms of competenceand conduct"(op cit: 171-172). As well, professions achieve...social closure around particular skills just as trade unions oremployers' associations within a monopoly would achieve closurearound a particular aspect of production(op cit: 173).Consequently, professionals lay claim to specific knowledge,124inaccessible to those outside the profession, which is critical tothe development of public policy: "A bureaucrat or politiciancannot, for instance, as a lay person decide the efficacy ofvarious types of medical care"(op cit: 180).Within the social services another group of professionals alsohold power and are integral to the development of public policies,those being "permanent officials, managers or bureaucrats". 4 Localmanagers attain their power by virtue of their influence or controlover other organizations within a given sector. As well, the closerelationship between senior bureaucratic officials and local areamanagers provide agencies external to the state apparatusconsiderable power in shaping public policy:"What is of particular importance here is therelationship between the central bureaucratic officialsand local agency or authority managers. Like othercorporate interests these local welfare managers wouldhave to be assumed to be in a position of sufficientproducer power to overcome the formal hierarchy of abureaucracy such that they were drawn into negotiationsover the form of intervention. There is indeed aconsiderable literature which highlights the bargainingbetween central and local or regional parts of thestate"(op cit: 181).Through the exercise of professional power a dependent relationshipdevelops between the central state and key local organizations,and, as a result, corporatism emerges as a distinct possibilitywithin the welfare field.Williamson is cautious in his analysis of welfare corporatism.First, he argues that inquiries into the area of welfarecorporatism are only beginning. Welfare corporatism has "...notbeen subjected to the same level of investigation from acorporatist perspective...as has economic intervention"(op cit:125185). Consequently, empirical and theoretical questions are...relatively thin on the ground"(op city. Indeed, one of thecentral problems facing corporatist theory is to examine thesimilarities and differences between corporatism within the realmof production and the realm of consumption.It is noteworthy that within GVMHSS, both elements ofprofessional power existed. As the provider of community clinicalservices for the chronically mentally ill, GVMHSS held a monopolyposition in Vancouver. With the centralization of power inVictoria, and the removal of a provincial presence in Vancouver,the state came to depend upon GVMHSS to assist in the coordinationof services at the local level, i.e. in Long Term Care, and toprovide ongoing information on the local situation. As well,throughout its history GVMHSS maintained a close association withthe provincial state. It was not surprising, therefore, for MentalHealth Services to approach GVMHSS in 1987 to assume responsibilityfor administering Vancouver's nonprofit sector.Consolidation Of GVMHSS Power Within Vancouver'sMental Health SystemGiven the distinct advantages of corporatism, one readilyunderstands why, for Offe, the state was predisposed to developingsuch arrangements. However, Offe's analysis offers only a weakunderstanding of why nonprofit agencies would enter into sucharrangements, and, once entered, how agencies that are chosen torepresent a given sector, called Private Interest Governments(PIG), are able to engender support for their new roles. Whereascorporatist theory has been weak remiss in theorizing the state,Offe's analysis is weak with regard to understanding developments126at the meso level.In understanding developments at the meso level, somecorporatist theorists, such as Schmitter, contribute a number ofinsights. Through corporatism, agencies acquire tangible benefitsand increased power. By virtue of the fact that PIGs acquire thepower to allocate scarce resources within a given sector, and thepower to monitor and evaluate the behaviour and activities ofagencies within that sector, PIGs are no longer on an equal statuswith other agencies; with their newly acquired power, PIGs controltheir own fate and the fate of other agencies.Quite naturally, the delegation of public power to a specificagency, especially an agency that competes for funds, would, oneexpects, meet with considerable resistance from other agencieswithin the sector. To consolidate their authority, PIGs, accordingto Schmitter, must weaken potentially disruptive agencies, and mustentice other agencies to participate in consensus decision-makingprocesses rather than engage in militant actions.A number of events, occurring between 1987-1992, bear on thisdevelopment. GVMHSS accepted its role as administrator withconsiderable trepidation. Ostensibly, there are a number of reasonsfor GVMHSS's reluctance. First, GVMHSS was weary about theadditional burden that its new responsibilities would place uponits own organizational structure. Only when Victoria agreed toadditional staff support was this issue resolved. Second, GVMHSSwas concerned that its new role would damage the good rapportGVMHSS had developed over the years with other nonprofit societies.Finally, GVMHSS was cognizant of the fact that its new role wouldbe perceived by other nonprofit societies as a conflict of interest127situation: GVMHSS, as administrator, would be responsible forrecommending funding for its own Mental Health Teams and for theexternal nonprofit societies. When it became apparent that theprovincial state was committed to decentralizing administrativefunctions, and would establish a regional office in Vancouver toperform such functions, GVMHSS decided to accept the role asadministrator.Throughout its five year tenure as administrator, GVMHSS haspursued a number of strategies to consolidate its power. First, andforemost, GVMHSS supported the growth of the smaller agencies-especially in the housing field- while curbing Coast's expansionaryaspirations. The effect of GVMHSS's actions are twofold. Bysupporting the development of housing through other agencies,including a new housing society created by GVMHSS, GVMHSSeffectively ended Coast's monopoly in housing. Whereas in 1987,only Coast, and possibly the Mental Patients Association, had thecapacity to develop a large number of housing units, by 1992several agencies have acquired skills and expertise in the housingfield.Besides containing Coast, GVMHSS's strengthening of thesmaller agencies had the secondary effect of engendering supportamong those agencies for GVMHSS's role as administrator. GVMHSSenhanced its paternalistic reputation by taking a "hands off"approach when dealing with the eight nonprofit agencies. 5 True, in1987, GVMHSS implemented the provincial contracting system, but, asof 1992, there is still only minimum monitoring and evaluation ofagency activities.GVMHSS's "hands off" approach was in direct contrast to its128active intervention in the community residential field. As Coastwas the only nonprofit society operating community homes, it wasunable to galvanize support among the other agencies in itsconflict with GVMHSS. Conversely, GVMHSS could pursue aggressiveaction within this area without alienating its support among thefunded agencies.The introduction of consensus decision-making processes,whereby all nonprofit agencies within the Vancouver mental healthsystem participated in generating recommendations for funding, wasthe second initiative implemented by GVMHSS during this period. Thesuccess of this initiative convinced GVMHSS to include agencies inmonthly meetings to discuss system issues and to provide input intoGVMHSS's strategic planning process.The monthly meetings provide an official forum for seniorpersonnel to meet regularly. 6 Such meetings are important inorganizing the interests of, and providing direction for, thoseworking within the mental health system. As well, the meetingsenable GVMHSS to develop strategies with the agencies on ways toaddress issues with the provincial state.Between 1987-1991, Coast was incapable of galvanizing supportfor its issues and in countering GVMHSS's actions. There areseveral reasons for Coast's ineffectiveness. First, Coast was, onceagain, preoccupied by internal developments and conflicts. Second,while containing Coast's aspirations, GVMHSS has not implementeddraconian measures to reduce Coast's power. GVMHSS could havedramatically reduced Coast's operations by decreasing its fundingbase. Yet, since 1990, Coast, as with all nonprofit agencies,received increased funding for new rehabilitation services.'129Conversely, the Ministry of Health has been reluctant to fund theincreasing accumulative deficit within the Community Home Division.By maintaining the status quo, GVMHSS was effective in curtailingCoast's growth while not providing Coast with an issue- cut-backsto vital services to the mentally ill- that would generate a publicoutcry.Events between 1987-1992 raise a number important issues foran understanding of corporatism. As indicated in chapter one,Schmitter, in contrast to Offe, argues that interest organizationsalways have the option of refusing to enter into a corporatistarrangement. GVMHSS's latitude to exercise choice, however, is opento interpretation. Senior personnel within Mental Health Servicesrecognized that "setting up shop" in Vancouver would have been avery difficult enterprise. Vancouver has always valued itsindependence from Victoria, and throughout the twenty years between1972-1992, Vancouver-based agencies have been effective, albeit onan intermittent basis, in generating a public profile in advocatingfor additional mental health resources. In recognizing thatconsiderable resistance would result from a provincial presence, itis very likely that Victoria exerted pressure on GVMHSS to acceptthe role of administrator. If Williamson's argument on"professional power" is valid, i.e. power is derived partially froma close association with senior state personnel, GVMHSS was obligedto take on the new role in order to maintain its power base.Dependency between the provincial state and GVMHSS was mutual.The "mutuality of interest" argument is further developed byChristian Joppke. He argues that:"The basis of the capital-labour accord...vanished, and130the instrument of class compromise itself became theobject of intense social and political struggle. Theagents of this struggle, however, are no longer clear-cutclass actors, defined by their relation to the capitalistmeans of production and acting on behalf of their class.Rather, the agents are social groups in the sphere ofreproduction and collective consumption, whose veryexistence as groups is partly due, to the institutionalnetwork of the welfare state"(Joppke, 1987: 244-245).The new social actors are welfare clients, state workers, andcommunity and nonprofit social service workers. Their interests andlivelihood are dependent upon the retention of welfare institutionsand services. Potentially, therefore, this group of new socialactors could form a socio-political alliance to combat the"productivistically oriented social groups and classes,who favour a segmented society polarized between theowners of capital, jobs, and skills-and the swellingmasses of have-nots who are no longer needed in theproduction system"(op cit: 251).Joppke's argument has implications for an understanding ofwelfare corporatism. While corporatist arrangements, ostensibly,are strategically important to the neo-conservative politicalagenda, i.e. they depoliticize conflict in an era of welfare cut-backs, they may be, in the long run, vital to the retention ofwelfare services. In developing this line of reasoning, one has torecognize that state workers are unable to publically criticizecut-backs. Non-aligned nonprofit societies, however, are able toraise public awareness and protest welfare reductions. It is in thebest interests of state workers, therefore, to support theorganization and development of a strong, non-aligned collectivevoice, external to the state apparatus.The establishment of corporatism in Vancouver contributes tothe development of an organized sector. As a result, the sector is131better able to protect existing resources: a wave of cut -backs,potentially, would now be resisted by the collective action of thenonprofit sector. Consequently, there is a mutual interest betweencertain factions within the state, i.e. Mental Health Services, andinterest organizations such as the nonprofit sector. In thisscenario, state workers are reluctant to enforce policies, i.e.arduous accountability measures, that would alienate themselvesfrom the alliance.Future of Corporatism In The Vancouver MentalHealth System and Related Theoretical IssuesThe resolution of a number of developments within both themacro and meso levels will determine the future fate of corporatismwithin the Vancouver mental health system.At the macro level, Riverview Hospital, as of 1992, isbeginning to downsize its operations. However, in an attempt tosecure a favourable future, Riverview personnel are seeking tomaintain control over the planning of the hospital's downsizingand, more importantly, over the future development of all mentalhealth service throughout the province. GVMHSS, supported byVancouver's nonprofit societies, is quite resistant to anyincursion of Riverview in the adminstration of the Vancouversystem. As well, GVMHSS believes that community resources that arecreated through the downsizing of Riverview should be administeredby community based agencies, such as GVMHSS. It is uncertain as tohow the conflict will ultimately be resolved. The resolution, nodoubt, will either decrease or increase GVMHSS's role within theprovincial mental health system.At the meso level there a number of developments that may132impact upon the future of corporatism. GVMHSS's strategy ofsupporting the smaller agencies vis-a-vis Coast is losing potency.By 1992, nonprofit agencies, such as the Kettle, MPA, Triage, andLookout, are no longer concerned with daily survival or fear ofincursions by other nonprofit societies. As well, all theseagencies provide a wide range of housing and rehabilitationservices. Like Coast, all these agencies are affected by actionstaken by GVMHSS. Consequently, if GVMHSS pursues a direction thatis not agreeable to all agencies, it could meet with considerableresistance.Between 1987-1992 GVMHSS has been very effective inmaintaining the support of all agencies within the nonprofitsector. However, issues are beginning to emerge that arepotentially divisive. One such issue is GVMHSS's expansion ofrehabilitation services within its own system, i.e. within theMental Health Teams. Over the course of its history, GVMHSS hasfocused almost exclusively on providing clinical services. Bydeveloping rehabilitation services, GMVHSS, potentially, iscompeting with nonprofit societies for resources i.e., funding andclients. Issues similar to the one just described will continue tosurface. It will be difficult for GVMHSS to maintain the level ofsupport it enjoyed in the first five years of corporatism, and, asa result, it may be difficult for corporatism to be sustained overthe long term.Corporatist theory must situate the development of corporatistarrangements within an understanding of broader historicalpolitical-economic developments. With notable exceptions, thenonprofit literature omits macro developments from its analysis.133Corporatist theorists give "lip service" to the fact that macrodevelopments affect meso level events, but continue to focus,theoretically and empirically, on meso level developments.As described throughout this inquiry, the establishment ofcorporatist arrangements can be interpreted as part of a statestrategy in reconstructuring consent within capitalist society.Even if this true, however, future research needs to engage incomparative studies to ascertain why some states choose torestructure consent through an extension of their coerciveapparatus, i.e. the police and judiciary, while other states adoptcorporatist strategies. Only by incorporating macro, historicaldevelopments within an understanding of corporatism can theforegoing problem be studied.As interest groups within the social services are intricatelytied to the state, i.e depend upon the state for legal andfinancial status (increasingly nonprofit societies rely upon thestate for funding), the starting point of any understanding ofstate-interest relations must begin with an analysis of the state.To date, corporatist literature has relied on neo-Marxist "theoriesof the state" in examining the state. Often, however, neo-Marxisttheory discusses the state in abstract terms and conceptualizes thestate as an homogenous entity. Given the state's importance as astarting point, there needs to be a more sophisticatedunderstanding of the state. In Canada, the state exists atdifferent levels, and between the different levels there isconsiderable negotiation and compromise. Within the state itself,i.e. the provincial state, there is conflict between the differentfactions. Conceptualizing the state in "neo-instititutional" terms134will enable theoretical understanding of the "...state itself andon conflicts within its internal bureaucratic and politicalinstitutions"(Albo & Jensen, 1989: 200).Developments within the nonprofit sector are as complex asdevelopments within the state. Yet, an understanding of this sectorremains relatively underdeveloped. For example, the evolution ofthe corporatist arrangement between GVMHSS and the provincial statewas a logical outcome of events that occurred over a 15 yearperiod. The recent establishment of corporatist arrangementsbetween the federal state and native organizations, on the otherhand, has taken a different course. In a one year period, 1992,native organizations have been created to fund and administertraining programs previously managed by the federal bureaucracy.The creation of these arrangements over a short period of time hasled to conflict between the state and the native associations andbetween the native groups themselves. The development of welfarecorporatism, therefore, takes different forms at different timeswith different groups. Corporatist theory needs to develop itsunderstanding of the complexity of the nonprofit sector.The establishment of corporatist arrangements withinVancouver's nonprofit sector gives rise to a number of issues. Asdemonstrated in this inquiry, pluralism existed prior to theemergence of corporatism. It may well be that pluralism can coexistwith corporatism: pluralist arrangements may exist in one sectorwhile corporatist arrangements exist in another sector. However,another possibility is that although pluralism exists prior tocorporatism, over a period of time the state will always introducemeasures at organizing and monitoring the activities of nonprofit135societies. Hence, corporatism, or some other institutionalarrangement, will inevitably emerge. Off'e analysis, on the otherhand, suggests that changing economic circumstances will propel thestate to construct corporatist arrangements. Certainly, thisinquiry supports Offe's argument. However, to further develop anunderstanding of corporatism, more research is required.Corporatist theory is only beginning to recognize that welfarecorporatism exists as a verifiable empirical reality. It isunclear, however, whether welfare corporatism can be sustained overa long period of time. Equally, an understanding of the differencesand similarities between welfare corporatism and "production"corporatism remain a critical issue for corporatist theorizing toexplore.This inquiry has demonstrated that corporatism can emergewithin the nonprofit sector. Converging events occurred whichcompelled the state to devolve some of its power. As Schmittersuggests, the provincial state, during the early 1980's, was bothstrong and weak. Centralizing authority for the administration ofsocial services had strengthened the provincial state. On the otherhand, the economic recession and the government's restraint programgenerated ongoing conflict which weakened the provincial state. Thesecond enabling condition that led to the establishment of acorporatist arrangement was the presence of a viable intermediaryorganization, which had fashioned a dependent relationship with thestate, capable of implementing quasi-public functions. Thus, theconditions necessary for corporatism to exist within the welfaresector have been demonstrated by this inquiry.Whether corporatism can be sustained in the nonprofit sector136is another question. Certainly, the GVMHSS has been effective insolidifying its status as an intermediary organization. However,over the next few years the provincial state may, once again,recentralize power, which will affect existing institutionalarrangements. As the smaller nonprofit societies develop, and asGVMHSS continues to compete more and more with other nonprofitsocieties in providing direct services to the mentally ill, thesmaller nonprofit societies may form an alliance with CoastFoundation in challenging GVMHSS authority. Such a challenge could,once again, undermine the basis of the existing corporatistarrangement.Corporatism has only begun to be understood and clarified asa theoretical paradigm. This thesis has focused upon developing abetter understanding of the conditions that give rise tocorporatist arrangements, the reasons why corporatism emerges as ameans of restructuring institutional arrangements within thenonprofit sector, and the strategies employed by intermediaryorganizations in legitimating and maintaining their authority amongother interest organizations. This study has also attempted toexplore broader sociological issues, i.e. the way in whichcorporatism relates to the reconstruction of consent withincapitalist societies. Obviously, these issues have only beenopened up in this study, but it is my hope that some light has beenshed on developments in the Vancouver mental health sector, andthat I have pointed to new directions for future research in theunderstanding of state-nonprofit intersections.137Endnotes1. Many reasons are given to explain why the statethroughout North America and Canada pursued policies ofdeinstitutionalization after the mid-1950's. Theintroduction of neuroleptic medication, which reducednegative symptoms, is often cited as the most importantfactor enabling the mentally ill to, once again, live in thecommunity. However, as Andrew Scull, in his bookDecarceration argues, the introduction of new medicationscould have been used to simply control patient behaviour inthe hospital, while having little effect on dischargepatterns.Scull argues that financial constraints forced thestate to pursue policies of decarceration. With the onset ofthe "fiscal crisis", the state could no longer afford tosupport the maintenance of large institutions and,therefore, began downsizing large institutions. In her bookManaging Madness, Joan Busfield takes issue with Scull'sinterpretation. While Scull's argument has merit with theonset of the recession in the mid-1970's, it does notadequately explain why the state began decarceration in the1950's and 1960's.Busfield identifies three reasons for the decarcerationmovement: the emergence of the welfare system after 1945which provided the mentally ill with access to basic foodand shelter; the desire of psychiatrists to be integratedwithin the mainstream medical community rather than isolatedin the hospital; and therapeutic optimism created by theemergence of new medications and new therapeuticinterventions.For a more complete examination of this issue, see: Scull,Andrew Decarceration New Jersey: Prentice-Hall, Inc. 1977;Busfield, Joan Managing Madness London: Hutchinson & Co.,1986; Davis, Nanette and Anderson, Bo Social Control: The Production of Deviance In The Modern State New York:Irvington Publisher, Inc. 1983.2. City Of Vancouver, Health Department Records. MetropolitanMental Health Advisory And Planning Committee-1972-1973Box # 146, E5 File #14.3. Cumming, John. M.D. Unpublished Paper. Plan For VancouverPresented to Metropolitan Board of Health Of GreaterVancouver, October 25, 1972.4. City Of Vancouver, Health Department Records. GreaterVancouver Mental Health Service-Historical Perspective byDr. J.D. Kyle, Executive Director, Greater Vancouver MentalHealth Services, 1976. Box #145 A7 File #8.1385. Margaret W. Andrews. "The Emergence Of Bureaucracy: TheVancouver Health Department 1886-1914". Journal Of UrbanHistory 12 (February 1986) p.p. 131.6. City Of Vancouver, Health Department Records. Review OfMetropolitan Board Of Health Of Greater Vancouver MinutesSince 1962 Re: Mental Health Services-important dates etc.Box #144 D3 File # 4.7. City Of Vancouver, Health Department Records.Kevin N. Fox, Chairman Metropolitan Board ofGreater Vancouver, to D.G. Cocke, ProvincialHealth Services and Hospital Insurance. Box14.8. City Of Vancouver, Health Department Records.Greater Vancouver Metropolitan Mental HealthPlanning Committee to the Metropolitan BoardGreater Vancouver. October 6, 1972. Box # 46Report by theAdvisory &of Health ofE5 File # 14.9. Tomlinson, Peter.^March 25, 1991, Interview.10. Kyle John D. Greater Vancouver Mental Health ServiceHistorical Perspective p. 2.11. City Of Vancouver, Health Department Records. MetropolitanBoard of Health Of Greater Vancouver Minutes of January 23,1973 Box #144 D3 File #8.12. Kyle, J.D. Greater Vancouver Mental Health Service-Historical Perspective, 1976. p. 5.13. Ibid p.p. 4-5.14. City Of Vancouver, Health Department Records. G.V.M.H.Project Annual Progress Report-1973 Box #145 A7 File # 6p.3.15. City Of Vancouver, Health Department Records. AnnualProgress Report- July, 1974 Box #145 A7 File #7 p.11.16. Ibid, p.3.17. Ibid p. 9.18. Coast Foundation Society. Annual Report-March 1973 p.1.19. Tomlinson, P. & Cumming, J. "Coast Foundation ApartmentProject" Canada's Mental Health Vol.24, No.l. March, 1976p.25.20. Coast Foundation Society Annual Report- March, 1973 p. 3.21. Coast Foundation Society Annual Report- March, 1973 p.10.Letter byHealth OfMinister of#146 E5 File #13922. Ibid, p. 11.23. Both Dr. Cumming and Peter Tomlinson became close friendsover the years. They collaborated on a number of differentprojects and published several articles together.24. Tomlinsion, Peter. March 25, 1991, Interview.25. Tomlinson, P. March 25, 1991, Interview.26. Coast Foundation Society Financial Statements, 1980.27. Coast Foundation Society Financial Statements, 1980.28. Coast Foundation Society Coast Foundation Society:Organization, Structure, and Staff Policy Unpublished, 1974Paper p. 7.29. Coast Foundation Society Management Council Minutes December1, 1978.30. Ibid, November 24, 1978.31. Ibid, November 2, 1979.32. Philip Resnick argues that, unlike central and easternCanada, B.C. experienced high rates of economic growthduring the mid-1970's. As a result, the Social Creditgovernment could pursue "pro-business policies without theneed to prune expenditures for education, health, or socialassistance. For the moment, the provincial economy was notof the zero-sum kind that Thoreau describes, with public-and private-sector activities engaged in a competitivestruggle for declining resources."Resnick, Philip "Neo-Conservatism on the Periphery: TheLessons from B.C." in BC Studies, NO.75 Autumn, 1987, p.10.33. Cumming, John. Dr. Report Of The Mental Health PlanningSurvey Victoria: Queen's Printer. May, 1979 p. 94.34. City Of Vancouver, Health Department Records. Letter FromT. Cairney to Dr. Bonham Re: Trends in Personal,Intermediate and Extended Care Box #144 C6 File #7.35. Cumming, John. p.91.36. Greater Vancouver Mental Health Service Annual GeneralReport, 1982 p. 18.14037. Hicks, Helga. Personal Interview With Helga Hicks, Directorof Support Services, G. V.M.H.S. April 3, 1991.38. Sumpter, Paula Personal Interview With Paula Sumpter, FormerHousing Director, Coast Foundation Society April 25, 1991.39. Sumpter, Paula Personal Interview With Paula Sumpter,Housing and Community Home Manager For Coast FoundationBetween 1981-1989 April 25, 1991.40. Sumpter, Paula Personal Interview With Paula Sumpter,Housing Manger With Coast Foundation Between 1981-1987.41. Smith, Mark. Personal Interview Mark Smith, ExecutiveDirector, Kettle Friendship Society. February 21, 1991.42. Dent, Marie E. H. The Era of Restraint And AccountabilityIn British Columbia: An Analysis Of The Challenge And CopingMechanisms For Social Work Administrators And Workers In theEighties. Master Of Social Work Thesis: University ofBritish Columbia, 1984 p. 17Philip Resnick argues that the fiscal crisis was not asacute as the Social Credit government portrayed. True,provincial revenues were down in 1982 and 1983, but between1972 and 1982 the government had been operating on surplusesand could therefore afford to operate on deficits for anumber a years. However, given the Social Credit'sideological orientation, the provincial government chose touse the economic downturn as a means "... to turn its backon social spending and spurn any meaningful consultationwith public sector employees or affected social groups." SeeResnick, Philip's "Neo-Conservatism on the Periphery" p. 10-13.43. Interagency Mental Health Council, Service PlanningCommittee Memorandum-Re: Recommendations For CommitteeStructure Changes Within The Interagency Mental HealthCouncil March 27, 1986 p.1 .44. Russell, John Personal Interview With John Russell,Executive Director, Greater Vancouver Mental Health ServicesSociety April 8, 1991.45. Throughout the 1985-1991 period G.V.M.H.S.S. has alwaysattracted influential city alderman, such as Marguerite Fordand Sandra Wilking, to sit on its Board; thus, maintainingits connection with the city.46. Greater Vancouver Mental Health Society Act, GreaterVancouver Mental Health Service Society, ConstitutionRevised 1987; 1989. p. 2.14147. Province of British Columbia, Mental Health Service. OpenLetter by Mr. Brian Copley To Proposed Participants InConsultation Process. July 15, 1985 p.2.48. Ibid, p.2.49. Province of British Columbia, Mental Health Service. OpenLetter by Mr. Brian Copley To Proposed Participants InConsultation Process. November 29, 1985 p.2.50. Province Of British Columbia Mental Health ConsultationReport: A Draft Plan To Replace Riverview Victoria: Queen'sPrinter, 1987. p. 28.51. Ibid, p.1.52. Mental Health Consultation Report p.21.53. British Columbia Government Employees' Union Response ToThe Consultant's Report On Riverview November 27, 1987. Seep.3 and 19.54. Provincial Legislature, Minutes of Legislative SessionDr. Tom Perry Addressing The Legislature Thursday, April27, 1989 p. 6395.55. Provincial Legislature, Minutes of Legislative SessionMr. Peter Dueck Addressing The Legislature Thursday, April27, 1989 p. 6400.56. The Greater Vancouver Mental Health Services Society (GVMHS)and several representatives from community mental healthagencies met with two senior bureaucrats in February of1991. As well, the new Deputy Minister toured Vancouver'smental health system in the middle of 1991. These meetingsdid not result in any allocation of bridge, or transitional,funding into the community.57. Vancouver Steering Committee Minutes of April 24th, 1991Meeting held at G.V.M.H.S. It was reported at this meetingby an official from Riverview that the hospital actual bedcount was currently between 900-920.58. Interagency Mental Health Council Memo to: AgenciesProviding Prevocational and Vocational Services August 31,1989. p.1.59. Coast Foundation Society Transcript Of Presentation Given ByG.V.M.H.S. To Board Of Directors Of The Coast FoundationSociety, February 23, 1989 p.1.60. Russell, John Personal Interview .61. Greater Vancouver Mental Health Service Society AnnualReport April 1, 1989-March 31, 1990.14262. Russell, John Personal Interview.63. Smith, Mark Personal Interview With Mark Smith, ExecutiveDirector, Kettle Friendship Society February 15, 1991.64 Coast Foundation Society Minutes Of July 22, 1987 MeetingBetween Coast Foundation and G.V.M.H.S.S. p. 1.65 Coast Foundation Society Transcript Of Meeting Between CoastFoundation and G.V.M.H.S.S. February 23, 1989 p.11.66^Ibid, p.11.67. Greater Vancouver Mental Health Services Society AnnualReport: April 1, 1988- March 31, 1989 p.22.68. Ibid, p.22.69 Burnham, Darrell Personal Interview With Darrell Burnham,Executive Director, Coast Foundation Society. November 12,1991.70 Burnham, Darrell Personal Interview.71 Western Management Consultants Organizational Review OfThe Operations Of Coast Foundation November 10, 1986. p.15.72^Ibid, p. 7.73. Ibid, p. 15.74. Coast Foundation Society Executive Director's Report October10, 1991.1. Williamson argues that since 1984 several theorists havetentatively begun to examine corporatist arrangements at thenational/macro level. Such inquiries have a distinctlysociological orientation.2. As stated in chapter one, there is a third function, that ofcoercion, that the state in democratic societies willutilize if required. However, the continued use of force, inthe long run, undermines the political legitimacy of thestate and leads to widespread conflict. Citing AntonioGramsci's works in this area, Stuart Hall, et al, argue thatwhile the state is involved in the exercise of both coercionand consent, it functions best when it operates normallythrough political leadership. Even "...the coercive side ofthe state worked best when perceived as legitimatelycoercing".See Stuart Hall, et al. Policing the Crisis: Mugging, the State, and Law and Order London: The MacMillan Press Ltd,1978. p. 203.1433. As most neo-Marxist theorists recognize, the distinctionbetween accumulation and legitimation is primarily foranalytical purposes. Often, state activities, i.e. socialservices, fall into both categories. As Gough argues,social-assistance schemes have "...the aim in part ofmaintaining and adapting the reserve army of labour, apotential labour force, and in part in maintaining andcontrolling groups that threaten social stability". SeeGough p. 52.4. Ibid, p. 180.5. In 1990, GVMHSS funded 13 nonprofit societies withinVancouver.6. The Inter-Agency Mental Health Council was another monthlyforum that enabled people within the mental health system tomeet. While effective during its first few years, thecouncil, by 1986, became, primarily, a vehicle forinformation sharing and, therefore, planning issues were notdiscussed. As well, the council is composed ofrepresentatives from both Vancouver and the Fraser Valley.Since these two regions compete for provincial funds, theInter-Agency Mental Health Council finds it difficult todiscuss substantive issues dealing with funding or planning.7.^In the 1990/91 fiscal year, Coast received an additional$144,000 for a new supported employment program, and in1992/93 Coast received $200,000 for a West End project.144BIBLIOGRAPHYAlbach, Dianna.The Mentally Ill In The Community M.S.W. Thesis. University ofBritish Columbia, 1985.Albo, Gregory & Jensen, Jane."A Contested Concept: The Relative Autonomy of the State" in GlenWilliams The New Canadian Political Economy Montreal. 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Thesis:University of British Columbia, 1984.Finch, Janet.Role Of The Greater Vancouver Mental Health Service In Support Services For The Adult Mentally Ill Person In The Community. Unpublished Study Sponsored by the Greater Vancouver Mental HealthService, 1978.Gordon, R.Mental Disorder, Law and State Doctoral Thesis. University ofBritish Columbia, 1988.Gough, IanThe Political Economy of the Welfare State  London: The MacMillanPress Ltd, 1979.Grant, Wyn. The Political Economy of Corporatism London: McMillanPublishers, 1985.Greater Vancouver Mental Health Service SocietyAnnual General Report. 1990.Greater Vancouver Mental Health Services SocietyAnnual General Report. 1989.Greater Vancouver Mental Health Service SocietyAnnual General Report. 1982.Greater Vancouver Mental Health Services SocietyRevised Society Constitution, 1987.Hall, Peter-Dobkin"Abandoning The Rhetoric of Independence: Reflections On theNonprofit Sector in the Post-Liberal Era" in Susan Ostrander'sShifting The Debate Oxford: Transaction Books, 1987.147Hicks, Helga.Personal Interview With Helga Hicks, Director of Support Services, Greater Vancouver Mental Health Services Society April 3, 1991.Interagency Mental Health CouncilMemo to: Agencies Providing Prevocational and Vocational Services August 31, 1989.Interagency Mental Health Council, Service Planning CommitteeMemorandum-Re: Recommendations For Committee Structure Changes Within The Interagency Mental Health Council March 27, 1986.Joppke, Christian"The Crisis Of The Welfare State, Collective Consumption, And theRise of New Social Actors" Berkeley Journal of Sociology Vol. 32,1987.Kramer, RVoluntary Agencies In The Welfare State Berkeley: University ofCalifornia Press, 1981.Langford, John"The Question of Quangos: Quasi-Public Services Agencies in BritishColumbia" Canadian Public Administration Vol. 26 Number 4.Margaret W. 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Simon Fraser University, 1973.Smith, Mark.Personal Interview Mark Smith, Executive Director, Kettle Friendship Society. February 21, 1991.Steadman, H. and Morissey, J."The impact of deinstitutionalization on the criminal justicesystem: implications for understanding changing modes of socialcontrol" in John Lowman's et al Transcarceration  Aldershot: GowerPublishing Company Limited.,1987149Stevenson, Garth."Federalism and Political Economy" in Leo Panitich, (ed.) TheCanadian State: Political Economy And Political Power Toronto:University of Toronto Press, 1977.Stuart Hall, et al.Policing the Crisis: Mugging, the State, and Law and Order London:The MacMillan Press Ltd, 1978.Sumpter, PaulaPersonal Interview With Paula Sumpter, Former Housing Director, Coast Foundation Society April 25, 1991.Tomlinson, P. & Cumming, J."Coast Foundation Apartment Project" Canada's Mental HealthVol-24, No.1 March 1976.Tomlinson Peter. Personal Interview With Peter Tomlinson, ResearchPlanner For Coast Foundation: 1972-1974. March 25, 1991.Vichert, Bruce.Internal Report On G.V.M.H.S. Clinical Services 1990.Vogel, DonnaNGO's, Development Assistance and the State:A Critical Analysis Doctoral Dissertation, University of Saskatchewan, 1989.Western Management ConsultantsOrganizational Review Of The Operations Of Coast Foundation November 10, 1986.Williamson, PeterCorporatism In Perspective Bristol: J.W. Arrowsmith Ltd, 1989Young, Dennis"Entrepreneurship and the Behaviour of Nonprofit Organizations" inSusan Rose-Ackerman, (ed.), The Economics Of Nonprofit Institutions Oxford: Oxford University Press, 1986.150APPENDIX AMETHODOLOGY This thesis is a socio-historical analysis within thesubject area of political sociology. The study utilizes a casestudy approach to assess a number of theoretical arguments.Through this approach, my intention was to describe, interpretand clarify events in order to provide direction for research onthe problem of corporatism.The genesis of this thesis can be traced to a number offactors. Some time ago I developed an interest in historicalsociology and in issues pertaining to the state. Specifically,the emergence of the welfare state and the impact that this stateform has upon different institutions, i.e. the family, tradeunions and nonprofit societies, has interested me for the pastdecade. Second, I worked as a senior manager for Coast Foundationfor the past eight years, and I have witnessed the fascinatingshift in relations between the state, the Greater VancouverMental Health Society, and the Coast Foundation.Sparked by an interest in the state and its relationship tothe nonprofit sector, I began a review of the theoreticalliterature on state-interest group relations. While the state hasreceived considerable attention from a number of differenttheoretical perspectives, state-interest group relations,especially those interest groups which are not associated withproduction (capital and labour), have received limited attentionas a focus of study. As well, an examination of corporatism, todate, has relied upon empirical studies from England and theUnited States. It is my view that in order to further an151understanding of state-interest group dynamics, corporatism mustconstitute part of the analysis. Therefore, I have attempted suchan analysis based on a Canadian example, hoping that it willstimulate further research of these issues in Canada.Research for this study occurred in three stages, and witheach stage a number of difficulties emerged. The first stage ofresearch involved a comprehensive review of secondary material,i.e. reports, theses, articles and books. This material providedthe author with an overview of historical developments withinmental health in British Columbia. For the most part, however,the material was general, addressing either macro theoreticalissues or analyzing historical events in cursory terms. Specificstudies detailing events within Vancouver were noticeably absent.More important, research into mental health has focused primarilyon the state. The interconnection between the state and thenonprofit sector has received little attention. As well, thehistorical development of nonprofit societies, such as CoastFoundation and the Greater Vancouver Mental Health ServicesSociety, has received little attention.Given the lack of secondary material, I found it necessaryto engage in a comprehensive search for primary materials. Suchmaterials were initially found in the Vancouver Archives.Archival documents enabled me to begin piecing together eventsthat led to the creation of the Vancouver community mental healthsystem, the Greater Vancouver Mental Health Services Society andthe Coast Foundation. Besides the Vancouver Archives, otherprimary material was provided by the two organizations understudy. These included Board Minutes, organizational reports152(especially Annual General Reports and Audited FinancialStatements), and other pertinent documents.One of the difficulties in examining primary sources of datais the identification of relevant information. Often, informationis poorly catalogued. It is possible that I did not find a numberof important documents could have inspired a differentinterpretation of events. The second problem with examiningprimary material concerns information that is omitted. Oftenminutes of meetings are edited before distribution for publicuse. Consequently, the intricacies involved in discussingparticular issues or reaching decisions are often absent.The final stage of research involved the interviewing of anumber of key informants. The purpose of the interviews wastwofold. First, interviews were used as means to fill in the gapsmissing from the secondary material. Second, interviews provide apotential corrective to the secondary data sources. Informantswere able to provide the author either with additional backgroundinformation or a different interpretation of events than thosedescribed in the official documents.Working in an official capacity within the mental healthfield provided me with some advantages and some disadvantages. Iwas able to identify and contact people who could provideinformation for this inquiry. I did not have to conduct a wholeseries of preliminary interviews in order to identify keyinformants. The second advantage of working in the field is thatsince I was involved in many of the events described throughoutthis inquiry, key informants would have found it difficult tomisrepresent events, had they been so inclined.153Informants were candid, despite the fact that some of theirinformation and opinions may have conflicted with my publiclystated views.The most difficult aspect of the interview process wasinterpreting the information provided by informants. Wheninterviewing people one knows, likes, and respects, there is atendency to take at face value information provided. I tried tocontrol my interpretative biases by focusing upon specificactions and decisions taken within the two organizations. Thisprovided an "events" standard for interpreting historicaldevelopments which curtailed interpretative license.The foregoing methodology generated the data upon which thisthesis rests. The principal issues and problems have beenidentified, along with the researcher's own predilections (i.e.as a worker in the mental health field). Except for the personalinterviews, all the data are publicly available for furtherscrutiny.154APPENDIX 13: GLOSSARY OF TERMSAVRS:^Arbutus Vocational Rehabilitation SocietyCMHA: Canadian Mental Health AssociationCMHC:^Central Mortgage & Housing CorporationGVMH Project: Greater Vancouver Mental Health Project.Established in 1972 to oversee the development ofcommunity mental health teams.GVMHS:^Greater Vancouver Mental Health Service. Replacingthe GVMH project, GVMHS assumed responsibility foradministering all the mental health teams.GVMHSS:^Greater Vancouver Mental Health Services Society.In 1985, GVMHS was incorporated into a nonprofitsociety.IAMHC:^The Inter-Agency Mental Health CouncilLMSRYA:^Lower Mainland Society for Rehabilitation forYoung AdultsMacro-^Refers to national arrangements often involvingCorporatism:^capital, labour and the state. The establishmentof tripartism has been the primary focus of macro-corporatist studies.Meso-^Refers to those arrangements that have beenCorporatism:^established with organizations concerned withsectoral interests, i.e. agriculture, steel,chemicals, and food processing.Micro-^Refers to arrangements established between theCorporatism:^state and individual firms (organizations). Such arelationship involves direct state interventionand does not involve the presence of anintermediary. To date, this level ofcorporatism remains conceptually vague and thereis question as to whether this should beconsidered a true level of corporatism.MPA:^Mental Patients AssociationNGO: Non-government Organization. NGO refers to thoseorganizations receiving funds from the state whichare either privately (for profit) operated ornonprofit.155PIG:^Private Interest GovernmentsQUANGOS:^Quasi-autonomous non-government organizations.SAFER:^Suicide Attempt Follow-up; Education and Research.Service provided by GVMHSS to counsel peopleregarding problems associated with suicide.Tripartism:^The arrangement in which the state, capital andlabour conduct discussions on economic policies.156

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