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UBC Theses and Dissertations

A volunteer programme for patients in a provincial mental hospital : a review of organization and services… Ross, Robert MacGregor 1958

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A VOLUNTEER PROGRAMME FOR PATIENTS IN A PROVINCIAL MENTAL HOSPITAL A Review o f O r g a n i z a t i o n and S e r v i c e s C o n t r i b u t e d , B a s e d on some C u r r e n t Developments a t E s s o n d a l e , B . C . , 1954-58. by ROBERT MacGREGOR ROSS T h e s i s Submi t ted i n P a r t i a l F u l f i l m e n t o f the Requi rements f o r the Degree o f MASTER OF SOCIAL WORK i n the S c h o o l o f S o c i a l Work A c c e p t e d as c o n f o r m i n g t o the s t a n d a r d r e q u i r e d f o r the degree of Master o f S o c i a l Work S c h o o l o f S o c i a l Work 1958 The U n i v e r s i t y o f B r i t i s h Co lumbia i i i A b s t r a c t The g o a l o f h o s p i t a l t rea tment i s the r e t u r n o f i t s p a t i e n t s t o t h e i r community i n a h e a l t h y , happy c o n d i t i o n . T h i s can be a p a r t i c u l a r l y d i f f i c u l t o b j e c t i v e t o a c h i e v e i n the c a s e fo± menta l i l l n e s s because o f t r a d i t i o n a l h o s p i t a l i s o l a t i o n , /and f e a r and m i s c o n c e p t i o n s about on the p a r t o f the p u b l i c . / M o r e and more i t i s b e i n g r e a l i z e d t h a t i f t h e r e i s t o be e f f e c t i v e r e h a b i l i t a t i o n o f the m e n t a l l y i l l , t h e r e must be g r e a t e r u n d e r -s t a n d i n g and a c c e p t a n c e o f menta l i l l n e s s by t h e i r c o m m u n i t i e s . T h i s s tudy examines the r e c e n t l y - d e v e l o p e d v o l u n t e e r programme a t the P r o v i n c i a l M e n t a l H o s p i t a l , ( E s s o n d a l e , B . C . , ) s p o n s o r e d by the Canad ian M e n t a l H e a l t h A s s o c i a t i o n . I t d e s c r i b e s the programme's o r g a n i z a t i o n , and i t s a c t i v i t i e s aimed at b r i n g i n g the community t o the p a t i e n t , as w e l l as i n t e r p r e t i n g h o s p i t a l and p a t i e n t needs t o the community. The method u s e d i n the s t u d y began w i th a r e v i e w o f p r o -f e s s i o n a l and o t h e r l i t e r a t u r e i n o r d e r t o l e a r n what v o l u n t e e r s e r v i c e s were b e i n g o f f e r e d i n menta l h o s p i t a l s e t t i n g s e l s e -where. A q u e s t i o n n a i r e was then comple ted and i n t e r v i e w s w i th key peop le i n the v o l u n t e e r movement c o n d u c t e d , i n o r d e r t o c o m p i l e d e t a i l s o f i t s deve lopment , o r g a n i z a t i o n and a c c e p t a n c e by h o s p i t a l management and s t a f f as a " t rea tment e x t r a " . In o r d e r t o i l l u s t r a t e v o l u n t e e r a c t i v i t i e s and p o t e n t i a l s i n d e -t a i l , the f o c u s was then narrowed t o the s tudy o f one p a r t i c u l a r ward (Chapter 3 . ) Types o f p a t i e n t s were d e s c r i b e d e x p e r i m e n t a l l y as b e l o n g -i n g t o b e h a v i o r groups o b s e r v e d on t h e ward, such as " a t t e n t i o n s e e k e r s " and " r e s c u e s e e k e r s . " (The p o s s i b i l i t y o f a ward c l a s s i f i c a t i o n a c c o r d i n g to the v a r i o u s c a t e g o r i e s o f menta l i l l n e s s such as c h r o n i c b r a i n syndromes, p s y c h o t i c d i s o r d e r s , e t c . , was c o n s i d e r e d but d i s c a r d e d because the r e q u i r e d i n f o r m -a t i o n was not a v a i l a b l e . ) Ways i n which v o l u n t e e r s can h e l p the p a t i e n t s i n the v a r i o u s b e h a v i o r groups when v i s i t i n g and a s s i s t i n g i n o c c u p a t i o n a l t h e r a p y a r e d i s c u s s e d , u s i n g two case examples f o r i l l u s t r a t i o n . The s tudy c o n f i r m e d the g e n e r a l t h i n k i n g t h a t the v o l u n t e e r programme i s c o n t r i b u t i n g a v e r y u s e f u l s e r v i c e t o the h o s p i t a l t rea tment programme. In the c o n c l u d i n g c h a p t e r some s u g g e s t i o n s a r e o f f e r e d towards i n c r e a s i n g the e f f e c t i v e n e s s of t h i s grow-i n g v o l u n t e e r s e r v i c e . These a r e r e l a t e d t o a problem common t o a l l v o l u n t e e r work, namely, s u s t a i n i n g the i n t e r e s t o f v o l -u n t e e r s . In a d d i t i o n , s u g g e s t i o n s a r e made as t o some ways i n which the v o l u n t e e r s c o u l d work w i th the S o c i a l S e r v i c e D e p a r t -ment i n t h i s h o s p i t a l s e t t i n g . In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available f o r reference and study. I further agree that permission f o r extensive copying of t h i s thesis for scholarly purposes may be granted by the Head of my Department or by his representative. I t i s under-stood that copying or publication of t h i s thesis f o r f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of The University of B r i t i s h Columbia, Vancouver 8, Canada. i i TABLE OF CONTENTS Chapter 1. M e n t a l H o s p i t a l s and Changing A t t i t u d e s Page The p a s t two hundred y e a r s . V o l u n t e e r programmes i n m e n t a l h o s p i t a l s : scope and f u n c t i o n . Two examples of v o l u n t e e r programmes: (a) B o s t o n ; (b) Saskatchewan. Scope and method o f p r e s e n t s t u d y 1 Chapter 2. The V o l u n t e e r Programme a t E s s o n d a l e The h o s p i t a l s e t t i n g . S t a r t i n g t h e v o l u n t e e r programme. V o l u n t e e r v i s i t s b e g i n . Types o f v o l u n t -eer s e r v i c e s . T r a n s p o r t a t i o n . R e c r u i t i n g and t r a i n i n g . H o s p i t a l and v o l u n t e e r programme r e l a t i o n s h i p 1<7 C h a p t e r 3. V o l u n t e e r A c t i v i t y on One Ward E a s t Lawn b u i l d i n g . A c l o s e d ward (H3). P a t i e n t c a t e g o r i e s , and v o l u n t e e r s * a c t i v i t i e s r e l a t e d t o them. V o l u n t e e r s and o c c u p a t i o n a l t h e r a p y . Case examples: (a) I n d i v i d u a l a i d ; (b) A "team a p p r o a c h " 42: Chapter 4. Summary and F i n d i n g s Restatement o f f o c u s . D i r e c t i o n and i n t e r e s t o f v o l u n t e e r s . The C o o r d i n a t o r as g u i d e . V a l u e o f i n -f o r m a t i o n g a t h e r i n g . A c o o r d i n a t o r ' s C o u n c i l . Super-v i s i o n o f v o l u n t e e r s . I n - s e r v i c e t r a i n i n g . V o l u n t e e r s ' r e a d i n g s h e l f . V o l u n t e e r s and S o c i a l S e r v i c e . V o l u n t -e e r s and community e n l i g h t e n m e n t 68: Appendices: A. Canadian M e n t a l H e a l t h A s s o c i a t i o n Q u e s t i o n n a i r e on H o s p i t a l V o l u n t e e r T r a i n i n g . B. Q u e s t i o n n a i r e f o r purpose of g a t h e r i n g i n f o r m a t i o n about t h e V o l u n t e e r Programme. C. B i b l i o g r a p h y . TABLES FOUND IN THE TEXT T a b l e 1. R e l a t i o n s h i p between t h e V o l u n t e e r and t h e H o s p i t a l 39 T a b l e 2. F l o o r p l a n o f C l o s e d Ward (H3). 5 0 i v Acknowledgements I w ish t o e x p r e s s my thanks and a p p r e c i a t i o n t o a l l those whose i n t e r e s t and a c t i v e h e l p have made t h i s s tudy p o s s i b l e . I p a r t i c u l a r l y acknowledge w i th g r a t i t u d e the d i r e c t i o n , c r i t i c i s m s and c o u n s e l o f the f o l l o w i n g p e r s o n s : D r . L . C . Marsh , M i s s M u r i e l C u n l i f f e and Mr . A . M a r r i a g e , o f the S c h o o l o f S o c i a l Work, U n i v e r s i t y o f B r i t i s h C o l u m b i a ; Mr . G. Dodsworth, C o o r d i n a t o r o f V o l u n t e e r s , M i s s 0 . C u r t i s , Department o f O c c u p a t i o n a l T h e r a p y , and the members o f the S o c i a l S e r v i c e Department a t E s s o n d a l e , B r i t i s h C o l u m b i a . V A V o l u n t e e r Programme  f o r P a t i e n t s i n a P r o v i n c i a l Menta l H o s p i t a l Chapte r 1 Menta l H o s p i t a l s - Chang ing A t t i t u d e s The P a s t Two Hundred Y e a r s C e n t u r i e s o f b e a t i n g s , s t r a i t j a c k e t s , b a r r e d windows, l o c k e d doors and o s t r a c i s m o f e m o t i o n a l l y d i s t u r b e d p e r s o n s have not s o l v e d the mystery o f menta l i l l n e s s . Nor was man's f e a r o f i n s a n i t y l e s s e n e d , h i s t r o u b l e d c o n s c i e n c e s o o t h e d . Even i n our own t imes we f l u c t u a t e between an out o f s i g h t , out o f mind a t t i t u d e toward menta l i l l n e s s and a y i e l d i n g t o a human-i s t i c d e s i r e t o h e l p t h o s e " s i c k s o u l s " . 1 More than a hundred y e a r s ago t h e r e was a de te rmined and e n l i g h t e n e d e f f o r t made t o combat menta l i l l n e s s which was c a l l e d " m o r a l t r e a t m e n t " . I t f l o u r i s h e d f o r a t ime i n the U n i t e d S t a t e s , r e a c h i n g i t s h e i g h t o f e f f e c t i v e n e s s between 1830 and 1840. The i d e a o f mora l t rea tment stemmed f rom the p h i l o s o p h i c a l and p o l i t -i c a l movements o f the n i n e t e e n t h c e n t u r y , and f rom the t e a c h i n g s o f the g r e a t F r e n c h p h y s i c i a n , P h i l i p p e P i n e l . I t was P i n e l who " s t r u c k the c h a i n s " f rom the i n s a n e a t S a l p e t r i e r e . A l o n g w i t h P i n e l , the e a r l y l e a d e r s o f mora l t rea tment b e l i e v e d t h a t i n s a n i t y was not n e c e s s a r i l y the r e s u l t o f a permanent l e s i o n o f the b r a i n . They were c o n v i n c e d t h a t i n many c a s e s the i n d i v -• ' •Greenblatt , M i l t o n , M e n t a l H o s p i t a l s ; From C u s t o d i a l t o T h e r a p e u t i c P a t i e n t C a r e . R u s s e l l Sage F o u n d a t i o n ; New Y o r k ; 1955. p. 37 . - 2 -i d u a l ' s s a n i t y c o u l d be r e s t o r e d i f p roper a t t e n t i o n was p a i d t o " p s y c h o l o g i c a l , e x p e r i e n t i a l , o r e m o t i o n a l f a c t o r s " . " 1 ' M o r a l t rea tment d i d not e n t a i l any s p e c i f i c r o u t i n e : i t was more a "way o f l i f e " o f f e r e d t o the p a t i e n t . B r i e f l y s t a t e d , the p h i l -osophy o f mora l t rea tment p l a c e d h i g h v a l u a t i o n on the i n d i v i d u a l as a f e l l o w human b e i n g and on h i s p o t e n t i a l r e c u p e r a t i v e powers. A f a v o u r a b l e envi ronment was c o n s i d e r e d e s s e n t i a l and e f f o r t s were made t o o r g a n i z e group l i v i n g i n o r d e r t o i n t e g r a t e work, p l a y , and s o c i a l a c t i v i t i e s . E v e r y a s p e c t o f h o s p i t a l l i f e was u t i l i s e d f o r i t s t h e r a p e u t i c e f f e c t . However, t h i s h i g h l y e n l i g h t e n e d approach t o menta l i l l n e s s was soon t o be d e c i s i v e l y d i s c a r d e d . From 1850 on t h e r e was a r a p i d i n c r e a s e i n p o p u l a t i o n i n the U n i t e d S t a t e s and an e v e r -growing demand f o r beds as menta l i n s t i t u t i o n s were d o u b l e d and r e - d o u b l e d i n s i z e . Founders of mora l t rea tment made p l e a a f t e r p l e a f o r s m a l l e r h o s p i t a l s as a b a s i s f o r more e f f e c t i v e t rea tment o f the m e n t a l l y i l l . They were l a r g e l y i g n o r e d and mora l t rea tment e x p e r i e n c e d i t s d e c l i n e and f a l l . I t was not an e f f e c t i v e method o f t rea tment i n the overcrowded i n s t i t u t i o n s and s t a t i s t i c s showed a s t e a d y f a l l i n improvement r a t e s . R e i n f o r c i n g the s t a t i s t i c s were r e p o r t s f rom p a t h o l o g i c l a b o r a t o r i e s s t a t i n g t h a t , th ro u g h new m i c r o s c o p i c t e c h n i q u e s , i t had been d i s c o v e r e d t h a t menta l p a t i e n t s s u f f e r e d l e s i o n s i n t h e i r c e n t r a l nervous s y s t e m s . There f o l l o w e d a p e r i o d when 1 G r e e n b l a t t , o p . c i t . , p. 407. 2 I b i d . , p. 408. 3 I b i d . , p . 414. - 3 -p s y c h i a t r y p r e f e r e d t o wa i t f o r c l e a r a n c e f rom the p a t h o l o g i c l a b o r a t o r y r a t h e r t h a n t o r e g a r d menta l i l l n e s s as a c h a l l e n g -i n g problem t o be a t t a c k e d w i th every means at hand . Treatment emphasis became c u s t o d i a l . 1 Then , towards the c l o s e o f the c e n t u r y , S i ground F r e u d * s dynamic c o n c e p t i o n o f p e r s o n a l i t y was becoming known and p r o -v i d e d a new o r i e n t a t i o n t o the mind and p e r s o n a l i t y . A l o n g wi th t h i s was the work o f menta l h e a l t h v o l u n t e e r Dorothea D i x who c r u s a d e d a c r o s s the U n i t e d S t a t e s and i n t o Canada f o r b e t t e r c o n d i t i o n s i n menta l h o s p i t a l s . Moreover she c a r r i e d h e r c r u s a d e a c r o s s the B r i t i s h I s l e s and o v e r to the C o n t i n e n t . By the sheer f o r c e o f her p e r s o n a l i t y , she awakened the p u b l i c t o t h e p l i g h t o f the m e n t a l l y i l l , i n a manner never e q u a l l e d by any p e r s o n b e f o r e nor f o r many y e a r s t o come. A t the end o f her l o n g c a r e e r she had made tremendous g a i n s f o r her c a u s e . Deutsch s t a t e s t h a t "Twenty S t a t e s had responded d i r e c t l y t o her a p p e a l s by e s t a b l i s h i n g o r e n l a r g i n g menta l h o s p i t a l s . In s e v e r a l S t a t e s more than one i n s t i t u t i o n was c r e d i t e d t o her p e r s o n a l e f f o r t s . . . . In a l l she was d i r e c t l y r e s p o n s i b l e f o r the f o u n d i n g o r e n l a r g i n g o f t h i r t y - t w o menta l h o s p i t a l s i n the U n i t e d S t a t e s o and a b r o a d . " In a lmost eve ry c a s e improvements f o l l o w e d i n h o u s i n g and p h y s i c a l c a r e o f the p a t i e n t . I t was a former m e n t a l l y i l l p e r s o n , C l i f f o r d B e e r s , who s p a r k e d the next s i g n i f i c a n t move toward p r o f e s s i o n a l and l a y en l igh tenment o f menta l i l l n e s s . S h o r t l y a f t e r the t u r n o f the c e n t u r y (1908) h i s book "A Mind That Found I t s e l f " was p u b l i s h e d 1 I b i d . , p. 414. 2 D e u t s c h , A l b e r t , The M e n t a l l y 111 i n A m e r i c a ; A H i s t o r y o f T h e i r Care and Treatment f rom C o l o n i a l T i m e s . Co lumbia U n i v e r s -i t y P r e s s ; New Y o r k ; 1946. p. 184. - 4 -w i t h an i n t r o d u c t i o n by W i l l i a m James, the o u t s t a n d i n g Amer ican P s y c h o l o g i s t and p h i l o s o p h e r o f h i s g e n e r a t i o n . Of B e e r s he s a y s : You have h a n d l e d a d i f f i c u l t theme w i th g r e a t s k i l l and produced a n a r r a t i v e o f a b s o r b i n g i n t e r e s t t o s c i e n t i s t as w e l l as layman. I t r e a d s l i k e f i c t i o n , but i t i s not f i c t i o n ; and t h i s I s t a t e e m p h a t i c a l l y , knowing how prone the u n i n i t i a t e d a r e t o doubt the t r u t h f u l n e s s o f d e s c r i p t i o n s o f abnormal menta l p r o -c e s s e s . 1 The menta l h y g i e n e movement a r o s e out o f t h i s and out o f B e e r s ' o r g a n i z i n g a b i l i t i e s and d e d i c a t e d d r i v e . When B e e r s r e c o v e r e d f rom h i s i l l n e s s and was d i s c h a r g e d f rom h o s p i t a l i n 1903 he made a s u c c e s s f u l r e t u r n t o h i s b u s i n e s s c a r e e r , but h i s consuming d e s i r e t o do someth ing about the p a i n f u l e x p e r -i e n c e s he had s u f f e r e d , and had seen o t h e r s s u f f e r , never l e s s e n -e d . He o b t a i n e d a l e a v e o f absence f rom h i s work and wrote h i s book "A Mind That Found I t s e l f " . Through t e l l i n g the s t o r y o f h i s own h o s p i t a l i z a t i o n B e e r s drew a t t e n t i o n t o the c o n d i t i o n o f the m e n t a l l y i l l and c a p i t a l i z e d on t h i s by i n c l u d i n g i n h i s book a c o n c r e t e programme t o r e c t i f y t h e s e c o n d i t i o n s . He t h e n formed the N a t i o n a l Committee f o r M e n t a l Hyg iene which was f o r m a l l y o r g a n i z e d i n 1908. H i s movement was t o be f o l l o w e d l a t e r i n o t h e r c o u n t r i e s . In 1917, f o l l o w i n g a c o n f e r e n c e between C l i f f o r d B e e r s and D r . C l a r e n c e M. H i n c k s o f T o r o n t o , the Canad ian N a t i o n a l Com-m i t t e e f o r M e n t a l Hygiene was o r g a n i z e d . T h i s i s now known as the Canad ian Menta l H e a l t h A s s o c i a t i o n , and i t s p r e s e n t day development i s l a r g e l y the r e s u l t o f the i n t e n s i t y and z e a l w i th •'•Beers, C l i f f o r d , A Mind That Found I t s e l f ; Doubleday; New Y o r k ; 1948. p. i i i . - 5 -which H i n c k s threw h i m s e l f i n t o h i s work. I t i s o f i n t e r e s t t o note t h a t D r . H i n c k s s t o r y i s somewhat s i m i l a r t o B e e r s * i n t h a t he i s a n e u r o t i c . In s p i t e o f t h i s h a n d i c a p , he has u s e d the p e r s u a s i v e power o f h i s p e r s o n a l i t y t o r a i s e " a t l e a s t $500 m i l l i o n s f o r menta l h e a l t h i n t h e U n i t e d S t a t e s and Canada f rom o r d i n a r y c i t i z e n s , m i l l i o n a i r e s , c h a r i t a b l e f o u n d a t i o n s and g o v e r n m e n t s . " * F o r s e v e r a l y e a r s , l i k e D i x , H i n c k s went " s t o r m i n g t h r o u g h " menta l h o s p i t a l s f rom c o a s t t o c o a s t i n an e f f o r t t o o b t a i n more humane t rea tment f o r the p a t i e n t s by " e d u c a t i n g , p l e a d i n g , f l a t t e r i n g and sometimes t h r e a t e n i n g government o f f i c i a l s and h o s p i t a l a u t h o r i t i e s . " Whichever approach he took h i s b a s i c s i n c e r i t y seemed t o come th rough and peop le r e a l i s e d t h a t h i s pr ime i n t e r e s t was i n h e l p i n g o o t h e r p e o p l e . The r o a d back was i n s i g h t . Improvement o f i n s t i t u t i o n a l c a r e ; emphasis on dynamics o f p e r s o n a l i t y development ( r a t h e r than c a t e g o r i e s o f d i s e a s e ) ; r e c o g n i t i o n o f impor tance o f p r e -v e n t i o n ; r e - e d u c a t i n g the p u b l i c on the m a t t e r , and emphasis on the p o s i t i v e o f menta l h e a l t h as a g a i n s t menta l i l l n e s s - t h e s e f i v e a r e a s were and a r e b e i n g d e v e l o p e d . T h e r e a re e n c o u r a g i n g s i g n s t h a t we a r e on the r o a d back t o more e n l i g h t e n e d t rea tment o f the m e n t a l l y i l l . C e r t a i n g e n e r a l p r i n c i p l e s o f s o c i a l t rea tment a r e emerg ing . In many r e s p e c t s we a r e s e e i n g a r e i n t e r p r e t a t i o n o f the mora l t r e a t -ment i d e a o f the 1830 's i n the l i g h t o f p r e s e n t day knowledge * K a t z , S i d n e y , "The Amazing C a r e e r o f C l a r e H i n c k s " , M a c l e a n ' s Magaz ine , Volume 67 (August 1, 1954) . p. 10. 2 I b i d . , p. 38 . - 6 -of menta l i l l n e s s - s p e c i f i c a l l y , the team a p p r o a c h . The r o l e o f the v o l u n t e e r would seem t o be c l o s e l y a l l i e d t o t h i s i n the s o c i a l i z a t i o n o f menta l h o s p i t a l p a t i e n t s . V o l u n t e e r Programmes i n M e n t a l H o s p i t a l s D u r i n g the l a s t decade bo th menta l h o s p i t a l p e r s o n n e l and the community a t l a r g e have been t a k i n g another l o o k a t t h e i r i d e a s on c a r e and t rea tment o f the m e n t a l l y i l l . The emphasis on " a s y l u m " , " i s o l a t i o n " and c u s t o d i a l c a r e i s g i v i n g way t o t h a t o f a c t i v e t rea tment and g e t t i n g as many p a t i e n t s as p o s s i b l e w e l l enough t o r e t u r n t o the community. A v e r y impor tan t g o a l o f the t rea tment programme i s t o encourage p a t i e n t i n t e r e s t and p a r t i c i p a t i o n i n s o c i a l l i v i n g as we know i t i n the community. Few p a t i e n t s i n menta l h o s p i t a l s a r e b e d - r i d d e n . T h e r e a r e many a c t i v i t i e s i n which they can p a r t i c i p a t e t h a t may h e l p them r e g a i n t h e i r c o n f i d e n c e and i n t e r e s t i n everyday l i f e . Much t h o u g h t f u l l e a d e r s h i p , gu idance and companionsh ip a r e r e q u i r e d i f t h i s type o f programme i s t o s u c c e e d . The v o l u n t e e r p r o -grammes i n menta l h o s p i t a l s a r e c o n s i d e r e d by many t o be an e s s e n t i a l p a r t o f the new t rea tment a p p r o a c h . 1 The v o l u n t e e r s a r e r e p r e s e n t a t i v e o f the community. I t has been s a i d t h a t they a c t as a b r i d g e between the h o s p i t a l and the community and t h a t t r a v e l on t h i s b r i d g e i s i n two d i r e c t i o n s : t o and f rom the h o s p i t a l . Through the v o l u n t e e r s the p a t i e n t s b e g i n t o r e g a i n c o n t a c t w i t h the community and the community w i th t h e i r f e l l o w c i t i z e n s who a r e i l l i n h o s p i t a l . G e n e r a l l y s p e a k i n g t h e r e a r e t h r e e t y p e s o f v o l u n t e e r s e r -v i c e s u s e d i n menta l h o s p i t a l s . F i r s t , t h o s e where v o l u n t e e r s G r e e n b l a t t , o p . c i t . , p. 89 . - 7 -come f o r a s p e c i f i c a f f a i r such as a dance, an e n t e r t a i n m e n t , o r t o p l a y games. O f t e n they come as g r o u p s , perhaps r e p r e s e n t -i n g some c l u b or o r g a n i z a t i o n . T h i s type o f v o l u n t e e r s e r v i c e has been g o i n g on f o r many y e a r s and i s g e n e r a l l y c o n s i d e r e d h e l p f u l t o p a t i e n t s not o n l y i n the e n t e r t a i n m e n t l i n e but i n g a t h e r i n g m a t e r i a l s such as c l o t h e s , b o o k s , g i f t s and s p e c i a l equipment . The second type o f v o l u n t e e r might be c a l l e d the " e x p e r t " v o l u n t e e r because he i s a s p e c i a l i s t i n such t h i n g s as m u s i c , a r t o r l e c t u r i n g on a p a r t i c u l a r s u b j e c t . A g a i n , t h i s type o f v o l u n t e e r has been s e r v i n g i n menta l h o s p i t a l s f o r many y e a r s . Because o f h i s s p e c i f i c use o f some p a r t i c u l a r s k i l l he u s u a l l y comes i n d e p e n d e n t l y and i s not i n t e r e s t e d i n the t r a i n i n g programme f o r v o l u n t e e r s e r v i c e s . A t h i r d type of v o l u n t e e r i s the p e r s o n who e x p r e s s e s a wish t o be of s e r v i c e i n the menta l h e a l t h s e t t i n g but who may have no p a r t i c u l a r s p e c i a l t y . The v o l u n t e e r programme under d i s c u s s i o n i n t h i s t h e s i s i s made up o f v o l u n t e e r s i n t h i s c a t e g o r y . The aim i n t h i s programme i s t h a t o f i n d i v i d u a l c o n t a c t w i t h p a t i e n t s by v o l u n t e e r s . Group p r o j e c t s o f v a r i o u s k i n d s a r e i n o p e r a t i o n but t h e s e a r e a means t o an e n d , namely, the i n d i v i d u a l f r i e n d l y v i s i t i n g w i t h the p a t i e n t t o h e l p him r e g a i n a h e a l t h f u l c o n t a c t w i th the community. T h i s t y p e o f v o l u n t e e r ( i n B r i t i s h Columbia) i s r e c r u i t e d by the B . C . D i v i s i o n o f the Canad ian M e n t a l H e a l t h A s s o c i a t i o n and f o l l o w i n g an o r i e n t a t i o n c o u r s e , may be s e l e c t e d f o r a c t i v e v o l u n t e e r work. I t i s u s u a l and d e s i r a b l e t h a t t r a i n i n g be g i v e n by the h o s p i t a l i n o r d e r t o f i t the v o l u n t e e r f o r work i n v a r i o u s h o s p i t a l depar tments . They a r e c a r e f u l l y - 8 -selected for t h e i r work with such things i n mind as "humanitarian sympathy", earnestness and willingness to work. As indicated, t h e i r aim i s to t r y to bring the community to the patient on an i n d i v i d u a l basis, characterized by a sincere and f r i e n d l y interest i n him.* It i s important to understand that the use of volunteers does not mean that "a shortage programme" i s i n operation. That i s , volunteer service i s not meant to f i l l the gaps i n profes-si o n a l programme and cannot, because, i d e a l l y the r o l e of the volunteer i s well thought out to f i t i n with the jobs of the paid personnel i n a harmonious manner. Volunteer services are o sometimes described as "plus services" or "treatment extras". If paid s t a f f i s not adequately prepared i n advance for inauguration of volunteer services there w i l l probably be a problem of " s t a f f acceptance" of volunteers. Staff tend to take a s c e p t i c a l view of volunteers i f they ( s t a f f ) are not taken into the planning of a proposed volunteer programme for t h e i r h o s p i t a l . However, "nothing so quickly k i l l s prejudice, r e -placing i t by a s p i r i t of helpfulness and cooperation, as personal 3 acquaintance." Those words, spoken by Mary Richmond, are very appropriate because i f paid s t a f f are to believe i n the volunteers' contribution they must understand what i t means i n r e l a t i o n to t h e i r own job and they should be given a chance to help i n the planning. The job of easing the volunteer into programme a c t i v i t y "^Sharp, Agnes A., How Volunteers Work i n State Hospitals, State of I l l i n o i s Department of Public Welfare, Chicago; p. 9. 2 Ibid., p. 22. 3 Richmond, Mary, The Long View; Russell Sage Foundation; New York; 1930. p. 96. - 9 -f a l l s i n l a r g e p a r t on s t a f f and i n t h e b e g i n n i n g w i l l p r o b a b l y be t i m e consuming f o r them r a t h e r t h a n p e r m i t more t i m e f o r t h e i r won s p e c i a l i z e d j o b s . I f t h e y a r e c o n v i n c e d i n t h e m s e l v e s of v o l u n t e e r s e r v i c e p o s s i b i l i t i e s t h e y a r e t h e n a b l e t o a c c e p t t h i s " b r e a k i n g - i n " p e r i o d w i t h t h e c o n v i c t i o n t h a t i n t h e l o n g r u n t h e p a t i e n t and t h e t r e a t m e n t team's e f f e c t i v e n e s s w i l l be enhanced. S e l e c t i o n and t r a i n i n g o f v o l u n t e e r s , t h e n , i s o f v i t a l i m p o r t a n c e . The N a t i o n a l Committee f o r M e n t a l Hygiene has de-v o t e d c o n s i d e r a b l e thought t o t h i s i n t h e i r manual on V o l u n t e e r P a r t i c i p a t i o n i n P s y c h i a t r i c H o s p i t a l Services." 1* A v o l u n t e e r who i s t o be o f r e a l a s s i s t a n c e t o t h e h o s p i t a l must be c a r e f u l l y s e l e c t e d not o n l y because o f h o s p i t a l needs but p e r s o n a l and p a t i e n t s ' needs as w e l l . F o r example, t h e d e s i r e o f t h e v o l u n t -eer t o work i n a p s y c h i a t r i c s e t t i n g s h o u l d be c a r e f u l l y a s s e s s e d . A p e r s o n who has had e x p e r i e n c e w i t h m e n t a l i l l n e s s i n t h e i r own f a m i l y may be w e l l s u i t e d t o work i n a v o l u n t e e r c a p a c i t y because o f h i s o r her i n c r e a s e d u n d e r s t a n d i n g o f t h e needs of t h e p a t i e n t . On t h e o t h e r hand the p r o s p e c t i v e v o l u n t e e r may have d e v e l o p e d g u i l t o r a n x i e t y about t h e r e l a t i v e c o n c e r n e d which i s perhaps accompanied by a sense o f shame. I t i s p o s s i b l e t h a t he i s r e p r e s s i n g h i s g u i l t and v o l u n t e e r work may be h i s a t t empt t o compensate f o r i t . I f such i s t h e c a s e i t w i l l p r o b a b l y not be l o n g b e f o r e such a t t i t u d e s b e g i n t o e x p r e s s t h e m s e l v e s t o t h e d e t r i m e n t o f t h e p a t i e n t ( s ) - t o say n o t h i n g o f t h e v o l u n t e e r . C a r e f u l s e l e c t i o n i s a v e r y n e c e s s a r y s t e p i n the, use o f "HlcBee, M a r i a n , and F r a nk, M a r j o r i e , V o l u n t e e r P a r t i c i p a t i o n i n P s y c h i a t r i c H o s p i t a l S e r v i c e s ; O r g a n i z a t i o n Manual and Program Guide, N a t i o n a l Committee f o r M e n t a l Hygiene; New Y o r k ; 1950. pp. 12-15. - 10 -v o l u n t e e r s i n h o s p i t a l programme. What a r e some o f t h e q u a l i t i e s n e c e s s a r y i n a v o l u n t e e r ? Dr. D a n i e l B l a i n , f o r m e r l y m e d i c a l d i r e c t o r o f t h e American P s y c h i a t r i c A s s o c i a t i o n , has s t r e s s e d c e r t a i n p e r s o n a l i t y t r a i t s . " G e n e r a l l y s p e a k i n g , one t h i n k s o f s t a b i l i t y , and r u l i n g o u t t o o g r e a t i n s e c u r i t y , f r u s t r a t i o n h o s t i l i t y , a g g r e s s i v e n e s s , n e u r o t i c and p a r a n o i d , e r r a t i c t r e n d s . " He a l s o s u g g e s t s t h a t one s h o u l d t r y t o e v a l u a t e such t h i n g s as c o o p e r a t i v e n e s s , hon-e s t y , p r o d u c t i v i t y , speech, mood, tone o f v o i c e , p o s t u r e , g a i t , and n e a t n e s s . Most i m p o r t a n t p o i n t s , he s t a t e s a r e "warmth and empathy." 3" An o r i e n t a t i o n p e r i o d i s a b s o l u t e l y e s s e n t i a l f o r v o l u n t e e r s because few have had e x p e r i e n c e w i t h m e n t a l l y i l l p e o p l e . As w e l l as t h e o r i e n t a t i o n c o u r s e g i v e n by t h e community agency o r a s s o c i a t i o n t h e r e i s u s u a l l y p r o v i s i o n f o r p e r i o d i c c o u r s e s o f i n s t r u c t i o n because c o n t i n u o u s growth o f knowledge i s e s s e n t i a l t o w o r t h w h i l e v o l u n t e e r p a r t i c i p a t i o n . An i n t r o d u c t o r y c o u r s e , f o r example, might i n c l u d e t h e f o l l o w i n g a r e a s : b a s i c needs and d r i v e s o f p e o p l e ; f a c t s and m i s c o n c e p t i o n s about t h e m e n t a l l y i l l and t h e i r c a r e , and community a s p e c t s . A p p r o p r i a t e r e a d i n g i s s u g g e s t e d and f i l m s shown as supplements t o t h e c o u r s e . Ex-amples of f u r t h e r t r a i n i n g a r e h o s p i t a l s e s s i o n s t o d i s c u s s r u d i m e n t s o f h o s p i t a l a d m i n i s t r a t i o n , t h e p s y c h i a t r i c p a t i e n t , h o s p i t a l e t i q u e t t e and e t h i c s and t h e v o l u n t e e r programme. The s e s s i o n s u s u a l l y i n c l u d e a t o u r o f t h e h o s p i t a l and s m a l l group d i s c u s s i o n s w i t h department heads and may i n c l u d e an o r a l o r w r i t t e n e x a m i n a t i o n . I t i s hoped t h a t t h r o u g h t h i s t y p e o f McBee, M a r i a n , and Frank, M a r j o r i e , op. c i t . , p. 72. - 11 -c o u r s e t h e new v o l u n t e e r w i l l be a b l e t o g a i n an u n d e r s t a n d i n g o f t h e v a r i o u s s e r v i c e s o f t h e h o s p i t a l and get a p i c t u r e o f how t h e p a t i e n t i s a d m i t t e d , t r e a t e d and r e h a b i l i t a t e d - i n c l u d i n g t h e v o l u n t e e r ' s r o l e i n t h i s . F o l l o w i n g c o m p l e t i o n o f t h e c o u r s e o f t r a i n i n g comes a s s i g n -ment t o a ward o r s p e c i a l j o b . The v o l u n t e e r i s under t h e gen-e r a l s u p e r v i s i o n o f t h e h o s p i t a l s u p e r v i s o r o f v o l u n t e e r s . S u p e r v i s i o n on t h e j o b i s g i v e n by p a i d p e r s o n n e l o f t h e d e p a r t -ment concerned. Dr. Agnes Sharp, i n her s t u d y o f v o l u n t e e r work i n s t a t e h o s p i t a l s , has s t a t e d a v e r y s i m p l e t r u t h : " V o l u n t e e r s a r e p e o p l e . " * T h i s s i m p l e t r u t h i s r e l a t e d t o t h e m a t t e r o f s t a f f a c c e p t a n c e of v o l u n t e e r s and b e a r s re-emphasis because c o o p e r a t i o n and c o n s i d e r a t i o n a r e so i m p o r t a n t t o t h e team approach o f t o - d a y . N e v e r t h e l e s s , t h e r e has been a tendency on t h e p a r t o f s t a f f members t o doubt t h e s t a y i n g power o f t h e v o l u n t e e r , o r t o be o v e r l y demanding i n t h e i r e x p e c t a t i o n s o f him. When p o i n t i n g out t h a t v o l u n t e e r s d e s e r v e t h e same c o n s i d e r a t i o n as s t a f f mem-b e r s under a l l c i r c u m s t a n c e s , Dr. Sharp g i v e s a good example t o 2 i l l u s t r a t e h e r p o i n t . A s t a f f p e r s o n had asked "how can you count on v o l u n t e e r s ? When you have j u s t f i n i s h e d t r a i n i n g one and, because her s i s t e r b r e a k s her l e g she t h i n k s she has t o s t a y home and t a k e c a r e of her "my answer t o t h i s p e r s o n was a q u e s t i o n : 'what does a s t a f f member do when her s i s t e r b r e a k s her l e g and she has t o t a k e c a r e of h e r ? ' " The s t a f f p e r s o n Sharp, Agnes A., op. c i t . , p. 25. Loc. c i t . - 12 -a r r a n g e s f o r t i m e o f f i n a manner r e c o g n i s e d i n e v e r y employ-ment c o n t r a c t . S t a f f a r e p e o p l e ; v o l u n t e e r s a r e p e o p l e . Examples o f S p e c i f i c Programmes. The B o s t o n P s y c h o p a t h i c H o s p i t a l ( r e c e n t l y renamed: M a s s a c h u s e t t s M e n t a l H e a l t h C e n t e r ) i s c o n s i d e r e d t o be r e p r e s -e n t a t i v e o f one o f t o - d a y s advanced t e a c h i n g and r e s e a r c h i n -s t i t u t i o n s c o n c e r n e d w i t h m e n t a l i l l n e s s . Dr. M i l t o n G r e e n b l a t t , p s y c h i a t r i s t i n charge o f t h e r e s e a r c h l a b o r a t o r i e s a t B o s t o n P s y c h o p a t h i c , has remarked on h i s "deepened" r e s p e c t f o r t h e p o s s i b i l i t i e s i n h e r e n t i n t h e s o c i a l s c i e n c e s f o r making h o s p i t a l s i n t o more t r u l y t h e r a p e u t i c communities.''' When d i s c u s s i n g t h e h i s t o r y o f t h e h o s p i t a l he n o t e s t h a t i n s p i t e o f i m p r e s s i v e advances t h e ward c a r e o f p a t i e n t s (even i n t h e e a r l y 1940's) l a g g e d and t h e d e e p l y p e r s o n a l s i g n i f i c a n c e of h o s p i t a l i z a t i o n s t o t h e m e n t a l l y i l l was l a r g e l y g l o s s e d o v e r . There were r e l a t -i v e l y few a t t e m p t s t o use t h e p h y s i c a l and s o c i a l environment of t h e h o s p i t a l f o r t h e p a t i e n t s b e n e f i t . However, many changes i n t r e a t m e n t , a t t i t u d e and p r a c t i c e were b e i n g e f f e c t e d . Not t h e l e a s t of t h e s e c o n c e r n e d t h e f o r m a t i o n of t h e B o s t o n P s y c h o p a t h i c H o s p i t a l A u x i l i a r y i n 1945. A t f i r s t i t was com-posed m a i n l y o f w i v e s o f p r o f e s s i o n a l h o s p i t a l s t a f f and t h e i r c l o s e f r i e n d s but to-day t h e r e a r e some 400 v o l u n t e e r s b r i n g i n g community t o p a t i e n t s . Dr. G r e e n b l a t t s t a t e s t h a t i t i s now d i f f i c u l t t o imagine how t h e h o s p i t a l c o u l d " t h r i v e " w i t h o u t t h e i r a s s i s t a n c e and o b s e r v e s " t h a t w i t h o u t such warm t i e s w i t h t h e community any p s y c h i a t r i c h o s p i t a l i s a l m o s t c e r t a i n t o be G r e e n b l a t t , op. c i t . , p. 38. - 13 -1 b e r e f t o f d i g n i t y and r e s p e c t a b i l i t y . " T h e i r a u x i l i a r y i s w e l l o r g a n i z e d and the programme i n c l u d e s r e c r u i t i n g , s e l e c t i n g , o r i e n t i n g , and p l a c i n g v o l u n t e e r s i n v a r i o u s p a r t s o f the h o s p i t a l . Some are former p a t i e n t s and i t i s i n t e r e s t i n g t o note t h a t the a u x i l i a r y c o n s i d e r s t h a t s e l e c t e d former p a t i e n t s o f t e n show g r e a t e r s e n s i t i v i t y and u n d e r s t a n d i n g than n o n - p a t i e n t s as a r e s u l t o f t h e i r own s u f f e r i n g . A r e v i e w o f some o f the v o l u n t e e r programme achievement a t B o s t o n P s y c h o -p a t h i c d u r i n g the 10 y e a r s s i n c e 1945 i s i m p r e s s i v e . They have conduc ted r e g u l a r p o t t e r y c l a s s e s ; a s s i s t e d p a t i e n t government i n p l a n n i n g o f l a r g e s o c i a l e v e n t s ; c o n d u c t e d and s u p e r v i s e d c o o k i n g c l a s s e s ; home n u r s i n g c l a s s e s , book d i s c u s s i o n g r o u p s , a r t c l a s s e s , t e x t i l e p a i n t i n g , d a n c i n g , drama, s p o r t s , and tournaments . They have a l s o a c t e d as s h o p p e r s , r e s e a r c h a s s i s t -a n t s and i n v a r i o u s o t h e r c a p a c i t i e s . The a s s i s t a n c e o f v o l -u n t e e r s i s f e l t t o be a lmost i n d i s p e n s a b l e i n b r i n g i n g p a t i e n t c a r e to i t s p r e s e n t l e v e l . The Saskatchewan D i v i s i o n of The Canad ian M e n t a l H e a l t h A s s o c i a t i o n has had i t s v o l u n t e e r programme i n o p e r a t i o n s i n c e May 1952 when groups of v o l u n t e e r s began v i s i t i n g the Saskatchew-an H o s p i t a l a t Weyburn. T h i s p r o g r e s s i v e v o l u n t e e r programme tends t o p l a c e i t s emphasis more on group a c t i v i t y than does the E s s o n d a l e programme a l t h o u g h f r i e n d l y i n d i v i d u a l v i s i t i n g t a k e s p l a c e as w e l l . The a c t i v i t i e s which take p l a c e a r e e s -s e n t i a l l y the same as t h o s e of the B o s t o n v o l u n t e e r programme and w i l l not be r e p e a t e d h e r e . I b i d . , p. 89 . - 14 -M e n t i o n o f t h e Saskatchewan programme i s made here because i t i s an i n t e r e s t i n g example o f v o l u n t e e r s c a r r y i n g t h e i r work d i r e c t l y i n t o t h e community as w e l l . They a r e a c t i v e l y p a r t i c -i p a t i n g i n a s o c i a l group p r o j e c t aimed a t r e h a b i l i t a t i n g d i s -c h a r g e d m e n t a l h o s p i t a l p a t i e n t s . Under t h e a u s p i c e s o f t h e C a nadian M e n t a l H e a l t h A s s o c i a t i o n s u i t a b l e p r e m i s e s were o b t a i n e d i n t h e c i t y o f R e g i n a which has a p o p u l a t i o n o f about 90,000 and i s s i t u a t e d some 75 m i l e s n o r t h o f t h e Saskatchewan H o s p i t a l a t Weyburn. The " C e n t r e " , as i t i s known, has an a c t i v e e v e n i n g programme and b o t h h o s p i t a l s t a f f members and v o l u n t e e r s a r e p r e s e n t . A c t i v i t i e s i n c l u d e a S o c i a l C l u b , D a n c i n g C l a s s , C r a f t C l u b s and B o w l i n g C l u b s . V o l u n t e e r s g i v e f r e e l y o f t h e i r t i m e and t a l e n t s i n g i v i n g l e a d e r s h i p t o t h e v a r i o u s groups. I t i s t h e j o b o f t h e s o c i a l worker t o i n t e r p r e t t o t h e A s s o c i a t i o n and t o t h e l e a d e r s , t h e need of b o t h t h e t e c h n i c a l and p s y c h o l o g i c a l know-how i n c o n d u c t -i n g t h e v a r i o u s a c t i v i t i e s . I t has been o b s e r v e d t h a t a p a r t i c u l a r group o f o v e r f o r t y former p a t i e n t s i s d o i n g e x t r e m e l y w e l l . O n l y one of t h i s group had t o r e t u r n t o h o s p i t a l a t t h e t i m e t h i s r e p o r t was p u b l i s h e d . I t i s i n t e r e s t i n g t o n o t e t h a t most o f t h e s e members have been t r e a t e d f o r t h e v a r i o u s c o n d i t i o n s which come under t h e g e n e r a l p s y c h i a t r i c d i a g n o s t i c c l a s s i f i c a t i o n o f s c h i z o p h r e n i a . I n o r d e r t o get more c o n c l u s i v e e v i d e n c e o f t h i s almost no r e t u r n t o m e n t a l h o s p i t a l t h e group p l a n s t o keep a c c u r a t e s t a t i s t i c s o f up t o f i v e y e a r s . * "Hlayotte, A.S., "A S o c i a l Group P r o j e c t i n t h e R e h a b i l i t -a t i o n o f D i s c h a r g e d M e n t a l H o s p i t a l P a t i e n t s " , A s t u d y made f o r t h e C anadian M e n t a l H e a l t h A s s o c i a t i o n , Saskatchewan D i v i s i o n ; The S o c i a l Worker, January I s s u e , 1957. - 15 -The Saskatchewan " C e n t r e " i d e a i s someth ing t h a t the B r i t i s h Co lumbia d i v i s i o n o f the Canad ian M e n t a l H e a l t h A s s o c -i a t i o n i s p l a n n i n g a l s o . Scope and Method T h i s t h e s i s i s a r e v i e w o f v o l u n t e e r s e r v i c e s t o the P r o -v i n c i a l M e n t a l H o s p i t a l a t E s s o n d a l e , B r i t i s h C o l u m b i a . In t h i s f i r s t c h a p t e r the c h a n g i n g a t t i t u d e towards menta l i l l n e s s has been d i s c u s s e d and t h i s was f o l l o w e d by some i n t r o d u c t o r y remarks on the growth o f the v o l u n t e e r i d e a i n the menta l h o s -p i t a l s e t t i n g c i t i n g two b r i e f examples of o t h e r v o l u n t e e r programmes. The second c h a p t e r d e s c r i b e s the o r g a n i z a t i o n and growth o f the Canad ian M e n t a l H e a l t h A s s o c i a t i o n v o l u n t e e r programme at E s s o n d a l e . In o r d e r t o get t h i s i n f o r m a t i o n , the w r i t e r i n t e r v i e w e d the E x e c u t i v e S e c r e t a r y o f the B r i t i s h Columbia D i v i s i o n o f the Canad ian M e n t a l H e a l t h A s s o c i a t i o n and the H o s p i t a l C o o r d i n a t o r o f v o l u n t e e r s at the P r o v i n c i a l M e n t a l H o s p i t a l . Wi th the generous h e l p o f the C o o r d i n a t o r d e t a i l s o f r e c r u i t m e n t were c o m p i l e d and q u e s t i o n n a i r e m a t e r i a l comple ted by v o l u n t e e r s as t o a g e - g r o u p i n g , s k i l l s , and where they had f i r s t h e a r d about the programme. M inu tes o f b o t h V o l u n t e e r P o l i c y Committee and V o l u n t e e r S e r v i c e s Committee meet ings were made a v a i l a b l e a l s o . The t h i r d c h a p t e r d e s c r i b e s the E a s t Lawn b u i l d i n g a t E s s o n d a l e w i th s p e c i f i c a t t e n t i o n b e i n g p a i d t o d e s c r i p t i o n of one ward and v o l u n t e e r a c t i v i t y on i t . F o r t h e purposes o f t h i s s t u d y , the p a t i e n t s a re d e s c r i b e d as b e l o n g i n g t o v a r i o u s - 16 " groups which were d e c i d e d upon w i t h t h e h e l p o f t h e C l i n i c a l D i r e c t o r and S o c i a l S e r v i c e S u p e r v i s o r o f E a s t Lawn. V a l u a b l e a s s i s t a n c e i n t h i s c o n n e c t i o n was r e c e i v e d a l s o f rom t h e Charge Nurse o f t h e ward c o n c e r n e d . The w r i t e r thought i t might be p o s s i b l e t o group t h e p a t -i e n t s a c c o r d i n g t o t h e v a r i o u s c a t e g o r i e s o f m e n t a l i l l n e s s such as c h r o n i c b r a i n syndromes, p s y c h o t i c d i s o r d e r s , and so on, but was a d v i s e d t h a t t h i s was not f e a s i b l e because an a c c u r a t e b r e a k -down o f t h a t k i n d o f i n f o r m a t i o n was not a v a i l a b l e a t t h i s t i m e . The a l t e r n a t i v e s u g g e s t i o n was t o c l a s s i f y p a t i e n t s i n t o groups a c c o r d i n g t o t h e i r ward b e h a v i o r . There f o l l o w s some comments on v o l u n t e e r s w o r k i n g w i t h p a t i e n t s i n t h e s e groups and some s u g g e s t i o n s as t o how t h e y c o u l d a s s i s t i n t h e O c c u p a t i o n a l Therapy programme on t h e ward. Two b r i e f c a s e s t u d i e s a r e i n -c l u d e d which i l l u s t r a t e a v o l u n t e e r ' s work w i t h a p a t i e n t and t h e worth o f a p p a r e n t l y s m a l l g a i n s . One c a s e i s i n c o l l a b o r -a t i o n w i t h a S o c i a l Yforker i n d i c a t i n g t h e h e l p t h e v o l u n t e e r can be. The f i n a l c h a p t e r r e s t a t e s t h e f o c u s o f t h e t h e s i s and makes some s u g g e s t i o n s r e g a r d i n g ways of d i r e c t i n g and s u s t a i n i n g i n t e r e s t o f v o l u n t e e r s . F i n a l l y , t h e r e a r e some s u g g e s t i o n s as t o how v o l u n t e e r s might be u s e d i n t h e S o c i a l S e r v i c e D e p a r t -ments a t P r o v i n c i a l M e n t a l H o s p i t a l and C r e a s e C l i n i c of P s y c h o l -o g i c a l M e d i c i n e . Chapter 2 V o l u n t e e r Programme at E s s o n d a l e The H o s p i t a l S e t t i n g The P r o v i n c i a l M e n t a l H o s p i t a l o f B r i t i s h Columbia i s s i t -u a t e d a t E s s o n d a l e , a p a r t i c u l a r l y l o v e l y p a r t o f the c o u n t r y -s i d e , about 17 m i l e s s o u t h o f the C i t y o f Vancouver . A t p r e s e n t , the h o s p i t a l , i n i t s wooded s e t t i n g w i th v iews of the F r a s e r on the h o r i z o n , i s c o n s i d e r e d to be i n a r a t h e r out of the way spot but p r e s e n t day b u i l d i n g i s r e a c h i n g towards i t and b e f o r e l o n g w i l l be e n c i r c l i n g i t . The h o s p i t a l , w i th i t s c a p a c i t y t o t a l o f about 4,000 p a t -i e n t s , i s made up o f s e v e r a l u n i t s - E a s t Lawn, West Lawn, C e n t r e Lawn, Nor th Lawn, Co lony Farm, Home f o r the Aged and the C r e a s e C l i n i c of P s y c h o l o g i c a l M e d i c i n e . The E a s t Lawn b u i l d i n g i s f o r women. I t c o n s i s t s o f 10 wards and i s f o r l o n g - t e r m p a t i e n t s . U n t i l 1954 a l l the wards i n E a s t Lawn were " c l o s e d " , i . e . l o c k e d , but i n F e b r u a r y of t h a t y e a r , a f t e r a g rea t d e a l o f p r e p a r a t i o n , the f i r s t ward was opened. T h i s has p roved t o be the f i r s t o f s e v e r a l and s i n c e t h i s t ime o t h e r wards have been opened not o n l y i n t h i s b u i l d i n g but i n o t h e r s as w e l l . - 18 -West Lawn i s t h e l o n g - t e r m u n i t f o r men. I t has 7 wards. There a r e two open wards h e r e . C e n t r e Lawn i s t h e a d m i t t i n g c e n t r e f o r t h e m e n t a l h o s p i t a l . I t has 8 wards f o r b o t h men and women p a t i e n t s , t h e m a j o r i t y o f whom a r e a c u t e l y i l l and have n ot been l o n g i n t h e h o s p i t a l . A n o t h e r main u n i t i s t h e Home f o r t h e Aged. I t has 9 wards and i s f o r b o t h men and women. Co l o n y Farm c a t e r s s p e c i f i c a l l y t o c e r t a i n c a t e g o r i e s o f armed s e r v i c e v e t e r a n s . B o t h d a i r y and a g r i c u l t u r a l f a r m i n g a r e c a r r i e d on her e i n a s u c c e s s f u l and h i g h l y o r g a n i z e d way. Cre a s e C l i n i c i s t h e newest t r e a t m e n t u n i t a t E s s o n d a l e . I t has i t s own a d m i t t i n g c e n t r e t o i t s 7 wards where b o t h men and women a r e t r e a t e d . I t i s a s h o r t - t e r m t r e a t m e n t c e n t r e w i t h a maximum t i m e o f f o u r months. One male and one fe m a l e ward i s open. I t has e x c e l l e n t o c c u p a t i o n a l and r e c r e a t i o n a l t h e r a p y accommodation. The o p e r a t i n g room f o r t h e e n t i r e E s s o n d a l e p a t -i e n t p o p u l a t i o n i s l o c a t e d on t h e t o p f l o o r a t Cr e a s e C l i n i c and a l l s u r g e r y i s performed t h e r e . Treatment o f f e r e d a t E s s o n d a l e i s h i g h l y e n l i g h t e n e d i n approach and v a r i e s w i d e l y a c c o r d i n g t o t h e needs o f t h e p a t i e n t . The t r e a t m e n t team, c o n s i s t i n g o f a l l t h e v a r i o u s d i s c i p l i n e s w i t h i n t h e h o s p i t a l t r i e s t o f o r m u l a t e a p l a n f o r each p a t i e n t even though i t may be a t e n t a t i v e one and even though t h e r e may be no immediate o p p o r t u n i t y t o c a r r y i t o u t . T h i s i s because, i n a c t u a l p r a c t i c e , i t i s t h e number o f s t a f f a v a i l a b l e which, of n e c e s s i t y , d e c i d e s t h e amount o f i n d i v i d u a l c a r e a p a t i e n t can be g i v e n . The s t a f f a r e ev e r m i n d f u l o f t h e s e c u r i t y and - 19 -p r o t e c t i o n o f t h e p a t i e n t and adequate s u p e r v i s i o n i s g i v e n a t a l l t i m e s , c a r e b e i n g t a k e n t o keep a c c i d e n t h a z a r d s away from t h e wards. S h o u l d a p a t i e n t d e v e l o p a p h y s i c a l i l l n e s s he goes t o t h e I n f i r m a r y ; i f he i s t u b e r c u l a r , a T.B. ward i s a v a i l a b l e ( N o r t h Lawn); i f he i s t o undergo i n s u l i n t r e a t m e n t s , he i s p l a c e d i n t h e i n s u l i n ward, and so on. O c c u p a t i o n a l t h e r a p y i s w e l l u t i l i z e d a t E s s o n d a l e and i s f o u n d t o be q u i t e e f f e c t i v e . The aim i s t o s u b s t i t u t e some r e a l and u s e f u l p i e c e o f work i n o r d e r t o s t i m u l a t e t h e p a t i e n t towards more normal and c o n s t r u c t i v e m e n t a l p r o c e s s e s . Farm work, c o o k i n g , l a u n d r y work, i n d u s t r i a l work, h a n d i c r a f t s o f v a r i o u s k i n d s seem t o be e s p e c i a l l y e f f e c t i v e towards t h i s end. I n a d d i t i o n t o t h e o c c u p a t i o n a l t h e r a p y t h e r e i s h i g h l y o r g a n i z e d r e c r e a t i o n a l t h e r a p y as w e l l . P r o f e s s i o n a l l y t r a i n e d r e c r e a t i o n a l t h e r a p i s t s conduct dances, w a l k s , i n d o o r p a r t i e s , i n d o o r s p o r t s , o u t d o o r s p o r t s , p h y s i c a l e x e r c i s e s , swimming, m o t i o n p i c t u r e s , music, c a r d s , e t c . The emphasis a g a i n i s t o s t i m u l a t e more p r o d u c t i v e t h i n k i n g and a t t i t u d e s o f o n e s e l f and one's community. P h y s i o t h e r a p y and h y d r o t h e r a p y a r e i n wide use t h r o u g h o u t t h e h o s p i t a l and a r e a f a r c r y f r om t h e water c u r e s and " b a t h s o f s u r p r i s e " o f a c e n t u r y ago. I n 1951 t h e P r o v i n c i a l M e n t a l H o s p i t a l and C r e a s e C l i n i c were awarded t h e A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n ' s e f f i c i e n c y award. However, i n s p i t e o f t h e c o m p a r a t i v e e x c e l l e n c e o f programme, i t i s more t h a n ever r e c o g n i s e d t h a t much t h a t needs t o be done and c o u l d be done, cannot be done because o f t h e - 20 -l a c k of enough t r a i n e d s t a f f t o g i v e the i n d i v i d u a l i z e d t rea tment so n e c e s s a r y f o r m e n t a l l y i l l p a t i e n t s . I t s h o u l d a l s o be no ted t h a t the one r e s e r v a t i o n s t a t e d i n the award was t h a t one problem common t o so many s t a t e h o s p i t a l s , namely, o v e r c r o w d i n g . S t a r t i n g the V o l u n t e e r Programme In the l a t e 1940 's M r s . W i l l i a m I rwin began some s e r i o u s t h i n k i n g about the use of v o l u n t e e r s i n menta l h o s p i t a l s . " 1 * The mat ter came t o her a t t e n t i o n th rough l e a r n i n g about v o l u n t e e r s d o i n g t h i s type o f work i n menta l h o s p i t a l s i n the U n i t e d S t a t e s . In o r d e r t o get such a programme s t a r t e d here she had t h r e e groups of p e o p l e t o c o n v i n c e , namely, the h o s p i t a l a u t h o r i t i e s , the B o a r d and S c i e n t i f i c P l a n n i n g Committee of the Canad ian M e n t a l H e a l t h A s s o c i a t i o n i n B r i t i s h C o l u m b i a , and the community. M r s . I rwin had f i r s t - h a n d i n f o r m a t i o n o f the v o l u n t e e r programme a t Topeka , Kansas and the emphasis t h e r e appeared t o be o c c u p -a t i o n a l and r e c r e a t i o n a l work. Her i n t e r e s t i n the p o s s i b i l i t y o f v o l u n t e e r s i n menta l h o s p i t a l s had r e a c h e d q u i t e a h e i g h t j u s t p r i o r t o the o r g a n i z a t i o n a l meet ing o f the B r i t i s h Co lumbia 2 d i v i s i o n of the Canad ian M e n t a l H e a l t h A s s o c i a t i o n i n 1951. At t h i s meet ing were l a y p e o p l e who were c o n n e c t e d w i t h v a r i o u s community groups and who had c o n s i d e r a b l e knowledge r e g a r d i n g the o r g a n i z a t i o n of community s p o n s o r e d programmes c o n c e r n i n g H e a l t h and W e l f a r e . D r . A . Gee, the D i r e c t o r o f M e n t a l H e a l t h S e r v i c e s i n B r i t i s h C o l u m b i a , and o t h e r members o f the m e d i c a l and p s y c h i a t r i c p r o f e s s i o n s were a l s o p r e s e n t . M r s . I rw in '''Selman, L a u r a , " V o l u n t e e r s i n a M e n t a l H o s p i t a l ; Canad ian  W e l f a r e ; December 15, 1956. p. 223. 2 H e r e a f t e r r e f e r r e d t o as C . M . H . A . - 21 -brought up the p o s s i b i l i t y of volunteer work being done at Essondale but the suggestion was not picked up at that time. The suggestion was presented i n terras of the volunteer work be-ing done i n Kansas which was i n the occupational and rec r e a t i o n a l work already mentioned. But as the Essondale programme was already highly organized along these l i n e s , and also because the whole idea of a c i t i z e n working i n t h i s s e t t i n g was so new, Mrs. Irwin's suggestion was not picked up. At any rate, the B r i t i s h Columbia d i v i s i o n of CM.H.A. was set up. The Director of Mental Health Services and the Deputy Director were i n d i v i d u a l members on the Board. Mrs. Irwin again suggested the p o s s i b i l i t y of volunteers and t h i s time there was a p a r t i a l response to the idea by the Deputy Director. He sug-gested that he would l i k e to see a programme of volunteer work begun on the p s y c h i a t r i c ward of Vancouver General Hospital. It i s i n t e r e s t i n g to note that the So c i a l Services s t a f f at Essondale expressed inte r e s t i n Mrs. Irwin's suggestion and that they arranged a luncheon to discuss the matter. Nothing concrete came of t h i s but i t showed an awakening inter e s t on the part of ho s p i t a l s t a f f and was encouraging to Mrs. Irwin i n her e f f o r t s . Another factor which stimulated interest i n volunteer work i n mental hospitals was the v i s i t by Lady Hamilton who was fam-i l i a r with volunteer programmes i n England. The CM.H.A. ar-ranged a tour of Essondale for her at which time she spoke to st a f f on the use of volunteers i n the mental health s e t t i n g i n England. While Lady Hamilton's v i s i t did not convince admin-- 22 -i s t r a t i o n when one of Manitoba's mental health service o f f i c i a l s v i s i t e d the ho s p i t a l and discussed the need for community part-i c i p a t i o n and the value of volunteer work i n mental ho s p i t a l programmes. It happened that t h i s renewal of intere s t took place just at the time when the present Director of C.M.H.A., Mr. J. Ward, took o f f i c e . He i s a man whose t r a i n i n g and prev-ious experience had been i n health and adult education i n Sas-katchewan and i n the State of Maine. His deep conviction of the value of community intere s t and p a r t i c i p a t i o n went a long way i n helping to interpret the poten t i a l value of a volunteer programme for the P r o v i n c i a l Mental Hospital. The Director of the mental health services now offered to set up a s t a f f committee at Crease C l i n i c and the Mental Hospital to study the p o s s i b i l i t y and d e s i r a b i l i t y of using volunteers i n those i n s t i t u t i o n s . Members of t h i s committee represented medicine, nursing, s o c i a l work, occupational and recrea t i o n a l therapy, music therapy and r e h a b i l i t a t i o n . At the same time a group of eight women were c a l l e d rogether i n Vancouver. These were women active i n , and with a knowledge of, community a f f a i r s . They discussed the volunteer programme from the community point of view. The two committees worked separately for some months before getting together to compare th e i r findings. Both committees decided favourably on the idea of volunteers working i n mental hospitals and the programme was en t h u s i a s t i c a l l y endorsed. In May 1954 a volunteer committee was formed under the Association. I t ' s Chairman, Mrs. L. Selraan, gathered together - 23 -some key women f rom such groups as J u n i o r League, L o c a l C o u n c i l o f Women, Paren t Teacher A s s o c i a t i o n and s i m i l a r groups who had r e s o u r c e s f o r v o l u n t e e r s and i n some c a s e s v o l u n t e e r e x p e r i e n c e . I t was out o f t h i s p o l i c y committee t h a t the appointment o f a Chairman of V o l u n t e e r s r e s u l t e d . The s t r u c t u r e and o r g a n i z a t i o n of commit tees w i l l be d i s c u s s e d more f u l l y be low, but s u f f i c e i t t o say here t h a t the f i r s t team of t e n v o l u n t e e r s under a c a p t a i n were chosen as a r e s u l t o f t h i s c o m m i t t e e ' s work.""" V o l u n t e e r V i s i t s B e g i n The v o l u n t e e r s s t a r t e d t h e i r work i n C r e a s e C l i n i c and on t h e i r a r r i v a l t h e r e on the f i r s t day were met by Mr . F . M c N a i r , the C l i n i c a l D i r e c t o r , who gave them a s h o r t t a l k on the C l i n i c and gave them a c h o i c e o f a r e a s of work. To b e g i n w i t h , t h i s 2 f i r s t team, c a p t a i n e d by M r s . G. C r e i g h t o n , worked every Thursday morn ing . B e f o r e b e g i n n i n g t h e i r work they had been g i v e n a two day t r a i n i n g c o u r s e s p o n s o r e d by the C . M . H . A . who worked i n c o -o p e r a t i o n w i th the h o s p i t a l s t a f f . They saw f i l m s and had d i s c u s s i o n s t o a c q u a i n t them w i th t y p e s o f menta l i l l n e s s , t h e i r t r e a t m e n t s , the purpose o f t h e i r v i s i t i n g and some e t h i c s f o r them t o o b s e r v e . In a d d i t i o n they were g i v e n i n d i v i d u a l i n t e r -v iews to a s s e s s t h e i r s u i t a b i l i t y f o r work i n a menta l h e a l t h s e t t i n g and upon a c c e p t a n c e took out membership i n the C . M . H . A . They were then a s s i g n e d t o the v o l u n t e e r team. The date o f the f i r s t v i s i t was s e t f o r June 2 9 t h , 1954 and t r a n s p o r t a t i o n was a r r a n g e d f o r team members. Some v o l u n t e e r s u s e d t h e i r own c a r s 1 E x n e r , H e l e n , "Development o f a Programme f o r V o l u n t e e r s i n M e n t a l H e a l t h i n B r i t i s h C o l u m b i a . " ( U n p u b l i s h e d M a n u s c r i p t . ) o P e r s o n a l I n t e r v i e w w i th M r s . G. C r e i g h t o n . - 24 -but bus f a r e s were p a i d by C M . H . A . i f d e s i r e d . M r s . C r e i g h t o n d e s c r i b e s the f e e l i n g s of the v o l u n t e e r s about g o i n g out to t h e C l i n i c on t h i s f i r s t day . "We were wonder ing j u s t what menta l p a t i e n t s would be l i k e t o work w i t h , how i t would f e e l to be l o c k e d i n , would i t be d e p r e s s i n g , and numerous o t h e r q u e s t i o n s . " The r e a c t i o n of the team a t the end o f the day was v e r y f a v o u r -a b l e . "I can say t h a t we found the work so i n t e r e s t i n g , the p a t i e n t s so easy t o t a l k w i t h , t h a t we never n o t i c e d the l o c k e d d o o r s , were not d e p r e s s e d and wondered where the t ime had g o n e . " Adjustment t o work i n the menta l h o s p i t a l was c o n s i d e r a b l y more d i f f i c u l t but t h i s w i l l be d i s c u s s e d i n some d e t a i l l a t e r . On t h a t f i r s t day a t C r e a s e C l i n i c they spent most o f t h e i r t ime i n the o c c u p a t i o n a l t h e r a p y department under the s k i l l e d s u p e r v i s i o n o f t r a i n e d t h e r a p i s t s . Two team members worked i n the women's o c c u p a t i o n a l t h e r a p y , two i n the men's o c c u p a t i o n a l the rapy and two i n the C l i n i c l i b r a r y t a k i n g l i b r a r y s e r v i c e t o the Home f o r the A g e d . The r e a c t i o n o f the women who had been p l a c e d i n men's o c c u p a t i o n a l the rapy was t h a t the p a t i e n t s r e s -ponded t o t h e i r p r e s e n c e and were f r i e n d l y . They n o t e d t h a t the s t a f f was f r i e n d l y toward them as w e l l but had no s p e c i f i c j o b s s e t up f o r them to d o . On t h i s f i r s t day they f e l t t h e i r way s l o w l y and were c o n t e n t t o walk amongst the p a t i e n t s , com-ment ing and showing an i n t e r e s t i n t h e i r work. The r e a c t i o n of the v o l u n t e e r s i n the women's s e c t i o n was e s s e n t i a l l y the same. In a s h o r t t ime the v o l u n t e e r s f e l t t h a t a h a l f day was not enough and on O c t o b e r 7 t h , 1954 the f i r s t a l l - d a y v i s i t i n g s t a r t e d . - 25 -As t ime went o n , and as more v o l u n t e e r s were r e c r u i t e d , i t was f e l t t h a t t h e r e was a g r e a t e r need f o r v o l u n t e e r work i n the M e n t a l H o s p i t a l b u i l d i n g s and a l s o on O c t o b e r 7 th the f i r s t v i s i t was made t o one of the more d i s t u r b e d wards i n E a s t Lawn women's b u i l d i n g . On t h i s f i r s t o c c a s i o n the v o l u n t e e r s d i d not take any work up but i n s t e a d t a l k e d t o p a t i e n t s and walked around among them. I t was n o t e d t h a t the atmosphere was q u i t e d i f f e r e n t f rom C r e a s e C l i n i c . Here many o f t h e p a t i e n t s were q u i t e h o s t i l e , s u s p i c i o u s and u n a c c e p t i n g o f the v o l u n t e e r s p r e s e n c e . T h i s c o n t r a s t e d s h a r p l y w i th the g e n e r a l l y p o s i t i v e r e s p o n s e n o t e d i n C r e a s e C l i n i c . R e c r u i t i n g was g o i n g on a l l t h i s t i m e , new v o l u n t e e r s were b e i n g t r a i n e d , new teams formed u n t i l t o - d a y , (March 1958) the t o t a l number of v o l u n t e e r s a t E s s o n d a l e i s 130. T h i s number i s composed a lmost e n t i r e l y o f women, t h e r e b e i n g o n l y s i x male v o l u n t e e r s . T h e i r a r e a s of work have i n c r e a s e d t o o , c o v e r i n g more wards. The two main a r e a s f rom which v o l u n t e e r s come a r e Vancouver and New Westminster and w h i l e they a re g e n e r a l l y r e f e r r e d t o as the Vancouver group and the New Westminster group, C M . H . A . p r e f e r s t o r e g a r d them s i m p l y as C M . H . A . v o l u n t e e r s . There i s a l s o a breakdown i n t o day v o l u n t e e r s and n i g h t v o l u n t e e r s . The Thursday v i s i t i n g day as such i s now a t h i n g o f the p a s t , and v o l u n t e e r v i s i t i n g i s s p r e a d over the e n t i r e week. Each v o l u n t e e r d e c i d e s which p a r t i c u l a r day or e v e n i n g i s most s u i t -a b l e f o r h im . The average t ime spent per v o l u n t e e r i s about twenty hours per month. A f o r m a l r e c o r d of the v o l u n t e e r ' s t ime i s kept by the C o - o r d i n a t o r o f V o l u n t e e r S e r v i c e s . - 2 6 -A few words f r o m Dr. Gee's message t o t h e v o l u n t e e r s would seem a p p r o p r i a t e . 1 The h o s p i t a l welcomes you as a v o l u n t e e r and i n v i t e s you t o p a r t i c i p a t e w i t h us i n t h e most s a t i s f y i n g work of a l l , h e l p i n g p e o p l e back t o normal m e n t a l h e a l t h . I t may be a new i d e a t o you, and f r a n k l y i t was a new i d e a t o u s , but i t does work. I n f a c t i t works i n many ways. I t a s s i s t s t h e p a t i e n t i n d i v i d u a l l y - y e t you a r e not g o i n g t o be a s k e d t o do t h i n g s t h a t norm-a l l y would be c o n s i d e r e d d u t i e s o f t h e s t a f f . You a r e g o i n g t o be d o i n g t h e t h i n g s t h a t p e o p l e j u s t cannot be p a i d t o do. You a r e g o i n g t o b r i n g a s p i r i t o f f r i e n d l i n e s s and hope t o t h o s e who have t h e s e needs. You a r e g o i n g t o b r i n g some o f t h e g r a c i o u s n e s s o f good h e a l t h y l i v i n g w i t h you. You a r e g o i n g t o i n i t -i a t e and a s s i s t i n some of t h e s o c i a l and d i v e r s i o n a l a c t i v i t i e s which a r e so w a n t i n g i n an i n s t i t u t i o n a l t y p e o f l i v i n g , no m a t t e r how good i t may be. You t o o , I am s u r e , a r e g o i n g t o d e r i v e many b e n e f i t s by p a r t i c i p a t i n g i n t h e V o l u n t e e r Programme. You a r e g o i n g t o get a l o t o f p e r s o n a l s a t i s f a c t i o n out o f a s s i s t i n g where a s s i s t a n c e i s so b a d l y needed. You cannot h e l p l e a r n i n g many i n t e r e s t i n g t h i n g s which w i l l , I am s u r e , a s s i s t you towards b e t t e r u n d e r s t a n d -i n g . Then, t o o , you a r e g o i n g t o l e a r n a good d e a l about t h e problems o f m a i n t a i n i n g and r e s t o r i n g good m e n t a l h e a l t h , which you a r e g o i n g t o t a k e back home w i t h you and s h a r e w i t h o t h e r s . There a r e many m i s c o n c e p t i o n s and m i s u n d e r s t a n d i n g s about m e n t a l i l l n e s s and me n t a l h o s p i t a l s . You w i l l be i n a much b e t t e r p o s i t i o n t o u n d e r s t a n d t h e s e t h i n g s and t o h e l p us i n our program o f p u b l i c educ-a t i o n . Remember t h a t you a r e a r e p r e s e n t a t i v e o f t h e B r i t i s h Columbia D i v i s i o n o f t h e Can a d i a n M e n t a l H e a l t h A s s o c i a t i o n , a group o f p u b l i c - s p i r i t e d c i t i z e n s and s c i e n t i s t s who d e d i c a t e p a r t o f t h e i r t i m e , v o l -u n t a r i l y , t o f u r t h e r good m e n t a l h e a l t h i n our p r o v i n c e . I am s u r e t h a t you w i l l e n j o y your work w i t h u s . We need your h e l p . T h i s t y p e o f a c c e p t a n c e and e n t h u s i a s m f o r t h e work o f t h e v o l u n t e e r s has w i t h few e x c e p t i o n s permeated t h e e n t i r e s t a f f o f t h e h o s p i t a l i n t h e a r e a s where t h e v o l u n t e e r i s s e r v i n g . W i t h o u t t h i s t h e e f f e c t i v e n e s s o f t h e v o l u n t e e r programme would be s e r i o u s l y undermined. Perhaps a c o n c r e t e example o f t h e Selman, L a u r a , op. c i t . , p. 224. - 27 -a d m i n i s t r a t i o n ' s a c c e p t a n c e and en thus iasm f o r the v o l u n t e e r ' s r o l e i s the f a c t t h a t a v o l u n t e e r s ' room has been b u i l t i n a c e n t r a l l y l o c a t e d p o s i t i o n on the h o s p i t a l g rounds . I t i s c o m f o r t a b l y f u r n i s h e d and s e r v e s as a c o m f o r t a b l e h e a d q u a r t e r s where the v o l u n t e e r s can s i m p l y r e l a x o r have d i s c u s s i o n s o r t r a i n i n g t a l k s . I t i s f rom t h i s base t h a t the v o l u n t e e r s move out t o the v a r i o u s h o s p i t a l u n i t s t o o f f e r t h e i r s e r v i c e s . Types o f V o l u n t e e r S e r v i c e s 1 These s e r v i c e s a r e many and v a r i e d . The f o l l o w i n g l i s t c o v e r s most o f them: Home f o r the Aged m o b i l e book s e r v i c e , f o r e i g n language s e r v i c e , b r i d g e s c o r i n g and p l a y i n g c a r d games g e n e r a l l y , a s s i s t a n c e i n l e t t e r w r i t i n g , f r i e n d l y c h a t s w i t h p a t i e n t s , r e a d i n g t o p a t i e n t s , s i n g - s o n g s , d a n c i n g , r e c o r d p l a y i n g , wa lks , s h o p p i n g s e r v i c e , games, f l o w e r making, b i r t h -day p a r t i e s and s p e c i a l day p a r t i e s , beauty c u l t u r e and grooming, b o w l i n g , swimming, d r i v e s , town v i s i t s , sewing g r o u p s , C h r i s t m a s g i f t s , A p p a r e l Shop, C o f f e e Shop. R e c e n t l y , some p o s t - d i s c h a r g e f r i e n d l y home v i s i t i n g has been done. A l o t o f work i s done i n the o c c u p a t i o n a l t h e r a p y s e c t i o n s a s s i s t i n g the t h e r a p i s t s i n g e t t i n g m a t e r i a l ready f o r the p a t i e n t s as w e l l as work ing w i th the p a t i e n t s . They a s s i s t the p a t i e n t s i n d o i n g such t h i n g s as u n t a n g l i n g the warp and s e t t i n g up the loom, t r a c i n g o u t l i n e s f o r t o y s - a t a s k too c o m p l i c a t e d f o r some p a t i e n t s , o r perhaps h e l p i n g a p a t i e n t work on a c o t t o n t a b l e mat or a r u g o r s l i p p e r s , o r maybe a s t a f f e d an imal and g e n e r a l l y m i n g -l i n g i n a q u i e t way among the p a t i e n t s i n harmony w i th the P e r s o n a l I n t e r v i e w s w i t h G. Dodsworth, C o o r d i n a t o r of V o l u n t e e r s . - 28 -t h e r a p i s t s ' p l a n n e d p a t i e n t a c t i v i t i e s . V o l u n t e e r s l e a r n e d e a r l y i n t h e i r e x p e r i e n c e t h a t t h e c l o s e s t c o o p e r a t i o n was n e c e s s a r y between t h e r a p i s t and v o l u n t -e e r . One i n s t a n c e r e c a l l e d by a v o l u n t e e r was when she, o v e r -a n x i o u s t o h e l p , u n w i t t i n g l y r e v e r s e d t h e t h e r a p i s t ' s p l a n and h e l p e d a p a t i e n t who s h o u l d have been a l l o w e d t o h e l p h e r s e l f . S t a f f i n t e r e s t and guidance i s o f t h e utmost i m p o r t a n c e t o t h e v o l u n t e e r s i f t h e y a r e t o f u n c t i o n h a r m o n i o u s l y i n t h i s s e t t i n g . Two v e r y i m p o r t a n t developments o f t h e v o l u n t e e r programme a r e t h e A p p a r e l Shop and t h e P e n n i n g t o n H a l l C o f f e e Shop. A c t u a l l y t h e r e a r e two a p p a r e l shops, one f o r men and one f o r women. The women's shop was opened on November 3 r d , 1955 and marked a m i l e s t o n e i n t h e growth o f t h e v o l u n t e e r programme. A f a s h i o n show f e a t u r i n g p r o f e s s i o n a l models was a h i g h - l i g h t of t h e o p e n i n g and gowns m o d e l l e d were from t h e s t o c k of t h e shop. A l l c l o t h i n g was and i s donated by v a r i o u s i n d i v i d u a l s , groups, and o r g a n i z a t i o n s i n t h e community. O n l y good c l o t h i n g i s a c c e p t e d and p e o p l e a r e asked t o g i v e c l o t h e s which t h e y would wear t h e m s e l v e s . A l l d r y - c l e a n i n g o f c l o t h i n g f o r t h e a p p a r e l shops i s l o o k e d a f t e r by t h e h o s p i t a l t h r o u g h i t s own l a u n d r y s e r v i c e which i s l a r g e l y p a t i e n t s t a f f e d . The A p p a r e l Shop was made p o s s i b l e t h r o u g h t h e h a r d work o f t h e v o l u n t e e r s and t h r o u g h t h e e x c e l l e n t s u p p o r t and c o o p e r a t i o n o f t h e hos-p i t a l a d m i n i s t r a t i o n who saw t o i t t h a t space was made a v a i l -a b l e f o r t h e e n t e r p r i s e . The women's shop i s l o c a t e d i n t h e E a s t Lawn b u i l d i n g and t h e s e r v i c e i s d e s i g n e d t o meet t h e c l o t h i n g needs o f p a t i e n t s who a r e on t h e r o a d t o r e c o v e r y whether t h e y a r e a c t u a l l y r e a d y t o go home o r n o t . The h o s p i t a l - 29 -o f c o u r s e , does s u p p l y good q u a l i t y c l o t h i n g t o p a t i e n t s who need i t b u t , o f n e c e s s i t y , t h e s t y l i n g i s u n i m a g i n a t i v e and u t i l i t a r i a n . The women's shop r e s e m b l e s any suburban d r e s s and a c c e s s o r y shop, and t h e p a t i e n t i s a b l e t o l o o k f o r what she w i s h e s w i t h t h e v o l u n t e e r p l a y i n g t h e r o l e o f s a l e s c l e r k . The men's shop, which was opened i n t h e West Lawn b u i l d i n g some t i m e a f t e r t h e o p e n i n g o f t h e women's shop, i s much more rough and r e a d y but t h e a r t i c l e s o f c l o t h i n g a r e o f good c u t and q u a l i t y . There i s a c l o t h i n g depot i n Vancouver, s t a f f e d by v o l u n t e e r s , which a c t s as a c l e a r i n g house. The v o l u n t e e r s have s i n c e s t a g e d f u r t h e r f a s h i o n shows i n c o n n e c t i o n w i t h t h e A p p a r e l Shop and , p a t i e n t s a r e becoming much more c l o t h e s c o n s c i o u s . P a t i e n t s a r e u s e d as models. The commentary i s done by a p a t i e n t and p i a n o music i s p r o v i d e d by a n o t h e r p a t i e n t . Many more p a t i e n t s f o rm a l a r g e and i n t e r e s t e d a u d i e n c e , and u s u a l l y have q u i t e a few f a m i l y members i n a t t e n d a n c e as q u e s t s . That t h e A p p a r e l Shop and t h e s e r v i c e i t p r o v i d e s i s t r u l y a p p r e c i a t e d by p a t i e n t s and e x - p a t i e n t s i s shown by t h e numbers of l e t t e r s o f t h a n k s r e c e i v e d a t t h e v o l u n t e e r o f f i c e . One of t h e s e l e t t e r s i s quoted i n which the p a t i e n t w r i t e s as f o l l o w s : Dear S a l e s l a d y , The work o f t h e A p p a r e l Shop d e s e r v e s a g r e a t d e a l o f c r e d i t , I t h i n k . May I thank you a g a i n f o r t h e c o u r t e i o u s s e r v i c e you gave me. Your shop as I remarked t h a t day i s s e t up l i k e an e x c l u s i v e s m a l l l a d i e s de-partment s t o r e and i s v e r y p l e a s i n g . I can a s s u r e you i t was a g r e a t p l e a s u r e t o be s e r v e d by you and t o see your l o v e l y l i t t l e shop. S i n c e r e l y , Even a f t e r a p a t i e n t has l e f t t h e h o s p i t a l t h e s e r v i c e p r o v i d e d by t h e A p p a r e l Shop i s s t i l l a v a i l a b l e t o him s h o u l d he need i t . On b e i n g d i s c h a r g e d f r o m t h e h o s p i t a l t h e p a t i e n t i s g i v e n t h e - 30 -card reproduced below: We know that when you have reestablished yourself, you w i l l prefer to choose and buy your own clothes, but i f i n the mean-time you need addi t i o n a l apparel, we would l i k e to help. PHONE us: THE CANADIAN MENTAL HEALTH ASSOCIATION 5 East Broadway Dickens 5330 The Coffee Shop at Pennington H a l l i s the most recent vent-ure undertaken by the volunteers.^ Pennington H a l l i s a recreation centre at the ho s p i t a l where movies are shown, dances are held and sports a c t i v i t i e s are conducted, and there i s a good sized canteen connected with i t . It i s a place where both s t a f f and patients may congregate for coffee or a snack. Observations of experienced volunteers indicated that while the canteen was serving a functional purpose, a l i t t l e imaginative planning would probably make i t more therapeutic for patients and t h e i r r e l a t -ives. The Canadian Mental Health Association volunteers thought that they could undertake to bring t h i s about. They f e l t that while the canteen operation on the h o s p i t a l grounds was a conces-sion of the Institute for the B l i n d i t nevertheless could come within the sphere of volunteer a c t i v i t i e s . Moreover, i t was f e l t that although the Canadian National I n s t i t u t e for the B l i n d was a worthwhile cause, that the cause of mental health was not being served as i t could be by t h i s resource. The matter was discussed at a meeting of the Pol i c y Committee 1 and a sub-committee was set up to look into the matter. The report came back from t h i s committee at the October 29th 1957 meeting recommending that Dodsworth, G., op. c i t . - 31 -the Canad ian Menta l H e a l t h A s s o c i a t i o n - v o l u n t e e r s take over the C o f f e e Shop o p e r a t i o n . D r . Gee s u b m i t t e d the p l a n t o Mr . P e n n i n g t o n , Deputy P r o v i n c i a l S e c r e t a r y , ( a f t e r whom the h a l l had been named) and e v e n t s t r a n s p i r e d more r a p i d l y than had been e x p e c t e d . A s p e c i a l e x e c u t i v e meet ing was c a l l e d a week p r i o r t o the r e g u l a r P o l i c y Committee meet ing and the Canad ian M e n t a l H e a l t h A s s o c i a t i o n committed i t s e l f t o the h o s p i t a l t o assume r e s p o n s i b i l i t y f o r the P e n n i n g t o n H a l l C o f f e e Shop. P r e l i m i n a r y p l a n n i n g was done at t h a t p o i n t i n terms o f s t a f f c o v e r a g e , p a i d and v o l u n t e e r , f i n a n c i n g , r e c r u i t i n g of e x t r a v o l u n t e e r s and f o r m a t i o n of an i n t e r i m c h a i r m a n s h i p of the p r o j e c t . The p r o j e c t went i n t o o p e r a t i o n on F e b r u a r y 4 t h , 1958 and as p r e s e n t l y c o n -s t i t u t e d has one f u l l - t i m e and one p a r t - t i m e p a i d s t a f f . They a re l o o k i n g a f t e r book a u d i t i n g , p u r c h a s i n g , e t c . As f a r as the v o l u n t e e r s a re c o n c e r n e d the p r o j e c t i s a means toward an end , namely, a p o i n t o f c o n t a c t between the v o l u n t e e r and the p a t i e n t and r e l a t i v e . I t i s p lanned t h a t a r e f r e s h e r c o o k i n g s c h o o l f o r p a t i e n t s w i l l be e s t a b l i s h e d so as t o u t i l i z e t o the utmost the k i t c h e n f a c i l i t i e s t h a t a re a v a i l a b l e . T h i s would p r o v i d e p a t -i e n t s r e t u r n i n g to ahome s i t u a t i o n a f t e r a l o n g absence w i th an o p p o r t u n i t y t o become f a m i l i a r w i th a k i t c h e n a g a i n . I t i s a l s o p lanned t h a t w a i t r e s s t r a i n i n g w i l l be p r o v i d e d f o r g i r l s who may p l a n , or have t o t a k e , employment o f t h a t k i n d . V o l u n t e e r s a re c o n d u c t i n g the t r a i n i n g programme and w i l l s e r v e p r i m a r i l y as h o s t e s s e s . The C o f f e e Shop i s open f rom 10:00 a .m. t o 10:00 p.m. seven days a week so t h a t s h i f t arrangements have been worked out t o take c a r e of i t . I t i s hoped t h a t t h i s p r o j e c t w i l l h e l p the v o l u n t e e r s e s t a b l i s h a p l e a s a n t atmosphere where - 32 -p a t i e n t s and r e l a t i v e s o f p a t i e n t s may v i s i t . S t a f f w i l l c o n -t i n u e t o p a t r o n i z e t h e C o f f e e Shop as i t i s f e l t t h a t t h i s f o u r -way m i x i n g o f p a t i e n t s , r e l a t i v e s , s t a f f and v o l u n t e e r s w i l l add r a t h e r t h a n d e t r a c t f r om t h e o p e r a t i o n . T h i s p r o j e c t w i l l a l s o p r o v i d e an o p e n i n g f o r c o n t a c t w i t h t h e men p a t i e n t s a t t h e h o s p i t a l which, up u n t i l now, has been q u i t e l i m i t e d . Any p r o -f i t s which may be r e a l i z e d f r om t h e o p e r a t i o n w i l l go back t o t h e p a t i e n t s t h r o u g h t h e v a r i o u s C anadian M e n t a l H e a l t h A s s o c i a t i o n a c t i v i t i e s . T r a n s p o r t a t i o n T r a n s p o r t a t i o n i s a v e r y i m p o r t a n t c o n s i d e r a t i o n i n t h e e f f e c t i v e l e s s o f t h e v o l u n t e e r programme. The m a j o r i t y o f v o l -u n t e e r s come from t h e c i t y o f Vancouver, some twenty m i l e s f r om t h e h o s p i t a l . I n t h e p a s t , t r a n s p o r t a t i o n has been a m a t t e r which caused a f a i r amount of d i f f i c u l t y and t o some e x t e n t a f -f e c t s t h e r e c r u i t i n g o f f u r t h e r v o l u n t e e r s . I t i s a f a i r l y e x p e n s i v e p r o p o s i t i o n f o r v o l u n t e e r s t o t a k e c a r e o f t h e m s e l v e s . The Ca n a d i a n M e n t a l H e a l t h A s s o c i a t i o n d e c i d e d t h a t t r a n s p o r t -a t i o n c o s t s o f v o l u n t e e r s s h o u l d be met by t h e A s s o c i a t i o n . In t h e b e g i n n i n g t h e r e was a t r i a l p e r i o d when v o l u n t e e r s were g i v e n 10 c e n t s per m i l e f o r t h e use o f t h e i r own c a r s p r o v i d e d t h e y brought a n o t h e r v o l u n t e e r as a passenger. The c o s t o f t h i s e v e n t u a l l y became p r o h i b i t i v e as numbers i n c r e a s e d and a bus was c h a r t e r e d a t a c o s t o f $22.50 per t r i p . The t r a n s p o r t a t i o n c hairman has s i n c e been a b l e t o a r r a n g e f o r t h e s u b s t a n t i a l l y cheaper r a t e o f $17.50 f o r t h e bus. The r o u t e has been e x t e n d e d now t o i n c l u d e New Westminster a t a c o s t o f $21.50 per t r i p . - 33 -T h i s bus r u n s on Thursdays and Tuesdays. The H o s p i t a l p r o v i d e s a bus on Wednesdays f o r near-by New Wes t m i n s t e r and a r e a v o l u n t -e e r s . R e c r u i t i n g and T r a i n i n g R e c r u i t i n g , o f c o u r s e , i s a v e r y i m p o r t a n t p a r t o f t h e v o l -u n t e e r programme and i s a c o n t i n u i n g p r o c e s s f rom one y e a r ' s end t o t h e next i n o r d e r t o r e p l a c e v o l u n t e e r workers who have dropped out f o r one r e a s o n o r a n o t h e r and i n o r d e r t o expand t h e v o l u n t -e e r f o r c e g r a d u a l l y as t h e programme d e v e l o p s . P u b l i c i t y f o r v o l u n t e e r r e c r u i t m e n t i s t h r o u g h t e l e v i s i o n , r a d i o , newspapers, magazines, speeches t o groups and t h e r e c r u i t i n g e f f o r t s o f p r e s e n t v o l u n t e e r s . F o r example d u r i n g Canadian M e n t a l H e a l t h Week i n May 1957 r a d i o s t a t i o n s C.K.W.X. and C-FUN made a v a i l -a b l e t h e i r r e c o r d i n g f a c i l i t i e s and d i s c s o f t a l k s by prominent a u t h o r i t i e s were made. These t a l k s were t h e n b r o a d c a s t on e v e r y r a d i o s t a t i o n i n t h e P r o v i n c e . I n a d d i t i o n , t h e r e were one minute " P l u g " d i s c s f o r m e n t a l h e a l t h which were l o g g e d on p r o -gramme s c h e d u l e s t h r o u g h o u t t h e P r o v i n c e . W h i l e most o f t h e p u b l i c i t y g i v e n d u r i n g M e n t a l H e a l t h Week was de v o t e d t o m e n t a l h e a l t h g e n e r a l l y , t h e r e n e v e r t h e l e s s was some d i r e c t m ention o f t h e v o l u n t e e r programme and a g e n e r a l h e i g h t e n i n g o f community awareness o f t h e problem. Once pe o p l e have h e a r d about t h e v o l u n t e e r programme and have become i n t e r e s t e d , t h e y r e s p o n d i n s e v e r a l ways. They may phone t h e Canadian M e n t a l H e a l t h A s s o c i a t i o n o f f i c e t o ask about t h e programme o r may make a p e r s o n a l v i s i t t o t h e o f f i c e . On th e o t h e r hand, one o f t h e r e g u l a r v o l u n t e e r s may phone i n a - 34 -name o r the V o l u n t e e r Bureau of the Community Ches t may r e f e r p o t e n t i a l v o l u n t e e r s . Whatever the c a s e , the Canad ian M e n t a l H e a l t h A s s o c i a t i o n s t a f f g i v e s the i n t e r e s t e d p e r s o n a c o r d i a l welcome and an o r i e n t a t i o n s e s s i o n i s a r r a n g e d . The v o l u n t e e r i s u s u a l l y n o t i f i e d by l e t t e r o f the date o f the o r i e n t a t i o n meet ing and t h i s i s f o l l o w e d up by a phone c a l l two days b e f o r e the date of the m e e t i n g . On the day o f the meet ing the v o l u n t e e r s a r e r e c e i v e d i n d i v i d u a l l y as they a r r i v e , and i n t r o d u c e d t o each o t h e r and t o the C o o r d i n a t o r o f V o l u n t e e r s and the Chairman o f V o l u n t e e r s . T h i s i s u s u a l l y f o l l o w e d by a t a l k on the purposes o f the Canad ian M e n t a l H e a l t h A s s o c i a t i o n and the v o l u n t e e r programme. There i s then a s e c t i o n o f the t a l k devoted t o v o l -u n t e e r h o s p i t a l v i s i t i n g , p o i n t i n g up t h a t v o l u n t e e r s a re the newest a d d i t i o n to the t rea tment team and d e f i n i n g the p u r p o s e s . These a r e , under the s u p e r v i s i o n o f the h o s p i t a l a d m i n i s t r a t i o n , as f o l l o w s : F i r s t , t o a s s i s t the t reatment team and the h o s p i t a l t o a c c o m p l i s h t h e i r p u r p o s e s ; s e c o n d , t o a s s i s t the p a t i e n t t o overcome h i s need t o be i l l and to be i n h o s p i t a l ; t h i r d , t o a s s i s t the p a t i e n t to l o o k f o r w a r d t o h i s d i s c h a r g e and t o see the community as b e i n g c o n c e r n e d about him and d e s i r o u s of h i s r e t u r n to normal l i f e ; f o u r t h , more r e c e n t l y t o a s s i s t the p a t -i e n t i n the immediate p o s t - d i s c h a r g e p e r i o d , sometimes i n c o n -j u n c t i o n w i th the f o l l o w - u p by the S o c i a l Worker . ( T h i s f o l l o w -up u s u a l l y t a k e s the form of moral s u p p o r t and o c c a s i o n a l l y has to do w i th h e l p i n g the p a t i e n t f i n d s u i t a b l e accommodation o r employment) ; f i f t h , t o o f f e r f r i e n d s h i p t o the p a t i e n t s , and s i x t h , t o p r o v i d e a s o u r c e of p u b l i c e d u c a t i o n i n the community d e s i g n e d t o c o u n t e r a c t m i s c o n c e p t i o n s about menta l i l l n e s s and - 35 -promote p o s i t i v e p u b l i c s u p p o r t o f the menta l h e a l t h programmes. In a d d i t i o n , the p r o s p e c t i v e v o l u n t e e r s a r e g i v e n i n s t r u c t i o n s on a t t i t u d e s and e t h i c s f o r v o l u n t e e r s . V o l u n t e e r s a r e i n s t r u c t e d about r u l e s o f p a t i e n t s e n t e r i n g and l e a v i n g the ward, the use o f k e y s , the approach t o p a t i e n t s on the ward, k e e p i n g matches, s c i s s o r s and o t h e r dangerous a r t i c l e s away fzcm p a t i e n t s and the c e n s o r i n g o f m a i l , which f o r o b v i o u s r e a s o n s has t o be done, between p a t i e n t s and the o u t s i d e w o r l d . V o l u n t e e r s a re a l s o made aware of c e r t a i n b a s i c , common human needs such as the need f o r peop le t o e x p r e s s t h e i r f e e l i n g s , bo th n e g a t i v e and p o s i t i v e ; the need f o r u n d e r s t a n d i n g r e s p o n s e t o the f e e l i n g s e x p r e s s e d ; the need t o be r e c o g n i z e d as a p e r s o n of worth and i n n a t e d i g n i t y , d e s p i t e dependency, weaknesses o r f a u l t s ; the need to be d e a l t w i th as a p e r s o n r a t h e r than a c a s e , a t y p e , or a c a t e g o r y ; the need not t o be judged as a f a i l u r e o r a w e a k l i n g o r the cause f o r the d i f f i c u l t y i n which the p e r s o n f i n d s h i m s e l f ; the need t o make o n e ' s own c h o i c e s and d e c i s i o n s r e g a r d i n g o n e ' s own l i f e . (Peop le want to be h e l p e d not b o s s e d o r commanded); and the need t o have p e r s o n a l i n f o r m a t i o n r e s p e c t e d and kept c o n f i d e n t i a l . V o l u n t e e r s , p a r t i c u l a r l y on t h e i r f i r s t few v i s i t s wonder how they s h o u l d conduct t h e m s e l v e s , and i n a d d i t i o n t o the above, they are g i v e n h e l p f u l h i n t s such as the need t o encourage the p a t i e n t s i n t e r e s t s i n t h i n g s o u t s i d e t h e m s e l v e s ; the need t o a v o i d comments which may be i n t e r p r e t e d as r e j e c t i o n and the need t o a v o i d c o n v e r s a t i o n on t o p i c s which seem to e x c i t e o r d i s t u r b the p a t i e n t s . The v o l u n t e e r i s a l s o c a u t i o n e d t o expect p e r s o n a l o r u n i n h i b i t e d remarks by the p a t i e n t s ans i s asked t o t r y t o c o n t r o l r e a c t i o n to t h e s e as much as p o s s i b l e . A f i n a l and - 36 -v e r y i m p o r t a n t e t h i c i s t o make s u r e t h e v o l u n t e e r r e a l i z e s t h a t o u t s i d e d i s c u s s i o n o f p a t i e n t s and problems cannot be condoned. F o l l o w i n g t h e o r i e n t a t i o n t a l k a v e r y complete q u e s t i o n -n a i r e i s g i v e n t o t h e p r o s p e c t i v e v o l u n t e e r t o f i l l o u t . T h i s q u e s t i o n n a i r e 1 i s d e s i g n e d t o a s s e s s t h e a p p l i c a n t ' s m o t i v a t i o n s f o r v o l u n t e e r work and t o b r i n g t o l i g h t any tendency on t h e a p p l i c a n t ' s p a r t t o be o v e r - i d e n t i f i e d i n one way o r a n o t h e r w i t h m e n t a l i l l n e s s . Care i s t a k e n i n t h i s r e g a r d not o n l y w i t h t h e p a t i e n t s i n mind but a l s o t h e w e l l - b e i n g of t h e v o l u n t -e e r . The co m p l e t e d q u e s t i o n n a i r e i s used as t h e b a s i s f o r a p e r s o n a l i n t e r v i e w and from t h i s i n t e r v i e w comes t h e d e c i s i o n f o r o r a g a i n s t a c c e p t i n g t h e a p p l i c a t i o n . The v o l u n t e e r u n d e r -s t a n d s t h a t he o r she i s v o l u n t e e r i n g f o r work i n any p a r t o f th e programme andon t h a t b a s i s , i f a c c e p t e d , i s soon a s s i g n e d t o one o f t h e v o l u n t e e r teams. The f o l l o w i n g f i g u r e s g i v e an i d e a o f t h e number o f v o l u n t -e e r s r e c r u i t e d , t h e number o f r e s i g n a t i o n s and t h e p e r c e n t a g e r e s i g n a t i o n s o f c u r r e n t year r e c r u i t s . 1954 25 j o i n e d 5 r e s i g n e d - or 20% 20 a c t i v e December 3 1 s t , 1954 1955 20 c a r r i e d f o r w a r d f r om Dec. 31, 1954 103 j o i n e d 23 r e s i g n e d (18.7%) - 5 1954 members 100 a c t i v e December 3 1 s t , 1955 18 1955 members o r 17.4% 1956 100 c a r r i e d f o r w a r d from Dec. 31, 1955 56 j o i n e d 82 r e s i g n e d (52.5%) - 5 1954 members 74 a c t i v e December 44 19550,members 3 1 s t , 1956 33 1956 members o r 59.1% 1 "''Appendix B. - 37 -1957 74 c a r r i e d f o r w a r d f rom Dec . 31 , 1956 112 j o i n e d 74 r e s i g n e d (39.74%) 2 1954 members 112 a c t i v e December 13 1955 members 8 1956 members 51 1957 members o r 45.5% 3 1 s t , 1957 These f i g u r e s a re not a b s o l u t e l y a c c u r a t e because s t a t i s t i c s o f t h i s n a t u r e have not been kept by the Canad ian M e n t a l H e a l t h A s s o c i a t i o n t o d a t e . However, they a re a p p r o x i m a t e l y c o r r e c t , h a v i n g been c o m p i l e d f rom the C o o r d i n a t o r ' s c a r d r e c o r d s y s t e m . I t was not p o s s i b l e t o a s c e r t a i n the r e a s o n s b e h i n d each r e s i g -n a t i o n because t h i s type o f i n f o r m a t i o n had not been r e c o r d e d . C e r t a i n g e n e r a l o b s e r v a t i o n s may be made. I t i s f a i r t o say t h a t a good many of t h e s e r e s i g n a t i o n s took p l a c e i n the summer t i m e , which seems t o be a common phenomenon wi th most v o l u n t e e r p r o -grammes. The percen tage o f c u r r e n t year r e s i g n a t i o n s i s d e c r e a s -i n g and t h i s may be a t t r i b u t e d t o e n e r g e t i c r e c r u i t i n g and g r a d u a l development of what might be termed "team s p i r i t " on the p a r t o f more and more v o l u n t e e r s . The g e n e r a l f e e l i n g r e m a i n s , however, t h a t s u s t a i n i n g the i n t e r e s t o f the v o l u n t e e r i n the programme i s the main problem and some s u g g e s t i o n s i n t h a t r e g a r d a r e made i n the f i n a l c h a p t e r . H o s p i t a l and V o l u n t e e r Programme R e l a t i o n s h i p I t i s impor tant t o u n d e r s t a n d the r e l a t i o n s h i p between the v o l u n t e e r s and the h o s p i t a l i f one i s t o get a c l e a r p i c t u r e o f how the programme o p e r a t e s . A g r e a t d e a l o f p l a n n i n g was done b e f o r e the i d e a of v o l u n t e e r s was a c c e p t e d and b e f o r e the a c t u a l - 38 -v o l u n t e e r v i s i t s got under way. A c h a r t (p. 39) i s i n c l u d e d which shows t h e o r g a n i z a t i o n a l s e t - u p o f t h e v o l u n t e e r programme. The f o l l o w i n g m a t e r i a l w i l l i n d i c a t e t h e r e p r e s e n t a t i o n on t h e s e committees and d i s c u s s t h e i r f u n c t i o n . Dr. A.M. Gee i s t h e head o f t h e P r o v i n c i a l M e n t a l H e a l t h S e r v i c e s and i t was he who gave t h e go-ahead on t h e v o l u n t e e r programme. He was v e r y a c t i v e i n th e i n i t i a l p l a n n i n g and i s now on t h e B o a r d o f D i r e c t o r s o f th e B r i t i s h C olumbia D i v i s i o n o f t h e Canadian M e n t a l H e a l t h A s s o c i a t i o n , t h e S c i e n t i f i c P l a n n i n g Committee and t h e V o l u n t e e r P o l i c y Committee. The H o s p i t a l Committee on V o l u n t e e r s s t i l l e x i s t s but meets o n l y r a r e l y . The v a r i o u s d i s c i p l i n e s i n t h e h o s p i t a l a r e r e p r e s e n t e d on t h i s committee ( d o c t o r s , charge n u r s e s , p s y c h o l o g i s t s , s o c i a l w o r k e r s , e t c . ) The purpose o f t h i s committee i s t o d i s c u s s t h e p r o g r e s s o f t h e v o l u n t e e r p r o -gramme, p o s s i b l e new a r e a s o f s e r v i c e , and any problems which may a r i s e a f f e c t i n g t h e h o s p i t a l p o l i c y . I n p r a c t i c e , s uch d i s c u s s i o n now t a k e s p l a c e between Dr. I . Kenning, C l i n i c a l D i r e c t o r i n charge o f t r e a t m e n t , and Mr. G. Dodsworth, C o o r d i n a t o r o f V o l u n t e e r s , o r i t may be d i s c u s s e d by t h e V o l u n t e e r P o l i c y Committee. Dr. Ke n n i n g s i t s on t h i s committee as does Dr. Gee. Mr. Dodsworth, as C o o r d i n a t o r , s i t s on b o t h t h e V o l u n t e e r P o l i c y Committee and t h e V o l u n t e e r S e r v i c e s Committee. The Chairman of t h e V o l u n t e e r S e r v i c e s Committee s i t s on t h e P o l i c y Committee as w e l l . The Chairman o f t h e P o l i c y Committee i s e l e c t e d t o h e r o f f i c e and i s a l s o an a c t i v e v o l u n t e e r worker a t t h e h o s p i t a l . She i s a l s o a member o f t h e Board's E x e c u t i v e Committee. The r e p r e s e n t a t i v e o f o t h e r p a r t s o f t h e v o l u n t e e r programme have - 39 -Relationship Between the Volunteers and the Hospital PROVINCIAL MENTAL HEALTH SERVICES CANADIAN MENTAL HEALTH ASSOCIATION (COMMUNITY) HOSPITAL COMMITTEE ON VOLUNTEERS VOLUNTEERS POLICY COMMITTEE COORDINATOR VOLUNTEERS SERVICE COMMITTEE RECRUITING- TRANSPORTATION EAST LAWN CENTRE LAWN WEST LAWN CREASE CLINIC HOMES FOR AGED APPAREL SHOP EVENING - 4 0 -r e p r e s e n t a t i o n on the V o l u n t e e r S e r v i c e s Commit tee . They a r e the Chairman o f R e c r u i t i n g (Vancouver and New W e s t m i n s t e r ) , the Chairman o f T r a n s p o r t a t i o n , and the v a r i o u s a r e a r e p r e s e n t a t i v e s l i s t e d a t the bottom of the c h a r t . Now t h a t the programme i s w e l l e s t a b l i s h e d , most m a t t e r s a re d i s c u s s e d and s e t t l e d a t the S e r v i c e Committee l e v e l . I f a q u e s t i o n o f p o l i c y e n t e r s about which they a re not s u r e and the C o o r d i n a t o r f e e l s a d i s c u s s i o n on p o l i c y i s i n d i c a t e d , the mat ter w i l l be r e f e r r e d t o the P o l i c y Committee f o r d e c i s i o n . An example o f such a q u e s t i o n i s "what happens t o p a t i e n t s who have been i n h o s p i t a l a l o n g t i m e , have l o s t c o n t a c t w i th f a m i l y and f r i e n d s , . . . w h e r e do they get c l o t h e s to wear?" The answer and end r e s u l t o f t h i s q u e s t i o n was the p l a n n i n g and e s t a b l i s h i n g o f the A p p a r e l Shop. I t i s e v i d e n t t h a t t h e r e i s f u l l y adequate o p p o r t u n i t y f o r h o s -p i t a l v o l u n t e e r communica t ion . The key p e r s o n upon whom e f f e c t i v e communicat ion depends i s the C o o r d i n a t o r o f V o l u n t e e r s . The d u t i e s o f the C o o r d i n a t o r a r e many and the i n c r e a s i n g number of v o l u n t e e r s i s making h i s job more impor tan t than ever t o the s u c c e s s o f the v o l u n t e e r programme. H i s d u t i e s i n c l u d e the f o l l o w i n g : a s s i s t a t o r i e n t -a t i o n m e e t i n g s , c o m p i l e l i s t o f i n t e r e s t s and t a l e n t s of v o l u n t -e e r s , u t i l i z e l i s t i n d i s c u s s i n g ass ignments w i th Chairman of V o l u n t e e r s , c o n t a c t ward charge n u r s e s as t o s t a r t i n g date f o r new v o l u n t e e r s , p e r s o n a l l y c o n t a c t new v o l u n t e e r s as t o when and where t o come, v i s i t v o l u n t e e r s on the j o b , d e v i s e ways t o m a i n t a i n v o l u n t e e r s i n t e r e s t , and keep bo th h o s p i t a l and C a n a d i a n M e n t a l H e a l t h A s s o c i a t i o n up t o date on programme a c t i v i t i e s . - 41 -The Coordinator i s a p s y c h i a t r i c nurse by t r a i n i n g and i s also president of the B r i t i s h Columbia P s y c h i a t r i c Nurses' Association. These q u a l i f i c a t i o n s are extremely h e l p f u l because they combine an understanding of hospital and ward routines plus a prestige position i n the Nurses' Association. As such, the Coordinator i s i n an excellent position to help the nursing s t a f f come to accept, and take an active inte r e s t i n , the work of the volunteer. This i n i t s e l f i s not enough, and some sug-gestions are made i n the f i n a l chapter which w i l l hopefully be of some value i n that respect. In the next chapter the focus narrows to a discussion of volunteer a c t i v i t y on a p a r t i c u l a r ward (H.3) i n East Lawn. Other wards are described b r i e f l y to set the frame of reference. Ward H 3 was chosen simply because several volunteers have been active on i t for some time and because i t i s a ward where the majority of patients have been h o s p i t a l i z e d for a good many years. In many cases the h o s p i t a l community w i l l be t h e i r com-munity for most, i f not the rest, of t h e i r l i v e s . The volunteers on t h i s ward are experienced and have a sincere desire to give of s e l f as well as of time. They combine f r i e n d l i n e s s and warmth with f l e x i b i l i t y and a c e r t a i n aggress-iveness, which i s often necessary to encourage patients. This aggressiveness i s based on understanding the patients needs as mentioned e a r l i e r . C h a p t e r 3 V o l u n t e e r Work i n E a s t Lawn (Ward H3) E a s t Lawn B u i l d i n g S i n c e t h e s t a r t o f t h e v o l u n t e e r programme a t t h e P r o v i n c i a l M e n t a l H o s p i t a l a good d e a l o f v o l u n t e e r a c t i v i t y has been c e n t r e -ed a t t h e E a s t Lawn B u i l d i n g . T h i s u n i t has been d e s c r i b e d b r i e f l y i n Chapter 2, b u t because t h e f o c u s o f t h e p r e s e n t c h a p t e r i s on t h e s p e c i f i c v o l u n t e e r a c t i v i t y i n one ward o f t h i s b u i l d -i n g , a more complete d e s c r i p t i o n o f E a s t Lawn i s w a r r a n t e d . E a s t Lawn i s one l a r g e b u i l d i n g and i s t h e l o n g term t r e a t -ment u n i t f o r female p a t i e n t s . I t s bed s t a t e i s about 1,450 beds which a r e a l l o c c u p i e d w e l l o v e r 90% o f t h e t i m e . There a r e 10 wards, t h e s m a l l e s t h a v i n g a bed count o f about 37 and t h e l a r g e s t 192. The average bed count per ward i s about 150. The p a t i e n t s who e v e n t u a l l y come t o E a s t Lawn have a l l p r e v i o u s l y had t h e b e n e f i t o f t h e i n v e s t i g a t i v e and t h e r a p e u t i c t e c h n i q u e s t h a t were a v a i l a b l e e i t h e r i n t h e C e n t r e Lawn a d m i s s i o n c e n t r e o r a t t h e Cr e a s e C l i n i c . These p a t i e n t s have a common problem i n t h a t t h e y f a i l e d t o r e s p o n d q u i c k l y enough t o be r e t a i n e d i n t h o s e a r e a s , o r t o be d i s c h a r g e d t o t h e community. As a r e s u l t , t h e y have been t r a n s f e r r e d t o E a s t Lawn f o r c o n t i n u e d - 43 -t r e a t m e n t and c a r e . Many have been p a t i e n t s i n E a s t Lawn f o r many y e a r s , and t h e i r p r o g n o s i s f o r r e h a b i l i t a t i o n t o t h e commun-i t y i s v e r y poor, a l t h o u g h some l o n g t erm p a t i e n t s have had g r a t i f y i n g r e m i s s i o n s o f t h e i r i l l n e s s and been a b l e t o r e t u r n home. O t h e r s who make p a r t i a l r e c o v e r y may be g i v e n ground p r i v i l e g e s , not o n l y w i t h freedom t o engage i n w a l k s i n t h e grounds u n a t t e n d e d and t o go t o v a r i o u s r e c r e a t i o n a l a c t i v i t i e s p r o v i d e d , but a l s o t o p a r t i c i p a t e i n t h e v a r i o u s o c c u p a t i o n s on o r o f f t h e wards. A b r i e f d e s c r i p t i o n o f t h e t e n wards i n E a s t Lawn as p r e s -e n t l y c o n s t i t u t e d i s as f o l l o w s : Ward F2: t h i s ward has t h e most h o m e - l i k e appearance o f any i n E a s t Lawn and t h e p a t i e n t s a r e a c t i v e i n a l l phases o f h o s p i t a l programme and a l s o i n t h e government o f t h e i r own ward. There i s some v o l u n t e e r a c t i v i t y on t h e ward but more d u r i n g t h e e v e n i n g t h a n d u r i n g t h e day because p a t i e n t s have f u l l ground p r i v i l e g e s and many a r e a c t i v e i n j o b s around t h e h o s p i t a l . The ward i s c o m f o r t a b l y f u r n i s h e d , h a v i n g c a r p e t s , p i c t u r e s , c u r t a i n s , r o c k maple f u r n i t u r e , smoking room, p i a n o , t e l e v i s i o n and o t h e r c o n v e n i e n c e s . There a r e a p p r o x i m a t e l y 173 p a t i e n t s on t h i s open ward. I t i s hoped t h a t a good many of them w i l l be r e -h a b i l i t a t e d t o t h e i r community. Ward F3: t h i s i s an open ward w i t h a p a t i e n t p o p u l a t i o n o f about 160. These a r e m o s t l y l o n g - t e r m p a t i e n t s who have p r o -g r e s s e d f a r enough t o make use o f ground p r i v e l e g e s but who need q u i t e a l o t o f s u p e r v i s i o n because t h e r e i s a f a i r amount o f d e t e r i o r a t i o n and a number of r e t a r d e d and e p i l e p t i c p a t i e n t s - 44 -among them. They p a r t i c i p a t e f a i r l y w e l l i n s u p e r v i s e d occup-a t i o n a l and r e c r e a t i o n a l a c t i v i t i e s p r o v i d e d and e n j o y movies and t h e o c c a s i o n a l ward p a r t y . V o l u n t e e r work i s b e i n g done on t h i s ward c o n s i s t i n g o f i n d i v i d u a l v i s i t i n g and c o n d u c t i n g s i m p l e p r o j e c t s such as f l o w e r - m a k i n g and s l i p p e r making. Ward F4: t h i s i s a c l o s e d ward w i t h a p a t i e n t p o p u l a t i o n o f about 160. These p a t i e n t s a r e l o n g t e rm c o n s i s t i n g o f many p r e - s e n i l e and m e n t a l l y d e f e c t i v e p e r s o n s c h a r a c t e r i z e d by a f a i r degree of d e t e r i o r a t i o n . They r e q u i r e a l o t o f n u r s i n g c a r e and s u p e r v i s i o n . O n l y a few have ground p r i v i l e g e s . There i s not much movement on t h i s ward and most w i l l be h o s p i t a l i z e d f o r t h e remainder o f t h e i r l i v e s . There a r e no v o l u n t e e r s on t h i s ward a t p r e s e n t a l t h o u g h t h e r e have been and w i l l be a g a i n when v o l u n t e e r s a r e a v a i l a b l e . Ward H I : t h i s i s a c l o s e d ward w i t h a p a t i e n t p o p u l a t i o n o f 115 and many o f t h e p a t i e n t s a r e m e n t a l d e f e c t i v e s r e q u i r i n g a g r e a t d e a l o f a s s i s t a n c e w i t h p e r s o n a l hygiene. A t t h e p r e s e n t t i m e v o l u n t e e r s a r e not a c t i v e on t h i s ward because t h e p a t i e n t s do not seem a b l e t o b e n e f i t by t h e i r s e r v i c e s . P o s s i b l y w i t h more v o l u n t e e r s a v a i l a b l e , and w o r k i n g i n c o n j u n c t i o n w i t h t r a i n e d r e c r e a t i o n a l t h e r a p y p e r s o n n e l , t h e y c o u l d be q u i t e h e l p f u l i n c o n d u c t i n g s i m p l e s i n g - s o n g s , p l a y i n g t h e p i a n o and h e l p i n g i n m u s i c a l games and c h i l d r e n ' s t y p e games. Ward H2: t h i s i s an open ward w i t h a p o p u l a t i o n o f 170 and t h e p a t i e n t s a r e between s i x t y and s e v e n t y y e a r s o f age. The o c c u p a t i o n a l t h e r a p y p o t e n t i a l i s c o n s i d e r e d t o be good on t h i s ward as i s t h e r e c r e a t i o n a l p o t e n t i a l i n t h e sense o f music and movies. There i s some i n t e r e s t i n grooming. - 45 -V o l u n t e e r s can be h e l p f u l i n a l l t h e s e a r e a s . Ward H4: t h i s i s a c l o s e d ward w i t h a p a t i e n t p o p u l a t i o n o f about 120. There i s a l s o p r o v i s i o n f o r k e e p i n g d i s t u r b e d p a t i e n t s on t h i s ward. V o l u n t e e r p o t e n t i a l i s good and t h e r e has been a r e q u e s t f o r more v o l u n t e e r s when a v a i l a b l e . There i s a case f o r f o r e i g n language s e r v i c e on t h i s ward. The p a t i e n t s i n c l u d e a Doukhobour l a d y , a C h i n e s e l a d y and J e w i s h l a d y a l l o f whom do not speak E n g l i s h and a r e , t h e r e f o r e , f o r c e d t o spend most o f t h e i r t i m e u n a b l e t o c o n v e r s e w i t h anyone. Arrangements a r e b e i n g made by t h e v o l u n t e e r C o o r d i n a t o r t o have v o l u n t e e r s v i s i t t h e s e p a t i e n t s and t a l k w i t h them i n t h e i r own language. Ward H5: t h i s i s a c l o s e d ward w i t h a p o p u l a t i o n o f 100 p a t i e n t s some o f whom have ground p r i v i l e g e s . The average age of p a t i e n t s on t h i s ward i s about s i x t y y e a r s o f age and t h e r e i s some d e t e r i o r a t i o n . There i s q u i t e good scope f o r s i m p l e o c c u p a t i o n a l and r e c r e a t i o n a l t h e r a p y programmes and v o l u n t e e r s a r e a c t i v e as w e l l . T h i s ward has language problems a l s o and v o l u n t e e r s c o u l d be v e r y h e l p f u l i n i n d i v i d u a l v i s i t i n g w i t h such p a t i e n t s . Many p a t i e n t s t o t o bed around e i g h t o ' c l o c k so t h a t e v e n i n g v o l u n t e e r s a r e not t o o p r a c t i c a l , a l t h o u g h t h e r e i s some v o l u n t e e r a c t i v i t y . Ward J 3 : t h i s i s one of t h e s m a l l e r wards w i t h a p a t i e n t p o p u l a t i o n c o n s i s t i n g o f 63. I t i s an i n f i r m a r y ward made up of bed o r wheel c h a i r p a t i e n t s . E n t e r t a i n m e n t c o n s i s t s m a i n l y of r e c o r d p l a y e r and shows w i t h some r e a d i n g . Ward J4: t h i s i s t h e o t h e r s m a l l ward i n E a s t Lawn and has between 38 and 40 p a t i e n t s , a " t o t a l push" t h e r a p y programme - 46 -has j u s t been s t a r t e d on t h i s ward, t h a t i s , a l l d i s c i p l i n e s a r e a c t i v e w i t h t h i s s e l e c t e d group of p a t i e n t s i n a t o t a l r e h a b i l i t a t i o n e f f o r t . There i s a p l a c e f o r v o l u n t e e r s t o h e l p w i t h language d i f f i c u l t i e s , i n d i v i d u a l companionship, dance c l a s s e s , and so on. Ward H3 Ward H3 i s d e s c r i b e d i n c o n s i d e r a b l e d e t a i l f o r a number o f r e a s o n s . F i r s t , i t seems n e c e s s a r y i n o r d e r t o g i v e t h e u n f a m i l -i a r r e a d e r a b e t t e r i d e a o f what a ward i n a m e n t a l h o s p i t a l can be l i k e . Second, i t s e t s t h e frame of r e f e r e n c e f o r t h e r e a d e r , o f t h e v o l u n t e e r i n t h e ward s e t t i n g . T h i r d , i t p o i n t s up mat-e r i a l f o r ward s u r v e y s which t h e c o o r d i n a t o r might c o m p i l e w i t h a v iew t o a p p r o p r i a t e v o l u n t e e r a s s i g n m e n t s and programme p l a n -n i n g . T h i s i s a c l o s e d ward f o r l o n g - t e r m m e n t a l l y i l l p a t i e n t s . I t has a bed count of about 170 beds, and i t i s n e a r l y always f u l l . The age range of p a t i e n t s a t p r e s e n t i s from 19 t o 74 y e a r s w i t h most of t h e p a t i e n t s b e i n g m i d d l e - a g e d o r o v e r . F o r example, a s t a t i s t i c a l count i n September, 1957 showed 8 p a t i e n t s under 30 y e a r s o f age, 121 p a t i e n t s between 30 and 59, w h i l e 26 p a t i e n t s were 60 and o v e r . About 64 p a t i e n t s on t h e ward have been i n h o s p i t a l more t h a n 15 y e a r s ; about 40 have been i n 5 y e a r s o r l e s s , and t h e r e m a i n i n g 60 o r so f a l l i n between. There v/ere 163 p a t i e n t s on t h e ward when t h i s count was t a k e n and 121 o f t h e s e were c l a s s e d as " L a d i e s o f L e i s u r e " . The r e m a inder were a c t i v e i n some form o f work. I n t h i s c a s e 10 worked a t t h e l a u n d r y , 1 a t t h e n u r s e s home, 12 i n t h e i n d u s t r i a l s e c t i o n s , - 47 -12 a t ward work, 6 a t t h e o c c u p a t i o n a l t h e r a p y shop and 1 d i d " o t h e r work." Of t h e 52 p a t i e n t s who had ground p r i v i l e g e s , 49 made use o f them. There i s a slow, s t e a d y movement o f p a t i e n t s u s u a l l y be-cause o f improvement i n c o n d i t i o n and t h e r e f o r e t o a more s u i t -a b l e ward. The ward f u n c t i o n i s p r o b a b l y b e s t d e s c r i b e d as t h a t o f h a b i t t r a i n i n g . Ward H3 i n 1955 was a f a r c r y from t h e H3 o f t o - d a y . Then i t had a s t r o n g s m e l l y odor and was d u l l and d e p r e s s i n g . There was a g e n e r a l u n t i d i n e s s about i t . To-day i t i s a c l e a n , b r i g h t ward w i t h no o f f e n s i v e o d o r s a l t h o u g h i t l a c k s t h e warmth o f a ward such as F2. When t h e p r e s e n t charge n u r s e t o o k o v e r i n 1955 she i m m e d i a t e l y made a r e q u e s t t h a t t h e f l o o r s be waxed and was t o l d by t h e waxer t h a t t h a t was t h e f i r s t r e q u e s t f o r t h i s s e r v i c e on t h a t ward f o r a y e a r . The p r e s e n t s t a f f s h o r t -age was a c u t e a t t h a t t i m e a l s o , and s t a f f m o rale was low and t h e r e was a l a c k of. i n s p i r e d ward l e a d e r s . S e c u r i t y was c a r r i e d t o q u i t e an extreme; not o n l y were a l l t h e doo r s l o c k e d b u t even almost empty cupboards were l o c k e d as w e l l . Ward b e h a v i o r was c o n s i d e r a b l y d i f f e r e n t t h e n . I t was v e r y n o i s y and a t y p e of s e c l u s i o n was i n q u i t e f r e q u e n t use - t h a t i s , p a t i e n t s who were u p s e t t i n g t o t h e ward were t a k e n out o f t h e day room and put i n t o t h e i r d o r m i t o r y . P a t i e n t s were common-l y seen l y i n g h e r e and t h e r e on t h e f l o o r , h u d d l e d i n a c o r n e r , s i t t i n g l i s t l e s s l y i n one s p o t o r p a c i n g o r r u n n i n g back and f o r t h i n t h e day room o r i n t h e c o r r i d o r . W h i l e i t was n o i s y , t h e r e were many who were e i t h e r c o m p l e t e l y s i l e n t o r made o n l y - 4 8 -g r u n t i n g sounds. Many of t h e p a t i e n t s showed l i t t l e o r no i n -t e r e s t i n f o o d and t h e i r p h y s i c a l c o n d i t i o n was not t h e b e s t , n e c e s s i t a t i n g q u i t e a b i t of m e d i c a l a t t e n t i o n . The above perhaps i m p l i e s t h a t t h e h o s p i t a l had a r a t h e r u n e n l i g h t e n e d approach towards t r e a t m e n t and c a r e of t h e m e n t a l l y i l l . I t must be c l e a r l y u n d e r s t o o d t h a t t h i s was not t h e c a s e . The impetus f o r change t o more e n l i g h t e n e d p a t i e n t c a r e d i d e x i s t as demonstrated i n t h e C r e a s e C l i n i c t r e a t m e n t programme. I t had a l s o been demonstrated r i g h t i n E a s t Lawn as seen i n t h e p r e p a r a t i o n f o r and o p e n i n g o f ward F2. The h o s p i t a l a d m i n i s t -r a t i o n was k e e n l y aware o f t h e needs f o r improvement i n t r e a t m e n t and c a r e o f t h e p a t i e n t s , and were e f f e c t i n g such changes as r a p i d l y as was p o s s i b l e , t a k i n g i n t o c o n s i d e r a t i o n t h e l i m i t e d budget and s t a f f s h o r t a g e s . I n c o n s i d e r i n g improvement i n c o n -d i t i o n s i n H3 t h e C l i n i c a l D i r e c t o r saw t o i t t h a t a t o p n o t c h charge n u r s e was t r a n s f e r r e d t o t h e ward. W i t h h i s f u l l b a c k i n g she would have t o g i v e i n s p i r e d l e a d e r s h i p t o m o t i v a t e her s t a f f t o be e n t h u s i a s t i c about t h e i r t a s k and t o g i v e them a sense of purpose. I t was a l s o v e r y n e c e s s a r y t o g a i n t h e i r complete c o -o p e r a t i o n i n f o l l o w i n g her f i r m and c o n s i s t a n t p o l i c y making. These p a t i e n t s were b a d l y i n need of h a b i t t r a i n i n g and l o n g months o f p e r s i s t a n t e f f o r t would be r e q u i r e d on t h e p a r t o f b o t h s t a f f and p a t i e n t s . When t h i s ward began i t s p r e s e n t h a b i t t r a i n i n g programme i n 1955 t h e p a t i e n t s were v e r y d i s o r g a n i z e d i n t h e i r r o u t i n e s . The c h a rge n u r s e r e p o r t e d t h a t on her f i r s t day on duty 75 women got up and s h u f f l e d t o b r e a k f a s t w i t h o u t t h e i r shoes o r s t o c k i n g s . Some were i n t h e i r nightgowns, some i n p e t t i c o a t s and some were - 49 -w e a r i n g t h e p l a i n denim d r e s s which was i n s t i t u t i o n a l i s s u e . A f t e r two weeks t h i s number was down t o 4 p a t i e n t s w i t h o u t shoes and t h e s e wore s l i p p e r s . P a r t o f t h e problem was g e t t i n g a p r o p e r and c o m f o r t a b l e f i t i n shoes f o r p a t i e n t s . A n o t h e r b i g s t e p t h a t t h e charge n u r s e i n i t i a t e d w i t h t h e C l i n i c a l D i r e c t o r ' s b a c k i n g was t o get a t t r a c t i v e d r e s s e s f o r t h e p a t i e n t s t h r o u g h t h e v o l -u n t e e r ' s A p p a r e l Shop. T h i s had t h e immediate e f f e c t o f p l e a s i n g t h e p a t i e n t s and e n c o u r a g i n g them t o t a k e more i n t e r e s t i n t h e i r grooming. One s t r i k i n g r e s u l t was t h e d e c r e a s e i n t h e number of l a d i e s who s a t o r l a y on t h e f l o o r . They d i d not want t o d i r t y t h e i r d r e s s e s . The charge n u r s e who was chosen had t w e l v e y e a r s e x p e r i e n c e a t t h a t t i m e and i s a s t e a d y , r e l i a b l e p e r s o n w i t h a s t r o n g sense o f d u t y . She i s f l e x i b l e but not p e r m i s s i v e . She i s c o n s i s t e n t i n h er f o l l o w t h r o u g h , shows no f a v o u r i t i s m and i s f i r m w i t h t h e s t a f f r e g a r d i n g t h e i r d u t i e s . She g i v e s c r e d i t where c r e d i t i s due. The w e l f a r e o f her p a t i e n t s i s uppermost i n her mind. She saw h a b i t t r a i n i n g as f o r t h e i r good and t h e r e f o r e was f i r m but k i n d i n her r e q u i r e m e n t o f i t . Above a l l , she had p a t i e n c e which was so n e c e s s a r y f o r t h e months ahead and a c c e p t a n c e o f t h e s l o w n e s s and s m a l l n e s s of g a i n s . A diagram showing t h e f l o o r p l a n o f ward H3 i s shown (p.50) i n o r d e r t o g i v e t h e r e a d e r a b e t t e r i d e a of t h e ward. The numbers n o t e d on t h e diagram i n d i c a t e t h e number o f beds per d o r m i t o r y . The numbers i n t h e m s e l v e s do not l e t us know whether beds were c o m f o r t a b l y spaced or n o t . A c t u a l l y , t h e d o r m i t o r i e s a r e crowded, and g e n e r a l l y s p e a k i n g , t h e n e a t l y made beds w i t h t h e i r w h i t e s p r e a d s , have o n l y enough room between them t o p e r -- 50 -©P6.N P o ^ C H PORCH 1 2 ___ i L —I I— O O R M i 1 6 DOR*"* 7 I I inmm C L O T H E S J i STo«.e.s O O R M . It 1 I R O T U N D A 1 r — 1 4 ~1 I— L A v A -ToAy O O f t M . 17 3 2 . F L O O R P L ^ M W A R O H 3 - 51 -m i t l i m i t e d movement. I t i s worth n o t i n g t h a t when t h e h o s p i t a l a d m i n i s t r a t i o n s h i f t e d i t s f o c u s t o c o n c e n t r a t e on t h i s ward one o f t h e f i r s t changes was t o r e p l a c e a good d e a l o f t h e bed-d i n g w i t h p r o p e r l y f i t t i n g s h e e t s and b l a n k e t s . The day rooms a r e now c h a r a c t e r i z e d by c l e a n f l o o r s and c l e a n w a l l s . The windows do not have c u r t a i n s but t h e r e i s a p l e a s a n t l y b r i g h t c l o t h v a l a n c e above each window. S e v e r a l more c o m f o r t a b l e c h a i r s have been p r o v i d e d a l t h o u g h t h e r e a r e s t i l l q u i t e a few o f t h e l o n g , s t r a i g h t - b a c k e d wooden benches. There a r e a few t a b l e s h e r e and t h e r e t h r o u g h o u t t h e two day rooms and t h e r e a r e some framed p i c t u r e s on t h e walls. Some of t h e s e were donated by v o l u n t e e r s . A t one t i m e t h e r e were a few r u g s i n t h i s ward but t h e y were i n such bad c o n d i t i o n t h a t t h e y had t o be d i s c a r d e d . I t i s a l s o t o be n o t e d t h a t t h e r e i s no g r o u p i n g o f f u r n i t u r e which would make f o r a homier atmosphere. One r e a s o n f o r t h i s i s t h e o v e r - c r o w d i n g of t h e ward. The l o n g wooden benches s e a t s i x p a t i e n t s i n much l e s s space t h a n would s i x i n d i v i d u a l com-f o r t a b l e c h a i r s . The l a v a t o r i e s a r e s p o t l e s s l y c l e a n . The one main drawback i s t h a t t h e p a t i e n t s have a b s o l u t e l y no p r i v a c y because t h e t o i l e t s have no p a r t i t i o n s whatsoever between them. A r e q u e s t was made by t h e C l i n i c a l D i r e c t o r f o r t h e minor s t r u c t u r a l changes n e c e s s a r y t o r e c t i f y t h i s but t o d a t e t h e r e has been no a c t i o n on t h e m a t t e r . P a t i e n t s r i s e a t s i x a.m. and a r e r e a d y f o r b r e a k f a s t by e i g h t a.m. A good d e a l o f t i m e i s r e q u i r e d because of t h e l a r g e number of p a t i e n t s and t h e s h o r t a g e o f s t a f f . There a r e 17 s t a f f members a s s i g n e d t o t h i s ward. T h i s does not r e p r e s e n t - 52 -t h e n u m b e r p e r s h i f t b u t t h e n u m b e r f o r t h e e n t i r e t w e n t y f o u r h o u r s . It c a n b e r e a d i l y s e e n t h a t t h e a m o u n t o f i n d i v i d u a l w o r k w i t h p a t i e n t s i s e x t r e m e l y l i m i t e d . F o l l o w i n g b r e a k f a s t , t h e r e a r e v a r i o u s a c t i v i t i e s s u c h a s w a r d h o u s e k e e p i n g , o c c u p a t i o n a l t h e r a p y a n d g r o u n d s ^ p r i v i l e g e s . Some o f t h e p a t i e n t s go o f f t h e w a r d t o w o r k i n h o s p i t a l i n d u s t -r i e s s u c h a s t h e l a u n d r y . A l l p a t i e n t s a r e b a c k i n t h e w a r d b y e l e v e n o ' c l o c k f o r l u n c h w h i c h l a s t s u n t i l o n e o ' c l o c k . A f t e r l u n c h , o c c u p a t i o n a l t h e r a p y p r o g r a m m e s r e s u m e , v a r i o u s w a r d d u t i e s c o n t i n u e , a n d t h e r e a r e s u p e r v i s e d w a l k s a n d v i s i t i n g . A t f o u r o ' c l o c k e v e r y o n e i s b a c k o n t h e w a r d a g a i n f o r t h e b e -g i n n i n g o f t h e s u p p e r p e r i o d . A f t e r s u p p e r many o f t h e p a t i e n t s a r e b a t h e d a n d t h e n a l l a r e p u t t o b e d w i t h t h e d a y e n d i n g b e -t w e e n e i g h t a n d n i n e o ' c l o c k . P a t i e n t C a t e g o r i e s When d i s c u s s i n g t h e t y p e s o f p a t i e n t s o n t h i s w a r d w i t h t h e C l i n i c a l D i r e c t o r , t h e S o c i a l S e r v i c e S u p e r v i s o r a n d t h e c h a r g e n u r s e , t h e w r i t e r a s k e d i f i t w a s f e a s i b l e t o g r o u p t h e m a c c o r d -i n g t o c a t e g o r i e s o f m e n t a l i l l n e s s , s u c h a s c h r o n i c b r a i n s y n -d r o m e s , p s y c h o t i c d i s o r d e r s , p e r s o n a l i t y d i s o r d e r s , a n d s o o n . T h e C l i n i c a l D i r e c t o r r e p l i e d t h a t o n a s m a l l w a r d w h e r e a t h o r -o u g h p s y c h i a t r i c e x a m i n a t i o n h a d b e e n m a d e , i t w o u l d b e p o s s i b l e t o g i v e a n a c c u r a t e a n s w e r t o t h i s q u e s t i o n b u t n o t o n t h i s w a r d . T h e w r i t e r s u g g e s t e d a n a l t e r n a t e way o f c l a s s i f y i n g p a t i e n t s w h i c h m i g h t b e c a l l e d a t y p e o f s o c i a l c l a s s i f i c a t i o n a c c o r d i n g t o t h e b e h a v i o r t h a t t h e i n d i v i d u a l p a t i e n t m a n i f e s t e d . T h e f o l l o w i n g b r o a d g r o u p i n g s w e r e s u g g e s t e d b y t h e C l i n i c a l D i r e c t o r a n d t h e C h a r g e n u r s e . T h e f i r s t g r o u p was t e r m e d " T r a n q u i l l i z e d - 53 -Long-term A p a t h e t i c S c h i z o p h r e n i c s . " The second group was termed "Long-term A p a t h e t i c S c h i z o p h r e n i c . " The t e r m s c h i z o -p h r e n i c i s d e f i n e d by t h e A m erican P s y c h i a t r i c A s s o c i a t i o n as f o l l o w s : A s e v e r e e m o t i o n a l d i s o r d e r o f p s y c h o t i c depth c h a r a c t e r i s t i c a l l y marked by a r e t r e a t f r om r e a l -i t y w i t h d e l u s i o n f o r m a t i o n s , h a l l u c i n a t i o n s , e m o t i o n a l disharmony and r e g r e s s i v e b e h a v i o r . F o r m e r l y c a l l e d dementia praeco x . The main d i f f e r e n c e between t h e s e two t y p e s , f o r our purpose, i s t h a t one i s on m e d i c a t i o n , sometimes v e r y h e a v i l y , and t h e o t h e r i s e i t h e r l i t t l e o r no m e d i c a t i o n . A p o s s i b l e d i f f e r e n c e t h a t was not c o n s i d e r e d h e r e i s t h a t t h e t r a n q u i l l i z e d p a t i e n t , w h i l e a p p e a r i n g v e r y s i m i l a r t o t h e a p a t h e t i c p a t i e n t on l i t t l e o r no m e d i c a t i o n , may have g r e a t e r p o t e n t i a l . T h i s i s , she may be on heavy doses o f t r a n q u i l l i z e r i n o r d e r t o c o n t a i n c o n -s i d e r a b l e a c t i v i t y d i s p l a y e d w i t h i n her p s y c h o s i s as a g a i n s t t h e apathy of t h e p a t i e n t not on m e d i c a t i o n . These two groups can be p i c k e d out v e r y e a s i l y on t h e ward because t h e y a r e u s u a l l y j u s t s t a n d i n g or s i t t i n g , o r s q u a t t i n g o r l y i n g , o r perhaps p a c i n g s l o w l y back and f o r t h . T h e i r f a c e s a r e u s u a l l y v o i d o f e x p r e s s i o n . They may t a l k o n l y r a r e l y o r not a t a l l . The m a j o r i t y o f p a t i e n t s f a l l i n t o t h e s e two c a t e g o r i e s and number about 120. A t h i r d g r o u p i n g has been c a l l e d t h e " A t t e n t i o n S e e k e r s " who a r e v e r y demanding o f s t a f f p e o p l e when ev e r t h e y appear on t h e ward. These p a t i e n t s a r e not g e n e r a l l y t r o u b l e makers i n t h e sense t h a t t h e y have v i o l e n t o u t b u r s t s but t h e i r A P s y c h i a t r i c G l o s s a r y , Committee on P u b l i c I n f o r m a t i o n A m e rican P s y c h i a t r i c A s s o c i a t i o n , 1957. p. 25. - 54 -s e e m i n g l y i n s a t i a b l e a t t e n t i o n needs consume a l o t of s t a f f t i m e . There a r e about 15 p e o p l e i n t h i s group. There i s a n o t h e r group which has been termed " A c t i n g - o u t P s y c h o p a t h s . " The term psychopath i s d e s c r i b e d by t h e American P s y c h i a t r i c A s s o c i a t i o n as f o l l o w s : A p e r s o n whose b e h a v i o r i s p r e d o m i n a n t l y amoral o r a n t i s o c i a l and c h a r a c t e r i z e d by i m p u l s i v e , i r r e s p o n s -i b l e a c t i o n s s a t i s f y i n g o n l y immediate and n a r c i s -s i s t i c i n t e r e s t s w i t h o u t c o n c e r n f o r o b v i o u s and i m p l i c i t s o c i a l consequences accompanied by m i n i m a l outward e v i d e n c e o f a n x i e t y o r g u i l t . " (They a l s o note: I n c r e a s i n g l y c o n s i d e r e d a poor and i n e x a c t t e r m . ) ! T h i s group numbers about t h r e e p a t i e n t s o n l y , and w h i l e t h e y to o c r a v e a t t e n t i o n , i t i s more because t h e y l i k e t o be t h e c e n t r e o f a t t r a c t i o n . I f t h i s t y p e o f a t t e n t i o n i s not g a i n e d t h e y a r e apt t o a c t out by b r e a k i n g windows, a t t a c k i n g o t h e r p a t i e n t s and so on. A f o u r t h group s u g g e s t e d was termed " O c c a s i o n a l l y V i o l e n t . w I t was f e l t t h a t t h i s group's o c c a s i o n a l d i s t u r b a n c e was u s u a l l y t h e r e s u l t o f t h e i r d e l u s i o n s and h a l -l u c i n a t i o n s . There a r e o n l y about t h r e e p a t i e n t s i n t h i s c a t e g o r y . The f i f t h group was termed t h e "Rescue S e e k e r s . " There a r e about 20 i n t h i s group and t h e y a r e s a i d t o be c o n f u s e d p s y c h o t i c s , who do not r e a l i z e t h a t t h e y a r e i l l and a r e a p p a r e n t l y i n d i g n a n t and s u r p r i s e d t h a t t h e y a r e " i n t h i s p l a c e . " A f i n a l t y p e seen o c c a s i o n a l l y on t h i s ward was termed "The M a n i p u l a t i n g E p i l e p t i c . " There i s none on t h e ward a t t h e p r e s e n t t i m e . V o l u n t e e r s and P a t i e n t C a t e g o r i e s 2 V o l u n t e e r s f i r s t came t o work on ward H3 i n September, 1956. I b i d . , p. 23. Dodsworth, op. c i t . - 55 -The C o o r d i n a t o r d i s c u s s e d t h e p l a n w i t h t h e charge n u r s e and l a t e r i n t r o d u c e d t h e v o l u n t e e r s t o ward s t a f f . There were t h r e e v o l u n t e e r s a t f i r s t and t h e n , a f t e r a few months, a f o u r t h j o i n e d t h e H3 group. S t a f f r e a c t i o n t o t h e v o l u n t e e r s was p o l i t e b u t t h e v o l u n t e e r s s ensed a c e r t a i n r e s e r v e . I f t h i s a c t u a l l y was so, i t seemed t o d i s a p p e a r q u i c k l y once H3's s t a f f and v o l u n t e e r s got t o know each o t h e r . C e r t a i n l y , t o - d a y , t h i s group f e e l s e n t i r e l y welcome on t h e ward and, i n f a c t , a r e most welcome a c c o r d i n g t o ward s t a f f comments. T h i s s m a l l group has come r e g u l a r l y and have prove d t h e i r m e t t l e , so t o speak. I n O c t o b e r 1956 t h e y gave a H a l l o w ' e e n p a r t y f o r t h e p a t i e n t s and have f o l l o w e d t h i s p r a c t i c e e v e r s i n c e whenever any s p e c i a l t i m e o f year comes a l o n g . A t C h r i s t m a s 1956 t h e y a r r a n g e d f o r a b i g C h r i s t m a s p a r t y w i t h d e c o r a t i o n s and p r e s e n t s . T h i s was t h e o c c a s i o n o f t h e f i r s t C h r i s t m a s t r e e on ward H3. One o f t h e v o l u n t e e r s v i s i t e d t h e Manager of Woodward's d i s p l a y department and a f t e r t e l l i n g him o f t h e purpose o f her v i s i t r e c e i v e d a l a r g e d o n a t i o n o f C h r i s t m a s d e c o r a t i o n s which t h e s t o r e d e l i v e r e d t o t h e H o s p i t a l . The s t o r e r e p e a t e d t h e i r d o n a t i o n l a s t C h r i s t -mas and s e n t a l o n g two o f t h e i r d i s p l a y men t o help s e t up t h e d e c o r a t i o n s . I t i s i n t e r e s t i n g t o n ote h e r e t h a t t h e v o l u n t e e r t o l d them a l i t t l e b i t about t h e ward and of what t o e x p e c t be-f o r e t h e y a r r i v e d which p r o v e d h e l p f u l l a t e r . The p r e s e n c e of t h e two men on t h e ward d i d e x c i t e b o t h p o s i t i v e and n e g a t i v e r e a c t i o n s on t h e p a r t o f some p a t i e n t s but t h e men t o o k i t i n t h e i r s t r i d e and e v e r y t h i n g t u r n e d out s a t i s f a c t o r i l y . O t h e r examples o f p a r t i e s put on by t h e v o l u n t e e r s a r e V a l e n t i n e ' s , S t . P a t r i c k ' s and E a s t e r p a r t i e s . - 56 -The p a t i e n t s ' - r e a c t i o n t o b o t h t h e v o l u n t e e r s and t h e i r a c t i v i t i e s , on t h e whole, has always been p o s i t i v e , and th e y a r e q u i c k t o e x p r e s s t h e i r a p p r e c i a t i o n . A l l o f t h e v o l u n t e e r s now f e e l p e r f e c t l y ; a t home d u r i n g t h e i r v i s i t s on t h i s ward but a l l admit t o f e e l i n g a p p r e h e n s i v e when t h e y f i r s t s t a r t e d . W i t h some i t was s i m p l y because t h e y were v i e w i n g , f o r t h e f i r s t t i m e t h a t t h e y were aware, f e l l o w human b e i n g s i n a f a r from normal s t a t e . W i t h a n o t h e r v o l u n t e e r t h e r e was t h e shock o f t a k i n g her f i r s t s t e p s i n t o t h e day room o f t h e ward, h a v i n g t h e door l o c k e d b e h i n d h e r , and h a v i n g a p a t i e n t d i v e a t her l e g s and h o l d on. A c t u a l l y , a l l t h e p a t i e n t wanted t o do was f i n d out i f t h e v o l u n t e e r was w e a r i n g s t o c k i n g s , and as t h e s t o c k i n g s were seamless she c o u l d n o t t e l l , she d i d what seemed l o g i c a l t o her t o f i n d o u t . T h i s v o l u n t e e r w i t h t h e m o r a l s u p p o r t o f a f e l l o w v o l u n t e e r was a b l e t o t u r n t h e s i t u a t i o n i n t o a b r i e f , f r i e n d l y c o n v e r s a t i o n . A n o t h e r v o l u n t e e r underwent a much more f r i g h t e n i n g e x p e r i e n c e when a s u d d e n l y u p s e t woman a t t e m p t e d t o choke her by s l i p p i n g a s t o c k i n g around her neck. An i n c i d e n t such as t h i s i s c e r t a i n l y t h e e x c e p t i o n r a t h e r t h a n t h e r u l e . The i n t e r e s t i n g p o i n t i s t h a t t h e o t h e r p a t i e n t s i n h e r group r e s c u e d her i n a m a t t e r o f seconds b e f o r e a s t a f f member c o u l d h e l p o u t . The p a t i e n t t h e n a t t e m p t e d t o do t h e same t h i n g w i t h a n o t h e r p a t i e n t . The v o l u n t e e r , w h i l e v e r y d e f i n i t e l y shaken by t h e e x p e r i e n c e a t t h e t i m e , r e t u r n e d t h e nex t week as u s u a l , made no mention o f what had happened and c o n t i n u e s t o come on a r e g u l a r b a s i s . From d i s c u s s i o n s w i t h t h e charge nurse and v o l u n t e e r s i t - 57 -would appear t h a t most o f t h e v o l u n t e e r v i s i t i n g on t h e ward t a k e s p l a c e w i t h t h e two l a r g e s t p a t i e n t groups, namely, t h e t r a n q u i l l i z e d l o n g - t e r m a p a t h e t i c s c h i z o p h r e n i c and t h e l o n g -term a p a t h e t i c s c h i z o p h r e n i c . T h i s i s p a r t l y because t h e y a r e t h e m a j o r i t y i n t h e ward but a l s o because t h e y a r e q u i e t e r and l e s s demanding, and t h e r e f o r e l e s s t h r e a t e n i n g t o t h e v o l u n t e e r . T h i s i s not t o say t h a t t h e o t h e r groups a r e i g n o r e d because t h e v o l u n t e e r s t r y t o move around t h e ward so t h a t t h e y can have a t l e a s t a b r i e f c o n t a c t w i t h most, i f not a l l t h e p a t i e n t s who can be i n t e r e s t e d . There seems t o be a n a t u r a l tendency on t h e p a r t o f t h e v o l u n t e e r s t o r e g a r d t h e s e two major groups as t h e " l e s s f o r t u n a t e and f o r g o t t e n ones." The v o l u n t e e r s work i n s e v e r a l ways w i t h t h e s e two groups. F i r s t , t h e y v i s i t w i t h them and encourage them t o t a l k i f t h e y seem i n c l i n e d t o do so and l i s t e n i n an u n d e r s t a n d i n g manner. The v o l u n t e e r s seem t o have a v e r y good a p p r e c i a t i o n o f t h e h e l p f u l n e s s t o t h e p a t i e n t o f " j u s t l i s t e n i n g . " Q u i t e o f t e n , i f a p a t i e n t seems i n t e r e s t e d , b u t has d i f f i c u l t y i n t a l k i n g h e r s e l f , t h e v o l u n t e e r may s i m p l y t a l k about her own f a m i l y , perhaps g i v i n g t h e p a t i e n t a snap-s h o t o r two t o t r y t o g i v e them a sense of b e l o n g i n g . Many o f t h e s e p a t i e n t s a r e now w i t h o u t l i v i n g r e l a t i v e s , o r t h e r e l a t i v e s perhaps have p r e f e r r e d t o f o r g e t them. I t i s s u r p r i s i n g t o t h e v o l u n t e e r s a t f i r s t t h e way i n which t h e p a t i e n t r e s p o n d s and remembers what may seem commonplace t o t h e v o l u n t e e r . Once t h i s has been e x p e r i e n c e d by t h e v o l u n t e e r t h e o l d q u e s t i o n , which seems t o p l a g u e most new v o l u n t e e r s , namely, "what w i l l I.say, what w i l l I t a l k about' 1 answers i t s e l f . A second way i n which - 58 -the v o l u n t e e r s h e l p i s by supp lement ing the s t a f f ' s h a b i t t r a i n -i n g e f f o r t s . For example, they h e l p m o t i v a t e p a t i e n t s by g o i n g on b r i s k walks w i th them, d a n c i n g w i th them, c o n d u c t i n g f l o w e r making c l a s s e s and so o n . T h i s h e l p s a rouse them out o f t h e i r apathy and s l u g g i s h n e s s which i s m a n i f e s t e d i n t h e i r s i t t i n g , l y i n g , c r o u c h i n g and s t a n d i n g d o i n g n o t h i n g . It i s s u r p r i s i n g t o f i n d t h a t so much i n t e r e s t can be shown by t h e s e groups when s p a r k e d by the en thus iasm o f the v o l u n t e e r . A t h i r d way i n which the v o l u n t e e r s h e l p i s by f o c u s i n g the a t t e n t i o n o f the p a t i e n t on her grooming. T h i s i s done i n a t a c t f u l manner and q u i t e o f t e n i s a r e s u l t o f the p a t i e n t ' s p l e a s u r e i n the v o l u n t -e e r ' s good appearance . There a re o f t e n r e q u e s t s made o f the v o l u n t e e r s f o r a r e p e a t per formance of one p a r t i c u l a r o u t f i t which a v o l u n t e e r has worn. The charge nurse and v o l u n t e e r s have remarked on the renewed i n t e r e s t i n c l o t h e s and even c o n c e r n about t h e i r h a i r , f a c e and f i g u r e on the p a r t o f p a t i e n t s . The v o l u n t e e r s per fo rm a ve ry u s e f u l s e r v i c e w i th t h a t group which has been c a l l e d " t h e a t t e n t i o n s e e k e r s . " One p a r t i c u l a r a s p e c t o f the s e r v i c e which i s a p p r e c i a t e d v e r y much on t h i s h a r d - p r e s s e d , s h o r t - s t a f f e d ward i s t h a t w h i l e the v o l u n t e e r s a re v i s i t i n g , the p a t i e n t s a r e much l e s s demanding o f s t a f f . That i s , the c o n t i n u a l k n o c k i n g on the door t o ask t r i v i a l q u e s t -i o n s and make i n c o n s e q u e n t i a l r e q u e s t s , i s narrowed down t o more l e g i t i m a t e demands. I t i s r e c o g n i z e d t h a t t h e s e i n t e r r u p t i o n s by p a t i e n t s a r e e x p r e s s i o n s o f t h e i r unmet needs , but n e v e r t h e -l e s s , they do take up s t a f f t ime which a l s o i s b e i n g d e v o t e d t o the o v e r - a l l r u n n i n g of the ward and w e l l - b e i n g of a l l the p a t -- 59 -i e n t s . The v o l u n t e e r s a r e a b l e t o meet, o r a t l e a s t a l l e v i a t e t h i s a lmost i n s a t i a b l e need f o r a t t e n t i o n t h r o u g h t h e i r w i l l i n g a t t e n t i o n . They a r e a b l e t o h e l p t h i s t y p e o f p a t i e n t t o h e l p t h e m s e l v e s more and a t t e n d t o t h e i r own needs. One o f t e n f i n d s t h a t t h i s t y p e o f p a t i e n t w i l l e a g e r l y r e p o r t t o t h e v o l u n t e e r on her n e x t v i s i t i n g day on what has happened d u r i n g t h e week and what she may o r may not have done about i t . When t h i s t y p e o f p a t i e n t f i n d s t h a t t h e y have someone who w i l l be coming, and who w i l l l i s t e n t o them, i t seems t o h e l p them a g r e a t d e a l i n c o n t a i n i n g t h e m s e l v e s . The v o l u n t e e r can a l s o a s s i s t t h i s t y p e o f p a t i e n t t o get a l o n g w i t h o t h e r s b e t t e r and t h e r e f o r e be more c o n s i d e r a t e o f o t h e r s . I n one o r two c a s e s t h e v o l u n t e e r has been a b l e t o e n l i s t t h e c o o p e r a t i o n of t h e a t t e n t i o n s e e k e r i n becoming a " p a t i e n t h e l p e r " . A p a t i e n t h e l p e r i s a p a t i e n t who w i l l t a k e an i n t e r e s t i n a f e l l o w p a t i e n t and h e l p her t o t a k e a g r e a t e r i n t e r e s t i n h e r s e l f and i n her s u r r o u n d i n g s . For ex-ample, th e v o l u n t e e r may s t a r t out by g e t t i n g a c q u a i n t e d w i t h t h e a t t e n t i o n s e e k e r t h r o u g h t a l k i n g w i t h h e r and l i s t e n i n g u n d e r -s t a n d i n g ^ so t h a t t h e p a t i e n t g r a d u a l l y f e e l s t h e v o l u n t e e r ' s i n t e r e s t i n her as a p e r s o n i s r e a l . Then t h e v o l u n t e e r may use t h e i r c o n v e r s a t i o n t o t e s t t h e a t t e n t i o n s e e k e r ' s awareness o f o t h e r p a t i e n t s . I f t h e a t t e n t i o n s e e k e r i s a b l e t o mention o r p o i n t t o some p a r t i c u l a r p a t i e n t i n , say, t h e " a p a t h e t i c " group, t h e n t h e v o l u n t e e r may be a b l e t o p i c k up on t h i s by t e n t a t i v e l y s u g g e s t i n g t h a t t h e two of them t a k e t h e a p a t h e t i c p a t i e n t f o r a walk, o r t r y t o t a l k w i t h h e r . The a t t e n t i o n s e e k e r may not be r e a d y t o p i c k up such a s u g g e s t i o n and i f t h e r e i s h e s i t a t i o n - 6 0 -the mat ter i s dropped f o r the t ime b e i n g . V o l u n t e e r s , because of the n a t u r e o f t h e i r s e r v i c e , and because of t h e i r warmth, s i n c e r i t y , and d e s i r e t o h e l p , a r e o f t e n a b l e t o devote the t ime and p a t i e n c e n e c e s s a r y t o a c h i e v e t h e i r e n d . V o l u n t e e r s and O c c u p a t i o n a l Therapy The v o l u n t e e r s ' r o l e i n a s s i s t i n g i n the o c c u p a t i o n a l t h e r -apy programme i n E a s t Lawn i s not yet c l e a r l y d e f i n e d . Perhaps because of t h i s i t has not been u n d e r s t o o d and made use o f most c o n s t r u c t i v e l y . In t h i s c o n n e c t i o n , the w r i t e r i n t e r v i e w e d the r e c e n t l y a p p o i n t e d head of the Department o f O c c u p a t i o n a l T h e r -apy , M i s s . 0. C u r t i s , to get her o p i n i o n on how v o l u n t e e r s might b e s t be a b l e to work on a ward such as H3, and i n the p a t i e n t c a t e g o r i e s under d i s c u s s i o n . M i s s C u r t i s i s e n t i r e l y i n f a v o u r of s e l e c t e d v o l u n t e e r s a s s i s t i n g i n the o c c u p a t i o n a l t h e r a p y department and i n the t h e r a p i s t a c t i n g as a c o n s u l t a n t t o v o l -u n t e e r s who a r e work ing on the ward. When d i s c u s s i n g the two major g r o u p i n g s o f p a t i e n t s on H3 M i s s C u r t i s p o i n t e d up t h e i r need t o be " a c t i v a t e d and s t i m u l a t e d " to take an i n t e r e s t i n t h i n g s and the need t o m a i n t a i n t h i s f u n c t i o n at the h i g h e s t p o s s i b l e l e v e l . She s t a t e d t h a t the g e n e r a l d i f f i c u l t i e s e n c o u n t e r e d by the t h e r a p i s t (and by the v o l u n t e e r s ) were i n "making c o n t a c t " and g e t t i n g the p a t i e n t s ' r e s p o n s e because of the l a t t e r * s l a c k o f i n t e r e s t , d e t e r i o r a t i o n , a n d / o r p h y s i c a l d i f f i c u l t y r e s u l t i n g f rom heavy m e d i c a t i o n , such as d r o w s i n e s s , poor e y e s i g h t , and s w e l l i n g o f the h a n d s . A com-b i n a t i o n o f one or a l l o f t h e s e f a c t o r s may l i m i t what the p a t i e n t - 61 -i s a b l e t o a c c o m p l i s h even i n what may seem v e r y s i m p l e t o the i n e x p e r i e n c e d v o l u n t e e r . Another ve ry impor tant a s p e c t , o f t e n not r e a l i z e d , i s t h a t when work ing w i th t h i s type o f p a t i e n t , the v o l u n t e e r w i l l have t o do more than j u s t get the p a t i e n t s t a r t e d ; she may have t o get the p a t i e n t s t a r t e d on each new s t e p o f the work no mat ter how o b v i o u s i t may seem t o h e r . On a h a b i t t r a i n i n g ward such as H3 t h i s a p p l i e s i n most c a s e s . The t r a i n e d o c c u p a t i o n a l t h e r a p i s t , a c t i n g as c o n s u l t a n t on ward, can be v e r y h e l p f u l t o v o l u n t e e r s e x p l a i n i n g the needs o f p a t i e n t s and, a t the same t i m e , r e c e i v i n g v a l u a b l e a s s i s t a n c e i n c a r r y i n g out her t h e r a p y . P a r t i c u l a r l y w i th new v o l u n t e e r s , she can h e l p them to u n d e r s t a n d and d e a l w i th the p a t i e n t s ' l a c k o f i n i t i a t i v e . Then the v o l u n t e e r w i l l be on the l o o k - o u t f o r d i f -f i c u l t i e s which the p a t i e n t i s e n c o u n t e r i n g and be a b l e t o h e l p the p a t i e n t h e l p h e r s e l f . By r e c o g n i z i n g the p a t i e n t ' s i n n a t e d i g n i t y and wor th ; by s i n c e r i t y o f a p p r o a c h ; by not p u s h i n g her beyond her c a p a c i t y and by c a r e f u l l y wa tch ing f o r , and commenting o n , the s m a l l e s t b i t s o f p r o g r e s s , the v o l u n t e e r w i l l be d o i n g her p a r t i n the l o n g s low p r o c e s s o f n u r s i n g a p a t i e n t back t o a h e a l t h i e r s t a t e of mind . When d i s c u s s i n g the a t t e n t i o n seeker group, M i s s C u r t i s s t r e s s e d the need t o get and keep t h i s pe rson i n t e r e s t e d i n d o i n g someth ing . F o r example, where t h e r e i s a group p r o j e c t under the gu idance of a t h e r a p i s t , w i t h v o l u n t e e r s a s s i s t i n g , the l a t t e r c o u l d encourage the a t t e n t i o n seeker to c o l l e c t the t o o l s . T h i s may seem a t r i v i a l t a s k t o some but may be the f i r s t l i n k i n a c h a i n o f l i t t l e t a s k s and t h i n g s the a t t e n t i o n seeker may do i n - 6 2 -order to develop her capacity to think of others. By helping i n occupational therapy she may be able to see ways she can help nursing s t a f f around the ward, rather than having to get t h e i r attention by other means. The praise that w i l l be forthcoming w i l l stimulate her to sustain small gains and move toward larger ones. The volunteers' potential i n t h i s area has already been mentioned but cannot be too strongly emphasized. The unsuspect-ing volunteer may f a l l into the p i t f a l l of l e t t i n g the attention seeker play her off against s t a f f and should be on the lookout for t h i s t a c t i c . For example, the hypochondriacal complaint i s commonly used by the attention seeker. A s p e c i f i c example i n occupational therapy would be a t o o l scratch, magnified out of proportion by the patient. When reasonable attention and kind-ness has been given by the volunteer, Miss C u r t i s advises an understanding firmness and d i r e c t i n g of the patient to some con-s t r u c t i v e work as planned by the therapist. In other words, i t i s not a case of being harsh and s t r i c t , but rather firm and consistant; the idea of r e j e c t i n g the attention seeker's devices but not the attention seeker h e r s e l f . Praise following the at-tention seeker's f i r s t e f f o r t s at carrying out the volunteer's r e - d i r e c t i o n usually brings p o s i t i v e r e s u l t s . It i s important that the volunteer r e a l i z e s that while praise may be enthusiastic, care must be taken to avoid sounding "gushy" which the patient senses as being insincere. Another group mentioned above was that termed the acting-out psychopath. Miss C u r t i s f e l t that t h i s would be a d i f f i c u l t group for the volunteer to work with because i n her experience they are persuasive, manipulative and i n c l i n e d to be aggressive. - 63 -In a d d i t i o n , they a re e a s i l y f r u s t r a t e d , q u i c k t o sense f a i l u r e , and , i f t h i n g s a r e too e a s y , q u i c k to become b o r e d . M i s s C u r t i s f e l t t h a t v o l u n t e e r work w i th t h i s group would be l i m i t e d u n l e s s , under c l o s e s u p e r v i s i o n of an e x p e r i e n c e d o c c u p a t i o n a l t h e r a p i s t o r o t h e r s t a f f p e r s o n , depending on the s i t u a t i o n . The f i n a l group d i s c u s s e d was the c o n f u s e d p h y c h o t i c s o r r e s c u e s e e k e r s . I t was f e l t here t h a t w i t h i n the o c c u p a t i o n a l t h e r a p y programme the v o l u n t e e r c o u l d a s s i s t by h e l p i n g the p a t -i e n t get a sense of p u r p o s e . That i s , the p a t i e n t s h o u l d be g i v e n work h a v i n g purpose and be h e l p e d by the v o l u n t e e r t o see work as a means o f p r o g r e s s i o n towards r e a l i t y . By h e l p i n g them a c h i e v e a sense of p u r p o s e , the v o l u n t e e r i s h e l p i n g the p a t i e n t t o a l l a y her a g i t a t i o n . As w i th a l l p a t i e n t s the need t o be t a c t f u l but t r u t h f u l s h o u l d a lways be kept i n m ind . The v o l u n t e e r can a l s o be most h e l p f u l i n p r e p a r i n g m a t e r i a l s and work f o r p a t i e n t s . F o r example, t h e r e i s a p e r i o d between the v o l u n t e e r s * a r r i v a l t i m e , 10:45 a . m . , and 1:00 p . m . , when p a t i e n t s and s t a f f a re at l u n c h , which c o u l d be u t i l i z e d by them, i f they w i s h e d , t o make t h e s e p r e p a r a t i o n s . A l s o , t h e r e i s q u i t e a b i t o f t r imming and t o u c h i n g up work t h a t i s needed on p a t i e n t s * handiwork b e f o r e i t i s s a l e a b l e . (Under the p r e s e n t sys tem, a p a t i e n t who i s u n a b l e t o buy the m a t e r i a l f o r her p r o -j e c t agrees t o make two i t e m s , k e e p i n g one and d o n a t i n g the o t h e r f o r h o s p i t a l s a l e . ) Some v o l u n t e e r s c o u l d be kept q u i t e busy on t h a t , a c c o r d i n g to m iss C u r t i s , and on c o l l e c t i n g m a t e r i a l f o r o c c u p a t i o n a l t h e r a p y . Examples a r e s p e c i a l m a t e r i a l s such as oddments o f s i l k and f u r , too e x p e n s i v e t o be p r o v i d e d f o r out - 64 -o f t h e budget. Case Examples Case I - Mary M. T h i s c a s e i s a b r i e f i l l u s t r a t i o n o f a v o l u n t e e r - p a t i e n t r e l a t i o n s h i p which has d e v e l o p e d as a r e s u l t o f s i m p l e f r i e n d l y v i s i t i n g . Mary i s 52 y e a r s o l d now and has been i n h o s p i t a l f o r 20 y e a r s . Her own f a m i l y and r e l a t i v e s have e i t h e r d i e d o r moved away. Mary's " V i s i t o r s ' S h e e t " i n t h e V i s i t o r s ' B o o k , l i k e t h a t o f many o t h e r p a t i e n t s , has had no e n t r y f o r a l o n g t i m e . Mary f a l l s w i t h i n t h e " A p a t h e t i c s c h i z o p h r e n i c " group and u n t i l r e c e n t -l y j u s t s a t o r s t o o d o r l o o k e d out t h e window most o f t h e day. She a p p a r e n t l y t o o k no i n t e r e s t i n a n y t h i n g , except t h a t she some-t i m e s t r i e d t o w r i t e p o e t r y . She has a h i g h s c h o o l e d u c a t i o n and was once a music t e a c h e r , h a v i n g s t u d i e d f o r , and been awarded, her A.C.T.M. One o f t h e v o l u n t e e r s , who a t t h a t t i m e had j u s t s t a r t e d on t h e ward, spoke t o Mary and i n t r o d u c e d h e r s e l f u s i n g her f i r s t name. Mary was u n a b l e t o r e s p o n d , but t h e v o l u n t e e r c h a t t e d f o r a few moments b e f o r e moving on, s a y i n g t h a t she would see her n e x t t i m e she was o u t . The v o l u n t e e r ' s next t i m e out was a week away b u t , w h i l e u n a b l e t o r e s p o n d a t t h e t i m e , t h o s few words meant a l o t t o Mary. E v e r y a f t e r n o o n f o r t h e n e x t week she w a i t e d near t h e door of her c l o s e d ward w a t c h i n g f o r t h e v o l u n t e e r t o come and v i s i t . One week l a t e r when t h e v o l u n t e e r came Mary was a b l e t o mumble " H e l l o " i n r e s p o n s e t o t h e v o l u n t e e r ' s g r e e t i n g . Mary w i l l p r o b a b l y never be w e l l enough t o l e a v e h o s p i t a l - 65 -but her h o s p i t a l community i s much e n r i c h e d by t h i s v o l u n t e e r and t h o s e who v i s i t w i t h h e r . She i s now t a k i n g more i n t e r e s t i n her appearance, e n j o y s w a l k s w i t h t h e v o l u n t e e r and p a r t i c u l a r l y a p p r e c i a t e s t h e o c c a s i o n a l c a r d r i v e around t h e l o c a l c o u n t r y -s i d e . When t h e v o l u n t e e r was away on v a c a t i o n she and Mary c o r -responded r e g u l a r l y . A s i m p l e l i t t l e poem w r i t t e n by Mary about her " F r i e n d " e x p r e s s e s v e r y c l e a r l y t h e happy change i n her l i f e . My F r i e n d Norah i s a g i r l Of H appiness and s o c i a l w h i r l Of g a i e t i e s and merry ways Grand s e r v i c e s b r o u g h t by t r a y s . One o f t h e most i m p o r t a n t t h i n g s a v o l u n t e e r can o f f e r i s F r i e n d s h i p . Case 2 - Dorothy D. T h i s c a s e i s an i l l u s t r a t i o n o f a way i n which a s o c i a l worker may e n l i s t t h e a i d o f a v o l u n t e e r t o h e l p a p a t i e n t t a k e more i n t e r e s t i n h e r s e l f and, h o p e f u l l y , become more a c c e s s i b l e t o casework s e r v i c e s . I t a l s o i l l u s t r a t e s how a s o c i a l worker can be h e l p f u l t o a v o l u n t e e r by b r i e f i n g her on t h e p a t i e n t ' s b e h a v i o r and p o s s i b l e s e n s i t i v e a r e a s . Dorothy i s a 41 ye a r o l d s i n g l e woman w i t h a u n i v e r s i t y degree i n e d u c a t i o n . F o l l o w i n g g r a d u a t i o n she ta u g h t s c h o o l b u t , w h i l e h er academic a b i l i t y was e x c e l l e n t , she c o u l d not make a s u c c e s s o f t e a c h i n g . As a c h i l d she had been s e c l u s i v e , s e n s i t i v e , and s u s p i c i o u s . A r e l a t i v e d e s c r i b e d h er as " o v e r - c o n s c i e n t i o u s " . In her t e a c h i n g c a p a c i t y she was not s u c c e s s f u l i n h a n d l i n g h e r c l a s s ; nor was she a b l e t o get a l o n g w i t h her f e l l o w t e a c h e r s . She s t a r t e d g o i n g from one s c h o o l t o a n o t h e r , had f r e q u e n t c r y i n g s p e l l s i n f r o n t o f t h e c l a s s , p e r i o d s o f s t a r i n g o u t t h e window, - 66 -and her p e r s o n a l appearance became v e r y u n t i d y . A p s y c h o t i c b r eak r e s u l t e d . Immediately p r i o r t o her h o s p i t a l i z a t i o n 11 y e a r s ago, Do r o t h y was as d e s c r i b e d above and g e n e r a l l y withdrawn f o r about 3 y e a r s . F o l l o w i n g a d m i s s i o n she r e c e i v e d e x t e n s i v e e l e c t r o - c o n v u l s i v e t h e r a p y and some i n s u l i n coma, but d i d not improve t o any g r e a t e x t e n t . Dorothy has remained f a i r l y a p a t h e t i c t h r o u g h o u t her h o s p i t a l i z a t i o n a l t h o u g h t h e r e have been a c t i v e p e r i o d s when she was q u i t e g r a n d i o s e . She has been on t r a n q u i l l i z e r s f o r some t i m e and would f a l l w i t h i n t h e " t r a n q u i l l i z e d a p a t h e t i c s c h i z o -p h r e n i c " group. R e c e n t l y she s t a r t e d t o show a g r e a t e r awareness i n t h i n g s and began t h i n k i n g about r e s u m i n g her t e a c h i n g c a r e e r . She i n g r a d u a l l y i m p r o v i n g t o t h e p o i n t where she may be d i s c h a r g e d i f a s u i t a b l e r e h a b i l i t a t i o n p l a n can, be worked out w i t h h e r . Her p r e s e n t i d e a o f t e a c h i n g i s not r e a l i s t i c a t t h i s t i m e and p o s s i b -l y never w i l l be. However, Dorothy f o u n d i t was d i f f i c u l t t o a c c e p t t h i s i d e a and would have n o t h i n g t o do w i t h h er d o c t o r i n t h i s r e g a r d , nor w i t h t h e s o c i a l worker who was a s s i g n e d t o t h e c a s e . F o r one t h i n g , t h e y were " p a i d " t o be i n t e r e s t e d and f o r a n o t h e r , t h e i d e a o f s o c i a l worker smacked of " c h a r i t y " which was a blow t o D o r o t h y ' s " p r i d e " . (Her f a m i l y had once been v e r y w e l l t o do.) Her r e f u s a l t o p a r t i c i p a t e i n d i s c h a r g e p l a n n i n g i s b l o c k i n g h er s u c c e s s f u l r e h a b i l i t a t i o n t o her community. The s o c i a l worker f e l t t h a t a v o l u n t e e r might be a b l e t o make f r i e n d s w i t h Dorothy and p a t i e n t l y h e l p h e r t o u n d e r s t a n d t h e t y p e o f s e r v i c e t h e s o c i a l worker had t o o f f e r and be more - 6 7 -accepting of i t and of more modest r e h a b i l i t a t i o n plans. The re s u l t was a planning conference between the Coordinator of Volunteers, the volunteer selected for the assignment, and the s o c i a l worker, The s o c i a l worker gave the volunteer a b r i e f picture of Dorothy's background and how she behaved as a r u l e . Then, the volunteer (herself a former teacher) was introduced to Dorothy. Dorothy was unresponsive the f i r s t time or two saying "Yes" or "No" to the volunteers remarks or perhaps just s t a r i n g at her. But she soon warmed to the s i n c e r i t y and f r i e n d l i n e s s of her " v i s i t o r " and i t was not long before she began to take more interest i n her cl o t h i n g and personal grooming generally. The improvement i n her appearance has been quite remarkable. In addition, she i s becoming more accepting of the idea that teaching would be a b i g step to take r i g h t away, having been away from i t for so long. Dorothy s t i l l has quite a way to go before she w i l l be able to p a r t i c i p a t e i n r e a l i s t i c discharge planning, and i n her a b i l i t y to accept, and benefit from, the s o c i a l worker and her knowledge of human behaviour and community resources. The volunteer contin-ues to v i s i t with Dorothy, go for walks with her, take her to town, a l l of which i s gradually o r i e n t i n g her to the community again and giving her a f e e l i n g of acceptance i n i t . Chapte r 4 Summary and F i n d i n g s Restatement o f F o c u s In the pas t h a l f c e n t u r y the menta l h y g i e n e movement i n s p i r e d by menta l h e a l t h c r u s a d e r s such as D i x , B e e r s and H i n c k s has c r e a t e d w idespread and s u s t a i n e d p u b l i c i n t e r e s t i n menta l h o s p i t -a l s . T h i s p u b l i c awareness has been sharpened even more i n the l a s t two decades i n Canada through the e d u c a t i o n a l e f f o r t s o f the Canad ian M e n t a l H e a l t h A s s o c i a t i o n . C M . H . A . has made wide and c o n s t r u c t i v e use of the p r e s s , the r a d i o , t e l e v i s i o n , movies and p u b l i c s p e a k i n g , to r e a c h more and more C a n a d i a n s . The once d i s c a r d e d i d e a of mora l t rea tment i s making i t s r e t u r n i n a more e n l i g h t e n e d fo rm. There i s a b l e n d i n g of " l a b o r a t o r y " knowledge w i th t h a t o f p s y c h o l o g y and the s o c i a l s c i e n c e s . There has been a change i n the approach to menta l h o s p i t a l s and m e n t a l l y i l l p a t i e n t s f rom s t r a i g h t c u s t o d i a l c a r e o f t e n c h a r a c t e r i z e d by t h o u g h t l e s s n e s s and p h y s i c a l abuse t o one where the w e l l - b e i n g of the p a t i e n t i s uppermost i n the minds of the t rea tment team. The day has not ye t come when the e n l i g h t e n e d t rea tment team approach can be e f f e c t e d f o r each p a t i e n t but de te rmined e f f o r t s a re b e i n g made and g r a d u a l g a i n s a r e b e i n g r e a l i z e d i n the s u c -c e s s f u l r e m o t i v a t i o n and r e h a b i l i t a t i o n of p a t i e n t s back t o - 69 -t h e i r community. The f o c u s and a t t e n t i o n o f t h i s t h e s i s has been on the development o f a v o l u n t e e r programme c o n s i s t i n g o f the s e r v i c e s o f f e l l o w c i t i z e n s who have v o l u n t e e r e d t h e i r t ime and t a l e n t as a " t rea tment e x t r a " t o b r i n g the community t o the p a t i e n t on a g r a d u a l n o n - t h r e a t e n i n g b a s i s , thus a s s i s t i n g i n b r i d g i n g the gap between menta l h o s p i t a l and community. I t i s the w r i t e r ' s hope t h a t t h i s l a s t c h a p t e r may p r o v i d e m a t e r i a l f o r thought out o f which w i l l come new i d e a s t h a t w i l l i n c r e a s e and g i v e depth to an a l r e a d y e f f e c t i v e v o l u n t e e r p r o -gramme. D i r e c t i o n and I n t e r e s t o f V o l u n t e e r s A main problem i n v o l u n t e e r programmes i s t h a t o f s u s t a i n i n g the v o l u n t e e r s ' i n t e r e s t i n the programme and g i v i n g the v o l u n t -e e r s " d i r e c t i o n " and a p p r o p r i a t e r e c o g n i t i o n f o r t h e i r e f f o r t s . T h i s i s b a s i c to s u c c e s s f u l community o r g a n i z a t i o n i n any a r e a . A group or i n d i v i d u a l r e s p o n s i b l e f o r c o n t i n u i n g a c t i o n i n a community programme, such as the v o l u n t e e r programme s h o u l d not have the r e s p o n s i b i l i t y f o r d i r e c t i o n of the o p e r a t i o n taken away f rom them by p r o f e s s i o n a l p e r s o n n e l . The impor tance o f t h i s r e l a t e s to " m o r a l e , f e e l i n g s of r e s p o n s i b i l i t y , m o t i v a t i o n f o r a c t i o n . " 1 That i s , i f the group does not have , o r r e l i n q u i s h e s , major r e s p o n s i b i l i t y f o r d i r e c t i o n of the o p e r a t i o n then some of t h e i r sense o f r e s p o n s i b i l i t y , some of t h e i r e n t h u s i a s m , c r e a t i v -i t y , and , v e r y i m p o r t a n t , some o f t h e i r sense of s t a t u s and achievement i s not f o r t h c o m i n g . T h i s , o f c o u r s e , l e a d s to d i s -couragement , d i s i n t e r e s t and d r o p p i n g out o f the programme. R o s s , Mur ray , Community O r g a n i z a t i o n ; Harper & B r o t h e r s ; New Y o r k ; 1955. p. 143. - 7 0 -C o o r d i n a t o r as Guide W h i l e i n g e n e r a l t h e v o l u n t e e r s e x p r e s s s a t i s f a c t i o n w i t h t h e o r g a n i z a t i o n o f t h i s programme and f e e l a c c e p t e d by most s t a f f , t h e y do e x p r e s s a w i s h f o r more d i r e c t i o n . A t f i r s t t h i s may seem out o f k e e p i n g w i t h t h e above remarks on t a k i n g c a r e t h a t r e s p o n s i b i l i t y f o r d i r e c t i o n o f programme i s not t a k e n away from them by p r o f e s s i o n a l p e r s o n n e l , but such i s not t h e c a s e . The v o l u n t e e r s do not want t o be d i r e c t e d i n t h e most o b v i o u s sense of t h e word but t h e y do want t o be g u i d e d o r e n a b l e d . T h i s d i f f e r e n c e may be h a r d f o r some v o l u n t e e r s t o a c c e p t because, p a r t i c u l a r l y when new and u n s u r e , t h e y p r o b a b l y b e l i e v e t h e y want more d i r e c t i o n t h a n t h e y a c t u a l l y would be w i l l i n g t o a c c e p t . That i s , t h e y would soon r e a l i z e t h a t t h e y were r e l i n q u i s h i n g a sense o f r e s p o n s i b i l i t y , achievement and s t a t u s . F o r example, t h e C o o r d i n a t o r i n t h e r o l e o f g u i d e must e x e r c i s e c o n s i d e r a b l e d i s c i p l i n e o f s e l f i n o r d e r t o p l a y t h i s r o l e s u c c e s s f u l l y . I t i s v e r y t e m p t i n g f o r him t o pass judgment on such q u e s t i o n s as "what would be t h e b e s t p r o j e c t f o r us t o s t a r t ? " or "what i s t h e most i m p o r t a n t t h i n g f o r me t o do t o - d a y ? " . The C o o r d i n a t o r , i n g i v i n g a d i r e c t "do t h i s " answer i s not o n l y s t e p p i n g out o f h i s r o l e but i s not p e r m i t t i n g t h e v o l u n t e e r ' s i n v o l v e m e n t i n programme t o d e v e l o p i n t h e h e a l t h i e s t manner. U n l e s s v o l u n t e e r s f e e l t h e y a r e i n on t h e p l a n n i n g , n ot me r e l y c a r r y i n g out p l a n -n i n g , t h e i r i n v o l v e m e n t w i l l be o f a f r i n g e n a t u r e o n l y . R e a l s a t i s f a c t i o n w i l l not be f o r t h c o m i n g and t h i s , p l u s l e g i t i m a t e r e c o g n i t i o n o f s e r v i c e s r e n d e r e d , i s t h e v o l u n t e e r s * pay check. - 7 1 -What can the c o - o r d i n a t o r do when asked such d i r e c t q u e s -t i o n s ? H i s a b i l i t y t o h a n d l e such q u e s t i o n s most c o n s t r u c t i v e l y w i l l depend on the d a t a he has on hand about p a t i e n t n e e d s . F o r example, s u r v e y s o f i n d i v i d u a l wards a r e e s s e n t i a l t o l e a r n the number o f p a t i e n t s , the g e n e r a l g r o u p i n g s o f p a t i e n t s on ward (such as H 3 ) r the t ime they go t o l u n c h , t h a t s t a f f goes t o l u n c h , t h a t ward d u t i e s a r e g o i n g o n , the numbers i n v o l v e d , the number o f ground p r i v i l e g e s (and those who do not make u s e o f them), the t ime p a t i e n t s a r e a t O c c u p a t i o n a l T h e r a p y , at R e c r e a t i o n a l Theraby (and when t h e s e a c t i v i t i e s a r e on the ward) and so o n . Wi th t h i s type o f i n f o r m a t i o n the c o - o r d i n a t o r may, a t a V o l u n -t e e r S e r v i c e s Committee meet ing o r at an i n f o r m a l g a t h e r i n g o f t h a t d a y ' s v o l u n t e e r s , gu ide t h e v o l u n t e e r s v i a t h e i r q u e s t i o n s t o p r o v i d e t h e i r own d i r e c t i o n . I f the C o - o r d i n a t o r does not g i v e d i r e c t answers t o " d i r e c t i o n " q u e s t i o n s how does he h a n d l e them? In h i s r o l e o f gu ide he may p r o v i d e d a t a upon which a judgment can be made by the v o l u n t e e r s o r he may summarize and c l a r i f y v a r i o u s arguments and p o i n t s o f v i e w . In a d d i t i o n he may p o i n t out the i m p l i c a t i o n s o f d i f f e r e n t c o u r s e s o f a c t i o n and perhaps suggest c o u r s e s not p r e v i o u s l y c o n s i d e r e d . 1 The whole p o i n t o f t h i s g u i d i n g r o l e i s to h e l p the v o l u n t e e r s grow i n c a p a c i t y , which they w i l l , as they s t r i v e t o a c h i e v e what they have d e c i d e d upon t h e m s e l v e s . I f t h e C o - o r d i n a t o r p r o v i d e s the s o l u t i o n per se t h e n the purpose i s d e f e a t e d . The i n t e r p r e t a t i o n o f t h i s r o l e t o the v o l u n t e e r s may not be e a s y , and p o s s i b l y a t f i r s t i t may seem t o them as u n s a t i s -f a c t o r y h a n d l i n g o f t h e i r q u e s t i o n s . However, t h o s e who may not R o s s , Mur ray , I b i d p.210 - 72 -a t f i r s t see the l o g i c o f t h i s approach w i l l e v e n t u a l l y u n d e r -s t a n d , a c c e p t , and a p p r e c i a t e t h i s type o f gu idance b e c a u s e , i n f a c t , i t i s r e c o g n i t i o n o f t h e v o l u n t e e r ' s c a p a c i t y as a p e r s o n and as a v a l u e d h e l p e r on the t rea tment team. V a l u e o f F a c t - F i n d i n g The a c c e p t a n c e o f t h i s approach by v o l u n t e e r s w i l l be p o s -s i b l e o n l y i f the C o - o r d i n a t o r has the d a t a a t h i s f i n g e r - t i p s ; o t h e r w i s e i t w i l l be i m p o s s i b l e t o h a n d l e the r e q u e s t s f o r d i r -e c t i o n i n a t r u l y c o n s t r u c t i v e manner. F a c t - f i n d i n g s h o u l d have v a l u e f rom t h r e e p o i n t s o f v i e w . F i r s t and o b v i o u s , the C o - o r d i n a t o r w i l l be f u l l y c o n v e r s a n t w i t h , and have a knowledge o f , the e n t i r e h o s p i t a l programme as t h i s r e l a t e s t o use o f v o l u n t e e r s . Second , one proven method f o r unanimous s t a f f p a r t i c i p a t i o n i n the v o l u n t e e r programme o f a menta l h o s p i t a l i s t o have the members o f each department and the employees o f each ward d i s c u s s and l i s t s p e c i f i c needs o f the p a t i e n t s and the depar tments as t o how v o l u n t e e r s may meet o r h e l p p r o v i d e f o r t h e s e n e e d s . 1 The t h i r d way i s t o get " p a t i e n t - m i n d e d " v o l u n t e e r s (who have had some e x p e r i e n c e i n v o l u n t e e r work a t the h o s p i t a l ) t o g e t h e r f o r d i s c u s s i o n group meet ings w i th the C o - o r d i n a t o r . They w i l l have s k i l l s , a b i l i -t i e s , and i d e a s t o r e l a t e and i f g u i d e d , w i l l do so i n a s p e c i f i c and d e t a i l e d manner. The C o - o r d i n a t o r w i l l then be a b l e t o s tudy b o t h l i s t s and at tempt t o o r g a n i s e the m a t e r i a l a c c o r d i n g t o f e a s i b i l i t y , t i m i n g , and i m p l e m e n t a t i o n . However, the a l r e a d y Sharp , Agnes , Why V o l u n t e e r s i n I l l i n o i s M e n t a l H o s p i t a l s , S t a t e of I l l i n o i s , 1952. - 7 3 -h a r d - p r e s s e d s t a f f cannot be e x p e c t e d t o take the t ime t o t a b -u l a t e t h i s i n f o r m a t i o n w i thou t gu idance and A d m i n i s t r a t i o n encouragement . F o r example, i f t h e C l i n i c a l D i r e c t o r makes i t known i n o f f i c i a l terms t h a t he wishes t h i s i n f o r m a t i o n com-p i l e d t h i s c o u l d w e l l s u p p l y the needed p u s h . T i m i n g i s a l l -impor tant i f such a r e q u e s t f o r i n f o r m a t i o n g a t h e r i n g i s t o be implemented. Here the C o - o r d i n a t o r can o f f e r gu idance by p r e -p a r i n g i n advance a mimeographed q u e s t i o n n a i r e a n t i c i p a t i n g ward needs which can be s i m p l y t i c k e d o f f where a p p l i c a b l e and which w i l l s t i m u l a t e i d e a s and thought as w e l l . I t would seem t h a t v o l u n t e e r s c o u l d be o f c o n s i d e r a b l e h e l p t o the C o - o r d i n a t o r here by s u g g e s t i n g p o s s i b l e v o l u n t e e r a c t i v i t i e s . Department r e p r e s e n t a t i v e s s h o u l d be brought i n t o p l a n n i n g a l s o by a d v i s i n g on o r g a n i z a t i o n and c o n t e n t o f e a r l y d r a f t s . C o - o r d i n a t o r ' s C o u n c i l In t h i s c o n n e c t i o n , t h e r e would seem t o be a good c a s e f o r a C o - o r d i n a t o r ' s c o u n c i l t o be formed, perhaps based on the e x i s t i n g H o s p i t a l Committee on V o l u n t e e r s which i s hot too a c t i v e at p r e s e n t . The V o l u n t e e r Manual on P s y c h i a t r i c H o s p i t a l S e r -v i c e s 1 ment ioned e a r l i e r d i s c u s s e s the h o s p i t a l c o - o r d i n a t i n g c o u n c i l i d e a . I t s u g g e s t s t h a t the S u p e r i n t e n d e n t u s u a l l y a p -p o i n t s a committee o f two o r t h r e e i n t e r e s t e d m e d i c a l s t a f f members, the C o - o r d i n a t o r , and when a d v i s a b l e the Heads o f S o c i a l S e r v i c e and N u r s i n g Depar tments . R e p r e s e n t a t i v e s f rom o t h e r dep artraents were not ment ioned but i t would c e r t a i n l y seem McBee, M a r i o n , and F r a n k , M a r j o r i e , op c i t p. 11 - 7 4 -a d v i s a b l e f o r O c c u p a t i o n a l and R e c r e a t i o n a l Therapy departments t o be r e p r e s e n t e d . The f u n c t i o n o f such a committee as s t a t e d i n the manual would be t o a s c e r t a i n and e v a l u a t e v o l u n t e e r needs o f a l l h o s p i t a l depar tments , f o r m u l a t e p l a n s and a c t on the b r o a d a s p e c t s o f the programme i n an a d v i s o r y c a p a c i t y . The C o - o r d i n a t o r i s g i v e n r e s p o n s i b i l i t y f o r e f f e c t i n g t h e s e p l a n s and f o r h a n d l i n g the everyday d e t a i l s o f c o - o r d i n a t i o n , ass ignments and s u p e r v i s i o n . I t i s a l s o recommended t h a t the committee meet a t l e a s t once a month. A s i t s tands now, the C o - o r d i n a t o r makes h i s d e p a r t m e n t a l c o n t a c t s m a i n l y on an i n d i v i d u a l b a s i s f o r which t h e r e i s c e r -t a i n l y a c a s e . However, f rom the p o i n t o f v iew o f the combined u n d e r s t a n d i n g of a l l concerned t h e r e would seem t o be a d e f i n i t e need f o r the c o u n c i l i d e a ; o t h e r w i s e the C o - o r d i n a t o r * s e f f o r t s w i l l be l e s s e f f e c t i v e i n t h i s growing v o l u n t e e r programme. Out o f such d i s c u s s i o n s based on i n f o r m a t i o n o f a c t u a l p a t i e n t and depar tmenta l needs can come the k i n d o f p l a n n i n g which i s backed by u n d e r s t a n d i n g and i n t e r e s t and t h e r e f o r e has a chance o f t i m e l y and e f f i c i e n t i m p l e m e n t a t i o n . S u p e r v i s i o n o f V o l u n t e e r s The term s u p e r v i s i o n as a p p l i e d t o a v o l u n t e e r s e r v i c e programme i s u s e d here f o r l a c k o f a more a p p r o p r i a t e o n e . I t i s not meant t o imply the h i g h l y d e v e l o p e d w o r k e r - s u p e r _ s o r r e l a t i o n s h i p u s e d i n s o c i a l work. The L a t i n r o o t o f the word " s u p e r v i s i o n " means l i t e r a l l y " l o o k i n g o v e r " . T h i s seems t o come c l o s e r to d e s c r i b i n g the t y p e o f s u p e r v i s i o n f o r v o l u n t e e r s - 7 5 -which i s i n d i c a t e d . That i s , the r e s p o n s i b l e s t a f f pe rson s h o u l d " l o o k o v e r " what they d o . The s o c i a l w o r k e r ' s r o l e , f o r example, would be t h a t o f a h e l p e r , a d v i s o r , and f r i e n d . There i s a t r a i n i n g f u n c t i o n i m p l i e d i n t h a t the worker c o n c e r n e d s h o u l d f a m i l i a r i z e the v o l u n t e e r w i th the s o c i a l s e r v i c e s e t t i n g . The v o l u n t e e r s h o u l d be i n t r o d u c e d to s t a f f and be g i v e n some i d e a o f how "the work o f the department i s c o n d u c t e d . The g e n e r a l p h i l o s -ophy o f the v o l u n t e e r - w o r k e r c o n t a c t s h o u l d be t h a t o f d e v e l o p i n g i n the v o l u n t e e r a sense o f p a r t i c i p a t i o n and invo lvement i n the t rea tment team. In each c a s e , when the d e c i s i o n o f assignment o f v o l u n t e e r s i s made, the v o l u n t e e r s c o n c e r n e d s h o u l d be put under the s u p e r -v i s i o n o f a d e s i g n a t e d s t a f f p e r s o n i n the department c o n c e r n e d . T h i s p rocedure i s f o l l o w e d t o some e x t e n t a t p r e s e n t but i n a r a t h e r l o o s e manner which c o n t r i b u t e s t o some v o l u n t e e r s f e e l i n g a l a c k o f d i r e c t i o n and perhaps f r u s t r a t i o n . Cont inuous s u p e r v i s i o n b a s e d on the v o l u n t e e r ' s j o b r e q u i r e -ments s h o u l d be worked o u t . The p o s s i b i l i t y o f s u p e r v i s i o n b e i n g p r o v i d e d i n group s e s s i o n s may be i n d i c a t e d c o n s i d e r i n g t h e l i m i t e d s u p e r v i s i o n t ime a v a i l a b l e . One S o c i a l S e r v i c e Department* has found the group method s a t i s f a c t o r y . I t was found t h a t the s h a r -i n g o f i d e a s and e x p e r i e n c e p l u s p r a i s e and c o n s t r u c t i v e c r i t i c i s m were p a r t i c u l a r l y m e a n i n g f u l i n the group s e t t i n g . The s o c i a l worker concerned would be r e s p o n s i b l e f o r p r e p a r a t i o n and o r i e n t a -t i o n o f the p a t i e n t t o v o l u n t e e r s e r v i c e s as w e l l as p r e p a r a t i o n and o r i e n t a t i o n o f the v o l u n t e e r t o the p a r t i c u l a r p a t i e n t ' s n e e d s . M c G r i f f , D o r o t h y . "A V o l u n t e e r Program i n a N e u r o p s y c h i a t r y H o s p i t a l " . S o c i a l Casework, F e b . ' 5 4 . - 7 6 -Th e V o l u n t e e r S e r v i c e s M a n u a l 1 recommends t h a t a c o n f i d e n -t i a l and b r i e f r e c o r d of the v o l u n t e e r i n r e l a t i o n t o the j o b s h o u l d be k e p t . The v o l u n t e e r s h o u l d know o f t h e r e c o r d which might i n c l u d e amount o f t ime g i v e n , p u n c t u a l i t y , r e l i a b i l i t y , competence and s u i t a b i l i t y t o t h e work. V/hen d i s c u s s i n g the v o l u n t e e r programme wi th v a r i o u s s t a f f members the w r i t e r n o t i c e d a tendency t o c o n s i d e r s u p e r v i s i o n o f v o l u n t e e r s a n i c e i d e a but t i m e - c o n s u m i n g and w i th s t a f f s h o r t a g e , not r e a l l y f e a s i b l e . C e r t a i n l y t h e r e i s an a c u t e s t a f f s h o r t a g e , b u t one wonders i f we a r e not u s i n g the term a l i t t l e too c o n v e n i e n t l y t h e s e days t o the e x t e n t t h a t we a r e l o s i n g out on i n v a l u a b l e community i n t e r e s t and p a r t i c i p a t i o n i n the h o s p i t a l programme. I f the purpose o f the v o l u n t e e r programme i s c l e a r l y u n d e r s t o o d , and a c c e p t e d , t h e r e s h o u l d be no h e s i t a n c y to a c c e p t s u p e r v i s o r y r e s p o n s i b i l i t y any more than t h e r e would be t o s u p e r v i s e a p a i d s t a f f member w h i l e on the j o b . Gran ted the v o l u n t e e r may r e q u i r e a l i t t l e more t ime a t f i r s t but on the a v e r a g e , t h i s i s because o f coming one day a week and c o n s e q u e n t l y t a k i n g t h a t much l o n g e r t o get the f e e l o f the s u r r o u n d i n g s . I t i s not because the v o l u n t e e r i s u n r e l i a b l e o r i n c a p a b l e o f g i v i n g h e l p f u l a s s i s t a n c e . S o c i a l w o r k e r s , w i th t h e i r f a m i l y - o r i e n t e d casework s e r v i c e s and keen a p p r e c i a t i o n o f the i n d i v i d u a l ' s need f o r community a c c e p t a n c e , can be o f g rea t h e l p h e r e . We can engage i n c o n t i n u i n g i n t e r p r e t a t i o n i n r e g a r d to what the v o l u n t e e r programme i s t r y i n g t o a c c o m p l i s h . I t s s u c c e s s depends on s t a f f u n d e r s t a n d i n g and t r u e a c c e p t a n c e . Assuming c o n s c i o u s s u p e r v i s i o n of v o l u n t e e r s work ing on wards o r i n departments i s an example o f such a c c e p t a n c e . McBee, M a r i o n , and F r a n k , M a r j o r i e , op c i t p.37 The a s s i s t a n c e o f an a d v i s o r y c o u n c i l and assumpt ion o f more c o n s c i o u s s u p e r v i s i o n o f v o l u n t e e r s by s t a f f c o n c e r n e d s h o u l d permi t the C o - o r d i n a t o r to c o n c e n t r a t e more e f f e c t i v e l y on a s s i g n m e n t s , per formance e v a l u a t i o n , and perhaps r e - a s s i g n m e n t o f v o l u n t e e r s . I t s h o u l d a l s o g i v e him g r e a t e r o p p o r t u n i t y t o keep h i s ward and depar tmenta l da ta u p - t o - d a t e and t o p l a n f o r p r e s e n t and f u t u r e h o s p i t a l v o l u n t e e r n e e d s . I n - S e r v i c e T r a i n i n g In the o p i n i o n of t h e w r i t e r the main f a c t o r i n s u s t a i n i n g the i n t e r e s t o f the v o l u n t e e r i s t h a t o f p roper d i r e c t i o n which has a l r e a d y been d i s c u s s e d . However, p roper d i r e c t i o n needs t o be supplemented by an a p p r o p r i a t e i n - s e r v i c e t r a i n i n g programme g i v e n to the v o l u n t e e r s a t r e g u l a r i n t e r v a l s . P r o f e s s i o n a l l i t e r a t u r e 1 b a s e d on e x p e r -i e n c e w i th v o l u n t e e r programmes i n menta l h o s p i t a l s e t t i n g s p o i n t s up the need f o r r e g u l a r i n - s e r v i c e t r a i n i n g s e s s i o n s f o r v o l u n t e e r s . Many menta l h o s p i t a l s h o l d i n - s e r v i c e t r a i n i n g th roughout one week o f each month so as t o i n c l u d e a l l v o l u n t e e r s most o f whom a r e out o n l y one day a week. I t i s f e l t t h a t i f v o l u n t e e r s a r e to be e f f e c t i v e and i n t e l l i g e n t i n t e r p r e t e r s t o the community they must get the gu idance of the h o s p i t a l s t a f f a t a l l l e v e l s as t o h o s p i t a l a ims , needs , programme o f t rea tment f o r p a t i e n t s , and h o s p i t a l a c t i v i t i e s g e n e r a l l y . The w r i t e r d i s c u s s e d t h i s p o s s i b i l i t y w i th the Heads o f the O c c u p a t i o n a l T h e r a p y , R e c r e a t i o n a l T h e r a p y , and S o c i a l S e r v i c e Depar tments , and they a l l ag reed t h a t the i d e a had m e r i t . The Head o f the R e c r e a t i o n a l Therapy Department s t r o n g l y recommended t h a t such F e c h n e r , A . H . and P a r k e , J . "The V o l u n t e e r Worker and the P s y c h i a t r i c H o s p i t a l " , Amer ican J o u r n a l o f P s y c h i a t r y p p . 602-03 . - 7 8 -a c o u r s e be not mere ly an u n r e l a t e d s e r i e s o f t a l k s by r e p r e s e n t -a t i v e s o f the d i f f e r e n t departments but r a t h e r a c a r e f u l l y s t r u c -t u r e d c o u r s e which would emphasize the t rea tment team i d e a . T h i s c o u l d be c a r e f u l l y p l a n n e d w i th the a s s i s t a n c e o f the C o - o r d i n a t o r * s C o u n c i l . V o l u n t e e r ' s Read ing S h e l f A t the p r e s e n t t ime t h e r e i s no v o l u n t e e r l i t e r a t u r e e a s i l y a v a i l a b l e t o the v o l u n t e e r s a t t h e i r h o s p i t a l h e a d q u a r t e r s . I t i s s u g g e s t e d t h a t the C o - o r d i n a t o r t ake s t e p s t o a c q u i r e c e r t a i n s u i t a b l e books on menta l h e a l t h which would h e l p the v o l u n t e e r i n c r e a s e h i s o r h e r u n d e r s t a n d i n g o f work i n a menta l h e a l t h s e t t i n g . In a d d i t i o n a few i n t e r e s t e d v o l u n t e e r s c o u l d be s e l e c -t e d t o check monthly p u b l i c a t i o n s f o r m a t e r i a l on v o l u n t e e r work. P o s s i b l y the l i b r a r i a n a t C r e a s e C l i n i c c o u l d a d v i s e the v o l u n -t e e r s o f the most e f f i c i e n t way t o check f o r s o u r c e m a t e r i a l . The b i b l i o g r a p h y a t the end o f t h i s s tudy c o n t a i n s numerous s u i t a b l e r e f e r e n c e s . By s c a n n i n g v a r i o u s a r t i c l e s the l i b r a r y p r o j e c t v o l u n t e e r s c o u l d p r e p a r e h e l p f u l summaries o f t h e i r c o n t e n t and o b t a i n some u s e f u l i d e a s . A l l v o l u n t e e r s c o u l d be asked t o c u t out m a t e r i a l f rom magazines and newspapers which they f e e l i s a p p r o p r i a t e i n one way o r another t o t h e i r work. F o r example, one v o l u n t e e r group s t a r t e d what they c a l l e d a grab b a g . T h i s was s i m p l y a bag o r box i n t o which the l i b r a r y v o l u n t e e r s (and any o t h e r i n t e r e s t e d v o l u n t e e r s ) put c l i p p i n g s from newspapers and magazines which had t o do wi th menta l h e a l t h . I t c o u l d be an e d i t o r i a l , a s t a t i s t i c , a l e t t e r t o the e d i t o r o r someth ing e l s e . I t p r o v e d p o p u l a r w i t h v o l u n t e e r s who l i k e d t o r e a c h i n and p u l l out a b r i e f c l i p p i n g t o r e a d -79-while at t h e i r headquarters. The l i b r a r y project should be the r e s p o n s i b i l i t y of the volunteers^ not the Co-ordinator. The Co-ordinator could take r e s p o n s i b i l i t y however, for compiling a p o l i c y manual including minutes of Volunteer Service Committee meetings which would be available at the volunteer's room for reference and study. The programme i s increasing r a p i d l y and a proper policy manual along with i n d i v -idual records i s e s s e n t i a l to i t ' s smooth functioning. Volunteers and S o c i a l Service To date the services of volunteers have not been u t i l i z e d by S o c i a l Service to any great extent, although the department's administration does recognize the value of t h e i r services to the Hospital. Supervisory s t a f f see c e r t a i n areas where volunteers could be of r e a l assistance to s o c i a l workers. One area of service would be to act as an escort, or chaper-one. The Mental Hospitals Act of B r i t i s h Columbia states that patients i f required to go o f f the h o s p i t a l grounds with a s t a f f person may do so only i f that person i s of the same sex. The problem t h i s brings up i s that a male s o c i a l worker, for example, i s d e f i n i t e l y hampered when working with a female patient. This may be p a r t i c u l a r l y true i f the patient has been h o s p i t a l i z e d for some time, and the matter of facing the community i s quite frightening. Planned outings and ego supportive casework may be indicated at the same time. A female volunteer acting as escort would meet the requirements of the Act. A second area would seem to be that of f r i e n d l y v i s i t i n g with patients on the ward. This of course i s being done at present but with selected volunteers attached to the S o c i a l -80-S e r v i c e Department more p u r p o s e f u l use c o u l d be made o f t h i s v i s i t i n g . That i s , where a s o c i a l worker i s work ing w i th a p a t i e n t the v o l u n t e e r ' s v i s i t i n g e x p e r i e n c e can be u s e d t o keep the worker i n c l o s e r touch w i th the p a t i e n t ' s moods, and t o u t i l i z e c o n v e r s a t i o n c o n t e n t t o t h e r a p e u t i c e n d s . A t h i r d and r e l a t e d a r e a o f h e l p might be termed a " d i s c h a r g e h o l d i n g c o n t a c t . " F o r example, a s o c i a l worker may work out a d i s c h a r g e p l a n w i th the p a t i e n t which i s approved but which cannot be e f f e c t e d f o r perhaps a month 's t i m e . T h i s may have to do w i th a j o b t h a t w i l l not be a v a i l a b l e u n t i l t h e n , an accommo-d a t i o n prob lem, o r some o t h e r m a t t e r . The s o c i a l w o r k e r ' s main purpose may have been a c c o m p l i s h e d and i n terms o f work p r i o r i t y he o r she s h o u l d be moving t o another c a s e . Through u t i l i z i n g the s e r v i c e s o f the v o l u n t e e r t o m a i n t a i n c o n t a c t w i th the p a t i e n t d u r i n g t h i s w a i t i n g p e r i o d , the worker i s f r e e t o c o n c e n t r a t e on another c a s e , knowing t h a t r e g u l a r l y s c h e d u l e d , b r i e f d i s c u s s i o n s w i t h the v o l u n t e e r w i l l keep him up t o date as t o whether the p a t i e n t has q u e s t i o n s t o d i s c u s s , i s e x p r e s s i n g c o n c e r n , and so o n . A f o u r t h a r e a where t h e v o l u n t e e r c o u l d a s s i s t i s a t the a d -m i t t i n g sect ion. S o c i a l S e r v i c e endeavours t o i n t e r v i e w a r e l a t i v e o r p e r s o n accompanying the p a t i e n t a t a d m i s s i o n i n o r d e r t o b e g i n t h e i r s tudy o f the p a t i e n t i n h i s home s i t u a t i o n . Q u i t e o f t e n the i n t a k e s o c i a l worker w i l l be i n t e r v i e w i n g when a new p a t i e n t a r r i v e s . The n a t u r a l d e s i r e o f a new p a t i e n t and r e l a t i v e i s t o be t o l d about the h o s p i t a l , and i n g e n e r a l what happens . The s e l e c t e d and e x p e r i e n c e d v o l u n t e e r , who s h o u l d be g i v e n some s p e c i f i c t r a i n i n g i n t h i s a r e a , w i l l be a b l e t o p r o v i d e t h i s i n f o r m a t i o n and a l l a y some o f the p a t i e n t ' s and r e l a t i v e ' s f e a r s -81-which may be due t o m i s c o n c e p t i o n s o f one k i n d o r a n o t h e r . The T h i r d Repor t o f the Wor ld H e a l t h O r g a n i z a t i o n " s E x p e r t Committee on Menta l H e a l t h d e s c r i b e s a s i m i l a r t y p e o f r o l e . They a r e s p e a k i n g o f a s t a f f p e r s o n who i s chosen t o r e c e i v e a new p a t -i e n t i n t o the h o s p i t a l group, but the s i t u a t i o n i s s i m i l a r enough t o warrant c o m p a r i s o n . "Such a r o l e s h o u l d be u n d e r t a k e n by a woman wi th a c a p a c i t y f o r s o c i a l c o n t a c t s , and w i th the p e r s o n a l q u a l i t i e s o f s e n s i t i v i t y , i n t e l l i g e n c e , and an a t t r a c t i v e p e r s o n -a l i t y . These q u a l i t i e s a re more impor tant than any t h e o r e t i c a l t r a i n i n g she may have h a d . " There has been o n l y b r i e f v o l u n t e e r - s o c i a l s e r v i c e c o l l a b o r -a t i o n on c a s e s t o date but i t seems e n t i r e l y f e a s i b l e t h a t t h i s be much more e x t e n s i v e . However, i t s h o u l d be on a g r a d u a l b a s i s t o ensure optimum work ing arrangements between v o l u n t e e r s and s o c i a l w o r k e r s . In a d d i t i o n , i t would seem d e s i r a b l e t h a t those v o l u n t e e r s s e l e c t e d t o work w i th s o c i a l s e r v i c e be a t t a c h e d t o t h a t depar tment . I m p l i c a t i o n f o r F u r t h e r Study There would seem t o be a c a s e f o r f u r t h e r s tudy o f t h i s v o l u n t e e r programme i n r e l a t i o n t o c a t e g o r i e s o f i l l n e s s . F o r example, t h e r e a r e no v o l u n t e e r s on t h e word f o r menta l d e f e c t i v e s . One r e a s o n g i v e n f o r t h i s i s t h a t t h e r e i s a l a c k o f v o l u n t e e r s t o meet t o t a l programme n e e d s . A s e c o n d , and s u p p o r t i n g r e a s o n g i v e n , i s t h a t n o t h i n g can be done f o r the d e f e c t i v e s , so t h a t t ime i s b e t t e r spend e l s e w h e r e . O t h e r r e a s o n s may be t h a t v o l u n -t e e r s a r e d i s c o u r a g e d at the l a c k o f r e s u l t s , o r they may f e e l p e r s o n a l d i s c o m f o r t over the type o f p a t i e n t , o r they may f e e l a l a c k o f d i r e c t i o n . - 8 2 -I t would be i n t e r e s t i n g t o t r y and s e t out t h e c r i t e r i a f o r one ward b e i n g chosen o v e r a n o t h e r because t h a t i s what i s happen-i n g . There may be a case f o r a s u r v e y t o be done of t h e d e f e c t -i v e s ' ward, f o l l o w i n g which a v o l u n t e e r team would work on t h e ward once a week f o r , say, s i x months t o see what p a t i e n t and s t a f f r e s p o n s e t h e r e might be. V o l u n t e e r s and Community E n l i g h t e n m e n t The c o n t r i b u t i o n o f s e r v i c e s by t h e v o l u n t e e r s t o t h e hos-p i t a l i s v e r y h e l p f u l and v a l u a b l e as r e v e a l e d i n t h e i r d a i l y a c t i v i t i e s w i t h t h e p a t i e n t s on t h e wards and o t h e r a r e a s . P o s s i b l y t h e i r g r e a t e s t c o n t r i b u t i o n however, i s i n h e l p i n g t h e i r f a m i l y , t h e i r f r i e n d s , t h e i r n e i g h b o u r s , t h e i r communities, t o g a i n a b e t t e r u n d e r s t a n d i n g o f m e n t a l i l l n e s s and what t h e p e r -s o n n e l o f t h e M e n t a l H e a l t h S e r v i c e s a r e t r y i n g t o do f o r t h e m e n t a l l y i l l p e r s o n . O n l y t h r o u g h g r e a t e r u n d e r s t a n d i n g o f m e n t a l i l l n e s s w i l l f e a r o f i t be overcome. The m e n t a l l y i l l man, woman, o r c h i l d q u i t e o f t e n behaves s t r a n g e l y , r e a c t s u n p r e d i c t a b l y , and o f t e n i n s p i r e s f e a r i n t h e b y s t a n d e r , n e i g h b o u r , o r even l o v e d one. I n some c a s e s , c e r t a i n l y , t h e r e i s f e a r r e s u l t i n g f r om r e a l danger o f p h y s i c a l v i o l e n c e , but p r o b a b l y i n most c a s e s i t i s t h e f e a r o f t h e unknown. Through t h e c e n t u r i e s t h e m e n t a l l y i l l p e r s o n has been r e -garded i n v a r i o u s ways. He has been c o n s i d e r e d as b e i n g o f a d i v i n e n a t u r e and as such was r e s p e c t e d but t h e r e s p e c t was b o r n out o f f e a r . On t h e o t h e r hand, he has been r e g a r d e d as a demon, p o s s e s s e d by an e v i l power, and e i t h e r d r i v e n away -83-o r k i l l e d . W h i l e t h i s may seem (and was) d r a s t i c i t d i d mark t h e b e g i n n i n g o f a t h e r a p e u t i c a t t i t u d e because t h e aim o f t h e i l l - t r e a t m e n t was t o e x p e l t h e e v i l s p i r i t r a t h e r t h a n t o cause s u f f e r i n g t o t h e p e r s o n u n f o r t u n a t e enough t o be p o s s e s s by i t . S t i l l l a t e r , a l t h o u g h f e a r e d , t h e m e n t a l l y i l l p e r s o n became an o b j e c t o f p i t y but n e v e r t h e l e s s d i f f e r e n t i n n a t u r e f rom o t h e r human b e i n g s , r e q u i r i n g t h a t he be l o c k e d up. T h i s was t o p r o -t e c t him from h i m s e l f but a l s o t o r i d s o c i e t y o f h i s presence.""" To-day, t h a n k s t o t h e work o f t h e m e n t a l h e a l t h c r u s a d e r s o f t h e l a s t hundred y e a r s and t o such o r g a n i z a t i o n s as our own Canadian M e n t a l H e a l t h A s s o c i a t i o n , not o n l y i s t h e b a t t l e f o r pr o p e r p s y c h i a t r i c t r e a t m e n t f o r m e n t a l l y i l l c i t i z e n s b e i n g won, but r e a l i n r o a d s a r e b e i n g made towards g e t t i n g community c o o p e r -a t i o n as w e l l . These advances have l e d t o t h e m e n t a l l y i l l b e i n g c o n s i d e r e d as s i c k p e o p l e c a p a b l e o f b e i n g t r e a t e d and c u r e d . However g r a t i f y i n g t h i s may be t h e f e e l i n g s t i l l p e r s i s t s i n our minds t h a t o n l y t h o s e who a r e not dangerous and who have a good p r o g n o s i s a r e s i c k ; t h e o t h e r s a r e i n s a n e . I t i s i n h e l p i n g t o overcome t h i s d i s t i n c t i o n , t h i s r e m a i n -i n g f e a r o f t h e i n s a n e , t h a t t h e v o l u n t e e r can c o n t r i b u t e what may be h i s o r h e r most w o r t h w h i l e s e r v i c e t o t h e cause o f m e n t a l h e a l t h , namely, i n t e r p r e t a t i o n t o t h e p u b l i c . E f f e c t i v e as h i g h l y o r g a n i z e d p u b l i c r e l a t i o n s e f f o r t s may may be they can be made even more so by t h e p e r s o n - t o - p e r s o n c o n t a c t s o f t h e v o l u n t e e r s . W o r l d H e a l t h O r g a n i z a t i o n T e c h n i c a l R e p o r t S e r i e s No. 98. " L e g i s l a t i o n A f f e c t i n g P s y c h i a t r i c Treatment," F o u r t h R e p o r t  o f t h e E x p e r t Committee on M e n t a l H e a l t h ; Geneva. 1955. p. 3. -84-Many a r t i c l e s have been p u b l i s h e d i n r e c e n t y e a r s about the m e n t a l l y i l l , but v e r y few about what t o t h o s e o f us i n h o s p i t a l s i s the most impor tant change f o r the b e t t e r i n our own case - our f r i e n d s , the v o l u n t e e r s . The p r i v a t e w o r l d o f the m e n t a l l y s i c k i s o n l y a p a r t -t ime t h i n g , except w i th the o l d s t y l e " b a c k w a r d s . " What t r o u b l e s us more than t h i s , which m e d i c i n e s and ; t rea tment can remove, i s the s u p e r s t i t i o n s . . . o n l y w i th u s , we a r e n ' t a f r a i d o f u n u s u a l b e h a v i o r - we a r e a f r a i d o f o t h e r p e o p l e s f e a r s o f u s l * The v o l u n t e e r has been to the menta l h o s p i t a l , has seen and v i s i t ed w i th " i n s a n e " p e o p l e and , p resumably , has d i s p e l l e d h i s o r her own f e a r s about the m e n t a l l y i l l p e r s o n . In t h e i r own way v o l -u n t e e r s can i n t e r p r e t c l e a r l y and f r a n k l y t o t h e i r ne ighbour o r f e l l o w worker (or whatever the c a s e may b e ) , the f a c t s o f the s i t u a t i o n as they see i t . Perhaps a smoother job o f i n t e r p r e t -a t i o n c o u l d be done by a p r o f e s s i o n a l p e r s o n , but t h e r e i s a r e a l c a s e f o r the f r a n k , d o w n - t o - e a r t h i n t e r p r e t a t i o n which the v o l u n t e e r can g i v e . We a r e l i v i n g i n a propaganda age , an a d -v e r t i s i n g age , the key note o f which i s p e r s u a s i o n . In t h i s w r i t e r ' s o p i n i o n we have had so much o f t h i s t h a t we now t e n d t o l o o k at any " p r o f e s s i o n a l " s a l e s " p i t c h " w i th r e s e r v a t i o n s which r e s t r i c t our o b j e c t i v i t y . G e n e r a l l y s p e a k i n g , the v o l u n t -eer has no axe t o g r i n d and i s much e a s i e r t o i d e n t i f y w i th -b e i n g a f r i e n d , n e i g h b o u r , o r work-mate - than i s a v o i c e on the r a d i o , a s t r a n g e r on the t e l e v i s i o n s c r e e n , o r a l e c t u r e r on a p l a t f o r m . The v o l u n t e e r ' s i n t e r p r e t a t i o n o f menta l i l l n e s s w i l l go a l o n g way toward s u b s t a n t i a t i n g l a r g e s c a l e p u b l i c r e l a t i o n s e f f o r t s and toward d i s p e l l i n g the r e m a i n i n g f e a r s o f the p u b l i c about menta l i l l n e s s . L e t t e r t o E d i t o r by a former m e n t a l l y i l l p e r s o n , Redbook; A u g u s t , 1957. - 85 -I n h i s 1957 a n n u a l r e p o r t , Dr. A r t h u r Gee, D i r e c t o r o f M e n t a l H e a l t h S e r v i c e s i n B r i t i s h Columbia had t h i s t o say about community awareness: The y e a r s f o l l o w i n g W o r l d War I I have seen a tremendous development i n t h e p s y c h i a t r i c s e r v i c e s o f our P r o v i n c e ... p r o b a b l y t h e g r e a t e s t s i n g l e development which has o c c u r e d has been t h e awakening o f p u b l i c i n t e r e s t i n m a t t e r s p e r t a i n i n g t o m e n t a l h e a l t h and an i n c r e a s i n g awareness of t h e p a r t which t h e community can p l a y i n m a i n t a i n i n g good m e n t a l h e a l t h f o r i t s c i t i z e n s . * This'"awakening o f p u b l i c i n t e r e s t " has r e s u l t e d i n t h e f o r m a t i o n o f t h e C anadian M e n t a l H e a l t h A s s o c i a t i o n ' s v o l u n t e e r s e r v i c e s t o t h e P r o v i n c i a l M e n t a l H o s p i t a l and C r e a s e C l i n i c . The s t a f f o f C.M.H.A.'s B r i t i s h Columbia D i v i s i o n and t h e v o l u n t e e r s d e s e r v e h i g h p r a i s e f o r t h e e x c e l l e n t programme t h e y a r e d e v e l o p i n g . T h i s community v o l u n t e e r programme has tremendous p o t e n t i a l and e v e r y e f f o r t s h o u l d be made by management and s t a f f not o n l y t o c o n t i n u e i t s p r e s e n t s u p p o r t and encouragement but t o i n c r e a s e a c t i v i t y i n t h i s r e g a r d . The more e f f e c t i v e we a r e i n i n t e r p r e t -i n g t h e h o s p i t a l ' s needs t o t h e v o l u n t e e r s , t h e more e f f e c t i v e t h e y w i l l be as i n t e r p r e t e r s t o t h e community. B r i t i s h C o lumbia, A n n u a l R e p o r t o f t h e M e n t a l H e a l t h  S e r v i c e s ; Queen's P r i n t e r s ; V i c t o r i a , B r i t i s h Columbia; 1957. p. 15. - 8 6 -Appendix A Canadian Mental Health Association Questionnaire on Hospital Volunteer Training. THE CANADIAN MENTAL HEALTH ASSOCIATION BRITISH COLUMBIA DIVISION HOSPITAL VOLUNTEER TRAINING - PRELIMINARY QUESTIONNAIRE 1. Miss, Mrs., Mr. 2, Address Telephone (Home) ZONE (Business) 3.(a) Occupation (b) Place of employment 4. (a) What languages do you speak? (b) What languages do you read? _ 5. (a) Can you provide your o\<m transportation to and from the hospital? (b) How many others can you accommodate? 6. (a) Have you ever done hospital volunteer work before? (b) What type? Length of time 7. (a) Do you l i k e to read aloud? , _____ (b) With what types of handwork or craftwork are you experienced? (c) What types of discussion groups, i f any, have you conducted? (d) Have you any l i b r a r y experience? (e) Have you any teaching experience? (f) Have you any special hobbies? A v a i l a b i l i t y : (a) Can you participate throughout the year? (b) W i l l you be out of town a certain amount? (c) Can you serve any day during the week? Preferences (d) Can you serve during the - daytime? - evenings? (e) How much time can you give - weekly? - monthly? 9. Do you have any preference for working i n any one hospital a c t i v i t y ? I f so, which? _____________ 10. Do you know others i n t h i s volunteer program with whom you would l i k e to work? I f so, give t h e i r names. QUESTIONNAIRE Name Date The following Questionnaire i s composed of a number of statements - some true and some false.. Each statement i s followed by the l e t t e r s "T" and "F". Read each statement carefu l l y . I f the statement i s true, c i r c l e the "T". I f the statement i s f a l s e , c i r c l e the "F" . Please answer a l l questions. 1. Unusual behaviour and peculiar ideas are always present i n a l l mental patients. T F 2. People who l i k e to work around mental patients are usually somewhat mentally queer themselves. T F 3. Mental disease i s not contagious. T F h. I t i s very d i f f i c u l t to i n s u l t or offend a mental patient. T F 5. I have had a nervous disorder. T F 6. People who work around mental patients often become i l l themselves. T F 7. A l l mental patients are very much a l i k e . T F 8. In order to work successfully with mental patients, you should f i r s t win t h e i r confidence. T F 9. Many people feign insanity to receive government support. T F 10., Knowledge of mental disease i s not harmful to well-adjusted normal people. T F 11. I have been under treatment for a nervous condition. T F 12. There i s much that can be done for mental patients aside from administering to t h e i r physical wants and hoping they w i l l get w e l l . T F 13. Insults and obscene language are invariably found with mental patients. T F 14'. Mental patients should be s t e r i l i s e d before being allowed to leave the hospital. T F 15. One should pay no attention to requests from mental patients since they do not know what i s best for them. T F 16. Some mental patients have a r e a l sense of humour. T F 17. When dealing with patients i n a mental h o s p i t a l , one should remember that they are different from normal people i n t h e i r thinking and fee l i n g . T F 18. Mental disease i s hereditary. T F 19. 1 have been a patient in-a mental hospital- • T F 20. Mental disease i s not more d e f i n i t e l y prevalent i n one race than another. T F 21. I t i s unnecessary to win a mental patient's confidence as he mistrusts everyone anyway. T F 22. Most mental patients are curable. T F 23. In working with mental patients, a sympathetic attitude i s more important than an understanding of t h e i r disease. T F Page 2. Name Date Most mental patients are homicidal. T F 25- Punishment often convinces a patient that he should behave more normally. T F 26. I have changed jobs frequently because of physical or mental ailments. T F 27. Wealthy people very seldom have mental i l l n e s s . T F 28. "Everybody i s a l i t t l e crazy" at times, and a l l of us have had serious doubts about our sanity at one time or another. T F 29- Most mental patients appreciate favours that you do f o r them. T F 30. A l l mental patients l i k e to be by themselves and resent interruptions and intrusions from outsiders. T F 31. I am subject to frequent blue s p e l l s or sick headaches. T F 32. You can usually t e l l whether a man i s insane by the look i n his eyes? T F 33. Mental patients are r e a l l y sick l i k e other patients i n other hospitals. T F 34. The actions and speech of most mental patients are revolting and disgusting to a person of f i n e breeding. T F 35. " Once a person has been mentally i l l , he can never lead a completely normal existence again. T F 36. I consider myself a rather high-strung person. T F 37. Some mental patients do not require kindness and consideration. T F 38. Most mental patients come from the slums. T F 39. Mental patients need more punishment and c r i t i c i s m than normal people because they do not understand what they are doing. T F 40. I often complain of various physical ailments. T F 4l. Demanding mental patients should be ignored. T F 42. People who lead immoral l i v e s often go insane as a r e s u l t . T F 43. Mental patients have feelings and emotions l i k e other people do. T F 44. Many insane people are r e a l l y criminals and are not sick. T F 45. People consider me a healthy, well-rounded person. T F Thank you f o r your good w i l l i n answering t h i s questionnaire. I t i s our desire to protect potential volunteers from assignments which may prove detrimental to them. Without the volunteer's co-operation i n answering a l l of the above items t r u t h f u l l y , that would be impossible. -87-\ Appendix B Questionnaire for purpose of gathering information about the Volunteer Programme. The purpose of this Questionnaire i s to assist i n the gathering of information about a Volunteer Programme.  Special S k i l l s and Education of Volunteer: Psychology Course 11. Sociology Course 4. Arts & Crafts 15. Physical Education 5. Music 13* Drama 3. Language (specify) 5. Other Specialties 15. No Specialty 46. AGE range of Volunteers 20 years and under 5. 21 - 30 years 1. 31 - 40 years 20. 4 1 - 5 0 years 35. 5 1 - 6 0 years 20. Over 60 years 8. 89. HOW did you hear of the Volunteer Programme? Radio ..' 10. Television 3. Newspaper 15. Hospital staff 2. Other Volunteer 37. Volunteer Bureau ........... 5. Relatives 1. Ex-patients '". 1. Community Groups (specify).. 16. Other source (specify) 6. DISTANCE . travelled from Home to Hospital average 17 miles approx. TIME spent i n travelling from Home to Hospital average 4-0 minutes " NAME -88-Appendix C. Bibliography General References Beers, C l i f f o r d , A Mind That Found I t s e l f ; Doubleday; New York; 1948. : Biestek, F e l i x P., "An Analysis of the Casework Relationship", S o c i a l Casework, 35. February 1954. B r i t i s h Colvimbia, Annual Report of the Mental Health Services; Queen's Pr i n t e r s ; V i c t o r i a , B.C. 1957. B r i t i s h Columbia, P s y c h i a t r i c Services Physicians Manual. 1956. Canadian Mental Health Association, B r i t i s h Columbia D i v i s i o n , Annual Report. 1957. Committee on Public Information, "A P s y c h i a t r i c Glossary", American P s y c h i a t r i c Association. 1957. Deutsch, Albert, The Mentally 111 i n America; A History of Their Care and Treatment from Colo n i a l Times. Columbia University Press; New York; 1946. Deutsch, Albert, The Shame of the States; Harcourt Brace and Company; New York; 1948. Exner, H.K., "The Development of a Program for Volunteers i n Mental Health i n B r i t i s h Columbia." Unpublished paper. Greenblatt, Milton, Mental Hospitals; From Custodial to Thera-peutic Care; Russell Sage Foundation; New York; 1955. Katz, Sidney, "The Amazing Career of Clare Hincks", Maclean's  Magazine, August 1, 1954. Richmond, Mary, The Long View; Russell Sage Foundation; New York; 1930. Ross, Murray G. Community Organization; Theory and P r i n c i p l e s ; Harper and Brothers; New York; 1955. Stern, Edith. M., Mental I l l n e s s ; A Guide for the Family. National Association for Mental Health, Inc; New York; 1951. von Mering, Otto, and King, Stanley, Remotivating the Mental  Patient; Russell Sage Foundation; New York; 1957. -89-W o r l d H e a l t h O r g a n i z a t i o n T e c h n i c a l R e p o r t S e r i e s No. 98, " L e g i s l a t i o n A f f e c t i n g P s y c h i a t r i c Treatment", F o u r t h  R e p o r t o f t h e E x p e r t Committee on M e n t a l H e a l t h ; Geneva; 1955. : S p e c i f i c R e f e r e n c e s C o l l i n s , M a r j o r i e A. "The V o l u n t e e r s R o l e i n R e n d e r i n g S e r v i c e t o I n d i v i d u a l s " , Casework P a p e r s 1957, F a m i l y S e r v i c e A s s o c i a t i o n o f A m e r i c a ; New Y o r k ; 1957. Evans, Ruth L., " V o l u n t e e r s i n M e n t a l H o s p i t a l s " M e n t a l Hygiene, volume 39, 1955. Fechner, A.H. and P o r k e , J . , "The V o l u n t e e r Worker and t h e P s y c h i a t r i c H o s p i t a l " , A m e rican J o u r n a l o f P s y c h i a t r y , volume 107, 1950-51. Frank, M a r j o r i e , " V o l u n t e e r s i n M e n t a l H o s p i t a l s " , M e n t a l  Hygiene, volume 32, 1948. Frank, M a r j o r i e , " V o l u n t e e r Work w i t h P s y c h i a t r i c P a t i e n t s " , M e n t a l Hygiene, volume 33, 1949. Handbook f o r V o l u n t e e r s , Canadian M e n t a l H e a l t h A s s o c i a t i o n , B r i t i s h Columbia D i v i s i o n . H u r l e y , C , " O c c u p a t i o n a l Therapy Program o f a M e n t a l H o s p i t a l " , A m e r i c a n J o u r n a l o f O c c u p a t i o n a l Therapy, volume 2, J u l y - A u g u s t , 1948. Hyde, R.W. and H u r l e y , C.F., " V o l u n t e e r s i n M e n t a l H o s p i t a l s " , P s y c h i a t r i c Q u a r t e r l y Supplement, volumes 24-25, 1950-51. K i m b a l l , Joy, Guide f o r O r g a n i z a t i o n o f V o l u n t e e r S e r v i c e i n  M e n t a l H o s p i t a l s ; M a s s a c h u s e t t s A s s o c i a t i o n f o r M e n t a l H e a l t h , I n c . McBee, M a r i a n , and Frank, M a r j o r i e , V o l u n t e e r P a r t i c i p a t i o n i n  P s y c h i a t r i c H o s p i t a l S e r v i c e s ; O r g a n i z a t i o n Manual and Program Guide, N a t i o n a l Committee f o r M e n t a l Hygiene; New York; 1950. M c G r i f f , Dorothy, "A V o l u n t e e r Program i n a N e u r o p s y c h i a t r i c H o s p i t a l " , S o c i a l Casework, volume 37, 1956. Mayotte, A.S., "A S o c i a l Group P r o j e c t i n t h e R e h a b i l i t a t i o n o f D i s c h a r g e d M e n t a l H o s p i t a l P a t i e n t s " , The S o c i a l Worker, Janu a r y , 1957. -90-N e l s s o n , G.L., "The C i t i z e n V o l u n t e e r s i n M e n t a l H e a l t h ? M e n t a l Hygiene, volume 35, 1951. Notes on V o l u n t e e r Work i n M e n t a l H o s p i t a l s , C anadian M e n t a l H e a l t h A s s o c i a t i o n , T o r o n t o , O n t a r i o , 1956. Ridgeway, E l i z a b e t h , "The V o l u n t e e r Program a t Delaware S t a t e M e n t a l H o s p i t a l " , J o u r n a l o f O c c u p a t i o n a l Therapy, volume 5, 1951. Selman, L a u r a , " V o l u n t e e r s i n a M e n t a l H o s p i t a l " , C a n a d i a n  W e l f a r e , December 15, 1956. Sharp, Agnes A., How V o l u n t e e r s Work i n S t a t e H o s p i t a l s ; Department of P u b l i c W e l f a r e ; 1953. Sharp, Agnes, Why V o l u n t e e r s i n I l l i n o i s M e n t a l H o s p i t a l s ; S t a t e o f I l l i n o i s , 1952. S t e t s o n , E d i t h , "The R o l e P l a y e d by V o l u n t e e r s i n a M e n t a l H o s p i t a l " , J o u r n a l o f O c c u p a t i o n a l Therapy, volume 5, 1951. S t e w a r t , Jean, and Gordon, A r t h u r . , "The Most Rewarding N i g h t o f Our Week", Redbook, J u l y 1957. 

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