DEPARTMENT OF HEALTH Mental Health Branch PROVINCE OF BRITISH COLUMBIA ANNUAL REPORT 1973 Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1974 To the Honourable Walter S. Owen, Q.C, LL.D., Lieutenant-Governor oj the Province oj British Columbia. May it please Your Honour: The undersigned respectfully submits the Annual Report of the Mental Health Branch, Department of Health, for the year 1973. DENNIS G. COCKE Minister oj Health Office oj the Minister oj Health, Victoria, B.C., January 31,1974. 1 Department of Health, Mental Health Branch, Victoria, B.C., January 31, 1974. The Honourable Dennis G. Cocke, Minister oj Health, Victoria, B.C. Sir: I have the honour to submit the Annual Report of the Mental Health Branch for 1973. F. G. TUCKER, M.B., B.S., C.R.C.P., M.Sc Deputy Minister oj Mental Health DEPARTMENT OF HEALTH MENTAL HEALTH BRANCH The Honourable Dennis G. Cocke, Minister of Health GENERAL ADMINISTRATION F. G. Tucker, M.B., B.S., C.R.C.P., M.Sc, Deputy Minister of Mental Health. A. Porteous, Assistant Deputy Minister of Mental Health. J. S. Bland, B.A., M.B., B.Chir., M.R.C.Psych., D.P.M., Co-ordinator of Mental Retardation and Children's Psychiatric Services. H. W. Bridge, M.A., M.B., B.Ch., B.A.O., M.Sc, M.R.C.PSYCH., F.R.C.P.(C), Co-ordinator of Adult Psychiatric Services. F. A. Matheson, Departmental Comptroller. R. H. Goodacre, B.A., M.A., C.P.H., Sociologist. Miss M. N. Lonergan, B.S.N.Ed., M.N., Nursing Consultant. R. S. McInnes, B.A., B.D., M.P.H., Co-ordinator of Mental Health Centres. A. G. Devries, Ph.D., Consultant in Psychology. Mrs. F. Ireland, B.A., M.S.W., Co-ordinator of Boarding-homes. P. Bingham, M.S.W., Assistant Co-ordinator of Boarding-homes. G. L. Tomalty, B.A., M.P.A., Departmental Personnel Officer. A. A. Bishop, B.Ed., Assistant Personnel Officer. K. Denecke, B.Com.,* Mrs. C. W. Porteous, B.A., M.A.,t Statistician. W. A. Blair, Management Analyst. R. H. Thompson, Director, Information Services. N. W. Wylie, Administrative Officer. Mrs. P. A. West, R.R.L., Consultant in Medical Records. COMMUNITY MENTAL HEALTH CENTRES P. Adrian, M.S.W., Administrator, Abbotsford Mental Health Centre. A. L. Aranas, M.D., D.Psy., Administrator, Victoria Mental Health Centre. Y. Bledsoe, M.S.W., Administrator, Powell River Mental Health Centre. V. N. Brown, M.S.W., A.C.S.W., Administrator, Port Alberni Mental Health Centre. R. L. Cameron, M.S.W., R.S.W., Administrator, Trail Mental Health Centre. M. A. Carvell, R.N., Administrator, Squamish Mental Health Centre. R. Gracey, B.A., B.D., M.S.W., Administrator, Prince Rupert Mental Health Centre. F. J. Hannah, M.A., Administrator, New Westminster Mental Health Centre. A. I. Holmes, B.A., M.S.W., Administrator, Kelowna Mental Health Centre. W. C. Holt, B.A., M.D., C.R.CP.(C), Administrator, Burnaby Mental Health Centre. P. Humphrey, B.A., M.S.W., Administrator, Williams Lake Mental Health Centre. J. A. Hutton, M.S.W., Administrator, Duncan Mental Health Centre. * Resigned August 31. t Appointed November 15. J. Kanevsky, M.A.* Administrator, Courtenay Mental.Health Centre. K. Lerner, B.A., M.S.W., Administrator, Langley Mental Health Centre. E. Little, B.S.N., Administrator, Fort St. John Mental Health Centre. E. Luke, M.B., Ch.B., D.P.M., F.R.C.P., M.R.C.Psych., Administrator, Maple Ridge Mental Health Centre. P. McArthur, P.H.N., R.N., Administrator, Port Coquitlam Mental Health Centre. A. J. McSweeney, Administrator, Sechelt Mental Health Centre. D. L. Mitchell, B.Ed., M.A., Administrator, Surrey Mental Health Centre. J. M. Mossing, R.N., B.N., Administrator, Penticton Mental Health Centre. B. Schikowsky, B.A., M.S.W., Administrator, Chilliwack Mental Health Centre. J. M. Smith, Ph.D., Administrator, Whalley Mental Health Centre. J. Snyder, B.Sc, B.S.W., M.S.W., Administrator, Prince George Mental Health Centre. E. J. Sopp, M.S.W., R.S.W., Administrator, Nelson Mental Health Centre. M. Stephens, M.S.W., Administrator, Cranbrook Mental Health Centre. S. G. Travers, M.S.W., Administrator, Terrace Mental Health Centre. R. D. Turner, B.A., B.S.W., M.S.W., Administrator, Nanaimo Mental Health Centre. P. Wheatley, M.S.W., Administrator, Kamloops Mental Health Centre. J. T. Wood, M.D., Administrator, Saanich Mental Health Centre. S. Zimmerman, B.S.W., Administrator, Vernon Mental Health Centre. MENTAL HEALTH SERVICES J. C. Johnston, M.D., F.A.C.H.A., Executive Director, Riverview Hospital. W. J. G. McFarlane, B.A., M.D., D.Psych., C.R.C.P., Clinical Director, Riverview Hospital. W. W. Black, M.B., B.Sc, D.P.M., C.R.C.P.(C), Superintendent, Geriatric Division. J. Bower, M.D., M.R.C.Psych., D.P.M., Superintendent, Tranquille. A. P. Hughes, M.D., B.Sc, C.R.C.P., Executive Director, Woodlands. Mrs. E. Paulson, B.S.N.,t Acting Director of Nursing Education. BRITISH COLUMBIA YOUTH DEVELOPMENT CENTRE A. G. Devries, Ph.D., Acting Director, Residential Unit. D. C. Shalman, Ph.D., Director, Psychological Education Clinic. A. A. Cashmore, M.D.(Lond.), Director, Family and Children's Clinic. * J. L. Kyle, M.A., on educational leave, effective September 17. t Retired July 31. 10 E 1 o Z o I-H H 3 O O EC 0 z 9 H Z tt! W H Z >< H D w n *3 o s> c ^ 6 •o fc. §0 I . "5 Pi o"ra 6 c 0 w s I-I rt ra u o "°Ph £ 3§ 111 » rt 3 *C u- ■a c « <u SogU U 2 o o 1? Ao Jm, S o - 3 2 oZ 0 S3 8 •- o « go is u r- ilJ .3 S E& DO u o Sa PD O cK || — &•£• _, 3.S <"d 'o. ^ O X s T3 4) ■.E o- 6! 11 HISTORICAL FEATURE TABLE OF CONTENTS Page 11 GENERAL ADMINISTRATION The Year in Review Business, Construction, and Maintenance Review.. Personnel Adult Psychiatric Services 17 20 22 24 Retardation and Children's Psychiatric Services 26 Nursing Consultation Services 27 Boarding-home Programme 29 Sociology Consultation Services 31 Psychology Consultation Services 32 Management Analyst Consultation Services 33 Statistics and Medical Records 34 Information Services 36 COMMUNITY MENTAL HEALTH SERVICES 39 Abbotsford Mental Health Centre 40 Burnaby Mental Health Centre 40 Chilliwack Mental Health Centre 43 Courtenay Mental Health Centre 44 Cranbrook Mental Health Centre 45 45 46 47 48 49 49 51 52 53 54 56 57 58 Duncan Mental Health Centre Fort St. John Mental Health Centre.. Kamloops Mental Health Centre Kelowna Mental Health Centre Langley Mental Health Centre Maple Ridge Mental Health Centre.. Nanaimo Mental Health Centre Nelson Mental Health Centre New Westminster Mental Health Centre. Penticton Mental Health Centre Port Alberni Mental Health Centre Port Coquitlam Mental Health Centre Powell River Mental Health Centre. Prince George Mental Health Centre 59 Prince Rupert Mental Health Centre 60 Saanich Mental Health Centre 60 Sechelt Mental Health Centre 61 Squamish Mental Health Centre 61 Surrey Mental Health Centre Terrace Mental Health Centre Trail Mental Health Centre Vernon Mental Health Centre Victoria Mental Health Centre Whalley Mental Health Centre Williams Lake Mental Health Centre.. 13 62 63 64 65 66 67 68 Page IN-PATIENT SERVICES Department of Nursing Education 73 Riverview Hospital 75 Geriatric Division 79 Woodlands 83 Tranquille 89 British Columbia Youth Development Centre 92 PATIENT MOVEMENT Patient Movement Trends 99 Patient Movement Data 100 FINANCIAL STATEMENTS : 103 14 GENERAL ADMINISTRATION The Year in Review Business, Construction, and Maintenance Review Personnel Adult Psychiatric Services Retardation and Children's Psychiatric Services Nursing Consultation Services Boarding-home Programme Sociology Consultation Services Psychology Consultation Services Management Analyst Consultation Services Statistics and Medical Records Information Services ■A GENERAL ADMINISTRATION THE YEAR IN REVIEW F. G. Tucker, M.B., B.S., C.R.C.P., M.Sc. Deputy Minister oj Mental Health The mental health programme of this Province continued to evolve satisfactorily in 1973 with significant advances in the field of community care and a continuing readjustment and realignment of in-patient resources to complement the regional programmes. These changes called for hard work and a high degree of co-operation by all concerned. Staff had to assume new attitudes, roles, and responsibilities as they pioneered programmes which, by their very nature, were often experimental and lacked the support of a well-tried administrative structure. For details of the various programmes, reference should be made to the appropriate section of this Report. However, I would like to draw attention to a number of developments which I believe warrant special mention. I am pleased to report that in February the Metropolitan Board of Health for Greater Vancouver agreed to assume responsibility for administration of the Greater Vancouver Mental Health Project. This can be viewed as a "bed replacement project" in that its intent is to assist and support the chronically disabled mentally ill individual, so that he or she can function adequately in the community and thereby avoid, or minimize, hospitalization. The basic team consists of nine or ten mental health personnel who are located in a variety of accommodation in the community they serve. This professional group attempts to work in co-operation with involved local residents in the development of the programme. During the year, the Mental Health Branch agreed to the establishment of seven teams and approved the necessary funds. These teams are coming into operation as quickly as suitable staff can be recruited. It should be emphasized that this project is only one limited component of the over-all mental health programme for Greater Vancouver. In the early summer, steps were taken to implement a comprehensive mental health programme for Burnaby. This is the first attempt in this Province to provide a truly integrated mental health programme for a clearly defined region. It will be noticed that there is a heavy emphasis on back-up services in this particular programme, in the form of the three community care teams and a large day-hospital component. Only 25 in-patient beds for a population of 140,000 are presently planned, in anticipation that these additional ambulatory services will provide an effective and less expensive alternative to the traditional hospital admission. A variation in the pattern of community care is being set up in the Lower Fraser Valley. This region is already served to a limited extent by five mental health centres and relies on the Riverview Hospital for the majority of its in-patient care. Steps have now been taken to deploy hospital psychiatrists in the community mental health centres in order to augment the local services to the adult mentally ill. They will, when necessary, admit and treat patients from their area at the Riverview Hospital. Once again we hope that the number of hospital admissions 17 L 18 MENTAL HEALTH BRANCH REPORT, 1973 and the length of stay can be reduced, so that in due course additional hospital staff can be freed from their hospital base and assigned to the local communities. The difficulty in recruiting trained psychiatrists seriously impaired the effectiveness of the Riverview Hospital programme during the first half of this year. By November, however, almost all medical staff vacancies had been filled by well-qualified physicians. I would particularly like to acknowledge the support and assistance that we received from the B.C. Medical Association, Section of Psychiatry. A number of private psychiatrists undertook sessional work in the hospital over and above their normal office practice. In September, the Branch and Hospital administration took active steps to divide the Riverview Hospital into five relatively self-contained programmes, each with its own specific goals and objectives. These changes will permit the resources of the hospital to be more readily adapted to meet the changing needs of the Province and allow for a more adequate assessment of standards and the evaluation of the effectiveness and cost of the various programmes. Above all, it will facilitate the melding of the hospital with the community. I must stress the magnitude of the task involved in structuring and reorienting a large hospital complex, a task that will require the fullest co-operation and dedication from all levels of staff if it is to be expeditiously and successfully achieved. There has been a general decline in the patient census at Riverview Hospital with an average bed occupancy for the first nine months of 2,002, compared to 2,240 for the same nine-month period in 1972. Although there was a substantial increase in staff from 1,667 to 1,986, these staff were required to replace patients formerly employed in various working situations, to compensate for increased fringe benefits approved by the Government for employees, as well as generally to improve standards of care. Delegates from eight Asian countries attended a conference on pyschiatric education from May 14 to 16 in Vancouver and Victoria. Their North American tour was under the auspices of the National Institute of Mental Health (U.S.A.), and during their two-day visit to the Province they were guests of the Department of Psychiatry of the University of British Columbia. The above photograph was taken at the Provincial Museum, Victoria. GENERAL ADMINISTRATION L 19 There has been no major expansion of the Community Mental Health Centre Programme. During 1973, centres were established at Abbotsford, Squamish, Sechelt, and Langley. After a long delay, the Prince Rupert Centre was also brought into operation. On August 9, the last class of psychiatric nurses graduated from the Department of Nursing Education at Essondale. Over the past 42 years, 3,065 nurses have graduated from this school, and the Province owes a debt of gratitude to the many dedicated faculty members who have served the programme during this time. We look forward to the first graduating class of psychiatric nurses from the B.C. Institute of Technology in 1974. While there have been no major changes in the field of retardation and psycho- geriatric care, these units continued to refine their programmes and to upgrade their standards and expectations. In all units there has been a general increase in the severity of illness of patients, as increasing numbers of more easily cared for patients and trainees are retained in the community. Nevertheless, these units continued to operate at a high level. The Mental Health Branch provided grants, under the auspices of the Treatment Resources Act, to a variety of agencies who care for both the retarded and emotionally disturbed: $ Alberni District Association for the Mentally Retarded 20,000 B.C. Association for the Mentally Retarded 60,000 Burnaby Association for Mentally Retarded 46,667 Children's Hospital, Vancouver 6,667 Rotary Club of Chilliwack 17,000 Maple Ridge Association for Retarded 21,707 M.S.A. Association for Retarded 8,332 Prince George and District Association for Retarded 28,666 Salmon Arm Association for Mentally Retarded 16,667 Terrace Association for Retarded Children 14,000 Vernon and District Association for Retarded 6,333 Williams Lake Association for Retarded 14,691 Kinsmen Club of Salmon Arm 32,927 Nanaimo Vocational Rehabilitation Workshop for Handicapped 22,783 Reorganized Church of Jesus Christ of Latter Day Saints (B.C. Division) 14,408 Terrace District Christian Council for Social Resources 13,333 During the year the Mental Health Branch has been stimulated by the new potential for change so that the Department may more readily meet present and future challenges in the field of mental health. It has not been free of anxieties and frustration, as pressing needs have called for staff to move forward often in the vanguard of the health care system. BUSINESS, CONSTRUCTION, AND MAINTENANCE REVIEW Riverview Hospital, Essondale A new recreational facility was under way at the Riverside Building, as well as general renovations to the building. The old Colony Farm cottage building was demolished and replaced by a new bunkhouse building to accommodate Colony Farm staff. Renovations to Nurses' Homes 6, 7, and 8 were completed. Planning was completed for the renovation of the second and fourth floors in the Crease Unit. Planning progressed in connection with the renovation of the Pennington Hall Canteen. Planning for a new laundry was held up pending a report from the Vancouver Regional Hospital Board regarding their requirements. In the meantime, the Department of Public Works endeavoured to find a new site for this laundry. Woodlands, New Westminster An addition to the industrial therapy building was completed and officially opened on May 9, 1973. An addition to the transport building was completed. Work progressed on renovations to Nurses' Home 3, to convert it into an academic and activity building. A site on the Woodlands property was selected to construct a 250-bed extended-care unit, which would be operated by the Queen's Park Hospital Society. Planning for the unit was proceeding. Tranquille, Tranquille The Department of Public Works awarded a contract in the amount of $1,800,000 for the construction of five 20-bed units, and work got under way in the late summer. Valleyview Hospital, Essondale Planning was under way to update Valleyview buildings and the 100-bed units, which would consist mainly of improvements in electrical services, plumbing, and the provision of oxygen. Dellview Hospital, Vernon Planning started for the renovation of the hospital building. A contract was entered into with the Jubilee Hospital, Vernon, to supply laundry services to the Dellview Hospital. Dellview's laundry facilities would be converted to other uses. Skeenaview Hospital, Terrace Preliminary planning started on the 75-bed replacement unit. At the year-end, Public Works was making a survey regarding the replacement of the Skeenaview Hospital laundry and constructing a new regional laundry to serve the Terrace area. 20 GENERAL ADMINISTRATION L 21 The Skeenaview Lodge Society was formed to take over the operation of the Skeenaview Hospital, possibly early in 1974. Mental Health Facilities, Burnaby Plans were completed to convert the Family and Children's Clinic, located in the Burnaby Mental Health Centre building, into a 25-bed in-patient unit. Mental Health Centres A new mental health centre was opened in Abbotsford, located in the Public Health building. New mental health centres were also opened in Langley, Sechelt, and Squamish in leased accommodation. The mental health centre in Fort St. John moved from leased premises into the new Peace River Health Unit building. The New Westminster mental health centre moved from its old office space to more adequate leased quarters, centrally located. The mental health centre in Port Coquitlam was provided with additional office space. General The Department of Public Works let a contract in the amount of $158,690 to convert St. Eugene's School, Cranbrook, into a residential and training unit for approximately 70 retardates, which would be operated by a private society. Arrangements were made during the year to provide all patients, who could benefit from such a programme, with $120 per year, in order that they might purchase their own clothing rather than be provided with institutional stores supplies. Arrangements were also made, with the Department of Human Resources, to provide patients, who qualify, up to $18.50 per month Comforts Allowance. Institutional Estimates for the fiscal year 1974/75 were prepared on a programme budget basis. PERSONNEL During the year the Mental Health Branch establishment of permanent positions was increased by 225 positions. In addition, the Mental Health Branch hired 240 students under the Government's Summer Programme. They were employed in regular types of jobs, in research projects, and to help on a number of summer activity programmes for patients and residents. The staff turnover in established positions for the fiscal year 1972/73, temporary staff excluded, was 30.5 per cent, up from the 13.36 per cent of 1971/72. Sick leave with pay during 1973 averaged 8.5 days per employee, and sick leave without pay averaged 1.6 days per employee. As of November 1, 1973, the Branch employed 167 handicapped persons. Increased salaries and sessional fees for psychiatrists, late in 1972, resulted in a much improved situation during 1973. The serious shortage of nurses that developed during 1972 continued throughout the year. Extensive advertising in Canada was not successful. Advertising in the United Kingdom was continued and 46 were hired from that source during the year. Recruitment of occupational therapists and physiotherapists was unsuccessful and there were 14 vacancies at the end of the year. The system of using on-call to provide relief for minor illness, minor WCB cases, and recruitment lag, was extended to cover nursing at Riverview Hospital and a number of smaller departments such as housekeeping and dietary. A trial roster system of four days on and two days off (repeated) was started in the Nursing Department at Woodlands in August for a six-month period. A new series of Nurses 1 to 9 was approved, which replaced the former Psychiatric Nurse and Staff Nurse series and included nurses from the beginning- level (Nurse 1) to the Director of Nursing at Riverview Hospital (Nurse 9). During the year the Civil Service Commission studied the classifications of Recreational Therapists, Instructor Handicrafts, and some Rehabilitation Officers. They proposed a series of Activity Therapists to replace these positions in the Mental Health Branch, and the proposal was being studied by the Branch at the year- end. Fifty-seven requests for classification reviews were received during the year, of which 34 were reviewed by the Branch Personnel Officers, who refused two and forwarded 29 to the Civil Service Commission for upgrading or a salary review. The Civil Service Commission approved seven, turned down two, and had 20 under review at the end of November. The balance were in various stages of review. Eighteen grievances were handled at the second step, six were denied, eight were referred to the Chief Personnel Officer for mediating, and four were resolved. Four others were still being investigated or mediated at the year-end. Thirty-two Mental Health Branch Personnel Circulars were issued during 1973 covering travel, benefits, vacation leave, recruitment, grievance procedures, training assistance, and many changes in routine procedures. The statistics in Tables 1 and 2 were based on the fiscal year ending March 31, 1973. 22 GENERAL ADMINISTRATION L 23 Table 1—Comparison oj Staff Totals, Showing Totals jor the Preceding Fiscal Year Fiscal Year 1971/72 Positions in Establishment as of March 31, 1972 Number on Staff as of March 31, 1972 Fiscal Year 1972/73 Positions in Establishment as of March 31, 1973 Number on Staff as of March 31, 1973 General administration- Department of Nursing Education Mental health centres and Boarding-home Programme. Subtotals 60 68 166 58 59 155 61 68 173 294 272 302 In-patient care—■ Riverview Hospital.. Woodlands Tranquille.. Valleyview Hospital— Dellview Hospital _ Skeenaview HospitaL British Columbia Youth Development Centre.. Subtotals 1,677 924 396 449 98 74 143 1,777 990 411 492 100 73 140 3,761 3,983 Total Civil Service positions- Student psychiatric nurses Totals- _ 4,055 325 4,255 87 4,380 4,342 1,678 924 408 449 98 74 142 3,773 4,075 325 4,400 56 46 148 250 1,822 1,056 446 470 104 81 140 4,119 4,369 31 4,400 Table 2—Breakdown by Classification of Recruitment and Separation Activity for the Mental Health Branch, Excluding Student Psychiatric Nurses. Recruited Separated Physicians 43 42 Medical interns 5 5 Registered nurses ) 357 Psychiatric nurses) Female psychiatric aides Male psychiatric aides Teachers Occupational therapists Seamstresses Recreational therapists Psychologists Psychiatric social workers Dietitians Cook's helpers Clerks Clerk-stenographers Laundry workers Child care counsellors Miscellaneous professionals Miscellaneous technical Miscellaneous 419 513 403 154 137 9 6 11 15 7 7 14 16 21 16 27 20 2 2 93 95 59 49 61 46 76 70 25 25 15 19 48 60 435 404 Totals 1,975 1,856 ADULT PSYCHIATRIC SERVICES The functions and responsibilities of the Co-ordinator of Adult Psychiatric Services were reviewed and redefined in the second half of 1972, and the pattern of activities decided upon at that time continued to constitute the main work of the Co-ordinator throughout 1973. BOARDS AND COMMITTEES The Task Committee of the Section of Psychiatry of the B.C. Medical Association completed its work early in 1973 and submitted its report. It then disbanded. Representation on the Graduate Training Committee of the Department of Psychiatry at UBC contributed to the constructive liaison between the Department of Psychiatry and the Mental Health Branch. RIVERVIEW HOSPITAL The Regional Programme in Centre Lawn continued, with some evidence of improved communication between in-patient teams and the professionals in the communities which they served. It made a specific advance during the year with the establishment of the Community Adult Psychiatric Service, in which a Riverview psychiatrist would be attached to each of the six mental health centre areas outside Vancouver located closest to Riverview Hospital. The designated psychiatrist worked with the mental health centre in its community, and also provided in-patient service in Riverview for any patient from his community who could not appropriately be dealt with by any other resource. MEDICAL STAFFING There was great improvement in medical staff in terms both of numbers employed, the number of applicants, and the standard of general and specialist qualifications of both. The number of vacant positions in the Mental Health Branch diminished rapidly, and very few vacancies remained. Vacancies which did remain were, for the most part, in remote areas. While there seemed some hope that these may be filled in the near future from the continuing flow of psychiatrists indicating a wish to locate in British Columbia, it might be necessary to consider the provision of some special incentives, if this did not take place within a few months of the filling of the last of the vacancies in the heavily populated areas. A very encouraging feature of the medical staff situation was the great reduction in the number of employed physicians with temporary registration. The situation was rapidly approaching where the physicians in the public service would be equal in qualifications and skills to their colleagues in other sectors of medicine in the community. MENTAL HEALTH CENTRES AND GENERAL HOSPITAL PSYCHIATRY Work related to the mental health centres was largely involved with the local general hospital psychiatric programmes. During the year, visits were made to Duncan, Port Alberni, Nanaimo, Courtenay, Port Coquitlam, Maple Ridge, 24 GENERAL ADMINISTRATION L 25 Whalley, Abbotsford, Penticton, Vernon, Kamloops, and Cranbrook. Consultation in the centres was chiefly related to their relationship to psychiatric services in the general hospitals of these communities. The Co-ordinator continued to provide limited clinical consultation service to Sechelt and Gibsons, both in the medical clinics and in St. Mary's Hospital. Similar service was provided to the newly established mental health centre, pending the recruitment of a psychiatrist to that centre. PROJECTS Forensic Psychiatric Services Committee—This committee was a major project, which was time-consuming and greatly limited all other activities between February and October. The work of the committee resulted in the preparation of a report and recommendations, which were completed in mid-October. RETARDATION AND CHILDREN'S PSYCHIATRIC SERVICES There were few advances in the provision of psychiatric services for children during the year; however, some progress was made in providing comprehensive, integrated programmes for the mentally retarded. Optimism was expressed that when the problems associated with the desirable change in emphasis from central delivery of services to community and regional responsibility were sorted, co-ordinated programmes would be developed in the future. It was disappointing to note that there was no evidence of decreasing incidence of handicapping conditions in the newborn. With the general lowering of the age at which the majority of women have their children, the availability of family planning advice and genetic counselling, and widespread efforts to ensure optimal perinatal conditions, it had been expected that primary prevention would show some results during the year. Perhaps it was too early to see such a trend. Secondary preventive services, however, were having an effect, and the identification of high-risk cases, followed by the provision of therapeutic and stimulation programmes, had already markedly improved the functions of many handicapped children. General recognition was needed, that expert professional evaluation of all pre-school children should be a priority, followed by appropriate intervention. In the pre-school age-group, the remediation of problems, both physical and psychological, paid high dividends in subsequent function. Pre-adolescent school-age children were adequately cared for and in most instances the back-up services required for the family and teacher were available. During the year the ability of some schools to hire special assistants for teachers in difficult cases meant that fewer children were rejected from school. Special programmes for severely disturbed adolescents, however, were far from adequate. There was no residential programme that could really provide intensive treatment for the most difficult problems. Such a programme should be a "health" responsibility, rather than a "social services" responsibility, although obviously there must be close interdepartmental and interdisciplinary co-operation. As fewer adult handicapped people were being admitted to institutions, more community services were required in the form of residential care and day activities. The Associations for the Mentally Retarded continued their efforts to expand such programmes during the year and, with Provincial Government support, progress was made. Once again, close co-ordination was required between different agencies to ensure that such people were integrated into the community as much as possible and that not only were they provided with the special services they needed but they were also provided with opportunities to five their lives as normally as possible. During 1973 the Co-ordinator continued to meet regularly with his colleagues, officials from other departments of Government, and with private social agencies that provided care and treatment for both emotionally disturbed children and mentally retarded of all ages. 26 NURSING CONSULTATION SERVICES Nursing consultation services during 1973 focused on the nursing component of a wide variety of programmes, services, and activities. Studies were undertaken which prepared material for the development of nursing care policies. The Consultant was also involved in the following: A revision of nursing position descriptions and classifications; the designation of clinical assignments; a trial project in altering the rostering system of staffing patterns; the use of teaching positions for staff-development programmes; determining the effect of recruitment difficulties in in-patient facilities; proposing new functions for the Education Centre, Essondale; and facilitating a study of in-service educational needs. A review was made of nursing staffing patterns and hours of available nursing care at two psychogeriatric hospitals, and a study undertaken to collect data on present staffing standards throughout the in-patient facilities. Staffing plans for a new in-patient facility in Burnaby were reviewed. Recommendations were made regarding the operation and staffing of a surgical service. Time and consideration was provided to nursing service departments of the in-patient facilities with respect to interpretation of policies affecting changes in nursing positions, hours of work, administrative structures, nursing care projects, and developing hospital-community services. Efforts were made to interpret the progress and the needs of nursing departments to decision-making bodies. Continued direction was provided to the Department of Nursing Education concerning the processes of terminating the psychiatric nursing programme, and the closure of teaching, clerical, and business aspects of that operation. The year saw the graduation of the final two classes in that programme and the retirement of its Acting Director, Mrs. Elisabeth Paulson, whose years of dedicated service were acknowledged at a reception in her honour attended by the Deputy Minister and many of her associates of years past and present. Procedures were instigated for the continued use of the Education Centre facilities by the B.C. Institute of Technology and its psychiatric nurse and registered nurse programmes. Arrangements were made for that institution to assume responsibility for providing a qualifying examination service for psychiatric nurses not eligible for registration. These arrangements were made in accord with the Registered Psychiatric Nurses Association of British Columbia, which assumed responsibility for the registration of psychiatric nurses on the proclamation of the Registered Psychiatric Nurses Act in June. Service was provided to the community mental health programme through visits to 16 mental health centres, participation in regional meetings, assisting mental health nurses in the task of role definition, arranging conferences and orientation, and participating in the development of plans to extend services of the centres. Community visits provided opportunities to confer with head nurses of psychiatric units in general hospitals, as well as discussion with public health nurses concerning continuity of care to patients. Other community activities included information- gathering visits to proprietary residences for care to the mentally handicapped, and exploratory discussions with agencies intending to initiate psychiatric services. As usual, assistance was afforded to the Civil Service Commission and to the Personnel Department is the following ways: 27 L 28 MENTAL HEALTH BRANCH REPORT, 1973 (a) participation in selection panels interviewing for mental health nurse, Director and Associate Director of Nursing positions; (b) replying to requests from nurses across Canada and in other countries for employment information; (c) interviewing nurses both within and outside the service with respect to employment, promotion, transfer, bursary assistance, and educational leave concerns; and (d) reviewing submissions regarding merit increases, reclassification, and grievance matters. The Nursing Consultant continued to use the vehicles of various committees and professional channels to communicate the requirements of psychiatric-mental health nursing practice to health care and supporting agencies. In this respect, she facilitated conferences of the Nursing Liaison Committee and participated in Advisory Committee meetings of the British Columbia Institute of Technology, the Nursing Co-ordination Committee of Vancouver Metropolitan Health Services, and the Post Basic Clinical Course Committee of the Registered Nurses Association of British Columbia, and reviewed community college proposals for continuing education for nurses. Discussions concerning the psychiatric nursing-mental health component in developing health care systems were held with members of the Health Security Programme Project staff, and assistance was provided to various groups of nurses preparing submissions to the project. Information regarding the education and utilization of psychiatric nurses, and nursing staffing standards, was provided to nursing consultants in three provinces. In preparation for changes in the organizational structure of facilities delivering nursing services, the Consultant visited the Programme Review Unit, Department of Mental Hygiene, Sacramento, Calif., and toured several of its psychiatric and community mental health facilities. This provided useful indices of the effect of the system change on patient care programmes, community-hospital interrelation, and staff motivation and effectiveness. The visit served as an orientation to developing changes in the health care system in this Province. BOARDING-HOME PROGRAMME During the year the Boarding-home Programme continued to expand at a steady pace. At the end of the year there were approximately 1,456 persons under supervision of the Mental Health Branch in some 200 boarding-homes throughout the Province. The emphasis during the year was on an evaluation of the quality of the programme and of individual boarding-homes, and a restatement of the programme goals, particularly in relation to rehabilitation of individuals. These measures resulted in the removal of residents from some inadequate homes and the purchase, with Government assistance, of one large home for retarded persons by the B.C. Association for the Mentally Retarded; the expansion of the Activities Programme; and an increase in the number of persons (122) discharged from the programme to more independent forms of living arrangement. The Activities Programme, initiated late in 1972, was expanded by the addition of further occupational therapist and activity therapist positions, and by the employment of summer students. Concentration was on the development of individualized activity programmes with stated objectives. Several groups of boarding-home residents formed their own clubs, and learned to plan and organize their own activities. Volunteers continued to support the Activities Programme, and special projects, such as the Volunteer Instruction Programme in the Fraser Valley, also provided worth-while services. The Occupational Therapy Co-ordinator visited several regions, offering consultation to the Boarding-home Programme staff and to local sheltered workshops. Some new workshops were opened through the work of individual groups of professional people and interested lay persons. A submission was made containing recommendations for standard setting and funding formulas with regard to sheltered workshops. Other submissions made during the year by the office of the Boarding-home Co-ordinator included (1) a report on the Boarding-home Programme to the Health Security Programme Project; (2) a submission to the Department of Human Resources on the need for a unified policy throughout the Province with respect to the provision of ancillary social services to Mental Health Branch boarding- home clients; (3) definitions of the Mental Health Branch types of care, submitted to the Chairman of the Community Care Facilities Licensing Board, Health Branch, for inclusion in the Provincial definitions of levels of care as adopted by the Health Branch; (4) job description and analysis of the case aide positions in the Boarding-home Programme, submitted to the Civil Service Commission; (5) preparation of a Rating Scale, to assist in the determination of an appropriate rate for individuals placed into boarding-homes. In the last half of the year some progress was made in the establishment of intermediate-care resources for Mental Health Branch clients. Several facilities providing intermediate services were funded by the Department of Human Resources at beginning intermediate-care rates. In June, the Central Mortgage and Hous- 29 L 30 MENTAL HEALTH BRANCH REPORT, 1973 ing Corporation announced a programme for the provision of mortgage funds of up to 100 per cent to nonprofit organizations to provide facilities to serve disabled groups, and several organizations were in the process of acquiring a resource in this way as the year closed. Boarding-home candidates being presented by Riverview Hospital for placement were persons bordering on intermediate-care levels in their needs, and consultation was given to the hospital throughout the year in placement possibilities for this group. Placement was also facilitated by visits of Riverview Hospital social service staff to several regions of the Province, to familiarize them with possible placement resources. Throughout the year workshops for boarding-home operators were held in all regions. A week-long conference was held in September for all Boarding-home Programme staff, where the emphasis was on new approaches to the rehabilitation of mentally disabled persons. Evaluation meetings, including staffs of the Health Branch and the Department of Human Resources, were held in several regions of the Province. In November, Langholm Lodge, a boarding-home serving 29 adult retarded persons, burned to the ground. Fortunately there were no injuries, and immediate efforts were made to locate the residents in suitable alternative accommodation. Various methods of improving and extending home activities were discussed at a workshop held in March for all boarding-home participants. Approximately 650 residents, volunteers, and staff attended the annual boarding-home picnic, held in Queen's Park, New Westminster, on July 26. Approximate Distribution of Placements Made and Case Load, Boarding-home Programme, 1973 Placements Case Load, Made, 1973 Dec. 31. 1973 Region 1 (Kootenay s) 28 70 Region 2 (Okanagan-Thompson) 150 376 Region 3 (Fraser Valley) 128 685 Region 4 (Skeena) 2 5 Region 51 (Greater Vancouver) 13 38 Region 6 (Cariboo-Peace River) 18 34 Region 7 (Georgia Strait) 86 145 Region 8 (South Vancouver Island) 49 103 Totals 474 1,456 1 Burnaby and North Vancouver were the only municipalities of the Greater Vancouver area where placements were made through the Mental Health Branch Boarding-home Programme. SOCIOLOGY CONSULTATION SERVICES PSYCHIATRIC HOME TREATMENT RESEARCH PROJECT The treatment component of the Project ceased on August 31, 1973. Patients requiring continued care were transferred to Riverview Hospital's out-patient services and to the community care teams of the Greater Vancouver Mental Health Project. A total of 213 patients awarded an admission to Riverview Hospital from the City of Vancouver was studied, having been randomly allocated to one of three groups—home treatment only, hospitalization followed by home treatment, and hospitalization without home treatment. The study commenced during the summer of 1971. At the year-end, data analysis, supported financially by a National Health Grant, was being undertaken, pertaining to the impact of the project on Riverview Hospital admissions, the replacement of hospital bed-days, comparative costs, and the effectiveness of treatment. A final report dealing with the entire project would be available by March 31, 1974. GREATER VANCOUVER MENTAL HEALTH PROJECT In February, the Consultant in Sociology was appointed as Acting Executive Director of the Greater Vancouver Mental Health Project, pending the employment of a full-time Executive Director in June. The Greater Vancouver project was essentially a hospital-bed replacement programme designed to provide a more appropriate type of service to patients, while at the same time decreasing hospital admissions and length of stay for the adult mentally disabled. These objectives were being pursued through the development of a system of community care treatment teams, supported by such services as day treatment, short-term residential, and sheltered workshop facilities. GENERAL PLANNING Progress was made in preparing guidelines designed to assist in planning for both the number and kind of community mental health facilities required to provide a spectrum of decentralized services. Guidelines being developed were based on data derived from the Branch Patient Categorization Surveys of 1970 and 1972, commonly accepted standards in use elsewhere, and estimates obtained from mental health centre administrators. COMMUNITY CARE FACILITIES LICENSING BOARD The Branch continued to be represented on the Community Care Facilities Licensing Board, throughout the year, at regular monthly meetings and a number of special hearings regarding the licensing of special-care and intermediate-care facilities. Through the Board, the Branch had a further avenue for monitoring the care and rights of some 1,400 patients in the Mental Health Branch Boarding-home Programme. 31 PSYCHOLOGY CONSULTATION SERVICES The year 1973 saw a great deal of challenge, reorganization, continued development, planning, and increased emphasis on providing more comprehensive health care and services. In order to be responsive to the needs of the various groups and individuals being served, the participation of local citizen groups and the development of local resources continued to be encouraged. The emphasis on assisting the local communities to deal with their mental health problems resulted in increasing the type and number of responsibilities for all mental health personnel. Because of the greater number of services being provided by the Mental Health Branch, as well as by other Government departments and community agencies, co-ordination of services became increasingly important. The special training of psychologists, particularly in the areas of programme development, documentation, and analysis, was reflected in their assistance in developing many innovative programmes and services and in the added responsibilities which they were asked to undertake. As services became more established in local areas, it became possible to shift the emphasis from dealing with accumulated existing problems to providing more services aimed at preventing problems from occurring. Together with other personnel, Branch psychologists continued to develop a variety of preventive mental health programmes for the young child, in addition to programmes dealing with the early recognition of problem areas, with assessing problems, and with devising remedial techniques. Services for adults also continued to increase. Improved co-ordination in terms of better communication and interaction between staff of different Branch facilities resulted in providing continuity of pre-admission, admission, and follow-up services for individual clients. New treatment programmes were developed for continued care of patients, as well as for those problems with which persons need only casual assistance. The demand for psychological services was reflected in the inability to fill all existing vacancies for psychologists with adequately trained personnel. The increased emphasis on health care, and the concomitant necessity to find more qualified personnel in all health professions, made this problem an area of concern for the future. 32 MANAGEMENT ANALYST CONSULTATION SERVICES Services of the Management Analyst were provided to various areas throughout the Mental Health Branch during the year. The spectrum of involvement covered such activities as systems and procedures development; forms analysis, design, and control; and studies relating to dietary, pharmacy, nursing, and general office organization and procedures. The necessary communication, preparation, and submission of material to the data processing facilities of the Departments of Finance, Industrial Development, and the Division of Vital Statistics, was conducted and channelled through this office. Additional statistical tabulations were produced to provide supplemental information for the Patients/Residents Categorization Study carried out by the Consultant in Sociology. The boarding-home reporting application, which was initially set up to be handled on a manual basis, was revised. The file maintenance and monthly output were computer-produced. A system to provide "positive" identification for all patients within a major in-patient facility was implemented. Embossed plastic identity cards and imprinting devices were introduced and located at all nursing stations. As a result, time required by professional staff in the performance of clerical duties was reduced, errors inherent in manual entry eliminated, and an increase in the document flow realized. The Management Analyst was appointed as Chairman of the Forms Control Committee and in this capacity carried out functions involving new forms design, the review and revision of existing forms, and associated reprinting requirements. With the previously mentioned implementation of the patient-identification system, it was necessary to revise all forms relating to an individual patient, to provide an imprinting area which was standard to all. Through the assistance of the summer student programme, a project was initiated to produce a Forms Catalogue which provided information relative to all forms used throughout the Mental Health Branch. Information was made available to a telecommunication consulting firm, delegated by the Provincial Government to investigate all communication media presently used within the Government Service. The area of programme budgeting (forms and methods) constituted a significant time involvement on the part of the Analyst. During the year, support was extended to Glendale Lodge in the development of an input data sheet. Data entered on this form would serve to create a data base from which required clinical assessment information could be obtained. 33 STATISTICS AND MEDICAL RECORDS During 1973, emphasis was placed on the preparation of data to assess the future demand for mental health facilities in the Province. Some of the statistical procedures were revised and the processing of statistical forms from all Branch facilities was directed to head office in Victoria. Three new mental health centres, at Prince Rupert, Abbotsford, and Langley, and the West End, Strathcona, and Mount Pleasant Community Care Teams, were incorporated into the statistical system. Research projects during 1973 concentrated primarly on the analysis of patient characteristics and the provision of Branch data to other departments and the public in general. Summer employment was provided for three university students who assisted in the compilation of a facilities inventory preparation of data to project future demand for mental health facilities, and in the tabulation of the Annual Statistical Report. DEVELOPMENT OF THE STATISTICAL SYSTEM A principal concern was the limited capacity of the data storage and retrieval system available to the Branch in the Division of Vital Statistics. This problem was a major topic at Departmental discussions, where a centralized data processing system for all branches was proposed. Data regarding the statistical system was also made available to the Provincial Health Security Programme Project. Additional discussions were held with Statistics Canada regarding the publication of Canada-wide statistics on patients in out-patient departments. Suggestions concerning the format and extent of these statistics were presented to Statistics Canada. To improve the mental health centre statistical system, more precise activation and termination criteria were developed and were made applicable to all centres. The feasibility of a problem-oriented medical records system for the Branch was investigated and two video tapes on this subject were made available for further information. Subsequent to the Medical Records Consultant's meeting with the staff in mental health centres, instructions on medical record-keeping and on completion of statistical forms were revised and updated. ROUTINE DATA RETRIEVAL During 1973 a monthly average of over 1,800 activation and termination statistical forms were edited at head office, prior to further processing at Vital Statistics for data storage. In addition to numerous general inquiries, over 30 requests for specific patient-data retrieval were received from the Department and the public in general. A case-load verification, to verify the number of patients at each facility with the data on storage, was in progress at the year-end. Other statistical reports prepared during the year included the Preliminary Patient Movement Report, the Monthly Statistical Bulletin, the 1972 Annual Statistical Report, and annual reporting to Statistics Canada. 34 STATISTICS AND MEDICAL RECORDS L 35 ADMINISTRATIVE AND PLANNING STUDIES A major project was the preparation of population growth data for each planning region, which, combined with data on the incidence of mental illness and capacity of existing facilities, provided the basic data to project the demand for mental health facilities up to 1980. Another important project was the compilation of an inventory of all facilities for the mentally handicapped in British Columbia. A study, showing the time and method of arrival of patients, was completed for the Riverview Hospital. Other studies included staff-to-population ratio reports for each mental health centre, and an analysis of admissions to Riverview Hospital by school districts. MEDICAL RECORDS DEVELOPMENT AND REPORTING CONTROL In February of this year, the Medical Records Consultant also assumed, temporarily, the function of medical records librarian at the Riverview Out-patient Department, located in Vancouver. Consequently, the co-ordination of all statistical reporting was turned over to head office in Victoria. Responsibility for the distribution of statutory forms was delegated at the beginning of the year to Central Stores, Riverview Hospital. Consultation and orientation on medical records was also provided to clerical staff at eight health centres, and at head office. In addition, the Consultant participated in four regional meetings which included all medical records staff of the mental health centres in each region. Principal results of these meetings were the clarification of medical records procedures and professional and clerical responsibilities which resulted in a revised procedure manual for medical records offices in all centres. Consultation was offered at two special meetings—one with the Lower Mainland mental health centres concerning standardization of the medical records, and the second with the Community Adult Psychiatric Services in Port Coquitlam, concerning compatibility of their medical records with the medical records at Riverview Hospital. Several meetings were also held with representatives of the Vancouver Mental Health Project to consider the setting up of a "data base," should a problem-oriented medical records system be adopted for the project. In her function as medical records librarian at the Riverview Hospital Outpatient Department, the Consultant initiated and set up the following: Policies and procedures for the medical records system. Review and organization of over 500 medical records. Colour-coding to regionalize the current case load of over 800 patients. Two verifications of the patient case load with data storage at Vital Statistics. Recording of interviews by discipline and date of admission as required for Statistics Canada. Integration of medical records and clerical staff of the Home Treatment Research Project with the Out-patient Department medical records system. Setting up of a mechanism to regularly review all out-patient cases. Appointment to the Out-patient Services Intake Committee. Assistance to the Metropolitan Mental Health Team. INFORMATION SERVICES One of the major functions of Information Services continued to be the consultative services provided to the Branch's facilities and mental health centres. A proposed public relations programme was developed for Riverview Hospital, which included recommendations for appointing a speaker's panel and implementation of a patients' opinion poll. Assistance was given in connection with media coverage for the hospital's workshop on "The Potentially Dangerous Patient," held in March, and a pamphlet outlining Riverview's treatment programmes and services was developed for distribution to the Canadian Psychiatric Association's annual convention in June. Riverview's Volunteers' Handbook, and Tranquille's pamphlet For the Professional Worker, were printed, and Valleyview's general information pamphlet was revised and reprinted. Assistance was provided to Woodlands in the planning of the official opening of their new Industrial Therapy Building in May, and in the preparation of their volunteers' pamphlet. At the year-end, consideration was being given to having the Director become more involved in direct media relations on behalf of the institutions. The Travelling Display was revised during the year, with emphasis placed on the activities of the local mental health centre, and it toured the Province from April through December. The centres were, for the second year, encouraged to participate in the observance of Mental Health Week, sponsored by the Canadian Mental Health Association. Informational literature dealing with a variety of subjects, including drug abuse, epilepsy, and schizophrenia, was provided to the centres. Material was being developed for use by the centres during the annual Careers Day Programmes observed by the Province's secondary schools. At the request of the Board of Directors of Glendale Lodge, assistance was given in publicizing their Open House Programme for Tillicum Lodge, and in the development of an informational pamphlet for Glendale. Other duties undertaken during the year included preparation of 11 issues of the Newsletter, an in-service publication; writing press releases, and articles for the journal of the B.C. Medical Association; assisting the Community Care Services Society in the printing of their reports; maintaining a daily news clipping service; handling general inquiries; initiating a Branch survey of VTR (video tape-recording) equipment and needs; and editing the Annual Report. The front of the Travelling Display (above) placed emphasis on the work of the local mental health centre. The reverse panels outlined the general Branch programme. 36 COMMUNITY MENTAL HEALTH SERVICES Mental Health Centres COMMUNITY MENTAL HEALTH SERVICES During 1973, mental health centre services were extended to Abbotsford, Langley, Prince Rupert, and Sechelt-Squamish. In addition, in co-operation with numerous community groups and the Metropolitan Board of Health, the Mental Health Branch began to develop a specialized service for patients in the Greater Vancouver area likely to require hospital admission. This programme would focus on the delivery of services through a community care team of psychiatry, social work, and mental health nursing. An in-patient service was being planned for the Burnaby Mental Health Centre to provide a full range of mental health services to the Burnaby community. This service would be tied in closely with the Vancouver programme and provide community service teams. The Branch continued to experience difficulty with the recruitment of mental health professionals in the far North and eastern Interior, but the situation was gradually improving. A typical mental health centre served a population of approximately 50,000, and had a staff consisting of a psychiatrist, psychologist, social worker, mental health nurse, boarding-home social worker, an activity therapist, and clerical positions. In some less populous areas the staff was smaller. In the Metropolitan Vancouver area the community care team consisted of a psychiatrist, psychologists, social workers or nurses, an occupational therapist, and a number of psychiatric nurses. Mental health centres provided direct services to persons of all ages with emotional and behavioural problems, and assisted various community organizations and services in the promotion of mental health and the alleviation of mental illness. Most centres reported wide involvement with community agencies and organizations during the year. Because of the array of other mental health services in the Vancouver area, including private psychiatry, the Vancouver programme concentrated on services to the adult patient with serious emotional disturbance. During 1973 there were more than 8,000 admissions to service at mental health centres and to the Vancouver programme. In addition to the extension of community services, there was a substantial development in the integration of services between the community and the Riverview Hospital. The hospital was divided so that new admissions to each ward in the acute admitting areas came from a limited area of from 100,000 to 300,000 people. In the area closest to the hospital, the Lower Fraser Valley and Metropolitan Vancouver, psychiatrists working in the community were responsible for 39 A conference on agency integration was held in Kelowna in January. Shown in discussion are (left to right) Dr. Frank McNair, psychiatrist; Ish Holmes, Administrator of the Kelowna Mental Health Centre; Mrs. Connie Hawley, of the Health Security Programme Project; and Colin Elliot, Administrator of the Kelowna General Hospital. L 40 MENTAL HEALTH BRANCH REPORT, 1973 admitting patients to Riverview Hospital and their subsequent care in the hospital. These psychiatrists were supported by other mental health staff to provide a well- integrated community adult psychiatry service. During the summer of 1973 the Mental Health Centre Programme was greatly enriched by the addition of over 50 college students participating in the student summer programme. They extended services to children and adolescents, and the chronically disabled in boarding-homes, and also helped mental health centres assess their services through a series of evaluation studies. ABBOTSFORD MENTAL HEALTH CENTRE Mental health services in this community, previously provided by a Travelling Clinic from Chilliwack, were expanded during the year with the opening of the new Centre in September. This Centre served the Abbotsford community, with the boundaries coincident with School District No. 34. The initial staffing consisted of a social worker who was Administrator, a half-time psychologist, a sessional psychiatrist, and a clerk-stenographer. The boarding-home social worker, an activity therapist, and a case aide also worked out of this Centre on a part-time basis. Direct services were offered, and a number of programmes of an indirect nature initiated. The programme was still in a relatively formative stage while community needs were being assessed, and working relationships with other agencies being established. Parents' discussion groups, hospital follow-up groups, and consultation to the hospital and social agencies were established. Plans toward developing special projects with specific target population groups, such as single- parent family and parents of emotionally disturbed children, were being considered at the year-end. BURNABY MENTAL HEALTH CENTRE In the operation of the Burnaby Mental Health Centre, 1973 was a year of major changes. The outcome of prolonged negotiations which involved the Mental Health Branch, the Burnaby General Hospital, the Greater Vancouver Mental Health Project, and the Metropolitan Board of Health was the approval and the initial implementation of a plan to provide comprehensive mental health facilities for the citizens of Burnaby. The "Burnaby Plan" took into account both existing facilities and deficiencies in service and provided for development of the following resources: Community care teams—The community care teams were the core service of the new pattern of psychiatric care for Burnaby. Three teams, each consisting of a psychiatrist, two senior mental health workers (i.e., psychologist, social worker, or mental health nurse), five basic mental health workers (community psychiatric nurses), and one occupational therapist, would provide the following services to adolescents, adults, and families in Burnaby: COMMUNITY MENTAL HEALTH SERVICES L 41 (a) Twenty-four-hour seven-days per week emergency psychiatric services. (b) Out-patient assessment and treatment. (c) Pre-admission and after-care services. (d) Home treatment services. (e) Consultation, education, and preventive services. (/) Collaboration with boarding-home, hostel, partial hospitalization, and in-patient services, as well as community agencies, including Public Health. The community care teams would provide basic services and continuity of care for the majority of patients entering the system. They would be highly mobile and co-ordinate closely with other agencies in the community. Although, initially, the out-patient teams would operate out of the centre, they would eventually operate in specific catchment areas within Burnaby, and two teams would be relocated in decentralized offices in North and South Burnaby. Team members would provide emergency psychiatric services in close association with the In-patient Unit, in order to provide adequate staff and back-up resources. The Burnaby Mental Health Centre children's team, which provided services to children, adolescents, and families, would be expanded by the addition of a part- time speech therapist and four child care counsellors, who would assist in the operation of a Day Care Programme for emotionally disturbed children and their parents. The children's team would make some services available through the Branch offices, and continue its close liaison with the Burnaby schools and public health nurses. In-patient service—A 25-bed In-patient Unit would be developed by conversion of space on the main floor of the Centre building. Three to four beds would be used as emergency or short-stay beds, to be cleared in 24 to 48 hours, and one or two beds would be available for night-stay patients. The unit would utilize modern techniques of crisis intervention, family therapy, and pharmacological treatment to foster rapid reintegration of patients, resulting in brief in-patient admissions (usually less than two weeks) and a minimizing of dependency problems. Patients who required more prolonged milieu therapy would be transferred to day hospital treatment as soon as possible. The use of a full-time area clinician would ensure efficient use of the in-patient facility and adequate patient-flow. Day hospital units—Crucial to optimum patient-flow in the plan was the development of additional day hospital places. Thirty additional day hospital places would be developed in the existing day hospital space at the Burnaby Mental Health Centre, and this could be done without significant capital expenditure by alternating the two programmes in the existing floor space, thus requiring only additional staff. Short-stay hostel—A short-stay hostel for eight psychiatric patients in the Burnaby area would meet the needs of a number of patients who would otherwise require hospitalization. This would also facilitate the operation of the Day Hospital Units providing occasional supervised overnight accommodation for those patients experiencing crisis in their therapy or their home environment. Adolescent services—It was expected that the community care teams would deal with adolescents and they would be admissible to Hostel, Ward, and Day Hospital Units. Other jacilities—When these facilities get into full operation, other needs would probably emerge, including rehabilitation and sheltered workshops, and an adequate community transportation system. In summary, the Burnaby Plan would emphasize the use of highly mobile mental health teams on a round-the-clock basis, backed up by in-patient hostel, and day hospital services, to provide the optimum level of care for all patients. L 42 MENTAL HEALTH BRANCH REPORT, 1973 The transition from the previously existing adult and child out-patient teams and 30-space Day Hospital would represent a major increase in resources and staff and involve a great deal of work in setting up the new facilities, especially in recruiting and training personnel. By the year-end the following had been accomplished: (1) Recruitment and training of seven new staff members for the out-patient teams and the opening of the North Burnaby Out-patient Office. (2) Recruitment and training of 22 staff members for the In-patient Unit, and the opening on a limited basis of 12 in-patient places, while renovations to the Centre building for the full 25- patient ward were proceeding. (3) Formation of a Citizens Advisory Committee to the Burnaby General Hospital and Project staff, which met regularly to advise on policy and assist in co-ordination and integration with community resources. While this planning and work was being accomplished, the Burnaby Mental Health Centre continued its out-patient and day hospital assessment and treatment programmes, as well as the training of psychology, nursing, social work, and occupational therapy students, and the provision of educational and consultative services to the community at large. Special programmes such as the Tuesday Evening Social Club, the SeCure organization for agoraphobics, and the marriage preparation courses sponsored in conjunction with the Burnaby Family Life Institute were continued and further developed. Some of the new services offered during the year included a psychiatric consultation service to the Burnaby General Hospital, efforts to upgrade and The moulding of clay into pottery of various shapes and sizes was one of the many interesting projects provided in occupational therapy. "Healthy bodies for healthy minds." Group exercises in the Day Hospital Programme helped tense bodies to relax, and generally toned up the muscles. The use of video tape-recording equipment proved to be effective in group therapy, and in workshop training programmes. COMMUNITY MENTAL HEALTH SERVICES L 43 increase the numbers of boarding-home places in Burnaby, and the beginning of programmes of parent effectiveness training, in co-operation with the Burnaby Family Life Institute. A number of staff participated in workshops, lectures, student field-work supervision, and other teaching programmes related to the University of British Columbia, Simon Fraser University, the B.C. Institute of Technology, and Langara City College. Also, during 1973, workshops were held at the Centre on the Day Hospital Programme, the use of transactional analysis in treatment, and the use of the problem-oriented record. At the year-end a multidisciplinary committee was at work on a new integrated system of patient records for all departments, utilizing the problem-oriented approach. During the summer a new Day Programme for 40 children and their families was operated by the Children's Team, with the assistance of a social worker, a teacher, and a recreational therapist, hired under a Community Care Services Society grant. This programme worked with groups of children in the 4 to 12 age- range, and focused on improving the social relationships and behaviour of these children. In most instances at least one family member was involved one day per week with the programme, in order to increase their understanding and improve their management of their child's difficulties. The programme was warmly received by the community and it was expected that it would be repeated in 1974. CHILLIWACK MENTAL HEALTH CENTRE As the geographical catchment area was again reduced, with the new Abbotsford Mental Health Centre assuming responsibility for services in that community, 1973 was a year of transition. This Centre became responsible for Chilliwack, Agassiz, and Hope, where biweekly Travelling Clinics were increased to weekly visits. Along with these organizational changes, there was considerable staff turnover. The mental health nurse resigned and the psychiatric social worker transferred to Abbotsford. Both positions were replaced. Additional sessional psychiatric services were obtained from two local psychiatrists. However, with the closing of their private practice, direct referrals increased proportionately and a third clerk was employed on a half-time basis. The net effect of these changes would permit a more concentrated and effective service in this area. Throughout the year, constant effort was made to maintain a reasonable balance between direct and indirect services. Regular liaison was kept with major medical, social, correctional, and volunteer agencies and organizations. Particularly significant were the interagency efforts of studying and evaluating the implication of the CELDIC Report for this community. Three programmes of special note initiated during the year were a hospital- based out-patient group therapy programme, the Ritalin treatment of hyperkinetic children, and parents' encouragement groups. The hospital out-patient groups were initially started by the mental health nurse for discharged patients from the psychiatric ward of the General Hospital. The success of this demonstration project, in terms of reducing the admission rate, resulted in the hospital hiring a psychiatric nurse to take over this project and further develop out-patient day-care services. L 44 MENTAL HEALTH BRANCH REPORT, 1973 The Ritalin programme was initiated by the psychologist in co-operation with schools and family physicians of children diagnosed with a hyperkinetic syndrome. The use of this drug, combined with behaviour modificiation reinforced at home and school, appeared an effective method of treating these children. Parents' encouragement groups were started by the psychiatric social worker. This was a six-week series of lectures, discussion, and practice exercises, open to all parents, patients, and nonpatients. This series provided a positive group experience for parents and dealt with understanding and the management of common behaviour problems of children, and offered effective communication skills to improve family relationships. This programme proved to be well accepted by the public and was subsequently taken over by the public health nurses and the Family Life Institute. COURTENAY MENTAL HEALTH CENTRE The Centre's focus during the year was toward maximizing indirect services to the community, and co-ordinating direct services with other agencies. During the first half of the year, the staff developed a co-ordinated and effective approach in spreading the services more broadly in the Courtenay and Campbell River areas. The Community Co-ordinator Programme, "Crossroads," Children's Coordinating Committee, and a Big Sisters Association, were all programmes which Centre staff helped to initiate and continued to develop and support. These were areas. The Community Co-ordinated Programme, "Crossroads," Children's Coordinating Committee, which biweekly brought together representatives of the schools and agencies for policy formulation and case conferences. Closer working relationships among agencies resulted from this regular meeting, and the school representatives especially valued this contact. The sessional paediatrician represented the Centre at a similar Children's Committee in Campbell River. The Community Co-ordinator was hired April 1 by a Subcommittee of the Union Board of Health to develop a preventive drug programme for the Campbell River and Courtenay areas. Centre involvement on the subcommittee dated back to its origin in October 1972, and hopefully would continue in 1974. Workshops for parents, teachers, professionals, and volunteers were geared to changing attitudes as well as disseminating information. The programme was strongly supported by the schools. "Crossroads," a crisis centre sponsored by the Upper Island Mental Health Society, began operating in March. Their staff looked to this Centre for training and consultation. In the latter part of the year, the Centre encouraged them to assume primary responsibility for training new volunteers, so that Centre staff could offer more consultation in regard to effective referral procedures and use of community resources. The co-ordination of services also improved with CFB Comox, and staff met regularly with their regional social worker and referrals were going more smoothly. Military families continued to be a significant part of the Centre's case load. Service to the North Island posed a problem, but requests for direct service decreased with the opening of offices by the Department of Human Resources and the Probation Service in Port Hardy, as well as School District No. 85 contracting with the UBC Department of Education for a Travelling Assessment Team. Efforts were being made to minimize direct service and support all efforts in the area to develop their own services. COMMUNITY MENTAL HEALTH SERVICES L 45 Throughout most of the year the Courtenay staff worked with the Branch's Consultant in Psychology on designing a model for the delivery of comprehensive community services. The boarding-home staff continued to expand their programme in the Courtenay area, Campbell River, and Powell River, and in November accompanied the Centre's Travelling Clinic to Port Hardy to investigate needs and discuss the programme with the newly formed Co-ordinating Committee there. This committee, composed of representatives from the Department of Human Resources, Probation, Public Health, Indian Affairs, and the UBC team, would serve as the Centre's primary contact in the area. During the year it was felt that the Centre became a more integral part of the Courtenay community. With the rapid growth of communities on the northern part of the Island, efforts to provide adequate service to the designated area would become increasingly difficult until a resident mental health worker could be assigned to the North Island. CRANBROOK MENTAL HEALTH CENTRE During the year the staff of the Cranbrook Mental Health Centre continued to provide direct service to the citizens of the East Kootenay, and consultation to the various agencies and community groups. The area of the East Kootenay was expanded to include Golden. The general hospital in Cranbrook had 10 beds designated as a psychiatric unit. This unit, in the beginning stages, was slowly developing a treatment programme and philosophy of care. Further impetus in its growth would result from the commencement of consultative services by a psychiatrist from the University of Calgary, who would provide monthly visits of one day, bringing with him residents and students of psychology, social work, and nursing. The boarding-home project became more a part of the Centre programme, with the appointment of a full-time case aide. The residents in the boarding-homes benefited from her efforts in planning for their activities, and by the year-end it was hoped that several would become part-time employees in the community. Renovations began to St. Eugene's Mission, which in the new year would be developed as a resource for the mentally retarded adults in need of training. In the coming year it would be necessary to develop methods of meeting the demands for service and consultation. In addition to reviewing the personnel requirements, consideration would be given to community programmes. The summer student programme was useful in providing students with an insight into mental health activities. At the year-end Cranbrook was in the process of coordinating services to school children. Effort toward co-ordination also needed to be considered for the other communities and services such as the volunteers. DUNCAN MENTAL HEALTH CENTRE The Duncan Mental Health Centre had an active and stimulating year. Staff consisted of the Administrator, a psychiatric social worker, two sessional psychia- L 46 MENTAL HEALTH BRANCH REPORT, 1973 trists, a regional boarding-home co-ordinator, a case aide, a secretary, and a clerk. Psychological services were provided by members of the Victoria Mental Health Centre on a bimonthly basis. It was anticipated a full-time psychologist would be hired in the next few months, and at the year-end recruiting was under way for an activity therapist for the Boarding-home Programme, which continued to expand over the past year. The Centre continued to operate on an open referral system, which had proven to be most satisfactory. Besides the direct service to clientele, staff were active in community development work to augment present services and programmes. One of the psychiatrists worked with the Hospital Board and staff toward the development of a psychiatric ward and Day Care Programme at the Cowichan District Hospital. The other provided consultation and training to the volunteer counsellors of the Cowichan-Malahat Family Life Association. This organization had been most successful in providing a range of services and programmes of a preventive nature, i.e., courses on child-rearing, transactional analysis, reality therapy, and many others. The Centre hoped to encourage the development of more programmes of this sort. The Duncan Mental Health Centre continued its involvement with the Lake Cowichan Activity Centre, which had been in operation for approximately two years. As a result of the success of this project, which was geared to providing day-time programmes for people of all ages, an Activity Centre was about to commence service in the Duncan district at the year-end, to be jointly funded by the regional district and the Department of Human Resources. It was anticipated that the Activity Centre in Lake Cowichan would evolve into an Activity and Resource Centre for that district. The Centre was partially responsible for the development of the Community Options Society, which was co-ordinating a special project funded by the Department of Human Resources to provide a range of alternative resources, on a community basis, for young people traditionally referred to placements such as Willingdon School. The project began operation in June and consisted of a Drop-in Centre, a Live-in Programme for adolescents with families in the region, and the Farm Project, which was an intensive group-living situation in a rugged section of the valley. The purpose of the farm was to provide a real alternative to some of the young people seeking a more basic life experience. Also in developmental stages was an Alternative School Programme, being jointly funded through Mala- spina College, the local school board, and the school-children. The philosophy behind the Community Options Programme is that these are our children, and we must learn to meet their needs. The most recent development in the area was the formation of a Community Resource Board, a concept that was most worth while but somewhat difficult to achieve. Progress was being made, however, and it was anticipated that early in the new year it would become a reality. As a result of these many activities, the community was developing the ability to get together to solve some of its own problems. FORT ST. JOHN MENTAL HEALTH CENTRE The Centre was staffed by a mental health nurse until September, during which time she carried an active case load of persons requiring crisis intervention, COMMUNITY MENTAL HEALTH SERVICES L 47 family and marital therapy, and long-term chronic care follow-up. Services were also provided in Dawson Creek and occasionally in other communities, including Chetwynd and Fort Nelson, and a number of community programmes were promoted. After September the Centre received service from the staff of the Prince George Mental Health Centre, and at the year-end efforts were under way to recruit a psychiatrist, a psychologist, and mental health nurse for the Fort St. John Centre. KAMLOOPS MENTAL HEALTH CENTRE The Kamloops Centre served a regional district with an estimated population of 80,000, with a full complement of staff all year. The former Administrator, a psychiatrist, went on a sessional basis in April, and a psychiatric social worker assumed the position. It was estimated that staff divided their time equally between direct patient services, educational support to community-oriented preventive programmes, and participation in the development of regional health and social service planning bodies. Direct psychiatric treatment services were readily available. Home nursing care to selected patients resulted in some decreased use of hospital bed space, as did long-term treatment with lithium carbonate of several patients with manic depressive psychosis. Medication continued to be rigidly prescribed and closely supervised. There was an increase in the number of long-term psychiatric patients utilizing the Drop-in Programme. The latter was attended by patients of the local psychiatric ward, serving as an effective introduction to the community out-patient services. A university social work student, hired under the summer employment programme, was assigned full-time to the psychiatric ward to assist in patient discharges. An increasing number of psychiatric patients utilized the boarding-home programme, which housed 80 residents in 34 homes. Strikingly, half of these patients were fully employed in either industry or at the community workshops. In addition to ongoing activity and social programmes, boarding-home patients participated in a wide variety of recreational activities, generated by a second student hired by the Centre. Boarding-home operators formed their own association, and a number of improvements in treatment and standards resulted. Individual, marital, and family counselling services were utilized. During the summer a third university student majoring in psychology assisted in the neuro- psycho-educational assessments of some 30 children. Children referred from the schools were assisted by an innovative programme placing volunteers, trained by the psychologist, in the classroom to monitor programmes utilizing behavioural techniques. Its success aroused considerable interest and support in the school system. Group-treatment methods were used with adolescent girls referred to the Centre for behaviour problems. The psychologist was moving toward the greater use of group methods to assist elementary-aged children experiencing interpersonal difficulties. Staff had considerable involvement in training and educational programmes for the Homemakers, Crisis Centre volunteers, Family Life counsellors, public health nurses, and school counsellors. The Centre hosted a two-day Learning Disability Workshop conducted by staff psychologists from the Victoria Mental Health Centre, and a YWCA-sponsored seminar on drug abuse. Cariboo College students were assigned to the Centre for their field placements. L 48 MENTAL HEALTH BRANCH REPORT, 1973 Centre staff participated in a growing community interest in the planning of health and social services. The staff psychiatrist, through a health-planning committee, consulted with the regional district, which subsequently retained the services of an independent firm to carry out a health-needs study. The Centre was an organizational member of the newly formed Community Resources Society, aimed particularly at integrating the planning and development of social services in the region. The Centre looked forward to an increased use of home care and out-patient services in the treatment of the mentally ill. With a greater emphasis on regional planning, a more orderly financing and development of community social services was expected. KELOWNA MENTAL HEALTH CENTRE During the year a Co-ordinated Community Services Committee assessed the need for facilities to provide more accessible services and to encourage interagency co-operation. A number of major agencies required additional space, and, if moves were necessary, it was felt they should be considered in the light of co-ordinated services. It was recognized that more services were required, but these services should be assessed co-operatively. Several all-day seminars were held to allow local input and to inform Provincial Government representatives about local views. The Methadone Programme continued to operate successfully under the name of the Kelowna Addiction Treatment Centre. Group therapy was provided by one of the Centre's psychiatrists, medical services by six local physicians, space by the Centre and Kelowna General Hospital, methadone and urinalysis by the Narcotic Addiction Foundation, and volunteer services by an interested individual. A request for funding to intensify and expand this service was made to the Drug, Alcohol, and Tobacco Commission. Many local groups, such as the RCMP, Probation Services, the Pharmacy Association, and local physicians expressed their appreciation of this service. The Boarding-home Programme continued to expand. A boarding-home social worker came on staff to serve the Kelowna area and another social worker operated out of the Penticton Mental Health Centre to serve the south end of the valley. One of the boarding-homes in the Kelowna area, with approximately 26 residents, was closed for not meeting the physical standards of the Community Care Facilities Licensing Board, and the re-placement of the residents put some pressure on local resources. The Centre has been exploring the area of family care homes quite extensively. A position for an occupational therapist was established in the Boarding-home Programme for the purpose of initiating life-enriching activities and programmes in the boarding-homes, and to help boarding-home operators upgrade their services to their residents. The Government's announced intention to support the establishment of intermediate care was welcomed. The Centre was fortunate in having a private hospital as well as extended care in the community, but there were a number of people whose needs could effectively be met in an intermediate-care facility. The Centre had the services of several summer students, which provided an opportunity to do several studies. The psychologist worked with these students, and COMMUNITY MENTAL HEALTH SERVICES L 49 also continued to produce papers on research for publication. He had a total of 10 papers accepted for publication in professional journals. The new 23-bed Psychiatric Ward in the Kelowna General Hospital was formally opened on March 31, 1973. Seventeen beds were used for acute in-patient care, and the six additional spaces were used for a day hospital service. Discussions continued with the Department of Psychiatry, University of British Columbia, about the placement of a psychiatric resident in Kelowna. Additionally, the Department of Psychology, University of British Columbia, requested an internship placement for a psychology student at the Centre. Centre staff were enthusiastic about these discussions, since they considered that exposure to community mental health at a training level was vital. All staff members continued to be actively involved in work with other agencies and professional groups, as well as participating in educative and preventive programmes in the community. LANGLEY MENTAL HEALTH CENTRE The new Langley Mental Health Centre was expected to be ready to provide service around the middle of December. The Centre was located in the Tower Building at 20560—56 Avenue, Langley. It had provision for five professional offices, a sixth space being set aside for either an additional office or play therapy room, depending on need. Staff included a social worker/Administrator, a part-time psychiatrist (with a private practice in Langley), a half-time psychologist, full-time boarding-home social worker, half-time case aide for the boarding-home social worker, and a volunteer (on a LIP grant) acting as an activity therapist for the boarding-homes in the area. Prior to the establishment of the Centre, the Langley area had been serviced by the Maple Ridge Mental Health Centre. The Centre's serving area had a population estimated at 31,000, and included Langley city, Langley township, Fort Langley, and South Aldergrove. MAPLE RIDGE MENTAL HEALTH CENTRE The Centre remained very busy in the field of direct service. There were 687 active cases on the case load as of the end of September, and an average of 40 new cases were seen each month. The co-operation with local agencies increased during the year. The Centre's psychologist acted as chairman of a local committee, pointing out the need for a local resource for disturbed children in the area. After the brief was presented, a meeting was held with the Central City Mission, who proposed to build a new modern resource for children, including a group-living home and also a day-care service, on a 40-acre ranch on the outskirts of Maple Ridge. A bus would transport the children to school so that there would be as little disruption of their life as possible. L 50 MENTAL HEALTH BRANCH REPORT, 1973 Weekly parental education groups were held in the evening at the Centre. The local Homemakers also held courses at the Centre for disadvantaged mothers, covering subjects such as nutrition and child care. An educational psychologist was appointed in the local school district and worked in co-operation with the Centre's psychologist, screening Kindergarten and Grade I pupils for early recognition of perceptual disorders. The local physicians gave approval to the concept of a local psychiatric ward in the general hospital, which would also serve the Mission area. It was hoped that the building would be under way during 1974. The local physicians formed a medical association which dealt with health concerns within the community, instead of confining their activities, as in the past, to strictly hospital concerns. The Centre was a member and actively involved in the association. The Community Services Council was also very active in this region, pinpointing the social needs of the community and making plans to implement these needs. The Maple Ridge Mental Health Centre was closely involved with Community Services and the Crisis Centre. This year marked the start of progress in the local boarding-home programme, and constructive and long-term planning became possible. This was made possible by the close teamwork of all involved in this programme—local programme staff, Centre and headquarters personnel, plus various other multicommunity agencies and volunteers, residents, operators, and boarding-home staffs. The case load in the Maple Ridge/Mission areas included an average of 200 residents in various stages of recovery, in some 15 licensed homes in both areas. Highlights of the year included the introduction of group sessions for residents; incentive allowances to give residents work experience; increased activities both within the homes and in communities, with participation from residents in planning; a workshop to give more training for boarding-home operators and their staffs; Mission Workshop established on full-time basis; Summer Camp at Hope, plus regular bus trips; more individualized personalized services for residents with emphasis on rehabilitation and self-help; visits to the Centre by Riverview patients, on a pre-boarding-home programme; the LIP Volunteer Instruction Programme; regular newsletters twice monthly to boarding-home operators to communicate changes in policy and programmes. An occupational therapist was appointed to the area, and she worked in conjunction with the activity therapist and the total boarding-home staff. A coordinator of volunteers was appointed under a local LIP Programme, and volunteers were to be trained to help the residents of boarding-homes develop their own potential. A survey of sexual attitudes in high school children was carried out by the Centre and the Narcotic Addiction Foundation. There was also a drop-out study done during the summer by a university student. On May 2, 1973, a successful Open House was held at the Centre, with approximately 60 people in attendance. On May 22, 1973, the boarding-home social worker and the Centre's Director presented a brief to the Standing Committee on Welfare and Education on the need for upgrading the boarding-home programme. The result was an increased awareness in the boarding-homes, and various workshops were proposed. A new boarding-home social worker was appointed for the Mission area. The Centre's psychologist and a public health nurse started a workshop to help mothers of pre-schoolers improve their relationship and management skills. COMMUNITY MENTAL HEALTH SERVICES L 51 A class for seven emotionally disturbed boys was set up at the Maple Ridge Mental Health Centre. The teacher used a behaviour-modification approach to improve work habits. Parents were invited to six two-hour evening sessions, aimed chiefly at improving family communication. NANAIMO MENTAL HEALTH CENTRE The staff of the Nanaimo Mental Health Centre consisted of a social worker/ Administrator, a clinical psychologist, a stenographer, and a medical records receptionist. In early October the Centre secured the services of a psychiatric social worker, who added to the direct and indirect service capability, particularly in the area of group programmes. There were also a part-time pharmacist and boarding- home social worker. Psychiatric consultation and assessment services were permitted two days a week. The Centre served a population of approximately 54,000, extending from Nanaimo to Qualicum, and south to Ladysmith. The Parksville-Qualicum area was served by an interdisciplinary travelling clinic on a weekly basis. A large proportion of staff time during the year was spent in the area of community organization, specifically working with statutory and non-statutory agencies to establish referral structures, eliminate service overlap, and implement measures to avoid agency fragmentation. The Centre was deeply involved in the development of a community Resource Board, which would provide consultation, advisory, and assessment services to agencies within the Nanaimo Regional District. The Community Resource Board would be a vehicle whereby agency role definitions could be clarified, and an integrated social service delivery system facilitated. Subcommittees oriented toward specific problem clusters such as special education, youth, and residential facilities had been established. The Nanaimo Mental Health Centre provided consultative services related to mental health programming through representation on such organizations as NARCO, Steps to Maturity, CMHA, Family Life Association, the proposed Reception and Diagnostic Centre, Family Division of Nanaimo Provincial Court, HOPE Centre, Malaspina College, and the Nanaimo Neurological and Cerebral Palsy Association- Through the Nanaimo Family Life Association, the Centre was active in facilitating the development of a training programme for volunteers who would work as lay counsellors in a number of private agencies within the catchment area. Due to the success of the initial course, the programme was taken over by Malaspina College, with university credit granted upon completion. In May, in conjunction with the Central Vancouver Island Health Unit, the Centre's psychologist developed a programme designed to provide, on a continuing basis, guidance in child development to parents of children under the age of 5. This preventive "drop-in" programme provided services to approximately 175 parents. Plans to expand this programme into regional self-help groups were under discussion at the year-end. The demand for direct treatment remained relatively high, although there were indications that the expanded Family Life Association programme would be able to cope with an increased number of marital and family situations. Centre staff provided direct service to individuals and families, through individual and group- L 52 MENTAL HEALTH BRANCH REPORT, 1973 therapy situations. Assessment and consultation services were provided on request, with a minimum waiting period. Referral sources included all statutory and nonstatutory agencies, with a provision for self-referral. Two groups of patients were being assessed by the Centre prior to admission to Provincial hospitals. All psychogeriatric patients referred to Valleyview Hospital were screened by Centre staff. Either a priority was assigned for admission, or an alternative resource was suggested. Secondly, the majority of organically braindamaged patients under the age of 70 who were referred to Riverview Hospital were being assessed by the Centre in an attempt to utilize Riverview in the most productive manner as possible. The Centre was continually involved in facilitating a close liaison between the Nanaimo Regional Hospital and the Provincial institutions. NELSON MENTAL HEALTH CENTRE In September the Centre acquired a psychiatrist and a community health nurse, which enabled the Centre to proceed with many new developments. Although direct therapeutic cases were accepted for service in ratio to the number of problems in the area, the Centre's main objectives were consultation and community education, which were considered the most effective means of providing the widest community-based mental health service. Despite reduced staff during most of the past year, the Centre achieved a number of direct therapeutic interventions, and was particularly pleased with its involvement in the community. There was a strong move in the community toward outright integration of all statutory and nonstatutory services, which required much intense study. The Centre provided consultation to, and received direct referrals from, the Kootenay Vocational School. Staff were involved in the original planning for ASPIRE, an intensive programme to deal with drop-outs, sponsored by the Department of Human Resources and the School District No. 7 Board. Presentation was made to the Post-secondary Education Committee concerning the retention of Notre Dame University. The Centre continued to work toward preventive and therapeutic measures being applied by nonteachers in classroom settings. Staff pursued case- finding, primarily through the schools, to locate and treat the 5 per cent of children who required acute care. More than 12 per cent were mentioned in the CELDIC Report as requiring some degree of care, which would represent 720 children and their families in the Centre's serving area. These figures led to meetings with members of the school system in an effort to cope with this monumental problem. In addition, the Centre would be increasingly involved in the community and educational television programmes in the area. The Centre continued to provide consultative service, to utilize volunteer case aides, and to be involved in their selection and training. The Nelson Community Service Centre increased in strength and offered wider services. The Nelson Mental Health Centre provided case consultation and was also consultant to the Board. The goal of the Nelson Mental Health Centre was to see similar community service centres, available on a 24-hour basis, established in all the communities it serves. The Centre continued to provide programme and case consultation to the New Denver Youth Centre, a Regional Youth Resource. Similarly, it provided pro- COMMUNITY MENTAL HEALTH SERVICES L 53 gramme and direct therapeutic consultation to the Dr. Endicott Home. An Activity or Sheltered Workshop, originally promoted by the Centre through the (Nelson) Professional Advisory Board, became a reality under the Kootenay Society for the Handicapped. The Centre was fortunate in acquiring the services of six summer students, one of whom served as office and case aide, and five others assisted in developing and applying the Students Summer Outdoor Activity Programme for a period of two months, for a number of emotionally deprived or disturbed children ranging in ages from 10 to 16. This successful programme indicated the need for such activity on a year-round basis, rather than a short-term student-hiring programme. Centre staff continued with ward rounds at the Columbia Psychiatric Unit. The Nelson Mental Health Centre was deeply involved in planning for psychiatric facilities at the Kootenay Lake District Hospital. Day Care and Rehabilitation Programmes were established, as well as a group for depressed patients. During the year the Centre was also involved in a multiplicity of meetings involving the Canadian Mental Health Association, Mental Health Branch regional meetings, nurse and other professional seminars, and the United Appeal, and provided consultation to health care and a large number of other nonstatutory services. NEW WESTMINSTER MENTAL HEALTH CENTRE In terms of both direct and community services, 1973 was a very active year for the New Westminster Mental Health Centre. There was an increase in direct service to residents of the area, accompanied by an improvement in "sense of community." The latter was evident in increased interaction with a broader array of local resources- Centre staff continued to attend to the combined tasks of planning and enacting Riverview Hospital regionalization, as related to the Centre's catchment area. January saw the beginning of a range of functions, including an evening therapy group for married couples, field placement of a student public health nurse, a survey of demand and supply regarding local community mental health facilities, and a vigorous search for alternative premises for the Centre. By February the Centre felt an influx in direct service requests. This coincided with an increase in the demand for community service, including active participation in the development of general hospital psychiatric facilities. The Centre was able to retain the services of a psychiatrist for four half-days per week, raising the complement to about V/% mental health centre professionals to serve an urban area population of approximately 55,000. Centre staff continued to be involved in advisory-consultative work with community self-help groups such as the local Detached Youth Programme, the Mental Health/New Westminster (CMHA), City Social Services Department, mental health centre activity and socializing groups, and the Share Society, including the Lifeline Crisis and Information Centre in Coquitlam. Liaison was either started or maintained with Parents Without Partners, the UGN Budget Review Committee, the YM-YWCA Board of Directors, and a school-organized committee concerned with developing an anti drug-abuse programme in the schools. Completion of the Community Mental Health Facilities Survey for the area was accompanied by continued involvement with negotiations regarding the major L 54 MENTAL HEALTH BRANCH REPORT, 1973 institutions of the Mental Health Branch (Riverview, Woodlands) and local community resources. These activities, plus the continued flow of direct service demands, extended the waiting period for service to about two weeks on the average, increased the need for additional pharmacy service, and forced the Centre to consider its limitations, particularly in respect to trying to serve adequately the Maillardville (Coquitlam) portion of its catchment area. A number of staff was involved with the planning of various picnics and camps set for the summer. Co-operative planning of a Conjoint Family Therapy Workshop for the benefit of workers from various local resources resulted in a programme spanning 10 weeks at the Centre, led by staff from the B.C. Youth Development Centre's Family and Children's Clinic. By mid-summer, another sessional psychiatrist was recruited, enabling more active involvement with development of the Royal Columbian Hospital psychiatric facility, and ongoing consultation with school personnel. The staff moved to much-needed alternative quarters during August, which relieved the increased congestion, and improved morale of staff and clients alike. The Centre provided a community placement extending 10 weeks for a number of students from the Psychiatric Nursing Programme at the B.C. Institute of Technology. During the fall the Community Adult Psychiatry Service associated with this Centre became a priority and more staff would be available for this programme. It was anticipated that this staff would continue with the planning and operation of the Day Hospital at Royal Columbian Hospital. Although there were six privately practising psychiatrists in New Westminster, strong pressure for direct services remained on the Centre, particularly in the follow-up of longer-term situations, for family therapy and other group work, and for assistance when multi-agency work is indicated. PENTICTON MENTAL HEALTH CENTRE In 1973 the Penticton Mental Health Centre witnessed a year of preparation and hopeful anticipation. The Centre staff included a full-time psychologist, a full- time boarding-home social worker, and a social worker and mental health nurse who each worked half-time with the Centre and the Penticton Regional Hospital. Efforts of lay persons and lay groups, as well as the members of the professional community, were directed toward review of the Penticton Profile (a community study done in 1969), of the CELDIC Report, the Hastings Report, and local submissions to Dr. Foulkes' Health Security Programme Project. A widely represented lay and professional Ad Hoc Committee for Penticton and district was formed to study the implications of the planned integration and co-ordination of health, welfare, and educational services, both Government and privately sponsored, and to take the steps necessary to establish a community resources board. As an adjunct to this future organization and its function, the Penticton Health and Welfare Association asked its 15-member voluntary organizations within the community to submit their operating budget for 1973 to the association in efforts to develop a global budget for voluntary organizations within Penticton and district. Several features of the Penticton Mental Health Centre influenced its role within the Penticton community and the Okanagan-Similkameen region during the COMMUNITY MENTAL HEALTH SERVICES L 55 year. The three private psychiatrists and the child-developmental specialist utilized sessional time only for consultation and education within the community and region. Sessional time was allocated by group decision on an ad hoc basis, according to existing commitments and new requests made to the consultants and staff of the Centre. The Centre staff and consultants had the support and involvement of a 25-member regionally appointed Board of the Okanagan Similkameen Society for Community Mental Health. The Board was organized in March 1972 to promote co-ordination and integration of services to the region through assessment of community needs and through appropriate planning to meet those needs. A 12-member professional multidisciplinary Advisory Board to this society was also the Advisory Board to the South Okanagan Human Resources Society, the Penticton Mentally Retarded Association, the Penticton Health and Welfare Association, and the newly formed Okanagan Similkameen Housing Society for Handicapped Citizens. The consultants and the Administrator of the Centre attended the Advisory Board meetings. The efforts of the regional representatives toward increased awareness of their respective communities, and the promotion of community mental health concepts, enhanced the Centre staff's involvement in these outlying regions. The close relationship with the Penticton Regional Hospital, through shared staffing and regular Centre/Hospital liaison meetings, fostered an orderly network of psychiatric services to the community. The mental health nurse, the social worker, and psychiatric unit nursing personnel provided patient assessment and consultation in the management of nursing care problems within the hospital. The 1973 summer student programme of the Centre, augmented by a hospital-sponsored summer student programme, permitted a recreational activity programme to be provided from May to September at the hospital for in-patients and day-care patients. The Centre's involvement with Youth Guidance Councils in schools in the region (as well as other consultative and educative services to schools), revealed a mutual concern for the 13 to 14-year-old potential school drop-out. A brief entitled Nowhere to Turn, prepared by the Summerland Youth Guidance Council, was presented to various Government departments. Centre staff were active in the formation of a society to establish a group-living home for mentally handicapped adults in the Penticton area. Four street workers were hired through special Federal and Provincial grants as an alternative response to local public and civic opposition to a summer youth hostel. Centre staff provided clinical supervision and had membership in the multi- disciplinary group providing joint administrative supervision. The programme was continued after the summer months were over. Major steps were taken to make the Penticton Training Centre a Work-training Programme and Assessment Centre, as well as an Activity Centre and Sheltered Workshop. Consultation by the Centre staff focused on assisting the Penticton Training Centre to provide a broader service to the community. The Naramata Centre for Continuing Education (sponsored by the United Church of Canada) provided half-way house accommodation and work experience for Centre patients. There was also co-sponsorship of educational programmes and consultation to the Naramata Centre staff. The Sorrento Centre (sponsored by the Anglican Church of Canada) requested consultation services and offered their facilities and programmes for patients. Services begun in the first year of operation by the Centre staff were continued and extended. Emphasis changed as needs have changed. The philosophy has been to consider staff roles (as skilled clinicians and community workers) primarily as enablers or catalysts within the community and region. L 56 MENTAL HEALTH BRANCH REPORT, 1973 PORT ALBERNI MENTAL HEALTH CENTRE During the year a full-time psychiatrist joined the staff of the Centre. Since the Port Alberni Mental Health Centre opened, the admissions to Riverview dropped from 30 to 16. Out-patient services to adults were greatly expanded. New referrals reached a high of 60 new adult cases in one month, to an average low of about 30, including approximately five new chronic cases, 17 family and marital problem cases and eight cases of individual neuroses and psychosis. The clinical demands for services remained strong in the adult population; however, other community resources were also meeting these needs. Family Guidance, Human Resources, Public Health, and local physicians carried a large number of cases, which sometimes required consultative services from Centre staff. Staff continued to plan to achieve group meetings for chronic patients, through the use of community volunteers and the creation of some kind of drop-in or daycare centre. Headquarters and Centre staff met with the administration and Board of the Port Alberni General Hospital to discuss plans for a 20-bed psychiatric ward, together with a 30-patient day hospital facility. The Centre's psychiatrist was on a committee which worked toward developing concrete plans. Services for chronic patients improved since Riverview staff visited the Centre. The family physician played a key role as he dealt with most of the chronic patients, and the psychiatrist was used as a consultant. About 15 new child referrals were activated each month, most of these were seen by the psychologist, who was very active in consultation with personnel within the school system and throughout the school district. Consultation was directed at helping the school personnel to understand and manage children with emotional and learning problems. The psychologist consulted closely with School Board personnel in planning an alternate school programme, commencing in January 1974, for drop-out secondary school students. The psychologist, in conjuiction with Human Resources, Public Health, and the School Board, did an activity-oriented programme for 21 school-aged children during the summer. It helped children function better, provided clear diagnostic pictures of children, and aided in making plans for the school-year. Perhaps one of its major contributions was that it brought many agencies and parents together working toward helping disturbed children. The past year was a very active one in terms of Centre involvement in the community. An interesting experiment was conducted during the month of October, in which the psychologist helped school counselling staff select 12 exceedingly disturbed children, suffering from a combination of physical and emotional disturbances, for a special class. The School Board provided a special teacher. In addition, the Centre's psychiatrist, social worker, and psychologist spent one and a half hours each day for two weeks in the classroom, in order to arrive at diagnostic and handling techniques for school personnel. In preparing these assessments the psychiatrist worked closely with the general practitioners on the medical aspects of each case. The experience seemed to work well and might prove the basis of further combined efforts in the area of seriously handicapped children within the school setting. Plans were made to have a therapy room in the school, where school, public health, and COMMUNITY MENTAL HEALTH SERVICES L 57 mental health personnel would be used in joint therapy roles for these children outside the classroom as a treatment adjunct to the classroom setting. At the invitation of the School Board, Centre staff consulted with Human Resources in the establishment of the day-care centre and a single-parent educational plan for the Alberni school system. It would serve two important functions aside from the educational goals, one was preventive mental health, and the other was direct counselling services. Staff worked with the public health nurse, the school principals, and local doctors in the Tofino-Ucluelet area. Bamfield was served on an individual case basis, and in most instances the patients came to the Centre. Several trips were made to Franklin River and increased service demands were anticipated. Several meetings were held with representatives of local native groups to discuss mental health programmes relating to their needs. Staff were involved on a consultative and planning basis for a possible community resources board. The psychiatrist was actively involved in the West Coast General Hospital on a consultative basis, which involved approximately 12 additional patients per month. The hospital agreed to dispense medications from their pharmacy, which were previously available only by mail from the Nanaimo Centre. Centre staff continued with all sorts of community activities, perhaps the most significant single group being the interagency group which met every second week throughout the school-year. During the year the mental health staff had direct working relations with Family Court, Family Guidance Association, Retarded Association, School Board, Service Groups, Human Resources, Ministerial Association, Parks and Recreation, RCMP, labour and management groups, medical group, nursing group and others. Staff relationships with community agencies were gratifying and co-operative. The Centre was grateful for the co-operation and help of Public Health staff, whose nurses cared for chronic patients, made home visits for the psychiatrist, and were very active in the schools. PORT COQUITLAM MENTAL HEALTH CENTRE In August 1973 the Port Coquitlam Mental Health Centre completed its second year, in a catchment area with a greatly increased population. The main focus remained on children and their families, both in offering direct treatment and in providing a consulting service to the community, to help increase services for children. Staff services were provided through the Centre in Port Coquitlam, and the Simon Fraser Health Unit in Coquitlam. During the year the Centre was again instrumental in organizing and running a camp for children with emotional and social problems. This was the second year for the camp, and both organization and staffing were also provided by the mental health centres in Maple Ridge, Chilliwack, and New Westminster, and the Family and Children's Clinic in Burnaby. The Centre ran several therapy groups throughout the year for early and pre-adolescent boys and girls. In the community, Centre staff participated on an interagency committee, working to organize a community school in Coquitlam and one in Port Coquitlam. L 58 MENTAL HEALTH BRANCH REPORT, 1973 Staff continued to work with a committee toward a residential treatment centre for children, and along with a committee from Port Coquitlam toward opening a pre-school day centre for children with emotional and behavioural problems. The adult services the Centre offered increased greatly with the start of the Community Adult Psychiatric Service (CAPS) programme in July. The programme was staffed by a psychiatrist who worked half-time at Riverview and half- time in the community, a community mental health nurse, and a stenographer. The main focus of the team was toward the patient who may require hospitalization, with a growing emphasis on preventive services. Prior to the arrival of the CAPS team, a community-based society had been formed to operate a sheltered workshop for chronically emotionally disabled adults. POWELL RIVER MENTAL HEALTH CENTRE The Centre's second year of operation, 1973, saw the consolidation of its total programme. The specific services offered by the Centre were more fully integrated into the fabric of the total Community Service Network. A basic problem was striking a balance between direct treatment of referred patients and indirect treatment through consultation. The patient load grew steadily, and created difficulties in the provision of sufficient consultative time. However, regular meetings were established with Public Health and Human Resources personnel, and on a more spontaneous basis with the school and probation authorities. In addition, the psychiatrist acted as consultant to a burgeoning Association of Children With Learning Disabilities. He also participated on a Community Health Committee to look into community health care, and a submission was prepared regarding the Centre's role in a totally integrated Health Care System for Powell River. The psychiatric social worker acted as consultant to the Youth Services Association, a community umbrella group concerned with services to children. She also held regular sessions at the Group-living Home for Girls, which took the form of "milieu therapy." Two programmes of special note were the development of a volunteer group, and a research project on the effectiveness of direct patient treatment. During the eight months of operation the volunteer programme proved to be a very successful venture. One of the most interesting features was that some of the most difficult "hard-core" cases achieved the most significant improvement with a volunteer. Prior to the setting-up of the formal research project, a limited project was attempted by the Centre which involved a questionnaire to find out about the patients' moods and feelings before they were seen on their first visit. It was hoped that the questionnaire could then be repeated some three to six months after the first visit, to determine if there had been any change. With the employment of a summer student, the research study was designed around the repeat use of the original Self-evaluation Questionnaire. Also, through personal interview, as well as measuring the change in people's feelings about themselves, staff attempted to measure their feelings about therapeutic treatment, using three categories—satisfied, undecided, and unsatisfied. Changes in feelings were scored numerically and comparisons made to such things as diagnosis, age, and number of visits. The major diagnostic categories were family problems, neuroses, psychoses, and personality disorders. COMMUNITY MENTAL HEALTH SERVICES L 59 PRINCE GEORGE MENTAL HEALTH CENTRE With respect to both in-patient and out-patient psychiatric care, 1973 saw a significantly more active involvement with the local regional hospital. Regular direct liaison on in-patients was developed. Out-patient care involved both direct follow-up by the Prince George Mental Health Centre after hospitalization, and active participation by the Centre in out-patient programmes. The mental health nurse and the psychologist each developed group programmes for out-patients in a private dwelling adjacent to the hospital, which was leased by the hospital for use as an in-patient and out-patient group and activity resource. A closer liaison with Riverview Hospital developed in 1973. An effective Boarding-home Programme meant more communication with Riverview in the area of planning for local placement of chronic patients. Increased input from the Centre into the local psychiatric ward of the general hospital was another factor. Visits by Centre Lawn staff to northern communities were a further significant contribution to improved communication between Riverview and the Prince George Mental Health Centre. In June, five staff members from Centre Lawn visited Terrace, Smithers, Houston, Burns Lake, and Prince George. They met and spoke to various community groups and met with all staff of the northern mental health centres— Williams Lake, Fort St. John, Prince George, Terrace, and Prince Rupert. A more meaningful understanding was accomplished with regard to pre-admission, care, and after-care- In November, Centre Lawn staff again met with the mental health centres in Terrace. At the year-end there were 37 patients in boarding-homes and it was expected this would increase to at least 50 in a short time. In addition to direct treatment and consultative and educative relationships with local public and private agencies, the Centre was closely involved in social planning. The Centre is a member agency of the newly created Fraser-Fort George Regional Community Services Board, which held its founding meeting in October. The Board was patterned after the CELDIC idea of neighbourhood councils represented on a community services board. The Board appointed three committees to carry on activities—an Interdepartmental Committee to find ways in which public agencies could work together, a Child Care Resources Committee to determine needs for new services in the community and to find ways of avoiding duplication, and an Interdepartmental In-service Committee to provide cross-agency in-service training. The Centre was represented on all three committees. Consultative visits to Vanderhoof and Burns Lake were continued throughout 1973, and Mackenzie, with a population of approximately 5,000, was added to the list during the year. The Centre's psychologist organized and directed a study in the Burns Lake area to assess school needs. The study was done in co-operation with the local school district and Public Health, and was completed and published in August. As a result of this study the Burns Lake School District provided funds and hired a psychologist for the district. At the year-end the psychologist was carrying out a study in Mackenzie to determine community incidence of mental and emotional problems and to acquire guidelines for needed services. This study was being done in co-operation with the public health nurse in Mackenzie. No regular visits were made to McBride and Valemount, but liaison was made through the public health nurse in McBride. Medication was supplied to patients L 60 MENTAL HEALTH BRANCH REPORT, 1973 in this area by the Centre through the public health nurse. The latter was instructed to contact the Centre by telephone for any emergencies, consultations, or requested visits. The mental health centre in Fort St. John was left without professional staff in September on the resignation of the mental health nurse, and a visit was made by the Prince George Administrator in October to arrange for continuation of pharmacy services and to meet with local representatives of Public Health, Department of Human Resources, RCMP, and the hospital. PRINCE RUPERT MENTAL HEALTH CENTRE The Prince Rupert Mental Health Centre was officially opened on October 5, 1973, by the Co-ordinator of Mental Health Centres. The staff consisted of the Administrator and a clerk-stenographer. The Centre's catchment area included Prince Rupert and the Queen Charlotte Islands, with an over-all population of about 27,000. However, referrals for assessment and treatment came from as far south as Bella Coola, and as far north as Port Simpson and Kincolith. Prior to the opening, which was followed by an Open House, the Administrator had established liaison with the health, social, and educational agencies in an attempt to communicate and co-ordinate existing services. A Community Resource Council was set up under the Societies Act to try to co-ordinate the services of many of these agencies. A Child Guidance Clinic was also established to assess and review the needs of children. Although Prince Rupert was expanding slowly and steadily, it remained a transient area, with a very high turnover of population and a heavy demand for direct services. The total case load at the end of October was 89. Prince Rupert also had a strong cosmopolitan population. Consultation work with teachers, counsellors, probation officers, social workers, public health nurses, and day-care workers was a vital part of the Centre's role. The Centre operated on an open referral system, but referrals came through most of the established agencies. Consultation also took place with the planning groups on the Queen Charlotte Islands, including the Regional Queen Charlotte Islands Health and Human Resources Council and the Masset-Haida Steering Committee, as well as the Queen Charlotte City, Sandspit, and Skidegate Steering Committee. The Queen Charlotte Islands was one of four communities that had been selected as a pilot project to establish a Human Resource and Health Centre. This ground swell of interest in community involvement, planning, and restructuring, in order to coordinate existing services and allow for greater accessibility and availability of services, meant more intense involvement in consultative work. The clinical aspect of the services also remained an important function of the role of the Centre. SAANICH MENTAL HEALTH CENTRE The Saanich Mental Health Centre continued to operate under the open referral system and accepted referrals from many community agencies, individuals, COMMUNITY MENTAL HEALTH SERVICES L 61 and from the community physicians. The active case load continued at a high level, and the pattern of referrals seemed to indicate that the Centre was providing services for clients from more remote areas in the district, as compared with the Centre's first months in the Royal Oak area. All staff members continued to work in close collaboration with the public and private agencies serving the people of Saanich, Central Saanich, North Saanich, Sidney, and the Gulf Islands. Principal activities included diagnostic assessment, treatment, and many supportive services in consultation with other community agencies. Staff were concerned with the need to extend preventive services to try to reduce the incidence of emotional illness. In addition to activities at the Centre in Royal Oak, visiting teams or staff members worked in Ganges, Sidney, and Brentwood. Part of the purpose for this was to assess the local community need for a service delivered in close geographic proximity to the location where the problems were occurring. In most instances the principal utilization of these outreach facilities was by persons who, for reasons of infirmity, illness, or poverty, were unable to arrange transportation to the central location. Staff members from this Centre participated in supportive work with the Cornerstone Project, a resocialization and rehabilitation programme developed jointly by the Canadian Mental Health Association and the Cordova Bay Irregulars, a citizens' group in Cordova Bay. Personnel also worked with several other projects initiated by laymen to develop programmes to train laymen in the area of providing services to those in need. Of these programmes, the Centre's participation in the Citizens' Counselling Centre in Victoria was particularly rewarding. Staff worked closely with this group and the Saanich Peninsula Guidance Association, as well as marriage-counselling services conducted by volunteers in 25 other British Columbia communities to help establish the B.C. Family Life Association. This was a Provincial organization to support, encourage, and help initiate new marriage counselling and guidance facilities staffed principally by volunteers. The Centre was particularly concerned with problems related to the selection, training, and supervision of voluntary counsellors. Staff members in the Saanich Mental Health Centre developed close, cooperative, and effective working relationships with staff members of other agencies serving people in need of help, and it was planned to continue to expand and develop this interagency involvement. In the new year the Centre also hoped to expand indirect services, and maintain the assessment and treatment load. SECHELT AND SQUAMISH MENTAL HEALTH CENTRES Mental health centres were established in Sechelt and Squamish toward the end of the year. A psychologist was recruited for the Sechelt office and a mental health nurse for Squamish. In addition to serving the Sechelt area, the psychologist would provide some consultation to Squamish. Staff time was initially occupied with orientation to various community agencies and practitioners, and the setting-up of an office operation. Prior to acquiring office space, a number of patients were given direct treatment in the psychologist's home, the client's home, or in offices provided by other Provincial agencies. L 62 MENTAL HEALTH BRANCH REPORT, 1973 SURREY MENTAL HEALTH CENTRE Approximately half of the staff psychiatrist's three to five sessions per week comprised assessments of new clients, and half comprised ongoing assessments of regional boarding-home residents. Weekly sessions of group therapy were also provided. The mental health nurse spent approximately two-thirds of her time on direct and consultative services to clients, including group work, and the remainder of her time in helping to develop community services. She left on an educational leave of absence in June and her replacement was mostly involved in direct service to Centre clients, which included an emphasis on service to children in play therapy and child management counselling. Other direct services included individual counselling for adults with chronic and acute problems, marital counselling, and some family and group-therapy sessions. Her involvement in community services included a number of community organizational meetings and educational sessions. The boarding-home social worker was highly successful in organizing the Boarding-home Programme; and the case aide spent some time doing behaviour modification with several individuals in the boarding-home. The activity therapist promoted independence among the boarding-home residents and was gradually achieving her objectives. The Co-Getters Club, a social activity club, was run entirely by the boarding-home residents. She also spent considerable time in organizing transportation, and other volunteer services, for the Boarding-home Programme. The mental retardation social worker continued her survey of services to the retarded in the areas served by the Surrey and Whalley Mental Health Centres. She also had some direct service responsibilities and continued to act as liaison between Woodlands and the community. The pharmacist provided medications to the Centre's clients and the boarding- homes. The social worker (regional consultant) was the most active direct service team member throughout the year and also continued to participate in community projects. He was active in Deltassist and on the Delta Social Agencies committee, ran Post Partum Depression groups, training groups for public health nurses, marriage counselling groups, and a group for parents of children on drugs. A psychologist and a mental health nurse volunteered up to five sessions a week to the Centre all year to run groups, do assessments, marriage and family counselling, and community projects. They provided invaluable assistance. The Administrator devoted a good deal of her time in community projects and Centre administration. The projects included development of a Surrey Learning Disabilities Project Proposal; helping to establish a Surrey-White Rock Family Life Association; setting up a series of eight free community legal forums ranging from "Mental Patients and the Law" through "Matrimony, Divorce, and the Law"; participating in several free child management courses; developing a tutorial and counselling service; organizing and supervising community survey of social services and learning disabilities services; as well as delivery of individual assistance to several pre-schoolers who showed signs of autism, with the help of eight incentive workers in Surrey. Direct service contributions comprised individual assessments and follow-up, and innumerable group-therapy sessions with adolescents in Surrey and Delta. COMMUNITY MENTAL HEALTH SERVICES L 63 TERRACE MENTAL HEALTH CENTRE The primary aims and objectives of this Centre continued to be the development of comprehensive mental health services within the local community. The focus was in the direction of primary prevention and education. Centre staff promoted the uniting and utilization of nonpsychiatric agencies to assist in this endeavour, as well as to meet the day-to-day requests for direct treatment. It was felt that gains were made in this direction during the year, with the result being a more comprehensive and meaningful service to the consumer. An additional benefit to the unification of resources, both in terms of health and social services, was the ability to reflect and identify the special needs of the community served. The development of community services did not negate the responsibility of the Centre to provide direct treatment, both on an interim and ongoing basis, to meet the large demand for these services. The area the Centre covered geographically was extremely large, and included the Skeena Health Unit (other than Prince Rupert), Ocean Falls, and the Queen Charlotte Islands. There was a regular travelling clinic to Kitimat, Hazelton, Smithers, and Houston. The clinic's most northern visit was to Telegraph Creek. Staff members included a psychiatric social worker, a boarding-home social worker, and two stenographers. The position of clinical psychologist was filled until September. Psychological and psychiatric consultation was provided by the Victoria Mental Health Centre and the B.C. Youth Development Centre. Pasdiatric assessments were provided on a sessional basis by a local paediatrician. The medical staff of both the Kitimat and Terrace hospitals appointed a local doctor as a liaison person between this Centre and the physicians. The total number of activations and reactivations of files from October 1972 to October 1973 was 417. This is a significantly high number in terms of size of staff and the large geographical area covered. The promotion of new services also meant the upgrading and expansion of the present ones, and a great deal of emphasis was placed upon in-service education. For example, Centre staff actively provided in-service assistance to social agencies, schools, the Northern Training Centre, clergy, police, nursing staff, Skeenaview Hospital, family physicians, and local volunteer groups. Progress toward regionalization of Riverview Hospital continued throughout the year. This was received favourably by the local communities, both in terms of a better service offered and also in terms of co-ordination of services and communication between community and hospital. The Centre received requests for help from expanding communities and industry. There was a possibility that a small industry might develop in one of the communities, and the Centre was asked to assist in forecasting some of the social changes that a new industry would bring a small community. Assistance was also provided to a local industry which inquired about their responsibility to their employees, over and above the normal salary and staff benefits. Centre staff met with the management and made some tangible recommendations to assist the employees and their families. During the year, Centre staff provided consultation to pre-schools, nurseries, Community Resource Councils, child care workers, schools, the Northern Training Centre, the Skeena Union Board of Health, and other social agencies. L 64 MENTAL HEALTH BRANCH REPORT, 1973 The goals established for 1974 were to continue to assist communities developing local resources, with the emphasis on community involvement, and to continue to offer indirect services through education, consultation, and community organization, as well as meet the Centre's responsibility to provide direct services. TRAIL MENTAL HEALTH CENTRE During 1973, Centre staff continued to make every effort to maintain an effective service to the people in the region. The problems of quantity versus quality, direct versus indirect services, expansion versus concentration of efforts, faced by most mental health centres, were in constant review over the year. A primary focus of the staff was to press for local integration of health and welfare services. This was stressed in all aspects of consultation, advisory, and public education endeavours throughout the region. The demand for direct services exceeded that which could be effectively met by available staff. As a result, it was necessary to terminate Travelling Clinics to the Boundary area in June. This was planned well ahead and had the following benefits: Mobilizing of community effort to press for residential staff, designation of Grand Forks as a location for one of the initial integrated community health centres, physical amalgamation of medical and public health services in Greenwood, and greater concentration of staff time in the Trail-Rossland and Castlegar-Kinnaird areas. Direct service referrals continued to be made at the rate of approximately 20 per month, with a waiting period for service in most cases of about three weeks. The summer student programme, which employed two young people in the Centre, was highly successful, as they helped to increase direct services to children and handicapped adults, as well as gaining valuable experience for their future careers. In addition, the short-term placement of Public Health and Selkirk College students was valuable to these people, although additional staff time was required to meet the training need. The year saw the Centre closely involved, through staff advisory and consultative roles, in the development of a number of new services in the region, and again emphasized the need for local integration. As an advisory member to the Board of the Trail and District Child Care Society, the Centre assisted in planning the Group Home facility, screening prospective houseparents, and becoming a member of the Admissions-Screening Committee. By the end of the year the Group Home had six adolescents in residence. Staff assisted in the research, public education, and initiation of the Trail Regional Child Day Care Society, with 16 children attending regularly. After two years of effort the Centre was successful in the establishment of a viable Big Brothers Association in Trail. As chairman of the Matching-Screen- ing Committee, the Administrator was closely involved in the progress of the organization. By the end of 1973, there were 12 boys benefiting from this service. The Centre's close involvement with the Trail Methadone Clinic led to the continuation of the programme in this area, with greater emphasis on the counselling and rehabilitative aspects. Changes in both the Aid to the Handicapped Committee and the Crisis Centre Programmes resulted in part from staff participation as advisory members. These reflected the changing needs of communities, and the importance of agency responsiveness to community concerns. The Trail and District Youth Liaison Committee continued to be a vital group for the ongoing resolution of children's emotional, educational, and social problems, COMMUNITY MENTAL HEALTH SERVICES L 65 as well as a vehicle through which gaps in services could be highlighted and dealt with more effectively. Through involvement with the Association for Community Planning, Centre staff served in advisory capacities to such groups as Meals-on-Wheels, Chimo Youth Hostel, Intermediate Care Society, LIP projects, and Project Integration (an ongoing effort by community lay and professional groups to improve even further one of the best co-ordinated networks in the Province). This was also fostered through staff membership in the Union Board of Health. The Centre's close working relationship with the Canadian Mental Health Association involved staff participation in Mental Health Week through the Centre's Open House, radio talks, distribution of pamphlets, and other forms of publicity. More importantly, staff members worked with the executive toward strengthening of the educational and voluntary functions of the group. Two orientation-training sessions for volunteers were held during the year, and in co-operation with other professionals the Centre assisted in the development of an after-care group for those persons with more difficult and long-standing emotional problems. This closely involved the Columbia Unit staff of the Trail Regional Hospital in the planning and implementation of after-care and volunteer programmes. In the area of public and professional education, all staff were involved in such activities as family-life group discussions; panels on drug use and abuse; marital growth; social problems in the region; presentation to the B.C. Teachers of the Mentally Retarded Workshop; CMHA (B.C. Division) annual meetings in Cranbrook, dealing with the emotional needs of children; and a wide range of presentation to various groups related to the further development of effective services. In all, the mental health programme for the year was highly successful, in keeping with the available manpower. Goals for 1974 were primarily to consolidate the gains made, to foster greater integration, and to respond as effectively as possible to public need within this region. VERNON MENTAL HEALTH CENTRE During 1973 the staff of the Vernon Mental Health Centre tried to divide their time appropriately between treatment programmes, consultations, community organization, and education to professional and lay groups. Staff members included a psychologist, a mental health nurse, two psychiatrists, a social worker in charge of the Boarding-home Programme, a full-time case aide for the Boarding-home Programme, two full-time stenographers, a part-time stenographer, and a social worker/Administrator. Due to the relatively large staff, and the area's wide range of needs, the Centre had a variety of treatment programmes, including reality-oriented brief service, behaviour modification, marriage and family therapy, transactional analysis, and hypno-therapy and chemo-therapy. There were two group-therapy programmes involving about 22 patients, and efforts were being made to expand this programme. Since the arrival of a psychiatrist in July, the Centre was able to again provide the psychiatric ward of the Vernon Jubilee Hospital with psychiatric consultation. The programme on the psychiatric ward included group therapy, chemo-therapy, E.C.T., and a new programme of behaviour modification which was going into effect at the year-end. L 66 MENTAL HEALTH BRANCH REPORT, 1973 All the staff members were involved in a number of community programmes during the year. The mental health nurse helped organize a volunteer bureau. There was a programme in Sorrento (a small community about 60 miles outside of Vernon), where one of the psychiatrists and the social worker were used as consultants and teachers in family therapy. This programme expanded to provide a number of families with family therapy for a full day, each family being interviewed by three therapists. The Centre organized a number of meetings with Public Health, school counsellors, and Department of Human Resources personnel to arrive at more specific plans to help co-ordinate community services. It was felt that a more concerted effort at co-ordination would provide a better delivery of services in general. Vernon's volunteer committees and associations, such as the Social Planning Council, North Okanagan Youth Resources Society, Canadian Mental Health Association and CACLD were all serviced by the staff of the Centre, either as members of the associations or on the advisory boards. The Centre continued to provide travelling clinic services to Salmon Arm and Revelstoke, which meant servicing a population of about 60,000. Staff were involved in education of both professional and lay groups. For example, under the auspices of Adult Education, the Centre provided a parent- education course in which 90 people enrolled. The psychologist provided consultative services on behaviour modification to school personnel, psychiatric nurses (both in the psychiatric ward of the general hospital and Dellview Hospital), local physicians, Department of Human Resources staff, and public health nurses. The Boarding-home Programme continued to be extremely active under the supervision of the boarding-home social worker, with approximately 160 people receiving care. It was considered that some of the unmet needs in the area included more intermediate care homes, and a better crisis intervention service in the outlying areas. During the year the Centre utilized five summer employment students, who provided a useful addition to staff services. VICTORIA MENTAL HEALTH CENTRE During the year the Victoria Mental Health Centre, with its multidisciplinary staff, continued to meet the increasing demands for services by the community and the various agencies. In spite of the increasing number of psychiatrists in private practice, the Centre was still asked to give direct patient care. The Centre was becoming highly specialized in many areas of discipline. The Psychology Department continued to be a very busy group, providing neuropsychological and educational evaluation to hundreds of children with learning disorders, and suspected minimal brain dysfunction. This specific function of the Centre resulted in the development of integrated services for children and their families. In the future this facility would become a focus for co-ordinating existing services for children with learning disorders, minimal brain dysfunctions, autism, and mental retardation. Such co-ordination would eliminate expensive duplication of valuable manpower and its expertise. COMMUNITY MENTAL HEALTH SERVICES L 67 As the service for children and families became autonomous, the remainder of the Victoria Mental Health Centre staff would continue to provide its services to adult patients. Various members of the Centre staff maintained close liaison with the Attorney- General's Department through their active involvement in the forensic field. The Regional Consultant of Psychiatric Social Work provided a weekly visit to the William Head Correctional Institution, as the demands for treatment for inmates and consultation with the correctional staff increased. The Art Therapy Programme, as in previous years, developed extensively. It participated in the annual Geigy Pharmaceutical Art Competition and "Achievement '73," an arts and crafts show sponsored by the Community Art Council and the Community Council of Greater Victoria. In observance of Mental Health Week, the Centre held an Open House on May 4, 1973, with approximately 100 people in attendance. There was excellent coverage of this event through local television, radio, and newspapers. Participation with various community agencies and committees allowed the staff to become closer to other workers interested in the mental health field. During the summer months the Centre employed university students in various aspects of its activities. Although there were a considerable number of staff changes, both in the professional and clerical group, the function of the Centre was never interrupted to the detriment of patient care. The Administrator's regular visits to the Terrace Mental Health Centre assisted in maintaining an amicable liaison with the local physicians and other community resources. WHALLEY MENTAL HEALTH CENTRE During the year the Whalley Mental Health Centre carried between 124 and 324 cases per month. During the first 10 months of 1973, 258 new cases were activated. In addition, the Centre also carried 42 boarding-home cases. Whalley staff were involved in the development of the Surrey Rehabilitation Workshop, which served up to 30 handicapped people and provided consulting and treatment services. Clients with physical, intellectual, or psychiatric disabilities were accepted. Centre staff also offered social work and psychological consultation to special teachers who were initiating a new programme for children who dropped out of school or who presented severe behaviour problems in school. The teachers worked individually with the children and were in contact with them in the community as well as in the school. In conjunction with Surrey Youth Services a continuing adolescent group session was held once a week for emotionally troubled youths. A number of special projects were developed in the community. The Centre assisted community groups at organizational meetings and in the provision of services. Meanwhile, Centre staff continued to work with established agencies such as the Surrey Social Service, the Probation Department, the schools, and Public Health. Whalley Mental Health Centre also provided speakers for groups such as the Association for Children With Learning Disabilities, the Twins' Club, Single Parents, and the Homemaker Programme. L 68 MENTAL HEALTH BRANCH REPORT, 1973 A summer student was employed to carry out a survey of the Centre's intake, including all the cases which had been opened in Whalley since the Centre started. The survey covered data on the previous psychiatric history of the clients and the extent to which their problems involved other family members. WILLIAMS LAKE MENTAL HEALTH CENTRE During its first full year of operation the personnel of this Centre, two professionals and one clerical staff, continued to provide service to the 50,000 people in the 50,000 square miles of the Cariboo. Located geographically in Williams Lake, staff travelled monthly for three consecutive days to Quesnel, and on an "as needed" basis to Lac la Hache, 100 mile House, the Chilcotin, Bella Coola, and other smaller isolated outposts. Familiarization with people and programmes in the variety of communities was an ongoing priority, as was the establishment of working relationships with professional and lay workers. The model introduced in this newly established Centre accentuated the consultation and public education approaches, with limited direct service offered in Williams Lake. All other locations were served exclusively via consultation. In an attempt to render a communicable and responsible service, staff documented in two written briefs the Centre's semiannual goals and programmes, with the aim of stimulating ongoing dialogue and continuing adaptation of mental health services to community needs. The main focus of the Centre's limited direct service was geared to providing after-care follow-up for patients who had been hospitalized in psychiatric facilities, and crisis intervention for people who could be helped to avoid a psychiatric hospitalization. Due to geographical and staffing necessities, this service was offered only from the Williams Lake office, though anyone in the catchment area could apply to be seen. Co-ordinated with this service were monthly consultation meetings with the public health nursing staffs in Williams Lake and Quesnel, during which a joint review was made of all admission and discharge reports of local patients in Riverview Hospital, and ongoing co-ordinated services to these patients and to their families were planned. Consultation was offered either by meeting with one consultee about a problem in their case load or programming, or by meeting with local teams composed of all community helpers involved with a referred individual. These team meetings were a particular asset in facilitating co-ordination and reducing duplication of local services. In the schools, Centre staff included parents and, if appropriate, the referred student, in the discussions which were based on a problem-solving approach. Detailed records of care consultations were kept, including plans for intervention and arrangements for follow-up. The three main geographical areas with which the Centre had most contact differed greatly. The tremendously rapid growth of Williams Lake created new community pressures and contributed to the fragmentation of the established socioeconomic structures and services. Growth in Quesnel, with a town population half that of Williams Lake, was slower, which enabled this community to retain more COMMUNITY MENTAL HEALTH SERVICES L 69 consistency of identity and continuity of functioning. The south, Lac la Hache and 100 Mile House, was still sufficiently small to maintain a frontier cohesiveness and self-reliance. Each area used mental health services differentially. Major clients in all areas were the school districts, which referred 75 per cent of the total number of cases conferenced. Cultural conditions proved to be the prime contributing factor in the cases which were consulted. For children in all geographical areas, the most prevalent presented problem was aggression in the school, with aggression at home placing second. The detailed record-keeping and statistical systems yielded information useful to the Centre in attempting to relate to each area and to stimulate local planning for personnel, resources, and co-operation. Although the consultation model was workable and productive, legitimate needs for direct service were going unmet. The Centre's objective for the next year was to acquire additional staff to be permanently located in the outlying areas, and to undertake direct service programmes. IN-PATIENT SERVICES Department of Nursing Education Riverview Hospital Geriatric Division Woodlands Tranquille British Columbia Youth Development Centre, The Maples, Burnaby IN-PATIENT SERVICES DEPARTMENT OF NURSING EDUCATION For 41 years the Department of Nursing Education, Essondale, was solely responsible for the preparation of psychiatric nurses in British Columbia. With the graduation of the September 1973 class the department relinquished the task of educating psychiatric nurses. The British Columbia Institute of Technology, which assumed responsibility for psychiatric nursing education in 1972, commenced the second year of its programme, and in September 73 students returned for this second year of study. One hundred and four new students enrolled in the programme, making a total of 177 students. The B.C. Institute of Technology continued to use the Education Centre classrooms, offices, and facilities as a "second campus" for both psychiatric and registered nursing students. Fifty-two students of the February and September 1973 classes completed the programme at Essondale. Students found experience in the community of considerable value and would welcome more opportunities for experience in acute psychiatric nursing. Those students who were assigned to the behaviour-modification programme enjoyed being part of the therapeutic team. The popular six- week elective allowed the students to work as graduates without assuming total responsibility. Registered nursing students completing the eight-week affiliation programme in psychiatric nursing totalled 129, as follows: Royal Columbian Hospital—78 students enrolled in six rotations. St. Paul's Hospital—51 students enrolled in six rotations. The annual review of terms of agreement between the Mental Health Branch and the General Hospital Schools of Nursing was held in February and the agreement was renewed. With the closure of the School of Psychiatric Nursing, the coordination of the affiliate programme was transferred to the Co-ordinator of Staff Development, Riverview Hospital. With the phasing out of St. Paul's Hospital School of Nursing, their last rotation of affiliating nurses was completed on November 26, 1973. Residence accommodation was provided for 285 persons; this number included 187 students, two staff, and 96 transients. Commencing in September, accommodation was limited to 92 places in Residence XI only. In addition to sleeping accommodation, lecture-room facilities were made available for a wide variety of workshops, seminars, and meetings conducted by the Mental Health Branch and other groups. Sixteen sessions were held, with approximately 375 persons participating. 73 L 74 MENTAL HEALTH BRANCH REPORT, 1973 With a gradual reduction of classroom and clinical responsibilities, faculty members directed their energies toward the completion of files of former graduates. Academic transcripts and confidential profiles were organized to be available on request for graduates whose records had been maintained by this department. Records were also summarized on graduates of the postbasic programme formerly offered to registered nurses. Records of faculty members formerly employed by this department were forwarded to the Consultant in Nursing, Mental Health Branch, Victoria. The final year of the programme was marked by several events; two of which require special mention— At the request of the graduating students, two graduations were held instead of one large Commencement Exercise. Both graduations were held in Valleyview Auditorium, with receptions following in Residence XI Lounge. In June, Mrs. E. Paulson, a devoted public servant and Acting Director of Nursing Education, was honoured at a retirement tea. Mrs. Paulson recalled events in her 23 years of service and noted especially that, prior to her retirement, two of her wishes had been fulfilled— the proclamation of the Psychiatric Nurses Act, and the transfer of the Psychiatric Nursing Programme to an educational facility. The graduation of the September 1973 class closed a chapter in the education of physchiatric nurses in this Province. All who served in this Department hoped the major changes that took place during the year would broaden horizons for psychiatric nurses, and prepare them for rewarding professional experiences, both in the institutions and in the community. The Honourable D. G. Cocke, Minister of Health, congratulates a graduate of (he 42nd Graduation Exercise, held in February. Ms. Rosemary Brown, M.L.A., and Dr. F. G. Tucker, Deputy Minister, officiated at the last class to be graduated from the School of Psychiatric Nursing, in exercises held in August. A reception was held in June to honour Mrs. Elisabeth Paulson, Acting Director cf Nursing Education, on her retirement following 23 years of distinguished service to the Department. RIVERVIEW HOSPITAL A bookmobile programme for all hospital units was started in June. Increased circulation figures were indicative of the interest shown in the new service. A panel discussed the treatment and rehabilitation of the homicidal and suicidal patient during a workshop held in March. Each year the Recreational Therapy Department conducts a two-week vacation programme for residents. A group is shown on a visit to the Capilano Salmon Hatchery. CLINICAL SERVICES Specific recommendations, as the result of common planning, were made by the Deputy Minister in January of 1973 regarding the reorganization of Riverview Hospital into five programmes. The five programmes designated were those for (1) the Greater Vancouver Service area; (2) the programme for the remaining patients in British Columbia who were admitted to Riverview; (3) a programme for patients who would be classified forensic; (4) a programme to look after the patients who would ordinarily require infirmary care; and (5) a programme for patients requiring a minimum of physical care, but having long-term mental illnesses. The programmes would encompass all aspects of Riverview Hospital operations and would, at the same time, permit a flexibility and the development of further programmes as warranted. The plan showed that closer activities and better working relationships on a regionalized basis could be undertaken. The programmes would endeavour to provide comprehensive treatment coverage for all patients, yet within each of the separate segments specific and detailed variants would be developed for certain groups of patients. For example, within the programme providing minimal care, there could be special programmes such as operant conditioning, types of retraining, home visiting, a special occupational treatment programme, and so on. Much time and many hours of effort were spent in working out details of this over-all plan from the point of view of the administrative organization to support it, as well as details on implementing each of these programmes. In keeping with the policy that Riverview Hospital should extend its activities into communities, efforts continued during the year in joint meetings with the Greater Vancouver Mental Health Project. Since this involved persons and 75 L 76 MENTAL HEALTH BRANCH REPORT, 1973 groups operating within Vancouver and under special auspices which were not directly related to Riverview Hospital, joint planning committees had to be structured. From the Vancouver point of view, these were set up and put in operation by the Metropolitan Board of Health. Special planning groups at Riverview Hospital were set up also, and the basis of the operating unit would be the health care team. The concept was for a combined Vancouver-Riverview Hospital Team, whose members could move in and out of the hospital and community, which would permit continuity of care for patients. Plans were developed to have part of the Crease Unit designated to provide in-patient care for the Vancouver service. By the year-end three Community Care Teams had been established in Vancouver. The out-patient services of Riverview Hospital continued, but where possible, patients belonging to the new service areas were transferred from the out-patient service roster to the local community service. Representatives from Riverview Hospital continued to meet with representatives for the Greater Vancouver Advisory and Planning Committee, as well as with the Co-ordinating Committee of the Metropolitan Board of Health. The programme for patients outside of Vancouver was established on the basis of the work being done in Centre Lawn, and at the year-end clinical staff were working the local mental health centres. During 1973, for the first time, clinical team members from Centre Lawn visited outlying community areas to arrange for local facilities and personnel so that patients could receive their treatment closer to home and avoid hospitalization where possible, and in other instances, to facilitate the transition from hospital to the community. ADMINISTRATIVE SERVICES DIVISION Changes in administration and the administrative services were necessary to provide the proper framework and operating mechanisms for the development of the new programmes for Riverview Hospital. Studies, discussions, and exchanges of ideas took place between Riverview Hospital administration and Mental Health Branch senior officers, in an effort to find the most suitable type of structure. This game of ring toss took place during a summer outing. Residents visited several parks in July and August. Two Riverview residents posed with members of the RCMP when a group visited their centennial exhibit at the Cleveland Dam. A ride on the Miniature Railway was the highlight for many of those who went to Stanley Park. IN-PATIENT SERVICES L 77 In September the Deputy Minister announced the new administrative structure for Riverview Hospital. This structure was such that the programmes would operate as independently as possible, and have their own administrative organization. Senior clinical personnel in Riverview Hospital were to be assigned consulting positions, and the administrative and support services would be combined under one administrative authority. As a result of a successful recruiting effort, a high level of medical staffing had been achieved by the year-end, and nearly all established positions had been filled with well-qualified personnel. Unfortunately, there continued to be a shortage of nursing personnel, particularly of registered psychiatric nurses, and it was necessary to utilize psychiatric aides in nurse positions. It was expected that this difficulty would be overcome by a programme of intensive nurse recruitment overseas in November and December. Within Programme 4, covering medical-surgical and other types of care, the plan was to have the central paraclinical services, such as laboratories, radiology, pastoral care, podiatry, and optometry, included within this general programme, and that as the other four programmes required these services, they would be arranged between the Programme Administrators. The planning and administrative structure for the Programme in Forensic Psychiatry had not been determined by the year-end. However, it was obvious that special administrative programming would be necessary to provide an improved forensic service. During the year, major structural changes were underway in the Riverside Unit, to make this building modern and safer and to provide more recreational and usable patient space. In order to do this it was necessary to reduce the bed complement, which was established at 145 patients. Additionally, it was planned to move patients from the Riverside Annex to other buildings within the hospital. Those who did not need to be within the Forensic Programme would be assigned to other programmes. One of the major improvements to the Riverside Unit was the development of a large recreational hall. The renovations to Residences 6, 7, and 8 were expected to be completed and ready for occupancy by the year-end. Residence 6 would provide new and improved service facilities; and Residences 7 and 8 would be used for patients and for those ready for discharge into community facilities such as boarding-homes, sheltered areas, and so on. New fire escapes for East Lawn and Crease Unit were finished during the year. The hospital continued to support the Canadian Red Cross Blood Transfusion Service by holding two major clinics. The activities of the volunteers continued at a high level and the numbers of hours of service, in this 20th year under the auspices of the Canadian Mental Health Association, were significant. The Legal Assistance Programme continued, and the patients benefited greatly from this generous service on the part of the participating lawyers. On October 31, 1972, Riverview had 2,121 patients; at the same date in 1973 the in-patient number was 2,000, and the hospital had provided 60,790 patient-days, a decrease of approximately 5,000 patient-days from the previous year. The lowest month of occupancy was August, with 1,950 in-patients, and a total utilization of 6,905 days. Several hospital committees were active during the year. The Master Planning Committee produced many useful ideas on development and planning. The Patient Care Committee dealt with all aspects of patient care, and department Di- L 78 MENTAL HEALTH BRANCH REPORT, 1973 rectors met regularly to review topics of concern and interest in the over-all area of patient care, such as the types of care necessary in dealing with the potentially dangerous patient. A successful seminar was conducted on the continuing concerns for this type of patient. A special Joint Steering Committee was formed to aid in developing closer working relationships between the Metropolitan Board of Health and the Riverview Hospital. The method of physicians' payment by sessional fees became popular during the year and a good number of the medical staff members who previously had a salary appointment, either full or part-time, moved on to the sessional method. It provided for flexibility and increased the number of physicians available to Riverview Hospital. GERIATRIC DIVISION In 1973 the Geriatric Division consisted of three units, with a total bed complement of 1,216. Valleyview Hospital, the largest, with 726 beds, accepted patients from the Lower Mainland and adjacent areas, and from Vancouver Island and the Gulf Islands. Dellview Hospital, Vernon, with 190 beds, accepted patients from the Okanagan and Kootenay areas, while Skeenaview Hospital, Terrace, with 300 beds, all of them male, accepted patients from the northwestern part of the Province. Patients from the extreme northern areas were admitted to Valleyview Hospital- To be accepted, patients had to be aged 70 or over and suffering from mental illness and in need of treatment, or suffering mental deterioration due to aging and with associated behaviour sufficiently disturbed that they could not adequately be cared for elsewhere in the community. Those showing mental deterioration without a behaviour problem, however, were not regarded as suitable for admission since they only require simple personal and nursing care. VALLEYVIEW HOSPITAL The rate of admissions during the year was a little below that of last year, as was the death rate, while resident population and discharges continued at last year's level. There was increasing evidence that the proportion of resident population requiring total personal and nursing care was gradually increasing. The preadmission screening programme continued at a similar level to last year, and late in 1973 an experienced psychiatric nurse was obtained, to observe and report on behaviour patterns. The four general physicians continued their medical care to patients, while the Assistant Superintendent was responsible for improvements in the quality of psychiatric care. In August the Assistant Superintendent resigned his position, but continued to serve on a half-time sessional basis. At the beginning of June the hospital lost the services of Riverview physicians in covering Valleyview at nighttime and Sundays and holidays, which had to be carried by Valley view's doctors. The staff of the Nursing Division continued to discharge their duties in a responsible and concerned way. A greater proportion of residents required total personal and nursing care, and the low nurse-to-aide ratio made this more difficult. The nursing staff again exerted themselves beyond their normal duties to provide enjoyment on special occasions for patients, for example, each unit arranged its own summer festival. During the year, staff turnover, particularly among the aides, was very high, which made it difficult to build up an adequate core of trained and experienced aides. The Associate Director of Nursing left in June on early retirement and was replaced in September. The health of the nursing staff at all levels continued to give considerable concern. Some staffing difficulties were relieved by the use of on-call both for nurses and aides. Occupational Therapy and Recreational Therapy Programmes continued as in former years. Two young students hired in the summer brought a great deal of interest and enthusiasm and were able to carry along a remarkably good programme. The dentist conducted a thorough survey of patients and drew up a plan for the guidance of nursing staff in the care of patients' mouths. His enthusiasm, energy, and knowledge would undoubtedly improve the level of dental care in the hospital. 79 L 80 MENTAL HEALTH BRANCH REPORT, 1973 The work load in the Pathology and Radiology Laboratory continued at the same previous levels. The laboratory changed over entirely to the unit value scheduled for laboratory procedures, which gave a better way of measuring work load since it was expressed in terms of time taken. An average of about 15 surgical operations a month were carried out in the Surgical Unit, Riverview Hospital. The Physiotherapy Department continued to give the patients excellent service. Staff were very active in educational sessions for nurses, to demonstrate how to lift patients so as to avoid back injuries. The Social Service Department was involved in work within the institution and in a major way with activities surrounding preparations and arrangements for discharge and after-care. One worker was active in the preadmission screening programme. Social work was vital in all phases of the hospital's clinical work. The Department of Volunteer Services completed its first full year of operation. The service provided was as varied as the needs of the patient. Some volunteers simply visited as a relative or friend might do, some helped with the personal needs of the patient, such as hairdressing or manicuring, some took patients out for walks, others wrote letters or read to the patients, some took them for car rides or to the store for shopping, and some volunteers took patients to their own homes to visit. Volunteers had always played a large part in the Recreational Therapy programmes, but the new department focused on the many other ways in which volunteers could be useful and helpful. The beautician in the beauty parlour provided a service which was considered a most valuable one for the patient's morale. Another valuable service to the hospital was that supplied by the chaplain. Weekly services were held on each ward and formal services in the Auditorium at Christmas, Good Friday, and Easter Sun- Twice each year Valleyview's Accident Prevention committee awards a trophy to the team with the best safety record. Team 2 received their award (above) at a ceremony held in March. Discarded pressure cans were a problem because of their explosive nature when inadvertently incinerated. Staff are shown receiving instructions on a device, developed at Dellview, to puncture the tins before being discarded. In May, 25 Dellview patients visited the Okanagan Game Farm in Penticton. Here they enjoy a picnic lunch at the farm. GERIATRIC DIVISION L 81 day, Thanksgiving, and Remembrance Day. The chaplain also visited seriously ill patients, including those in Riverview Hospital, for surgery- In addition, he was widely sought as a counsellor both by patients and their relatives and by staff. The Safety Committee worked diligently throughout the year. Administrative—In 1973 a total of 130 new positions was requested, of which 30 were authorized. Twenty-seven of these were filled during the year, which permitted the extension of food service to seven of the nine outside wards. Graduate nurses averaged a 46-per-cent rate of turnover during the year, the highest rate for many years. Significant funds were authorized for the employment of temporary staff, who assisted in meeting needs brought about by staff illness and other reasons. In the latter part of the year a Co-ordinator of In-service Training was hired, who began to set up a department for the in-service training of all hospital staff. Business management—Programme budgeting was introduced April 1, 1973, and problems related to the introduction of the new system were gradually worked out. In buildings and maintenance programmes a significant updating of heating controls took place in the main building, conversion of a reserved area at the lower level of the building to serve offices was under way at the year-end, and the Public Works Department was conducting a comprehensive survey of all projects in the institution. A study was made of the proposed expansion in the central administration. The hospital's ability to cope with a fire emergency, and improvement to the necessary communication systems, was also under study. DELLVIEW HOSPITAL Applications for admission to Dellview Hospital continued at the usual level, and there was a slight decline in male applications toward the end of the year. Improvements in the standard of nursing care were recorded during the year. Psychiatric consultations were provided to this unit by the psychiatrist of the Vernon Mental Health Centre, while regular medical services were provided by a physician on a visiting basis. Ministerial services were provided by a local clergyman. The Volunteer Programme renewed its efforts during the year with assistance from the local Mental Health Association and the Vernon Friendship Club. For those patients capable of responding, emphasis was placed on activation, motivation, and recreational therapy. A psychologist from Riverview Hospital conducted a remotivation workshop for staff, emphasizing reactivation methods and procedures- The Director of Nurses transferred to Valleyview Hospital on a promotion, and the Nursing Supervisor in Valleyview became the new Director of Nursing at Dellview on October 15. In April, 10 additional staff positions were authorized, nine of these being nurses. One person from the Education Centre at Riverview Hospital was transferred to Dellview to develop a programme of in-service education. In July, Dellview's laundry services were transferred to become part of the regional operation in the Vernon Jubilee Hospital. Three members of the laundry staff were utilized to provide a central linen-room service. A new P.A.B.X. telephone system was installed late in the year. Several proposed renovations to ward nursing stations, assorted storage, a staff dining-room, and so on, were under consideration. The hospital Safety Committee met regularly throughout the year. L 82 MENTAL HEALTH BRANCH REPORT, 1973 SKEENAVIEW HOSPITAL During the year, Skeenaview was involved with preparations for conversion to a community operation. The administration placed increased emphasis on the activation and motivation of patients, and on improved relations with the community. The activation and motivation of patients was achieved through ward- based programmes, and a variety of recreational programmes. A 10-bed self-care unit was set up to be used by patients preparing to return to the community- The 27-bed infirmary ward was provided with new beds, chairs, and other equipment. Means of co-operating more closely with Mills Memorial Hospital were also considered. Community involvement was encouraged, and approximately 25 senior citizens met with 20 patients every second Sunday for dinner and a social evening. With the appointment of a full-time Co-ordinator of Volunteers, the number and effectiveness of the volunteers increased. Staff educational activities included several separate programmes. Nurses took part in two courses offered at the Mills Memorial Hospital, and another in sociology offered by Caledonia College. The first part of the Community Nursing course was held at Skeenaview, sponsored by the Registered Psychiatric Nurses Association (B.C.). The Civil Service Commission had a special session on Management Training for supervisors, and the hospital held a similar one on Management by Objectives. Members of the Telephone Employee's Community Fund, which provides support to community health and welfare services, visited Woodlands in September. Included among those being honoured at a Volunteers Recognition Evening was Mrs. Lucy Cross (centre), who had been a volunteer for 19 years. The Woodworking Shop (above) is one of seven workshops in the new $780,000 Industrial Therapy Building, which was officially opened May 9. WOODLANDS Woodlands is a residential facility for the mentally retarded of all ages who, because of the complexity of their problems, are unable to have their needs met in the community. During the year, diagnostic, treatment, training, and educational services were provided for those who required specialized services, and who liyed in the western half of the Province. The resident population for 1973 was approximately 1,100, the same as in 1972. Admissions for 1973, to November 1, totalled 70. During 1973 the waiting-list varied between 13 and 30, with over half requiring an extended-care type of accommodation. As of November 1, 1973, only four names of 23 on the waiting-list had been there prior to January 1, 1973. A multitude of new programmes and constructive changes at Woodlands had positive impact on the mentally retarded during the year. These included: a Halfway House for six mildly retarded young adults within a residential district of New Westminster; expansion of the foster- home project; Woodlands Academic School Programme being placed on a continuous year basis; enrolment of residents of Woodlands and Alder Lodge in community schools and sheltered workshops; introduction of community retarded into Woodlands' Gold Creek Camp at Alouette Lake; sharing of the facilities in hosting a banquet for 400 participants and their families at the Annual Fred Dietrich Swim Meet; comforts allowances for the adult resident population, granted by the Department of Human Resources; increased staff establishment; evaluation of a different method of rostering shift personnel; introduction of addressograph system and reorganization of clinical files; special laboratory techniques, such as micro-method for blood phenylalanine levels, and special staining techniques for chromosomal studies. 83 L 84 MENTAL HEALTH BRANCH REPORT, 1973 Innovative programmes initiated or advanced during the year included a new wage-incentive structure for residents working within Woodlands; community preparation programmes, including how to spend and budget money independently for personal needs; a demonstration project for nonspeaking children using a linguistic approach to language acquisition; a week-long field trip for both Indian and non-Indian residents to Ksan Indian Village in Hazelton; cooking classes for severely disturbed older women; participation by residents in Riverview's Nurses Aide Training Programme; and staff-development courses given at Woodlands, with recognition assigned by Douglas College. Students in the summer employment programme provided services in summer camping, nature park development, academic tutoring, research, programmes for severely and profoundly retarded in pottery and other crafts, cooking, and language. Another successful annual parade and carnival was held on June 12. For the third year, Open House was held, with approximately 2,000 visitors attending. This provided the occasion for the official opening of the newly completed Industrial Therapy Building. Many of the staff and the volunteers lived in temporary quarters during a renovations programme. When completed, the building would accommodate the Academic School, Occupational Therapy, Sheltered workshops, In-service Education, the Apparel Shop and Canteen, as well as departmental and programme offices. TRAINING, EDUCATIONAL AND TREATMENT SERVICES The year 1973 was the beginning of the reorganization of Woodlands into five programmes, as opposed to the previous three units. The unit system emphasized a medical model. One major group of residents was those with special physical A summer student helped instruct severely disturbed and retarded young ladies, in a special cooking class in the Intermediate Care Preparation Programme. Young residents are shown "scrubbing up" in the Self Care Training Programme conducted in Ward 32. An Alder Lodge resident disembarks from the bus after attending Sunny Cedars School, operated by the Coquitlam School Board. IN-PATIENT SERVICES L 85 Woodlands annual parade and carnival took place on June 12. These young wheelchair residents were followed by bands, floats, drum majorettes, and clowns. Work experience, including clearing the grounds (above), was part of the programme conducted by the Training and Education Department. A summer student and two residents are shown working in Woodlands Nature Park, as they assist in the selective clearing of saplings and brush. needs, with the balance of the residents being divided into those requiring psychiatric treatment and those without special psychiatric needs. The division into programmes was an attempt to provide more homogenous groupings, with special emphasis on the type of programmes any one group required, in order to help them develop to their fullest potential. General medical and psychiatric back-up services were incorporated into all programmes. Acute physical illness and infectious diseases were treated in special wards within the Health Care Programme. The very youngest children who were ambulant were programmed on a developmental model within the Developmental Opportunity Programme. Because of increased community resources, a high proportion of the ambulant population at Woodlands was severely or profoundly retarded. These residents were divided into two large programmes — Intermediate Care Motivation and Intermediate Care Preparation. The fifth programme, Life Education, was for the mildly retarded and brighter who were at Woodlands primarily because of psycho-social problems. Each programme had an advisory council, with the majority of the members elected from ward teams. In case a specific discipline was not among the elected, an appointment was made so that the advisory council reflected the views and influence of all disciplines. The Health Care Programme consisted of eight wards, with a resident population criteria of extended care, as defined by BCHIS From one particular ward, a number of cerebral palsy residents participated in teen clubs for the physically handicapped or the adult indoor sport club. "Operation Wheelchair" was held in December, to give some of the physically handicapped residents an opportunity to shop in a department store. A few residents were enrolled in a Surrey sheltered workshop, and some were able to attend Camp Chehalis with other physically handicapped from the community. L 86 MENTAL HEALTH BRANCH REPORT, 1973 For these residents, to return to the community meant, in the majority of cases, placement within extended-care or intermediate-care facilities, hopefully in communities close to their immediate family. The Developmental Opportunity Programme consisted of five wards, with a resident population of 131. The programme was directed toward community involvement. Ward 32, with its well-established programme based on developmental and behavioural principles, enrolled one child in Sunny Cedars School and another in a community pre-school. Although the five wards were spread around Woodlands, it was expected they would merge into one programme with the completion of the new proposed 20-bed units and the centralized learning centre. The programme would also need community group-living homes, an increase in foster homes, and adequate back-up to families, to achieve its objectives. The Intermediate Care Motivation Programme consisted of eight wards, with a resident population of 243. Admissions to the wards was expedited when there was an urgent situation within the community. A ward for severely retarded who were blind was part of this programme. The special summer student programme made it possible for some of these blind residents to take part in a pottery programme. A peripatologist doing graduate work at UBC voluntarily conducted mobility-training sessions. Some residents received individual behaviour therapy under the supervision of one of the psychologists, with the assistance of a volunteer group of Douglas College students. The newly instituted comforts fund provided by the Department of Human Resources was used to provide ward music, picnics, bus tours, and other socializing experiences. New ward furniture and colourful drapes were made, and the living accommodation of several of the wards within this programme was much more attractive. The Intermediate Care Preparation Programme consisted of six wards and Alder Lodge, with a resident population of 226. The programme gave residents the training and experiences necessary to facilitate their return to the community, usually to a boarding-home. Emphasis was placed on behaviour modification, supervised by the psychology staff. Alder Lodge, a residential facility for 50 in Maillardville, located 3 miles from Woodlands, facilitated the community placement of these residents. One of the highlights of the year was the enrolment, for the first time, of 17 residents at Sunny Cedars School under the Coquitlam School District. Recreation and medical care continued to be provided at the community level for Alder Lodge residents, rather than by the institution. The Life Education Programme consisted of seven wards and a Half-way House, with a resident population of 201. Five of the seven wards were renovated and furnished. It was planned that two of the proposed new five 20-bed units would accommodate the group with the most severe management problems, as they would be more amenable to therapy if they lived in smaller units planned to their needs. The intent of the Life Education Programme was the habilitation of residents through the concept of normalization, and emphasis was placed on unlocked doors, integrated living, developing social skills, and a greater attention to personality and identity development. In addition to the academic classes and limited vocational training which were provided, a number of the residents were enrolled for vocational training at the community level, in either workshops or training situations. Medical care in Woodlands continued to be of a good standard, and close liaison was maintained with the School of Medicine, University of British Columbia, particularly with the Department of Paediatrics. Woodlands' Medical Director was appointed Clinical Assistant Professor with the Department of Paediatrics, and acted as resource member to one of the teaching teams at the Health Centre for Children. IN-PATIENT SERVICES L 87 A paediatrician and human geneticist with the Department of Paediatrics spent one day a week at Woodlands, and provided a great deal of consultation to the Chromosome Laboratory, and genetic counselling to part of the Out-patients Department. Paediatric residents continued to rotate at Woodlands on a two-month basis. Woodlands continued to be involved in the follow-up of all children with the diagnosis of homocystinuria and phenylketonuria in the Province. Medical consultation for Woodlands' residents was offered by a number of specialists, with approximately 800 appointments set up in 1973. Clinical rounds were conducted at weekly intervals as a form of in-service education, and allowed staff to share information gained by attending conferences and workshops. A research project was conducted to assess the interaction of anticonvulsant medication and calcium metabolism, and preliminary work was undertaken for a project to evaluate megavitamin therapy. The Dental Department, in addition to increasing the amount of restorative work and oral rehabilitation, improved in-service education of nursing personnel with regard to mouth care. The Laboratory service set up a micro-method for calculating blood phenylalanine levels. A spectrophotometer was purchased, for enzyme studies by the kinetic method, and to evaluate blood barbiturate and dilantin levels. The Chromosome Laboratory technician set up the Giemsa staining technique for chromosomal studies, for the identification of certain abnormalities. Under the direction of a Genetic Consultant, a fifing system was established to catalogue genetic conditions, which would facilitate genetic counselling, and aid the recognition of newly described syndromes and genetic diseases. The physiotherapist provided a high standard of consultative service to the medical and nursing staff. Three additional clerk positions in the Nursing Department freed nursing supervisors to provide a more direct service to residents and supervision to staff. Ten new nursing positions were added to the establishment to carry out the intensive programme in the paediatric age-group. Six full-time nursing positions on the night shift provided a greater degree of safety for both residents and staff. An additional six part-time temporary nursing positions were provided to integrate the two school pupils' wards in the Life Education Programme. In August a project to evaluate a new system of rostering was instituted at Woodlands, as a co-operative endeavour between Woodlands' administration, the Registered Psychiatric Nurses Association, the Registered Nurses Association of B.C., and the Provincial Government Employees' Union. It was expected there would be greater continuity of care, due to the same number of staff being available on any given day. Social workers were assigned to the five programmes, and played an important role in the team approach to the delivery of service to the residents. Staff were enthusiastic about the appointment of two mental retardation social workers within the community, one in the Surrey-Delta area and the other in the North Shore. During the year the Psychology Department experienced increased involvement by psychologists in many varied facets of facility functioning. This was evident on ward teams, advisory councils, and committees, as well as in a wide range of programming activities and in-service functions. There was also increased interest and participation in research endeavours. One of the psychologists was asked by the Government of the Northwest Territories to provide consultative services at Chesterfield Inlet. The Training and Education Departments maintained their core services, participated in programme innovation, and assisted in the change to a programme system. L 88 MENTAL HEALTH BRANCH REPORT, 1973 In October, two nursing instructor positions were added to the establishment. Staff development, utilizing a multidiscipline approach, was a top priority emphasis at Woodlands, and it was recognized that in-service education would play a major role. In addition to the services provided by volunteers working within Woodlands, community organizations expressed their concern for the retarded by providing funds, equipment, and services. More young people, particularly students, were becoming interested in volunteer experiences. At a Volunteer Recognition Evening held June 5, service awards were handed out, and one lady was honoured for her outstanding record of 19 years of service. The Co-ordinator of Volunteers and the school Principal arranged a special orientation programme for Grade XII students in the Lower Mainland in which approximately 400 students took part. Several workshops and tours were provided to accommodate professional groups. ADMINISTRATIVE SERVICES The establishment of Woodlands increased from 924 positions to 973, effective April 1, 1973, as 49 new positions were approved by Order in Council. The turnover of male psychiatric nurses declined during the year, and the increased turnover of female psychiatric nurses was apparently due to a desire to travel, and pregnancy leave. Total days lost due to illness in the eight-month period, January 1 to August 31, 1973, amounted to 6,235 days, an increase of 24 days over the same period in 1972. Workmen's Compensation Board days lost in the same eight-month period totalled 827 days, a considerable improvement over the 1972 period in which 1,210 days were lost. Early in the year a monthly meeting of department heads responsible to the Business Administrator was instituted. The final inspection was made on the Transport Building addition, which was accepted subject to minor deficiencies. The Industrial Therapy Building was officially opened on May 9, 1973. During the year the municipal supervised fire-alarm system became operational throughout Woodlands. The two-way traffic system from the front of the Centre Building to the boiler- house was reinstated to allow easier road access to the Centre Building from within the grounds. The paving of the roads and parking-lot at Alder Lodge, and refining of the parking area in the upper Fraserview, was completed. A report was completed containing recommendations regarding structural alterations in the Fraserview Building, required to update the quality of service to residents. Regular meetings continued to be held with the Provincial Government Employees' Union, the Registered Psychiatric Nurses' Association, and the Registered Nurses' Association. Phase I of the Academic and Activity Building was completed, and the control of Public Works operations at Woodlands continued to be centralized at Riverview. TRANQUILLE HP v An Exercise Circuit was developed to help improve the patient-trainees' coordination, sense of balance, strength, and cardio-respiratory endurance. sisin." mm ?* < Exercise equipment included trampolines, rolling cylinders, tumbling mats, a rowing-machine, and a treadmill. :: Male patient-trainees received training in the Woodshop in the manufacture of garden furniture. At the end of the year, Tranquille, a residential school-hospital for the mentally retarded of all ages, had accommodation for 494 beds, plus 10 sick-bay beds. There were 448 patient-trainees in residence and 71 in boarding-homes, with Tranquille having jurisdiction over a total of 519 patient-trainees. All types of training and treatment for the problems of the retarded were provided at Tranquille, primarily directed toward behaviour modification. Some considerable numbers of the patient-trainees suffered from superimposed psychiatric illnesses, and these were treated if at all possible, although there were problems of security. Some 50 patients were admitted during the year, and at the end of the year the waiting-list consisted of four patients. Visits to Victoria by senior staff continued, on a monthly basis, and in October the entire senior staff attended a headquarters conference with senior Mental Health Branch officials. Kamp Kiwanis again operated efficiently throughout the year, and the Superintendent, a Kiwanian, maintained regular contact with the Directors of the organization. Throughout the year, regular meetings were held among the Business Administrator, the Director of Nursing, and the Superintendent, representing management, and representatives of the two unions operative at Tranquille- The Executive Secretary of the Registered Psychiatric Nurses Association of British Columbia was a great help in improving what was often a difficult communications situation. During the year, Tranquille was involved with the faculty and students of Cariboo College. Staff of Tranquille provided programmes at the college, and faculty members utilized the clinical facilities and expertise of Tranquille to the benefit of their students. Summer meetings were held with the faculty and the 89 L 90 MENTAL HEALTH BRANCH REPORT, 1973 new Department of Nursing at Cariboo College, and a continuing association appeared likely. Good communication between Tranquille and the Royal Inland Hospital continued during the year. The specialists attached to that institution, who were elected as Tranquille's consultant staff, provided excellent service. Clinical Team—At the beginning of the year the Clinical Team was reorganized under the chairmanship of the Director of Clinical Medicine, and consisted of the Director of Social Work, the Director of Training, the Director of Nursing, and the psychologist. These people, with consultations from the two psychiatrists at Tranquille, were responsible for the programming and treatment of the patient-trainees in residence. They also acted as resource personnel to the ward teams and served as consultants in problem areas. Family therapy—Early in the year a residence was selected as headquarters of a family therapy unit. This enabled families with behavioural problem children to live at Tranquille with their child and professional staff in a family environment. It proved to be very successful, and it was hoped that a bigger house would be available in the near future. Teams from Tranquille also went to homes in the immediate region to see problems at first hand and to help families on an extramural basis. Training Department—The Training Department endeavoured to provide a more effective service during the year by the use of teachers and other professionals working in the area. Construction of the 20-bed units began in the spring, and it was hoped they would be available for occupancy in the early part of 1974. The modern facilities would enable the Training Department to provide a complete programme in the delivery of services. Staff—There were some staff changes at a senior level during the year. A new psychologist joined the staff in the summer, A comfortable garden chair, the finished product of the Woodshop, was a popular item at Tranquille. A highlight of the year for many of the patient-trainees was a summer vacation at Kamp Kiwanis in the Dew Drop mountain range. A favourite spot was the swimming-pool (above). *HW These young campers examine articles collected during a nature walk. IN-PATIENT SERVICES L 91 and at the end of the year a second psychologist with a post-doctoral degree in psychology came to Tranquille from the Max Planck Clinic in Munich. Out-patient Department—The Out-patient Department, which was directed by a senior social worker, was used quite extensively during the year as a referral source for a variety of services. Volunteer services—A new Co-ordinator of Volunteer Services was appointed in December 1972, and she had remarkable success in activating programmes for volunteers, in conjunction with the Department of Continuing Education and the Training Department, and also in organizing the community to extend itself to Tranquille and the extramural activities of this institution. Extramural education—With the opening of new facilities at the Fitzwater School, which were funded by the Mental Health Branch, more children were in attendance at that institution in 1973. Fitzwater staff took some training at Tranquille, as did people from the workshop operated by the Kamloops Society for the Mentally Retarded. Communication between the society and Tranquille was good, with some of the professional staff at Tranquille serving as consultants to, and officers of, the society. Extended-care services—Medical treatment service in the Greaves Building continued apace, utilizing the entire medical staff of Tranquille. All the physicians, including the Superintendent, took regular night and week-end duties. Isolation rooms for infectious illness were being equipped at the year-end. Business Department—The laundry continued to work on a five-day-a-week basis. The Transport Department functioned well, although their vehicles required continual servicing. The Transport Department also serviced the machinery required for heating and lighting at Kamp Kiwanis, and did a superlative maintenance job. The Business Administrator, in the dual role of Personnel Officer, continued to provide invaluable service. BRITISH COLUMBIA YOUTH DEVELOPMENT CENTRE THE MAPLES FAMILY AND CHILDREN'S CLINIC The Clinic's functions of the training and treatment of young children in the pre-school programme continued actively during the year. Field placements were provided, for the first time, to counselling students from the Faculty of Education at the University of British Columbia, and a good relationship was established with the Department. There were a considerable number of requests for brief training workshops, including several from areas outside the Lower Mainland, and most of these were met. The longer training programmes for public health nurses, homemakers, and probation officers continued during the year. An ongoing, interagency training group was set up in New Westminster for professionals working together in the community with families. The Day Centre pre-school was busy with morning programmes for very disturbed, very young children. The staff also extended their consultative and training functions within the community. The community team in South Vancouver became increasingly involved in direct service to families, working with groups in schools, and providing consultation to teachers and public health staff. The five staff members became involved with the four multi-agency "mini-teams" set up in South Vancouver during the year. Clinic staff provided training and consultation for 10 counsellors staffing a two-month summer camp programme at Harrison Lake for disturbed children up to the age of 12 years. PSYCHOLOGICAL EDUCATION CLINIC The Psychological Education Clinic has evolved a type of programme that 92 Separate tables and small classes facilitate the development of individualized school programmes. This young lad tries his hand at a basic arithmetic problem. A teacher and a pupil work out a problem together. IN-PATIENT SERVICES L 93 The sandpile provided its own special type of motivation and therapy. As well as providing fun, this playground equipment at The Maples helps youngsters to improve their motor co-ordination. I Swimming is a healthful sport that helps to keep the body fit, as well as providing the opportunity for the emotionally disturbed to play together. meets the needs of children who have experienced failure in their schooling in every available setting. The general approach was to begin with something that the child could succeed at, and build only as fast as he was able to go. The day was divided into academic sessions, recreational activities, snack time, arts and crafts, social interaction, and at least one day a week for a field trip. The entire group of about 45 children and 15 staff also went to a one-week camp, twice a year. Some of the smaller classes went on additional camping outings. The camp experience proved to be a valuable part of the programme, providing the staff with a different dimension than what they would normally see in a day setting. The important part of working with children with emotional and learning disabilities was family intervention, and staff endeavoured to see these families at least once every six weeks to discuss their child's progress. During the year the programme consisted of six groups located at The Maples, and an additional three groups located at the Granville Centre. The age of the children at both centres was approximately 6 to 13 years, with the Granville Centre taking children solely from the Vancouver area, while The Maples accepted children from the Lower Mainland. The Psychological Education Clinic also offered a Travelling Clinic service to those areas of the Province that requested psychological consultation. During the year a psychologist travelled extensively in Health Unit 16, consulting with the communities and the schools in Terrace, Kitimat, Smithers, Hazelton, Aiyansh, Greenville, Houston, and Kemano. He conducted workshops on Child Management, The Alienated and Alienating Adolescent, and Programme Evaluation. In addition, he consulted to the Department of Human Resources in Smithers and to the Skeena Mental Health Centre in Terrace. Over the past several years the clinic developed a neuropsychological assess- L 94 MENTAL HEALTH BRANCH REPORT, 1973 ment battery, which provided a comprehensive profile of the relevant strengths and weaknesses of intellectual motor and sensory functioning. During the past year the battery was expanded to include a comprehensive examination for aphasia and language impairments, as well as static and phonetic motor disabilities. This service was provided not only for clinic cases, but was also made available on a limited basis to referrals from mental health centres. The clinic assessed both adults and children, with many of the requests for adult assessment being in relation to acute brain damage, and for children because of extreme difficulty in learning in school. A research programme was being planned around the collection of neuropsychological information, which would be of use not only to the unit but would have a general applicability. The clinic was involved in a variety of training programmes, both of a direct and indirect nature. Workshops were set up in the area of behaviour modification, as well as conducting child-management training courses. During the year the unit was made available to a large number of professionals in the community and became more involved in their training. RESIDENTIAL TREATMENT UNIT The treatment programme at two of the three residential cottages was aimed mainly at working with adolescents who had difficulties relating to their family, the school, and other adults or peers. Referrals were made from a variety of sources, but came mostly through Special Placement. In addition to providing fairly intensive treatment programmes, the Residential Unit staff also provided assistance to parents and school personnel. A special treatment programme for the third cottage was developed in the latter part of the year, for the more seriously disturbed adolescent. The training of personnel for this cottage was completed by the year-end, and the first residents would be admitted in January 1974. The Day Care Centre, which operated on a school semester system, was located in the community. The programme was aimed at teenagers who had problems which were severe enough to need attention but not of such a magnitude that they required 24-hour care. All activities of the Day Care Centre took place as much as possible within the community, and were aimed at teaching the teenagers to cope with everyday life. A farm programme was specifically designed for a smaller number of adolescents who needed closer interpersonal contacts and supervision, and who were unable to deal with the more strenuous demands of the other programmes at the Youth Centre. Many of the youngsters at the Youth Centre were school drop-outs or had difficulty with the regular school programme. The educational programme tried to interest them in attaining skills commensurate with their ability and aptitude. The outdoor camping programme was designed for teenagers who needed to be away from it all for a short period of time, or who needed the opportunity to expend some of their excess energy. In order to provide follow-up care, the Alumni Programme provided continuity of treatment. This programme was open to any discharged teenager from the Youth Centre, and emphasized dealing with problems which the teenager had encountered after discharge. Although each cottage operated independently of the others, a number of support services were shared. These included the swimming-pool, the gymnasium, a variety of sports, and arts and crafts activities. IN-PATIENT SERVICES L 95 Because of the importance of family relations between the teenager and his family, the Youth Centre staff provided programmes for parent groups. The emphasis of these groups was on dealing with actual relationship problems between family and teenager. Two specialty programmes were developed at the Youth Centre. These were job survival and school survival. The Job Survival Programme, administered in close co-operation with the British Columbia Vocational School, prepared teenage residents at the Youth Centre for employment after discharge. The School Survival Programme operated along similar lines, and prepared the teenager to deal with the school personnel, his peers, and the academic course work. Youth Centre staff worked very closely with the school counsellors and teachers of the schools attended by the teenagers after discharge. In order to provide well-qualified staff for working with the teenagers at the Youth Centre, successive 180-hour training programmes were given for new staff. In addition, staff-development workshops and seminars were provided to keep the staff informed about current developments in the area of child care. A number of institutions for higher education, including Douglas College; the University of British Columbia Schools of Nursing, Counselling, and Social Work; and the University of Victoria Training Programme for Child Care Counsellors asked the Youth Centre to provide training for their students. PATIENT MOVEMENT Patient Movement Trends Patient Movement Data /<?73 PATIENT MOVEMENT PATIENT MOVEMENT TRENDS TRENDS, SEPTEMBER 1973 Yearly Sum of Entriesi From— Resident or Case Load Facility Oct. 1970 to Sept. 1971 Oct. 1971 to Sept. 1972 Oct. 1972 to Sept. 1973 End of Sept. 1971 End of Sept. 1972 End of Sept. 1973 9,871 3,870 3,652 2,962 51 639 500 116 23 218 160 58 6,001 4,958 10,589 3,349 3,059 2,487 39 533 442 76 15 290 214 76 7,240 6,363 11,976 2,650 2,480 1,911 37 532 421 86 25 170 121 49 9,326 8,120 15 524 527 331 157 264 93 330 328 476 224 267 265 201 417 263 320 121 72 304 388 385 226 628 613 357 24 557 114 35 278 52 52 118 12,189 5,300 3,516 2,336 25 1,155 685 234 236 1,784 1,217 567 6,889 5,422 12,025 4,785 3,207 2,100 26 1,081 655 214 212 1,578 1,097 481 7,240 6,097 576 384 172 332 199 119 227 350 371 160 246 136 171 178 94 129 14,017 4,583 3,033 1,976 23 Geriatric facilities —— 1,034 656 180 198 1,550 1,099 451 9,434 Woodlands - Tranquille All mental health centres Abbotsford (September 1973)2 8,175 15 587 321 255 219 32 1 276 339 276 74 210 193 537 387 301 382 189 142 274 330 371 180 152 168 223 572 313 178 155 32 1 255 313 404 145 210 98 567 465 Courtenay Cranbrook Duncan Fort St. John Kamloops — 126 144 315 74 343 399 687 Nanaimo 296 471 New Westminster 263 241 Port Alberni (November 1972) 2 247 38 283 120 138 38 210 294 410 692 133 Prince Rupert (May 1973) 2 66 240 190 308 207 452 330 301 166 353 207 486 507 166 368 164 197 157 681 449 444 227 147 198 601 520 116 458 Surrey - — Terrace Trail — . . - 411 124 218 733 605 Whalley (November 1971)2 258 Williams Lake (Oct. 1972)2 12 385 406 68 28 276 57 42 ... 1,018 821 54 15 221 31 1 773 114 534 90 34 11 268 156 25 229 26 7 West End Mental Health Unit6 99 i Includes permanent transfers, admissions from community, and returns from leave and escapes. 2 Month Centre/Department commenced reporting. 3 Fifteen patients active in the Riverview Hospital Centre Lawn out-patient case load are not included. <t March 1972. 5 May 1972. 6 March 1973. 99 PATIENT MOVEMENT DATA DATA, 1973 Entries Exits Facility Total ca q o > rt il 3° 5 2 So Total eo %H ft O S > rt u a a, da, 11 s- rt <u ■-. u Q 2,655 2,479 1,931 42 506 404 78 24 176 121 55 12,348 2,400 2,263 1,755 42 466 378 65 23 137 89 48 244 209 172 ~37 23 13 1 35 28 7 11 7 4 3 3 4 4 2,871 2,665 2,070 45 550 395 113 42 206 120 86 9,018 1,462 1,409 1,283 45 81 70 8 3 53 31 22 884 825 682 143 106 36 1 59 3 56 84 7 6 1 1 77 77 Residential programmes Facilities for the mentally ill 441 424 99 Youth Development Centre Geriatric facilities Valleyview _ Dellview Skeenaview Facilities for the mentally retarded 325 218 69 38 17 9 Tranquille 8 9,948 8,636 180 544 542 316 170 261 105 338 341 496 246 291 260 206 479 272 325 136 173 293 409 401 220 623 641 344 24 572 118 35 274 55 56 202 7,556 6,378 ~569 494 363 291 181 165 194 308 162 93 31 149 79 212 224 125 118 14 325 184 455 182 593 595 257 15 652 62 44 281 56 50 33 Abbotsford (Sept. 1973)2 Chilliwack - Courtenay. Cranbrook Duncan Fort St. John... Kamloops Kelowna , Penticton (Oct. 1971)2 Port Alberni (Nov. 1972)2 Port Coquitlam Powell River (Jan. 1972) 2 Prince Rupert (May 1973)2 Surrey Trail Vernon Whalley (Nov. 1971)2 Williams-Lake (Oct. 1972) 2 Riverview Out-patient Woodlands Out-patient Tranquille Out-patient B.C. Youth Development Centre Woodlands waiting-list Tranquille waiting-list West End Mental Health Units... i Table compiled from actual data through September 1973, and projected for the remainder of the year. (Note—In case of centres/departments opened in 1973: Table compiled on basis of available data for 1973 and projected for remainder of year.) 2 Month Centre/Department commenced reporting. 3 About 228 patients active in the Riverview Centre Lawn out-patient area case load are not included. t March 1972. 5 May 1972. 6 March 1973. 100 FINANCIAL STATEMENTS The following are financial reports of the Mental Health Branch for the fiscal year ended March 31, 1973. ,\ - ; :. -■ ■ ■ .■■,■■..:■■ 0 FINANCIAL STATEMENTS FINANCIAL TABLES Table A—Showing the Average Number of Patients in Residence Each Year, the Total Amounts Spent for Maintenance, and the Gross Yearly and Daily per Capita Cost, 1963/64 to 1972/73. Institution Average Number in Residence Maintenance Expenditure Yearly per Capita Cost Daily per Capita Cost 1963/64 Crease Clinic 220.63 2,791.99 1,306.35 433.92 94.07 737.69 236.51 292.83 $ 1,442,627.00 7,534,673.00 3,916,660.00 1,077,011.00 414,787.00 2,029,118.00 512,128.00 713,594.00 $ 6,538.67 2,698.67 2,998.17 2,482.05 4,409.35 2,750.64 2,165.35 2,436.89 $ 17.87 Provincial Mental Hospital, Essondale . . The Woodlands School, New Westminster The Tranquille School 7.37 8.19 6.78 Provincial Mental Home, Colquitz 14.41 Valleyview Hospital, Essondale 7.52 Dellview Hospital, Vernon 5.92 Skeenaview Hospital, Terrace. 6.66 6,113.99 17,640,598.00 2,885.28 7.90 1964/65 227.59 2,740.84 1,314.20 512.79 753.91 234.70 290.44 1,573,366.00 8,054,536.00 4,501,364.00 1,509,947.00 2,351,885.00 553,985.00 510,679.00 6,936.16 2,938.71 3,425.17 2,944.57 3,119.58 2,360.40 1,758.29 18.94 Provincial Mental Hospital, Essondale The Woodlands School, New Westminster 8.05 9.38 8.07 Valleyview Hospital, Essondale 8.55 Dellview Hospital, Vernon _ 6.47 Skeenaview Hospital, Terrace 4.82 Totals for the year. _ 6,074.47 19,055,762.00 3,137.02 8.59 1965/66 Riverview Hospital, Essondale The Woodlands School, New Westminster The Tranquille School 2,797.80 1,291.27 562.37 763.44 227.35 295.38 10,230,637.00 4,981,190.00 1,876,093.00 2,510,228.00 595,532.00 551,447.00 3,656.67 3,857.59 3,336.05 3,288.05 2,619.45 1,866.91 10.02 10.57 9.14 9.01 7.18 Skeenaview Hospital, Terrace 5.11 Totals for the year.. 5,937.61 20,745,127.00 3,493.85 9.57 1966/67 Riverview Hospital, Essondale.- The Woodlands School, New Westminster 2,760.21 1,307.53 602.46 760.73 219.13 284.32 11,162,462.00 5,376.492.00 2,267,399.00 2,668,056.00 635,710.00 589,492.00 4,044.06 4,111.95 3,763.57 3,507.23 2,901.06 2,073.34 11.08 11.27 10.31 Valleyview Hospital, Essondale 9.61 7.95 Skeenaview Hospital, Terrace 5.68 Totals for the year 5,934.38 22,699,611.00 3,825.10 10.48 1967/68 Riverview Hospital, Essondale The Woodlands School, New Westminster The Tranquille School 2,716.22 1,282.95 660.10 755.53 220.07 290.38 12,111,825.00 6,001,180.00 2,813,051.00 2,948,516.00 734,800.00 666,762.00 4,459.07 4,677.64 4,261.55 3,902.58 3,338.94 2,296.17 12.18 12.78 11.64 10.66 9.12 Skeenaview Hospital, Terrace 6.27 Totals for the year 5,925.25 25,276,134.00 4,265.83 11.66 103 L 104 MENTAL HEALTH BRANCH REPORT, 1973 Table A—Showing the Average Number of Patients in Residence Each Year, the Total Amounts Spent for Maintenance, and the Gross Yearly and Daily per Capita Cost, 1963/64 to 1972/73—Continued. Institution Average Number to Residence Maintenance Expenditure Yearly per Capita Cost Daily per Capita Cost 1968/69 Riverview Hospital, Essondale The Woodlands School, New Westminster 2,643.12 1,283.72 652.61 746.21 225.56 265.58 $ 13,072,972.00 6,364,354.00 3,096,131.00 3,165,707.00 808,169.00 696,355.00 $ 4,946.04 4,957.74 4,744.23 4,242.38 3,582.95 2,622.01 $ 13.55 13.58 13.00 Valleyview Hospital, Essondale Dellview Hospital, Vernon ._ Skeenaview Hospital, Terrace 11.62 9.82 7.18 Totals for the year 5,816.80 27,203,688.00 4,676.74 12.81 1969/70 Riverview Hospital, Essondale_. The Woodlands School, New Westminster 2,506.21 1,257.98 608.46 711.15 225.36 257.98 15,423,584.00 7,534,683.00 3,593,393.00 3,698,227.00 922,330.00 814,091.00 6,154.15 5,989.51 5,905.72 5,200.34 4,092.69 3,155.64 16.86 16.41 16.18 Valleyview Hospital, Essondale 14.25 Dellview Hospital, Vernon. 11.21 8.65 Totals for the year ... 5,567.14 31,986,308.00 5,745.55 15.74 1970/71 Riverview Hospital, Essondale 2,510.44 1,279.60 579.15 685.33 225.60 254.28 16,186,488.00 8,168,889.00 3,787,785.00 3,824,163.00 974,623.00 865,471.00 6,447.67 6,383.94 6,540.25 5,580.03 4,320.04 3,403.61 17.66 The Woodlands School, New Westminster The Tranquille School 17.49 17.92 Valleyview Hospital, Essondale... 15.29 11.84 9.32 Totals for the year 5,534.40 33,807,419.00 6,108.60 16.74 1971/72 2,363.70 1,216.51 548.76 669.84 227.41 233.91 17,393,443.00 8,745,677.00 4,149,495.00 4,203,564.00 1,055,612.00 941,455.00 7,358.55 7,189.15 7,561.58 6,275.47 4,641.88 4,024.85 20.11 The Woodlands School, New Westminster The Tranquille School . . 19.64 20.66 17.15 Dellview Hospital, Vernon Skeenaview Hospital, Terrace 12.68 11.00 Totals for the year 5,260.13 36,489,245.00 6,936.95 18.95 1972/73 2,131.45 1,112.34 485.53 660.32 210.44 212.16 18,757,094.00 9,574,840.00 4,460,869.00 4,512,183.00 1,175,207.00 998,938.00 8,800.15 8,607.84 9,187.63 6,833.33 5,584.52 4,708.41 24.11 The Woodlands School, New Westminster The Tranquille School... 23.58 25.17 18.72 Dellview Hospital, Vernon Skeenaview Hospital, Terrace 15.30 12.89 Totals for the year.. _ 4,812.24 39,479,131.00 8,203.89 22.47 FINANCIAL STATEMENTS L 105 Table B—Summary Statement Showing the Gross and Net per Capita Costs oj Patients in All Mental Health Institutions jor the Year Ended March 31,1973 Gross operating costs— $ Riverview Hospital, Essondale 18,757,094 The Woodlands School, New Westminster 9,574,840 The Tranquille School , 4,460,869 Valleyview Hospital, Essondale 4,512,183 Dellview Hospital, Vernon 1,175,207 Skeenaview Hospital, Terrace 998,938 39,479,131 Less collections remitted to Treasury 2,628,600 36,850,531 Daily average population 4,812.24 Gross per capita cost, one year 8,203.89 Gross per capita cost, one day 22.47 Net per capita cost, one year 7,657.66 Net per capita cost, one day 20.97 L 106 MENTAL HEALTH BRANCH REPORT, 1973 Table C—Expense Statement of Riverview Hospital for 12 Months Ended March 31,1973 (Includes Out-patient Services) Salaries, Supplies, and Operating Expenses Vouchered Expenditures Services and Supplies From Public Works Department Inventory Adjustment Actual Plus on Hand, March 31, 1972 Less on Hand, March 31, 1973 Cost of Operation $ 14,427,367 47,273 20,627 15,943 776,555 1,409,176 12,310 46,973 2,306 26,080 16,786 547,005 17,654 15,037 275 19,039 51,759 923 $ $ $ $ 14,427,367 Office expense. 47,273 20,627 15,943 146,818 147,286 776,087 1,409,176 12,310 46,973 127,500 2,306 Maintenance and operation of equipment- 26,080 16,786 134,468 553,973 Occupational and recreational therapy 17,654 15,037 275 19,039 General expense 51,759 210,000 923 1,486,542 165,000 1,441,542 Less— Increase in inventory, institutional stores 17,453,088 103,441 4,272 30,343 5,980 1,486,542 446,286 484,786 18,901,130 103,441 4,272 30,343 5,980 17,309,052 1,486,542 446,286 484,786 18,757,094 Yearly Salar per capita cc ies st— $ 6,768.80 2.031.35 i ,800.15 FINANCIAL STATEMENTS L 107 Table D—Expense Statement of The Woodlands School for 12 Months Ended March 31,1973 Salaries, Supplies, and Operating Expenses Vouchered Expenditures Services and Supplies From Public Works Department Inventory Adjustment Actual Plus on Hand, March 31, 1972 Less on Hand, March 31, 1973 Cost of Operation $ 7,893,977 11,695 8,101 1,183 232,288 551,669 42,186 12,249 176 10,483 2,120 275,855 5,044 6,054 2,117 4,093 32,510 160 $ $ $ $ 7,893,977 11,695 8,101 1,183 38,100 38,210 232,178 551,669 42,186 12,249 176 Maintenance and operation of equipment 10,483 2,120 275,855 5,044 6,054 2,117 4,093 32,510 160 546,642 546,642 Less—■ Increase to inventory, institutional 9,091,960 55,415 6,432 1,805 546,642 38,100 38,210 9,638,492 55,415 6,432 1,805 9,028,308 546,642 38,100 38,210 9,574,840 Yearly per capita cost— $ Salaries 7,096.73 Expenses 1,511.11 8,607.84 L 108 MENTAL HEALTH BRANCH REPORT, 1973 Table E—Expense Statement of The Tranquille School, for 12 Months Ended March 31,1973 Vouchered Expenditures Services and Supplies From Public Works Department Inventory Adjustment Actual Salaries, Supplies, and Operating Expenses Plus on Hand, March 31, 1972 Less on Hand, March 31, 1973 Cost of Operation $ 3,232,509 10,034 6,703 1,579 90,202 320,770 16,895 7,515 170 7,171 1,341 130,395 18,330 1,752 1,344 4,409 14,486 425 . $ $ $ 3,232,509 10,034 6,703 1,579 90,202 Dietary.. 11,363 12,268 319,865 16,895 7,515 170 Maintenance and operation of equipment.—. Transportation _ , - 7,171 61,856 1,341 62,741 129,510 Occupational and recreational therapy 18,330 1,752 1,344 4,409 14,486 425 Buildings and grounds 629,147 629,147 Less— 3,866,030 12,870 19,648 629,147 73,219 75,009 4,493,387 12,870 19,648 3,833,512 629,147 73,219 75,009 4,460,869 Yearly per capita cost— $ Salaries 6,657.69 Expenses . 2,529.94 9,187.63 FINANCIAL STATEMENTS L 109 Table F—Expense Statement of the British Columbia Youth Development Centre for 12 Months Ended March 31, 1973 The British Columbia Youth Development Centre expenditure statement covers the following departments: General Administration for all units of the Mental Health Branch, Burnaby; Forensic Clinic; Family and Children's Clinic; Psychological Education Clinic; Residential Unit. General Administration covers 38 staff (salaries, $257,610). The salaries for General Administration are divided among the following units: Mental Health Centre, Burnaby Forensic Clinic Family and Children's Clinic Psychological Education Clinic Residential Unit Total General Administration salaries $ 51,522 $ $ 51,522 240,686 1,700 36,168 $ 25,761 122,872 4,834 35,574 $ 128,805 439,306 17,585 81,232 $ 257,610 46,911 3,932 849,775 904 28,955 Unit expense 152,974 Buildings and grounds 52,426 28,616 50,843 330,076 19,077 189,041 28,616 666,928 114,465 1,289,314 190,774 Totals - 81,042 50,843 349,153 217,657 781,393 1,480,088 Table G—Expense Statement of the Valleyview Hospital, Essondale, for 12 Months Ended March 31,1973 Salaries, Supplies, and Operating Expenses Net Vouchered Expenditure Services and Supplies From Public Works Department Actual Cost of Operations $ 3,763,269 5,162 7,173 2,136 141,325 333,866 23,212 3,295 6,627 1,518 135,891 2,208 2,211 2,754 2,538 80 $ $ 3,763,269 5,162 7,173 2,136 141,325 333,866 23,212 3,295 6,627 1,518 135,891 2,208 2,211 2,754 2,538 120,542 80 Buildings, grounds, etc. 120,542 Less— Increase in inventory for Institutional Stores 4,433,265 25,861 15,763 120,542 4,553,807 25,86i 15,763 4,391,641 120,542 4,512,183 Yearly per capita cost- Salaries Expenses 5,699.16 1,134.17 6,833.33 L 110 MENTAL HEALTH BRANCH REPORT, 1973 Table H—Expense Statement of the Dellview Hospital, Vernon, for the 12 Months Ended March 31,1973 Salaries, Supplies, and Operating Expense Vouchered Expenditures Services and Supplies from Public Works Department Inventory Adjustment Actual Plus on Hand, March 31, 1972 Less on Hand, March 31, 1973 Cost of Operation $ 828,316 1,486 1,608 29,591 445 103,569 5,943 66 38 997 40,072 58 527 3,884 2,135 $ $ $ 5,728 4,437 $ 828,316 1,486 1,608 5,817 4,268 12,891 29,680 445 103,400 5,943 66 12,685 38 997 40,278 58 527 3,884 2,135 161,670 161,670 Less— 1,018,735 1,104 4220 161,670 22,976 22,850 1,180,531 1,104 4,220 Adjusted expenditure ... 1,013,411 161,670 22,976 22,850 1,175,207 Yearly per capita cost- Salaries Expenses 3,936.11 1,648.41 5,584.52 FINANCIAL STATEMENTS L 111 Table I—Expense Statement of the Skeenaview Hospital, Terrace, for the 12 Months Ended March 31,1973 Salaries, Supplies, and Operating Expenses Vouchered Expenditures Services and Supplies From Public Works Department Inventory Adjustment Actual Plus on Hand, March 31, 1972 Less on Hand, March 31, 1973 Cost of Operation $ 653,753 1,676 1,839 1,238 38,593 113,391 7,604 22 270 521 267 32,989 1,465 2,932 54 2,604 3,142 $ $ 13,248 12,145 $ 14,714 14,154 $ 653,753 1,676 1,839 1,238 38,593 111,925 7,604 22 270 521 267 30,980 Occupational and recreational therapy 1,465 2,932 54 2,604 147,590 3,142 147,590 Less— 862,360 3,935 3,602 147,590 25,393 28,868 1,006,475 3,935 3,602 854,823 147,590 25,393 28,868 998,938 Yearly per capita cost— Salaries Expenses ~ $ 3,081.41 1,627.00 4,708.41 L 112 MENTAL HEALTH BRANCH REPORT, 1973 Table J—Expense Statement of the Community Services jor 12 Months Ended March 31,1973 Mental health centres— Burnaby. Victoria- Saanich. Kelowna. Trail. Nanaimo. Prince George. Kamloops. Chilliwack. Training programmes Courtenay. Cranbrook. Vernon. Nelson. Maple Ridge. Surrey. New Westminster. Terrace. Port Coquitlam- Whalley. Fort St. John. Duncan. Penticton. Port Alberni. Prince Rupert. Williams Lake. Powell River. $ 1,477 Assistance for retarded children 121,595 Development of pyschiatric home treatment services Operation expenses of Glendale Hospital Technical services and development of new patient-care programmes Establishment of new mental health centres Salaries Office expense Travelling expense Office furniture and equipment Medical care Dietary Laundry Maintenance and operation of equipment Transportation General supplies Occupational and recreational therapy Patient education Motor-vehicles and accessories General expense Less salary adjustments 33,000 16,392 310,483 4,083 1,819,868 19,659 69,896 29,039 361,685 509 24,273 12,560 1,072 5,604 2,864 253 10,788 18,458 2,863,558 104,764 2,758,794 FINANCIAL STATEMENTS L 113 Table K—Expense Statement oj General Administration jor the 12 Months Ended March 31,1973 $ Salaries 589,131 Office expense 14,186 Travelling expense 30,644 Office furniture and equipment 1,613 Grant to Trustees of Patients' Comfort Fund 12,000 Printing and publication 8,900 Grant to UBC research 30,000 Audio-Visual 52 General expense 1,258 Administration of Psychiatric Nurses Act 3,582 Council of Psychiatric Nurses' Bursary Trust Fund 1,200 Mental health care and training grants 240,279 Stores equipment 415 Social Service Index subscription 32 933,292 Less salary adjustments 29,052 904,240 Table L—Expense Statement oj the Department oj Nursing Education jor the 12 Months Ended March 31,1973 Salaries 557,105 Office expense 5,906 Travelling expense 263 Office furniture and equipment 796 Medical care 713 Dietary 3,394 Laundry 4,957 General supplies 9,933 Audio-Visual 3 7 General expense 568 Affiliate and postgraduate training 6,479 Bursaries for psychiatric nurses 73,348 663,499 Less salary adjustments 26,124 637,375 L 114 MENTAL HEALTH BRANCH REPORT, 1973 Table M—Institutional Stores $ Net undistributed stores as per Public Accounts 267,784 Adjustment re farm profits 9,149 276,933 Inventory adjustment— Plus on hand March 31, 1972 564,843 841,776 Less on hand March 31, 1973 657,059 The increase in inventory has been transferred to the following institutions proportionately, using the vouchered expenditure as the basis for distribution: Per Cent Riverview Hospital 56 103,441 The Woodlands School 30 55,415 Valleyview Hospital 14 25,861 184,717 Reconciliation With Public Accounts, 1972/73 Table K—General Administration $ $ Salaries 589,131 Expenses 344,161 933,292 Deduct salary adjustments 29,052 As per Public Accounts 904,240 Table L—Department oj Nursing Education Salaries 557,105 Expenses 106,394 663,499 Deduct salary adjustments 26,124 As per Public Accounts 637,375 Table J—Community Services Salaries 1,819,868 Expenses 1,043,690 2,863,558 Deduct salary adjustments 104,764 As per Public Accounts 2,758,794 FINANCIAL STATEMENTS Table C—Riverview Hospital and Out-patient Services $ $ Salaries 14,427,367 Expenses 4,329,727 Vouchered expenditure 18,757,094 Deduct— Buildings and grounds 1,486,542 Salary adjustments 796,356 2,282,898 16,474,196 Add— Sundry adjustments, board, etc. 144,036 Increase in inventory 38,500 182,536 As per Public Accounts L 115 16,656,732 Table G—Valleyview Hospital Salaries Expenses Vouchered expenditure Deduct— Buildings and grounds 120,542 Salary adjustments 202,380 Portion of farm profits 798 Add—Sundry adjustments, board, etc. As per Public Accounts 3,763,269 748,914 4,512,183 323,720 4,188,463 41,624 4,230,087 Table H—Dellview Hospital Salaries Expenses Vouchered expenditure Deduct— Buildings and grounds Salary adjustments Decrease in inventory _. 161,670 43,620 126 Add—Sundry adjustments, board, etc. As per Public Accounts 828,316 346,891 1,175,207 205,416 969,791 5,324 975,115 L 116 MENTAL HEALTH BRANCH REPORT, 1973 Table I—Skeenaview Hospital $ $ $ Salaries 653,753 Expenses 345,185 Vouchered expenditure 998,938 Deduct— Buildings and grounds 147,590 Salary adjustments 32,112 179,702 819,235 Add— Sundry adjustments, board, etc. 7,537 Increase in inventory 3,475 11,012 As per Public Accounts 830,247 Table D—The Woodlands School— Salaries 7,893,977 Expenses 1,680,863 Vouchered expenditure 9,574,840 Deduct— Buildings and grounds 546,642 Salary adjustments 407,400 Portion of farm profits 1,294 955,336 8,619,504 Add— Sundry adjustments, board, etc. 63,652 Increase in inventory 110 63,762 As per Public Accounts 8,683,266 Table E—The Tranquille School— Salaries 3,232,509 Expenses 1,228,360 Vouchered expenditure 4,460,869 Deduct— Buildings and grounds 629,147 Salary adjustments 170,856 Portion of farm profits 2,201 802,204 3,658,665 FINANCIAL STATEMENTS $ Add— Sundry adjustments, board, etc. Increase in inventory As per Public Accounts 32,518 1,790 34,308 L 117 3,692,973 Table F—B.C. Youth Development Centre Salaries Expenses Deduct—salary adjustments As per Public Accounts Table M—Net Undistributed Stores New patient-care programmes . 1,205,820 152,974 1,358,794 69,480 Special Warrant 8—Grant to Granville School Special Warrant 9—Grant re Treatment Resources Act Special Warrant 17—Grant to Kamloops School District No. 24 Total expenditure as per Public Accounts 1,289,314 267,784 175,400 4,150 507,913 75,000 41,688,390 Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1974 780-773-6112
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Mental Health Branch PROVINCE OF BRITISH COLUMBIA ANNUAL REPORT 1973 British Columbia. Legislative Assembly 1974
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Title | Mental Health Branch PROVINCE OF BRITISH COLUMBIA ANNUAL REPORT 1973 |
Alternate Title | MENTAL HEALTH BRANCH REPORT, 1973 |
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British Columbia. Legislative Assembly |
Publisher | Victoria, BC : Government Printer |
Date Issued | 1974 |
Genre |
Legislative proceedings |
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Text |
FileFormat | application/pdf |
Language | English |
Identifier | J110.L5 S7 1974_V01_20_L1_L117 |
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Sessional Papers of the Province of British Columbia |
Source | Original Format: Legislative Assembly of British Columbia. Library. Sessional Papers of the Province of British Columbia |
Date Available | 2019-01-10 |
Provider | Vancouver: University of British Columbia Library |
Rights | Images provided for research and reference use only. For permission to publish, copy or otherwise distribute these images please contact the Legislative Library of British Columbia |
CatalogueRecord | http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198 |
DOI | 10.14288/1.0376290 |
AggregatedSourceRepository | CONTENTdm |
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