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UBC Publications

UBC Reports Jan 23, 1969

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 V   RETURN     POSTAGE  GUARANTEED/
Health Unit
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Offers Public
New Concept
In Psychiatry
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Dr. 7ames Tyhurst is head of the Department of Psychiatry in UBC's Faculty of Medicine, and Director of
the new psychiatric unit, pictured above.
By T.A.  MYERS
Director,  Information Services
University of B.C.
THE University of B.C. has completed the first
stage of its long-planned Health Sciences
Centre, in the form of a psychiatric unit that
represents a radical break with the past.
It embodies the best of contemporary ideas in its
physical design, and its program of patient care represents the revolution that is taking place in enlightened
centres throughout the world in the treatment of
mental illnesses.
The unit stands ready to offer British Columbians
a quality of service and a continuity of care that have
never before been available. In addition, it is
equipped to produce the trained personnel needed to
raise the standard of psychiatric care throughout the
province.
But the opening of the psychiatric unit has been
delayed because of the inability of the University and
the provincial government to reach agreement on a
suitable formula for financing operating costs.
To understand the present situation, and the role
of the new unit in community service and university
training, some background information is pertinent.
For ten years as part of a co-ordinated national
program, UBC has been planning and developing an
integrated Health Sciences Centre, which will draw
together the faculties of medicine, dentistry and pharmacy, the schools of nursing and rehabilitation medicine, and other units concerned with the training of
professionals in all the health sciences. Such teaching
centres were recommended by the Royal Commission
on Health Services. This recommendation has been
implemented and Ottawa provides half the construction costs.
Under the Health Sciences Centre concept, students in all the health fields would work and learn
together, so that each would come to understand the
capabilities and special functions of the others. The
aim is to produce men and women who, in their professional lives, can form a true health team.
A Health Sciences Centre must be organized
around its own hospital—a quite unusual kind of hospital, with built-in facilities for the teaching and research that are so intimately linked to exemplary
patient care.
UBC has approval from the provincial government
to build such a hospital with 410 beds, as the core of
its Health Sciences Centre. Construction of the hospital began with the psychiatric unit July 2, 1966.
This building was completed last year, furnished,
equipped and staffed by psychiatrists, psychologists,
nurses and other professionals recruited from all
across Canada. The unit consists of 60 in-patient
beds, closely integrated with a variety of out-patient
services, and supported by facilities for training and
research.
Apart from its 60 in-patients, the psychiatric unit
will have 35 part-time patients. That is, it will offer
eight-hour-a-day care for 25 patients who need treatment during the daytime but are well enough to
spend the nights at home, and for 10 patients who
may be able to get along on their own during the day
but need the security of a hospital bed, with nurses
and doctors on hand, at night.
In addition, the unit will provide out-patient services for patients who need come in only occasionally
for treatment, as well as group therapy and psychiatric emergency service.
Other facilities in B.C.—general hospitals, mental
hospitals and other psychiatric units—provide some of
these services. What is unique about the UBC psychiatric unit is the way all these services are to be integrated, in order to give patients the continuity of
care that is recognized to be vitally important, but
which has never before been available in B.C.
A patient may first come to the unit in an acutely
ill stage of his illness, perhaps arriving in an ambulance at the emergency department.
He would then probably be admitted to the unit as
an in-patient, where he might remain a few days or
weeks. As his condition improved he might spend
much of his time away from the hospital, working in
the daytime and returning at night, or being treated
during the day and going home at night.
WHEN sufficiently recovered, he might become an out-patient, spending only a few
hours a week at the unit. As he improved
further, he would continue to receive treatment as an
office patient. If his illness flared up again, he might
be put back on day-care or night-care or if necessary
readmitted as an in-patient, to be looked after by the
same doctors and nurses.
In fact, at every stage of his illness—as in-patient,
out-patient, day-care, night-care or emergency
patient—he would be cared for by the same treatment
team of psychiatrists, psychologists, social workers,
nurses and others. This is conceded to be the most
efficient   way   of   providing   care   for   psychiatric
continued on next page
O New Treating
LARGE well-lit bedrooms with broad windows and tasteful drapes provide patients with a pleasant environment
for rest or individual relaxation. Left to right are Miss Peggy Moland, Miss Lily Ann Marshall, and Mrs. Linda
Ewing. All are nurses in the psychiatric unit.
A fast snack or a leisurely cup of coffee are available in the modern cafeteria area which combines up-to-date
catering equipment with a bright and relaxing decor. Left to right are Miss Mary Jane Fraser, head nurse in the
new psychiatric unit, Mrs. D.K. Leonard, and Mrs. Dorothy Frosman. Miss Lily Ann Marshall is behind the
serving counter. The latter three are nurses.
2/UBC Reports/January 23, 1969
Permits Mai
To Lead Ni
Continued from page one
patients, since it eliminates repeated testing and diagnostic procedures and enables the treatment team to
maintain long-term contact with the patient.
A further advantage of this pattern of care is that
more and more patients may be treated throughout
their illness without ever being admitted to hospital.
With earlier diagnosis and with these more adequate facilities and services available to the patient
where he lives and works, hospitalization becomes a
less and less necessary part of psychiatric treatment.
In contrast to the traditional pattern of psychiatric
care, which has often resulted in the removal of ^^r
patient from home and family and his hospitalization
for a period of years, the new unit will shorten the
period of hospitalization to a matter of weeks and in
many cases will make it possible for the patient to
receive treatment without interrupting his work or
leaving his home and family. This is not only more
economical but is also much more effective treatment.
The physical setting of the psychiatric unit is in
itself a major factor in the new concept of care for
the mentally ill. Visitors, at first sight, are impressed
by its air of warmth and comfort, but puzzled by the
contrast with other hospitals.
NOWHERE in this unit are there the stark
white walls, hard-tiled floors, long echoing
corridors, spartan furnishings and high-rf^P
beds of a traditional hospital. Instead the visitor sees
bedrooms that would grace a good hotel, small
cafeteria-style dining rooms, intimate lounges with
chairs grouped in front of fireplaces, busy recreation
areas and workshops.
He will also see much wood panelling, carpets on
floors and hallways, vinyl on the walls. And he may
question this use of funds.
But there are sound financial and medical reasons
for every element in the decor. The hard-wearing carpet is inexpensive, easy to maintain and significantly
reduces the troublesome noise levels. The vinyl wall
covering costs about as much as two paint jobs and
will last much longer. The wood panelling needs
almost no care and will look even better with age.
And the entire ambiance is designed with the special
needs of the psychiatric patient in mind, designed to
be as un-hospital-like, as comforting and familiar as
possible.
The treatment required for many types of physical
illness places heavy emphasis on complicated and expensive "hardware," as in operating rooms and intensive-care units. The counterpart, in psychiatric care, is
the architecture, the physical environment, the
quality of finishes and furnishings in the treatment
unit.
Besides the patient-care areas, the unit also includes seminar rooms and other teaching areas, as
well as research facilities. In fact, more than half of
the unit's space is devoted to teaching and research
programs.
Despite its unique design, the psychiatric unit was
built for slightly less than the $5,000,000 which was
the maximum permitted for its construction. It is the
only hospital ever built in B.C. below a fixed financial
ceiling.
The unit has been ready to go into service since
Nov. 18, 1968, but the absence of adequate financing
\ tat Approach
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^
for the entire program for which it was designed has
delayed the admission of patients and the use of the
unit for teaching purposes.
The difficulty in arriving at a new agreement on
operating  costs  stems  from   the   fact   that  existing
formulas do not cover some of the services proposed
i      nor do they cover teaching costs.
THE operating costs of hospital in-patient services in B.C. are financed almost entirely out
of payments from the B.C. Hospital Insurance
Service. These payments are calculated on the basis of
a per-diem rate -that is, so many dollars for each day
that each patient is treated in the hospital.
In 1965, the UBC Health Sciences Centre Hospital
<^ftuested a budget which BCHIS calculated to be the
equivalent of a per-diem rate of almost $40 for the
I    proposed psychiatric unit. BCHIS was willing to pay
only $34.46.
In the three years between the signing of that
agreement and the completion of the psychiatric unit,
costs of operating all in-patient services increased substantially. BCHIS has taken this into account, and has
increased its per-diem rates for all hospitals in B.C.
by what was calculated to be an equivalent amount.
The per-diem rate now offered by BCHIS for the
UBC unit is $55.00.
While this increase reflects the higher costs of all
such hospital services, it does not cover the costs of
out-patient services and the teaching program, and is
therefore not nearly enough to pay the actual costs of
^^^rating the unit.
One problem is that this one small unit must have
all the supporting services of a full-scale hospital. It
must have its own pharmacy, kitchens, medical records department and so on. Had the entire University hospital been built at once, the cost of these
services would have been spread over the per-diem
rate for 410 beds instead of 60, and would have been
proportionately lower.
But there are more important factors in the discrepancy between what BCHIS offers and what the
psychiatric unit needs.
The new unit will provide out-patient services, for
the treatment of patients who are not so ill as to
require admission to the hospital. Out-patient services
are an integral part of all up-to-date psychiatric hospitals. But in 1965, when the $34.46 rate was
reached, these services were not recognized nor
financed by BCHIS, and therefore could not be included in the financial agreement.
The same is true of the professional services of
psychologists employed by the unit. In 1965 psychologists were just beginning to penetrate the hospitals; today they are accepted as integral members of
the treatment team, and no modern psychiatric hospital would be without them. But the 1965 agreement did not provide for adequate psychological services by today's standards.
URTHERMORE, the existence of this clinical
facility on campus makes it possible, for the
first   time   in   B.C., to  inaugurate a training
program   for   clinical   psychologists.   But   again   the
1965 agreement made no provision for psychological
training.
Another problem is that of including in the
funding of a teaching hospital the cost of administration and supervision of the clinical services and of the
clinical education of the various health personnel.
Such  costs include the support of highly qualified
F
THE concept of integrating treatment with teaching is carried out in the design of this interview room. Physician
discusses case with patient while student nurses take notes on the other side of one-way viewing window. Patients
must consent to staff members and students "sitting in" on interviews. The "patient" is Miss Peggy Moland, a
nurse. Dr. C. G. MacRae, a resident psychiatrist in the new unit, interviews her. Watching are. left. Miss Eileen
Schmelzle. a nurse and, right, Mr. Bill Turtell. a male helper.
doctors who form the core of the teaching and research staff of the unit, and who are an essential part
of the program.
UNTIL three years ago, all Canadian medical schools paid the salaries of these department heads and other senior staff members from university funds, even though these doctors spent only about half their time in teaching and research, ancl the other half on treatment of patients and other matters which were as
much hospital as university activities. Thus the universities, through their medical schools, have been
defraying a significant part of the operating costs of
the teaching hospitals.
Since that time other provincial governments have
agreed to pay 50 per cent of these clinical teaching
salaries from hospital insurance funds, with the universities putting up only the remaining 50 per cent, thus
freeing money for other educational purposes.
An exception to this rule is British Columbia.
UBC, under present government policy, must still pay
the   full   cost  of administration  and  supervision of
patient care in the teaching hospitals.
All these added costs must be included in the
psychiatric unit's operating budget. Altogether the
budget amounts to $1.7 million per year. The university contends that this budget is reasonable and compares favourably with budgets for similar services
provided elsewhere in Canada.
For some months UBC has been advancing money
to pay the salaries of the staff and other essential
costs. But the university cannot go on financing the
hospital indefinitely.
THE Provincial government has agreed to establish an inter-departmental committee to identify the variety of services to be provided by
this and other mental health facilities in B.C., and to
develop a basis for adequate financial support.
The university expects that this committee will
find a solution to the problem which will permit the
early opening of this psychiatric unit.
OPEN fireplace and informal furniture with subdued lighting set the mood for quiet conversation and informal
get-togethers in this comfortable lounge area. In the foreground are. left. Miss Toni Morin and. right, Mrs. Jane
Auman. Behind are, left, Miss Ellen van Nethen and, right, Miss Menjia Scmadeni.   All are nurses.
UBC Reports/January 23, 1969/3 WEEKEND MEETING  HELD
Union of Students Formed
British Columbia's 40,000 college and university
students will become a united political action movement for the first time if a newly-formed student
organization achieves its aims.
The British Columbia Union of Students, which
says it represents 40,000 students enrolled at eight
provincial colleges and universities, was organized at a
meeting this month on the University of B.C. campus.
Public Support to be Sought
David Zirnhelt, president of the UBC Alma Mater
Society and chairman of the new group, says a primary aim will be to win public support for increased
financial aid to higher education.
In an interview with UBC Reports Zirnhelt said
students plan to organize a concerted public relations
program and a political but non-partisan campaign in
the next provincial election.
"I think the public has got to put pressure on
Premier Bennett and that is why one of the prime
aims of the BCUS will be to launch a campaign in the
next provincial election," he said.
"We will define our policies and be prepared to
exploit the opportunity of the next election. The
campaign won't be partisan in the sense of supporting
any one party but it will try to get across to the
public the urgent needs of higher education."
Zirnhelt said the BCUS campaign will attempt to
give the public information by which they can judge
for themselves the positions of individual candidates
towards education financing.
"We will be doing public relations with the public
as well as various kinds of political action from lobbying to mobilizing students for peaceful demonstrations that will be effective."
He said the political action movement will be supported by funds already available from member student councils and additional money raised by student
assessments.
Zirnhelt said the Alma Mater Society has $14,000
available from last year's budget and BCUS plans a 10
cents per semester assessment on students at each
member institution.
The BCUS chairman said the general theme of the
campaign will be the need for better financing of
higher education and research material will be
developed on such specific points as:
Co-ordination of higher education development to
ensure enough regional and junior colleges are developed to handle the rapidly-growing number of students.
^f«i ^ _r--_____-p- **iwf .■:.;«§,
Alma Mater Society President David Zirnhelt chaired
weekend meeting.
The method of allocating resources between institutions by a grants commission and possibly a form
of formula financing.
A clear and acceptable policy on admissions standards and transferability between institutions.
At its organizational meeting the BCUS decided to
request a  meeting with  Premier W.A.C. Bennett to
put the student case but Zirnhelt is not optimistic
that an interview will be granted or of the results if
one does take place.
"If Mr. Bennett grants an interview we will point
out what we consider to be the desperate situation of
the universities and ask him what he intends to do
about financing," Zirnhelt said.
"We don't intend to prepare a lengthy brief
because he probably wouldn't read it. We feel that we
have got to approach the premier but ultimately we
will have to go directly to the public."
Zirnhelt said if a meeting with the premier is not
granted the union of students will ask its members to
take part in a demonstration at the Legislature during
the budget debate.
Zirnhelt said formation of the student union has
been under consideration for some time and was not
related in any way to the resignation of Dr. Kenneth
Hare as UBC president.
"But we hope that the impact of Dr. Hare's resignation will make the public realize the intense problems facing students and universities."
The BCUS chairman said he and other organizers
consider the new group as a successor to the B.C.
Assembly of Students which was set up to represent
both secondary and post-secondary students in B.C.
"We think that the BCUS supplants the Assembly
because that organization is essentially defunct and
has not been operating," he said.
"We started anew and set up our own structure
which is quite different. We don't have a president or
an executive. The chairmanship of BCUS will rotate
and the power of our union will be in the power of
the constituent parts."
Organizational Problems
Zirnhelt said he is aware of such organizational
problems as communication with a membership
spread over eight institutions, the summer recess
when many students are off campus and the coordination of policy.
"The B.C. Assembly wasn't a success for a number
of reasons, one of which was not having any person
whose sole responsibility it was to make sure that
things were prepared for meetings. Quite often the
meetings just didn't happen until it was too late," he
said.
"We plan to hire a paid executive secretary whose
job it will be to look after such matters and we will
hold regular meetings every month or six weeks."
Zirnhelt said the executive secretary will play a
key role in the organization and will likely be a
graduate student who is taking a year out before returning to university.
"We want someone who is still fairly close to university and student problems who will act as a
resource person and do a certain amount of travelling."
Indications of Support
Zirnhelt said UBC students he has talked to think
an organization like BCUS is necessary and have indicated their support for it. He said the organizational
meeting had a full turn-out of three delegates from
each of the eight member institutions.
But Zirnhelt feels the success or failure of BCUS
will depend ultimately on the degree of co-operation
and support it gets from students and the ability of
each student union to generate action.
"The power of the union will be in the power of
its constituent parts. We are essentially a federation
of student councils, not a union in the true sense of
the word," he said.
"The ability of each institution to mobilize its
people for a program will be the determinant of
success."
FESTIVAL FEATURES
/ /
Committee"
The Festival of the Contemporary Arts this year
will take place between 29 January and 7 February.
As in past years, the aim of the Festival will be to
bring to the campus community and environment,
performances, events, happenings, and exhibitions,
which represent some of the most advanced directions being taken in the different arts at this moment.
Members of the San Francisco Committee Workshop
This year there will be a certain emphasis on
experimental forms of drama and theatre. In particular, the San Francisco Committee Workshop—a group
of 10 young actors which has grown out of "The
Committee", the satirical San Francisco-based revue
company,—will be on campus for the period of 28
Jan. to 5 Feb.
The Committee Workshop does improvizational
theatre. Its members operate without scripts, props,
costumes or make-up.
Besides the Committee Workshop, at least two
other important theatrical groups or 'events' will be
taking part in the Festival. One of these is the Vancouver Living Theatre, a mime group which has
grown out of the UBC School of Architecture this
year. This group is concerned with involvement, notj
with performance. They try to create environments in"
places which people tend to think of as just neutral
'space'; they work to create relationships where
normally there is passivity and non-relationship.
The Programmed Scores are under the direction of
Helen Goodwin, and will take place throughout the 8
days of the Festival.
Other major events in the Festival programme will
include:
Morton Feldman (3 performances of his own
music)
Jackson McLow reading his own poems
John Logan reading his own poems
Four performances of a play by Chris Johnson,
called "Super-Safe", in the Freddy Wood Theatre
An assorted programme of recent experimental
films by Brakhage, Warhol, Emschwiller, Michael
Snow, Markopoulos, Jutra, and others.
A detailed programme for the whole Festival,
including the sequence for the Programmed Scores,
will appear in the Ubyssey on Tuesday, 28 January,
and should be taken out and kept as one's official
programme. In addition, the same programme will be
separately distributed, in scroll form, both before and
during the Festival. For all and any further enquiries,
phone the Fine Arts Department at the University,
228-2757.
\
■ ■■^^■k   Volume    15,   No.   2   January   23,
■ I PJV IM| 1969. Authorized as second class
I I PJK I mail by the Post Office Depart-
III I 11 ment, Ottawa, and for payment of
UIJ0 ^Af postage   in   cash.   Postage  paid  at
______  Vancouver   B.C.   Published  by  the
"rOHl o University of British Columbia and
distributed free. J.A. Banham, Editor; Barbara Clag-
horn, Production Supervisor. Letters to the Editor
should be addressed to the Information Office, UBC,
Vancouver 8, B.C.
4/UBC Reports/January 23, 1969

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