DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE Mental Health Services Branch PROVINCE OF BRITISH COLUMBIA ANNUAL REPORT FOR TWELVE MONTHS ENDED MARCH 31 1966 Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1967 To Major-General the Honourable George Randolph Pearkes, V.C., P.C., C.B., D.S.O., M.C., Lieutenant-Governor of the Province of British Columbia. May it please Your Honour: The undersigned respectfully submits the Annual Report of the Mental Health Services Branch, Department of Health Services and Hospital Insurance, for the year ended March 31, 1966. ERIC MARTIN, Minister of Health Services and Hospital Insurance. Office of the Minister of Health Services and Hospital Insurance, Victoria, B.C., December 1,1966. Department of Health Services and Hospital Insurance, Mental Health Services Branch, Vancouver, B.C., December 1,1966. The Honourable Eric Martin, Minister of Health Services and Hospital Insurance, Victoria, B.C. Sir,—I have the honour to submit the Annual Report of the Mental Health Services Branch for the 12 months ended March 31, 1966. A. E. DAVIDSON, B.A., M.D., F.A.P.A., Deputy Minister of Mental Health Services. TABLE OF CONTENTS PART I.—GENERAL ADMINISTRATION Page Report—Director of Mental Health Services 7 Report—Business Manager 18 Report—Personnel Manager 38 Report—Social Service Consultant 43 Report—Nursing Consultant 49 Report—Consultant in Medical Records and Statistics 52 PART II.—RIVERVIEW HOSPITAL Report—Superintendent 54 Statistical Tables—Riverview Hospital 69 PART III.—THE WOODLANDS SCHOOL Report—Superintendent 85 Statistical Tables—The Woodlands School 87 PART IV.—THE TRANQUILLE SCHOOL Report—Superintendent 94 Statistical Tables—The Tranquille School 96 PART V.—GERIATRIC DIVISION Report—Superintendent 98 Statistical Tables—Valley view Hospital, Essondale 102 Statistical Tables—Dellview Hospital, Vernon 109 Statistical Tables—Skeenaview Hospital, Terrace 113 PART VI.—COMMUNITY MENTAL HEALTH SERVICES Report—Director of Mental Health Centre, Burnaby 117 Statistical Tables—Mental Health Centre, Burnaby 120 Report—Director of Mental Health Centre, Victoria 126 Report—Director of Okanagan Mental Health Centre, Kelowna 130 Report—Director of Vancouver Island Mental Health Centre, Nanaimo 133 Report—Director of Kootenay Mental Health Centre, Trail 135 Statistical Tables—Kootenay Mental Health Centre, Trail 137 5 NO NO 5 Ph < Ph O t/1 < o H < N < o o < m tzi w u M w H < M X i z Q Z < tn W O «z ftBi OW a< WW «z £< 2S tn >-Z H" P*< §S W0j c/j o B, o e M .2 — tj.SS- S'lo "2 On _SS| |So s.s s 3 tU EO.fe C3 "S s 2 _3 c O OJ O -Q'3- w CJ CM -o|Q ^j-x: tu ■mJ3 S.2H tn w o> "to E2B || QZ « ffi-S "Si & tu >,?! £H *> 0) C —| =1 tu *«! 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X 1 s lis c .2 0 to to U ri V 0 5 « 0 O w _1 3 •a ra « fl u o u £ ft » 9 N H C •a tn e a 0 to a to I and depa catio c -a rt C M 3 V c ease tded dry n « H to >• 3 a u bOJa^HSV TS »- M C fl *3 a « B c i s t u c Travelling e: Office furnit Heat, light, Medical car 1 I ri | c a c Patients' lib Maintenanc Transportat General sup Occupation; Audio-visua Patients' ed General exp .a oj O X J A K w f- 1 ft) GENERAL ADMINISTRATION G 25 a u ft < a w a z a tn X H z o CN Pi o ft ft ft H z ft ft ft" o o x u co co Q Z < ft O o o w X H ft o H Z ft 2 h H < H CO ft cn Z ft ft ft ft ft < ft) o oooorNvoocnr-oosoosoomoeNTi-omvoir- cn©'-iir^sososooo©so©'-|ir^\Omcnc^tnin ! 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K. Carroll Throughout the Mental Health Services Branch, the social service departments have found this year to be one of increasing demands for service requiring sharp focusing and refinement of skills, extension of services, and a reaffirmation of personal and professional commitment to the service of the individual, the family, and community. The following programme formulations and advancements taking place this year are noteworthy:— (1) The continuing programme of integration of hospital treatment and care services with community health, welfare, education, and rehabilitation services which, through the establishment of special projects, provide for a continuum of treatment and care. (2) Treatment planning, which involves the patient in his family wherein the family is the unit to be treated. (3) The continuing extension and co-ordination of community mental health services and their integration with community mental health services. (4) The development of community resettlement programmes, such as home care, family care and boarding home, group homes for therapeutic care, group homes for pre-occupational experience and training, and nursing- home care. PROFESSIONAL EDUCATION RESPONSIBILITIES During the year 19 students (7 second-year and 12 first-year postgraduate students) had field-work placements in the following divisions of the Mental Health Services: Riverview Hospital and After-care Clinic, 10 students; Mental Health Centre, Burnaby, 7 students; The Woodlands School, 2 students. Supervisory social-work staff, in their capacity as field-work instructors of student social workers, attended a one-day institute under the auspices of the School of Social Work, University of British Columbia. Throughout the year approximately 100 in-service training students from the Department of Social Welfare were oriented in three sessions to the Mental Health Services programme generally, and to the role and services of social workers in a mental health setting. Additionally, this staff met with the faculty of the Welfare Aide Course, Vancouver City College, to discuss a programme of orientation. Later, 30 students from the college attended group sessions focused on understanding of structure, functions, and services of social service in a large mental hospital. Additionally, educative group sessions were conducted by Mental Health Services supervisory social-work personnel for groups of nursing students from the School of Nursing, University of British Columbia, and from the schools of nursing in Vancouver General Hospital, Royal Columbian Hospital in New Westminster, and St. Joseph's Hospital in Victoria. PUBLIC EDUCATION AND INTERPRETATION RESPONSIBILITIES Public education and interpretation to both professional and lay groups is an important responsibility which must be assumed by the entire staff of the Mental Health Services Branch. In this way individuals and groups at community level are kept abreast of developments in the mental health programme and thus are enabled to incorporate the principles of mental health into community planning and programming. To this purpose the social service departments of the Mental Health Services have, during the year, been active with staffs of the National Employment G 44 MENTAL HEALTH SERVICES REPORT, 1965/66 Services, Department of Indian Affairs and the Indian Health Services, the Department of Veterans Affairs, the probationary services, the Children's Aid Societies of Vancouver, the family service agencies of Vancouver, Vancouver General Hospital Social Service Department, Shaughnessy Veterans' Hospital Social Service Department, the Sisters of the Vincent Home and Shelter, and with representatives from the Canadian Mental Health Association. The orientation of lay people and professional people to the Mental Health Services is another effective way to carry out the purposes of community education and interpretation. All social workers in every division of the Mental Health Services have assisted in these orientations during this year. District Supervisors, Department of Social Welfare, in Burns Lake, Prince George, Vanderhoof, Haney, Abbotsford, Chilliwack, Langley, and Richmond were oriented to Riverview Hospital, Valleyview Hospital, and The Woodlands School programmes and to the social service departments in these institutions. These orientations have been extended also to Medical Health Officers and public health nurses as well as to the staff of the G. F. Strong Rehabilitation Centre, the Municipality of Burnaby school social worker and psychologist, the Pre-social Work Club, University of British Columbia, school counsellors, and many groups of high-school students, including one from Blaine, Wash. Additionally, well over 200 relatives and friends of patients have been oriented to the services of divisions of the Mental Health Services. An institute was offered by Riverview Hospital to boarding-home operators and family-care holders working with the social workers—Mental Health Services in the community resettlement of mentally disabled patients who no longer need in-hospital treatment or care. The institute was focused on the understanding of mental disability and ways of effecting habilitation and rehabilitation through programmes such as the boarding home or family care. STAFF-DEVELOPMENT PROGRAMME This year four social workers in the Mental Health Services attended advanced study courses in Community Development and Organization, and in Administration and Supervision offered by the Department of Extension, University of British Columbia. Additionally, 25 social workers attended an Institute on Family Group Therapy given by Mrs. Virginia Satir under the auspices of the Mental Health Centre, Burnaby; 10 social workers attended a Workshop on Religion and Psychiatry given under the auspices of the Mental Health Centre, Burnaby; 15 social workers attended the workshop and institutes conducted by the Conference of the American Public Welfare Association; Northwest Regional Conference, Child Welfare League of America; Northwest Conference of the American Association on Mental Deficiency; Pacific Northwest Regional Institute, Family Service Association of America; the Pacific Northwest Regional Institute of the National Association of Social Workers for practitioners in medical and psychiatric settings. SOCIAL-WORK CONSULTATIVE SERVICE This is a staff service to superintendents, directors, and social service departments in the Mental Health Services Branch. This year 53.6 per cent of the consultant's total man-hours of work was spent in direct services through visitation to social services throughout the divisions of the Mental Health Services Branch, on request. Additionally, 11 per cent of man-hours of work was spent in rendering consultation as requested by the use of the mails and telephone. The percentage of consultative time has risen sharply from 42.6 per cent in 1964 to 64.6 per cent during GENERAL ADMINISTRATION G 45 the year. Consultation continued to be requested in the following areas, and in this order of priority:— (1) Community resettlement of patients resident in hospitals and schools for the retarded; programmes for remotivation and socialization in boarding homes and intermediate-care homes, including further reports on the subsequent and future developments in this service. (2) Administration and organization of small group-care homes, boarding homes, and intermediate-care homes interdivisionally and interdepartmentally with the Department of Social Welfare. Further reports on the extension of the use and repositioning of the Co-ordinator of Boarding Homes position together with suggestions regarding regional development of this programme with indications for the relocation of social-work staff to man the service. (3) Personnel procurement, maintenance, and retention; staff development and training; staff-patterning, including a special report on a social-work classification series for workers in the Mental Health Services, including reference to the value of an establishment for technical workers. (4) Social service emphases as these relate to the continuing organizational and functional changes in the departments consequent to community- centredness of services subsequent to the regionalization of mental health services. (5) Integration of the contribution of public health nursing in the after-care and community resettlement of patients. (6) Pre-admission and after-care continuum of social services in hospitals and schools for the retarded as these become further conceptualized out of recent changes in mental health legislation. DISTRIBUTION OF CONSULTATIVE RESPONSIBILITIES Riverview Hospital Consultation has been given as requested in relation to social service organization and programme in relation to the adolescents in treatment and their resettlement in community; staffing, organization, and programme for social service in the reception and acute-treatment areas of the regionalized hospitals at Centre Lawn and Crease Unit; pre-admission services and after-care social services in the regionalized hospitals; the development of boarding homes for young schizophrenic patients during the initial phases of leave from hospital; recommendations were submitted regarding the responsibilities to patients as well as their status on transfer to boarding homes. The manual for co-operative services and procedures between Mental Health Social Services and community health and welfare agencies was completed and sent forward for printing. Continued consultation has been requested and given in relation to the development of the public health contribution in the resettlement of patients in boarding homes in the upper and central Fraser Valley public health areas. Consultation has been given from time to time in regard to social services in complex case situations. The Woodlands School Consultation was sought and given in relation to the specifics of the positions, functions, and responsibilities of the supervisory positions in the social service department and the out-patient department; the on-going development of the adult boarding-home programme; social-work consultative services to public health districts adjacent to the School; the development of group homes for training adoles- G 46 MENTAL HEALTH SERVICES REPORT, 1965/66 cents in jobs and their subsequent job placement. The project for foster-home placement of children resident in the School was studied and an evaluation of the programme was written. This project has proven to be a most successful experiment, indicating the value of foster-home placement as a care and training form among a number of care and training variants necessary in a programme for retarded children. The Tranquille School During the year, consultation has been requested on a regular basis. During the year the social service department gained in established staff positions. The organization, functions, procedures, and services have now been delineated. Staff now stands at three trained social workers. Consultation continues in the areas of boarding home, special group homes, and employment placement. In the latter programme an employer-employee placement agreement has been devised which defines the conditions under which each employee (trainee) is being hired and the supervision and training obligations assumed by the employer. Attempts are being made by the social service department to help families accept their retarded back into the home when the School's education and training goals have been reached. With the use of Disabled Person's Allowance and community health and welfare services, the family can be assisted in assuming responsibility for care and supervision in the home. This programme is necessary as many residents in The Tranquille School were admitted when services for the retarded did not exist in their communities. As a result, families having retardates tended to view the disability as beyond the resources of the home and community. Today, because of the developments in public education for the educable and trainable retardate and the services which community health and welfare agencies are prepared to offer the family with a retardate, admissions of the mildly and moderately retarded should be largely unnecessary. The contribution of the social service department in The Tranquille School deserves the highest commendation. The employment, placement, and boarding- home programme developed during this year is an outstanding development. Valleyview Hospital Consultation was sought and given in relation to procurement and maintenance of staff, and the continuing development of the pre-admission and post-admission social services as well as the programmes for nursing- and boarding-home placement, care, and supervision. The contribution of the social service department in services to discharged patients, their relatives and families, is an outstanding one and resulted in the community resettlement of 195 patients this year. BOARDING-HOME AND FAMILY-CARE PROGRAMME In the on-going development of this programme, the following factors must receive consideration:— (1) Basic Planning: Service Policy.—Exploration of the possibility of extending the present programme through— (a) Formulation of a definitive statement of policy as concerns the specific responsibilities for programme and services by Public Health and Mental Health Branches and the Department of Social Welfare in relation to the needs of those unemployable and disabled adults who " on account of age, infirmity, physical or mental defect, or other disability " are in need of " care and attention " as defined in the Welfare Institutions Licensing Act and regulations. This would include services available from decentralized mental health centres in areas not accessible to the institutions. GENERAL ADMINISTRATION G 47 (b) Staff. The increase of staff in the district offices of the Provincial and municipal departments of social welfare, as well as an increase or relocation of social-work personnel in mental hospitals and schools for the mentally retarded to district offices. This would permit the social workers to work directly with these adults and integratively with district health and welfare services. Extensive work is needed at field level with general practitioners and boarding-home operators to develop a programme of protective supervision and activation to adults who because of " mental defect or other disability " require " care and attention " while domiciled in a boarding home. (c) Some study of the role of public health in services to these adults and to boarding-home operators. In relation to this, an evaluation of the co-operative service project between Central Fraser Valley Public Health Unit and the Mental Health Services Co-ordinator of Boarding Home Programme might be undertaken. Such an evaluation might provide useful guidelines in developing co-operative services across the departments. (2) Present Programme.—(a) It is possible to extend the present programme in Riverview Hospital, Valleyview Hospital, The Woodlands School, and The Tranquille School with services assumed by some relocation of social work staffs in these departments. (b) Provision of clothing to disabled adults continuing to reside in a boarding home beyond an initial period of six months could be assumed by the Department of Social Welfare through coverage which exists for all recipients of social allowance. It is to be noted that the Municipality of Burnaby has accepted this responsibility. (c) It is possible for disabled adults to visit a local doctor of their choice shortly after placement in the boarding home. A group of doctors in the Central Fraser Valley area have asked that disabled adults be helped to choose a doctor and visit him soon after placement before emergency or crisis illness. (d) Those patients who are residents of the Province and who are admitted to hospital to undergo a course of treatment extending from a few weeks to two years may either be discharged in full or placed on extended leave to their area of residence with a recommendation for boarding-home or private-hospital care. These patients are referred to the local municipal office or the Department of Social Welfare district office for boarding-home or private-hospital placement and related supervision. MENTAL HEALTH CENTRES—BURNABY, VICTORIA, KELOWNA, TRAIL, AND NANAIMO Regular consultation has been available to the social service departments in the Mental Health Centres in Burnaby and Victoria. Three consultative visits were made to the Mental Health Centre in Nanaimo. During the year one consultative visit was made to the Mental Health Centres in Kelowna and Trail. Social workers practising in these mental health facilities are extremely active in bringing their competency as part of a team-directed service to the development of community- based mental health programmes which involve them in direct treatment, consultation, community organization, community education, and the exploration of preventive measures and services. These latter have ranged from workshops on family life, adolescence, and an institute on marriage for moderns. Other preventive ser- G 48 MENTAL HEALTH SERVICES REPORT, 1965/66 vices have concerned the development of special foster homes for adolescents and for children with beginning emotional and (or) behavioural disorders. Continuing services for foster-parents and to the children placed are offered by the centres. The regional supervisors of psychiatric social work in the Mental Health Centres continue to make a significant contribution in the development of community mental health programmes focused on the prevention of mental ill health. CENTRAL BRANCH RESPONSIBILITIES These centre around the following conference bodies:— (a) The Branch staff meeting. (b) The Interdepartmental Case Review Committee. (c) Unit administrative conferences. (d) The Boarding Home Programme Committee. (e) The Rehabilitation Consultative Council. if) Social Work Council. Additionally the responsibility for community development in health and welfare which this position together with all others at Branch Administration assumes has demanded active participation in the Community Placements Committee of the Association for Retarded, British Columbia; Scientific Planning Committee of the Canadian Mental Health Association; the Welfare and Recreation Division of the Council of Agencies; the Welfare Institutions Licensing Board; the Division for the Guidance of the Handicapped and the Conference on B.C. Health and Welfare. GENERAL ADMINISTRATION G 49 REPORT OF NURSING CONSULTANT Miss M. M. Lonergan, Nursing Education At the request of the Department of Nursing Education, its various teaching programmes were reviewed during the past fiscal year by the Branch Administration. Purposes and functions were clarified, and significant beliefs and recommendations approved. These decisions influenced each programme and formed the basis for immediate and more distant goals and plans. The psychiatric nursing programme showed a year-end census of 263 students compared to the previous year's total of 221. The department received 1,311 and processed 466 applications. One hundred and seventy-eight candidates enrolled in the programme. The academic standing of the September entrance class was high- school standing on either the University Programme or the General Programme. The same was true of 63 per cent of the February entrance class, with the remaining students deficient in one or two subjects. The expectation is that these will be completed by correspondence within two years. Forty-seven students withdrew from the programme during the year; 38 per cent failed academically, 55 per cent for personal reasons, including marriage and illness, and 1 per cent were considered to have unsuitable personalities. The latter figure showed a marked decrease from the 30 per cent of previous years. The final comprehensive examination, in the second year of its use, accounted for 17 failures at the first writing; four students were unable to pass the supplemental and consequently were required to withdraw from the programme. Ninety-three students successfully completed the programme and became eligible for licensure as psychiatric nurses in the Province of British Columbia. The psychiatric-aide programme offered 21 five-day courses encompassing 735 hours of instruction for 274 psychiatric aides entering the Service or on staffs of Dellview, Riverview, Skeenaview, and Valleyview Hospitals, The Tranquille School and The Woodlands School, and Vista and Venture. The requirement that all psychiatric aides receive formal instruction was established by policy. Instructors were assigned to clinical areas for one day a week in order to evaluate the effectiveness of their teaching in the light of nursing service expectations of the psychiatric aide. Projects completed by instructors included {a) revision of the Information Bulletin, (6) implementation of a form for the assessment of aide performance in class, (c) development of a form for the evaluation of the aide's performance following a course, (d) completion of educational records for presently employed aides, and (e) use of experience records as teaching-tools. A four-month time study showed that instructors assigned to this programme contributed an average of 40 per cent of their time to assigned teaching in the psychiatric nursing programme. The senior instructor visited each Interior institution to conduct one two-week course to supplement on-going orientation and in-service education provided in these institutions. A review of the Post-basic Programme prompted the decision to hold in abeyance any further refresher courses for the graduate staff of the Lower Mainland institutions until studies concerning the priority needs of nursing staff for educational programmes had been completed. The Clinical Programme for Registered Nurses enrolled 16 students and graduated 12. Two graduates accepted employment with the Mental Health Services, three went on staff in psychiatric units of general hospitals, two returned to general nursing, two entered the public health field, and two returned to their homes. One hundred inquiries were processed; it was noteworthy that a large G 50 MENTAL HEALTH SERVICES REPORT, 1965/66 number of these indicated a preference for a short two- to three-month programme in basic psychiatric nursing. The curriculum included 170 academic hours correlated with clinical experience in intensive- and continued-treatment wards of Riverview Hospital. Nurse-patient relationship therapy was the focus of learning initially, and rehabilitation, group and community relationships for the latter half of the programme. The instructor's hours of structured teaching and related activities totalled 850. At the close of the fiscal year, developments in the professional nursing community were being studied to determine whether or not the clinical programme was meeting the current needs of registered nurses for psychiatric nursing experience. The Affiliate Programme, which had been temporarily discontinued in October, 1964, resumed in April. Agreement, with respect to the responsibilities of each party, was formalized by an exchange of letters between the Mental Health Services and each of three participating schools of nursing. The Department of Nursing Education appointed a Co-ordinator charged with the administration of the programme, teaching designated curriculum content, conducting courses for public health nurses, and arranging tours for visiting students. Each school of nursing assigned one of its faculty for the clinical teaching and supervision of its students. Although the curriculum was designed to have a body of fundamental content, each instructor was able to modify this to ensure that the affiliation was an integral part of the students home school of nursing curriculum. For the student, the applicability of psychiatric nursing concepts and principles to the general nursing care of patients became more discernible. Nevertheless, such transfer of learning continued to find obstacles in the general hospital setting. With a view toward reducing these, instructors participated in faculty and in-service programmes for nursing staffs in their home territories. Two hundred and two students from three schools of nursing and four nurses from the Health Services Branch completed the programme. The Co-ordinator contributed 602 hours of structured teaching and related activities in the operation of the Affiliate Programme. The department's faculty functioned through standing committees to accomplish a number of tasks. The Library Committee revised policies, developed a guide to evaluate books recommended for purchase, established a library-user identification- card system, and instituted a policy of fines for a six-month trial period. The Examinations Committee prepared and marked 95 promotional examinations for nursing positions and two examinations for candidates seeking licensure. The Curriculum Committee developed criteria for evaluating the psychiatric nursing programme curriculum, reviewed content and teaching methods, and outlined lesson guides for nursing arts. The chairman was instrumental in initiating, for psychiatric nursing students, junior-level courses in geriatric nursing and in training the retardate. The Evaluation of Progress Committee reviewed the performance of each student with respect to academic and clinicial performance, personality, and deportment, and made appropriate recommendations to the department's administration. The physical facilities of the department were increased by the acquisition of three additional residences, thereby increasing the capacity for student accommodation by 99 beds. Some repair and remodelling took place through the residences. The plan for gradual replacement of residence furniture continued for the fourth year with gratifying results, largely due to the excellent workmanship provided by the Industrial Therapy Department. GENERAL ADMINISTRATION G 51 NURSING CONSULTATION Orientation to the Mental Health Services was provided for a number of newly employed nurses, department heads, and distinguished visitors. Among the latter were Mrs. E. McCue, Nursing Consultant, Department of National Health and Welfare, and Miss G. Stokes, Project Director, Maimonides Hospital, Brooklyn. The availability and utilization of Mental Health Services for educational purposes prompted formal and informal discussions with representatives of the Registered Nurses' Association of British Columbia, the Health Branch, and the University of British Columbia. Guidelines were developed for determining enrolment and clinical placement of learners from the latter two organizations. Three visits were made to The Tranquille School and two to the Mental Health Centre, Victoria. Psychiatric units at the Vancouver General Hospital and the Royal Jubilee Hospital were toured. In connection with reorganization plans in nursing departments, the Nurse Consultant met with medical and nursing administrators, together with executive officers of the Branch, and participated in a number of recruitment activities. She was also involved in a variety of projects, such as educational conferences, building programmes, surveys of facilities, and assessment of staffing plans. She represented the Mental Health Services on various professional committees and carried out assignments which ranged from invigilating registration examinations to participating in the development of criteria for schools of nursing in British Columbia. Nursing Council reviewed the work of the Core Nursing Procedure Committee and approved new and revised nursing procedures. It sought solutions to problems concerning supplies of all types, transfers of nursing staff between institutions, studied the extent to which present medical-surgical stock supplies were used, and made recommendations regarding policies affecting medicine and nursing. The Nursing Liaison Committee enlarged its membership to include representatives from general hospitals with psychiatric services and from the University of British Columbia School of Nursing. Discussion clarified the responsibilities of nurses in agencies involved in mental health programmes and provided information about changing concepts in institutional care of the mentally ill. The effect of some sections of the Mental Health Act, 1964, upon psychiatric programmes in general hospitals was discussed with a view toward better understanding of the factors involved. Through the discharge of her responsibilities, the Nursing Consultant was privileged to acquire an overview of the nursing division, which showed convincingly that the quality of total care available to patients in the institutions of this Service depended largely upon the competency of nursing, that the degree of competency was significantly greater in direct ratio to the strength of the nursing administration and its ability to direct its own service toward specified goals, and that the attainment of general and specific goals were dependent upon a mutually co-operative relationship with other departments and disciplines. G 52 MENTAL HEALTH SERVICES REPORT, 1965/66 REPORT OF THE CONSULTANT IN MEDICAL RECORDS AND STATISTICS Miss A. D. Dingle The past year has brought some important changes in procedures in the medical records of the mental health facilities. With the proclamation of the Mental Health Act, 1964, new terms and routines had to be employed to meet the requirements of the Act and new forms designed for recording and communicating data. Supplies of forms for admission under the new Act are being issued to the public from this office, and a special effort is being made to interpret the Act and the use of the forms to the private physician's office staff when a request for forms is received. The change to the unit numbering system throughout the Mental Health Services Medical Records Offices was also effective on April 1, 1965. Changes have been made in the statistical tables of this year's annual report for all facilities which are involved in placing patients in the community in significant numbers. These tables will show separate details regarding the actual number of patients in residence, those in boarding homes, and those on other extended leave, rather than grouping all patients on the books, as has been done in the past. As a result of the appointment of a Research Officer in the Division of Vital Statistics, 80 per cent of whose time is assigned to the Mental Health Services Branch, additional studies have been done for the Deputy Minister and for the various facilities. CONSULTATION TO UNITS Riverview Hospital On April 1, 1965, an expanded form for the collection of statistical data was instituted in Riverview Hospital. With the large residential population for whom forms were required, in addition to admissions and separations, the medical-records staff have made a very praiseworthy effort to meet the challenge, and the programme is operating fairly smoothly. The forms are pre-coded to assist in completion. Members of the medical staff are looking forward with interest to the first reports of the data collected and a review of the first six months is now under way. SCHOOLS FOR MENTALLY RETARDED During the year special statistical-data forms were designed for The Woodlands School. Preparatory planning was done by a committee within the school in collaboration with the Division of Vital Statistics and this Consultant. This programme will be started on April 1, 1966. The data to be gathered includes comprehensive diagnostic detail, and the forms have been designed to permit later information to be added as the patients develop. The Out-patient Department will also complete these forms for children referred to them. A manual has been compiled giving instructions and codes, and this has been issued to staff concerned. It is hoped to extend this programme to The Tranquille School. An interesting development is taking place in the Medical Records Department of The Woodlands School. Open-shelf filing is replacing the filing-cabinets, and colour coding is being installed for a numerical system of filing. This is the first departure from alphabetical filing of active medical records in the in-patient faculties of the Mental Health Services of this Province. GENERAL ADMINISTRATION G 53 Geriatric Division Special statistical-data forms have also been designed for Valleyview Hospital. A first attempt is being made on these forms to indicate periods of extramural care, such as boarding-home placement, as this now involves a significant number of the patients on the books of Valleyview Hospital. This statistical programme will also start on April 1, 1966, and it is hoped that after a period of trial it can be expanded to Dellview and Skeenaview Hospitals. A manual of instructions and codes has been issued for the guidance of staff. Mental Health Centres With approval being given for appointment of part-time clerical assistance in the smaller centres, there has been a considerable improvement in the completion of statistical forms. However, some difficulties are still being experienced. The index of cases referred is proving its value in linking up medical records of persons appearing at more than one centre. A visit was paid to the Victoria Mental Health Centre to discuss problems in the statistical programme and to the Okanagan Mental Health Centre in February following a change in clerical staff there. In September, 1965, a meeting was held in Vancouver bringing together the clerical staff of the various Mental Health Centres. The main topic was the statistical programme. The meeting was felt to be of great value to those present, who gained an understanding of the purpose and of the processing of the statistical forms, and were able to clarify points of difficulty. It also provided an opportunity to discuss other mutual problems and get acquainted with each other's counterpart in the widely separated centres. G 54 MENTAL HEALTH SERVICES REPORT, 1965/66 PART II.—RIVERVIEW HOSPITAL REPORT OF THE SUPERINTENDENT B. F. Bryson, Superintendent GENERAL COMMENTS March 31, 1966, marks the end of the first year of operation of Riverview Hospital as a distinct entity and as a mental health facility under the Mental Health Act, 1964. It has been a challenging, exciting, and productive year as new programmes and procedures became possible with the stimulus of the more liberal and progressive legislation, and the combination of the previously separate Provincial Mental Hospital and the Crease Clinic into a single administrative unit. Riverview Hospital is composed of six units, each with a specialized function and treatment programme co-ordinated by a Unit Director who is a psychiatric or medical specialist. Crease unit serves as the admitting and acute-treatment unit for all patients admitted from the Greater Vancouver area, while Centre Lawn unit functions similarly for patients from the remainder of the Province. West Lawn unit and East Lawn unit provide special treatment and rehabilitative services for men and women respectively who require continued in-patient care. Riverside unit has been extensively reorganized and contains security wards, as well as the alcoholism clinic and improved accommodation for patients working at the Colony Farm. North Lawn unit continues to provide chronic infirmary and acute medical and surgical care. Every effort has been made to provide a high standard of service to all patients, and treatment and administrative policies have been revised or new ones developed to reflect the progressive intent of the new legislation and the concepts of modern psychiatry. In our efforts to reach these goals, the Superintendent has been ably assisted by the senior officers and department heads, and by the co-operation and loyalty of all Riverview staff. During the year a total of 7,706 patients received psychiatric treatment at Riverview Hospital, an increase of 166 over the total of the Provincial Mental Hospital and the Crease Clinic during the previous year. The following table gives a summary of the movement of population for Riverview Hospital for the year ended March 31, 1966:— Male Female Total 1,526 112 78 6 1,392 145 152 2,918 On extended leave— 257 Other 230 6 Totals 1,722 1,689 3,411 2,027 7 3 2,250 5 3 4,277 12 6 2,037 2,258 4,295 3,759 3.947 7,706 RIVERVIEW HOSPITAL G55 Male Female Total 2,012 2,239 4,251 72 61 133 15 19 34 4 5 9 131 170 301 80 75 155 5 3 8 2,319 2,572 4,891 -86 -17 — 103 1,440 1,375 2,815 Separations— Discharged in full.. Died Transferred to geriatric facilities Transferred to facilities for the mentally retarded.. On extended leave— Boarding home _ Other _ On escape... Total separations Decrease in population In residence, March 31, 1966.- A comparison of the above table with those for the Provincial Mental Hospital and Crease Clinic during the previous year shows that there has been a considerable increase in both total intake of patients and total separations, a reversal in trend from that noted last year, when there was a decrease in both categories from that of two years ago. It is felt that this trend reflects the greater acceptance of the hospital by patients and the less restrictive nature of the new admitting criteria of the new Act. During the year 4,295 patients, including 2,037 men and 2,258 women, came in to hospital as either new admissions, readmissions, or, to a small extent, transfers from other units. This is an increase of 448 patients compared to last year. There were 2,345 informal admissions, representing 55 per cent of the total. Separations increased by 526 and totalled 4,891 for the year, including 2,319 men and 2,572 women. Of the separations, 4,251 were discharged in full directly The admitting office. At admission, the admitting clerk in a few minutes gets necessary information from the patient and her relative. The clerk types directly on to a stencil which is used to prepare the beginning of the medical record. The stencil at the same time is used to set up all the records needed in other departments of the hospital. G 56 MENTAL HEALTH SERVICES REPORT, 1965/66 to the community, an increase of 373 over the previous year, and represents 86.91 per cent of all separations. In spite of the greater number of patients under care at Riverview during the year, deaths increased by 1 to a total of 133. This represents only 2.7 per cent of total separations and 1.7 per cent of the total number of patients under care during the year. As of March 31, 1966, the number of patients in residence at Riverview Hospital totalled 2,815 (1,440 men and 1,375 women). This is a decrease of 103 compared to the same date a year ago. The admitting office. A new, bright and cheerful admitting office has recently been opened. Its hours are from 7 a.m. to 11 p.m., 7 days per week. There is little doubt that if the patient and her relatives have a good initial impression, they will have far less apprehension about admission to the hospital. TREATMENT SERVICES Implementation of the Mental Health Act, 1964, promoted much clinical progress, but the full effect of the facilitating legislation will not be experienced until next year as the initial impact presented more challenges than solutions and meeting new demands absorbed a great part of our energies. Despite the almost overwhelming volume of admissions, the number of long- stay patients was reduced by 176 (118 male and 58 female) during the 12 months, and 92 per cent of all admissions were returned to the community after an average stay of 45 days. Only 312 patients admitted during the year were transferred to long-stay units of Riverview Hospital, but a small number were transferred to other facilities, such as the Valleyview Hospital. Psychoactive drugs are still of great importance, and their variety and complexity have increased. During the year we undertook clinical trials of Haloperidol for psychotic overactivity, of Tegretal for psychomotor (temporal lobe) epilepsy, B RIVERVIEW HOSPITAL G 57 and of a phenothiazine injected twice monthly in a slow-release medium for maintenance therapy of schizophrenic in-patients and out-patients. Electroconvulsive therapy is invariably modified by anaesthesia and muscle relaxation, and approximately 1,050 such treatments are given each month. A significant increase in therapeutic community methodology has developed. Several wards have community meetings, as often as every day, and different specialized groups have included marital partners' groups, adolescents, intensive interaction, and various staff-training groups. On September 7th, the first integrated admission ward (West 3 in Crease unit) came into operation, followed by daytime integration of the patients on the fourth floor of Centre Lawn unit in December in mixed clinical teams. Various methods of treatment of alcohol addiction were conducted, including electrical and drug-induced motor-deprivation ("paralysed awareness") aversion therapy. An out-patient pre-admission and follow-up service was provided in Vancouver in space made available by the Alcoholism Foundation. A new standard of medical staffing was achieved, with an increase of five new positions in our psychiatric establishment, bringing our medical strength to 21 medical specialists in psychiatry and one each in neurology, pathology, radiology, and internal medicine. Teaching activities by the medical staff were increased, and a record of 226 professional visitors observed parts of our programme in the month of February. Third-year as well as second-year medical students visited the hospital for seminars and demonstrations. Research continues, and in particular Dr. Greiner, who was enabled to attend the NATO Advanced Study Institute on Schizophrenia at Oslo in August, led his co-workers in a profitable investigation of that disease and its relationship to melanosis, culminating in two very well-received publications in the Lancet of December 4, 1965, and February 12, 1966. During February, after-care services at Burnaby Mental Health Centre came under the direction of the Crease Unit Director, facilitating greater contact with the community and the future development of out-patient and pre-admisison services. DEPARTMENT OF NURSING During the year the nursing staff have been required to make adjustments to meet the challenge of rapidly changing attitudes and philosophies of patient care. With the increased number of patients admitted to hospital, the nursing staff have continued to strive toward higher standards through more individualized care afforded by the Mental Health Act, 1964. They have met these challenges admirably. More is being demanded of the nursing staff than ever before, and they have sought out all educational opportunities, including films, lectures, and clinics. A group of the ward administrators attended an institute at the University of British Columbia on psychiatric nursing. All new staff were given an orientation to the hospital, and all new psychiatric aide staff had a one-week orientation course, held in the Department of Nursing Education. In June the first steps were taken to establish an integrated admission ward in the Crease unit. Although the concept of a patient and staff integrated ward is not new to our hospital, it was a new venture in an acute psychiatric treatment admission area. Careful planning in staff selection and orientation took place. Minor constructional changes were made. A therapeutic environment for the patients was G 58 MENTAL HEALTH SERVICES REPORT, 1965/66 thereby achieved. Subsequently, two other admission areas have been similarly organized. Nurses have continued to be encouraged to seek post-basic education. During the year one supervisor has been on leave of absence in order to take the Administration of Hospital Nursing Units Diploma Course at the University of British Columbia. Four head nurses and assistant head nurses are enrolled in the combined workshop and extension course in nursing unit administration being presented jointly by the Canadian Nurses' Association and the Canadian Hospital Association. The Central Supply Room continues to provide an excellent service in supplying sterile supplies to the nursing units. This year services were extended to the Crease unit. The Surgical unit reports an increase in the number of surgical procedures and consultations. The completion of the post-anaesthetic recovery room and consultation area for examinations has greatly facilitated the work flow in this unit. Several units have completed the first year of decentralization of duty rostering to the ward level. The rostering of vacations and adjustment of hours from the ward level resulted in much better ward coverage, and in most cases the staff were satisfied with their choice of vacation. Crease unit has had a busy year, with the increased number of admissions. Team nursing is established on all wards. This method of nursing care appears to provide the best means of staff supervision, as well as the most individual attention to patients. October 1, 1965, marked the appointment of a Director of Nursing. This position is a new position established to integrate the two nursing divisions into one department under one nursing administrator. This major change in the administration of nursing will encourage a uniform pattern of nursing care throughout the hospital. There will be one nursing policy. Duplication of duties and responsibilities at the administrative level will be eliminated. Since October 1, 1965, one of the main foci of interest has been an assessment of the nursing services presentiy provided at Riverview Hospital. This evaluation has been done with a view toward the objective of the reorganization of the divisions of nursing into one department. A complete evaluation, report, and organizational chart was submitted for approval in January, 1966. On February 15, 1966, 17 female staff were assigned to the West Lawn unit. This included an exchange of two assistant charge nurses to female wards, one in East Lawn and one in Crease unit. In addition, the male charge nurse on R3 was replaced by a female charge nurse, plus two female psychiatric nurses. After a period of adjustment it was found that the exchange proved to be an asset to the wards and much appreciated by the patients. Riverside unit has undergone considerable reorganization, particularly as a result of the closing of the Riverside Cottage as a patient residence. To accomplish this, 48 patients were moved from the Riverside Building to West Lawn. Minor physical changes were made on Riverside 2 to make two wards—R2 East, a closed ward with a capacity of 40 beds, and R2 West, an open ward with a capacity of 70 beds. The transfer of the patients was planned and executed without incident on December 20, 1965. DEPARTMENT OF PSYCHOLOGY Considerable progress has been evident in the Department of Psychology, particularly in the attraction and maintenance of qualified staff and in the development of a variety of adjunctive treatment methods. Riverview psychologists participated in the total treatment of patients by the development of several differential RIVERVIEW HOSPITAL G 59 programmes, including group therapy (900 hours), joint and individual interviews (412 hours), and 204 hours of behaviour therapy. Marital group therapy and joint interviews totalling 540 hours have also been conducted with out-patients at the After-care Clinic. In addition, the department administered 2,780 psychological tests and prepared 373 reports for patients, as well as administering group tests to new students in the School of Psychiatric Nursing. Department staff participated with medical and nursing staff in several treatment research projects, including systematic desensitization treatment of anxiety states, the effect of verbal conditioning on group therapy, the relative merits of two techniques in differentiating organic from non-organic patients, the psychological functioning of aged individuals with normal and abnormal electroencephalograms, and a study designed to assess whether two analogues of mescaline have the same psychomimetic effects as mescaline itself. SOCIAL SERVICE DEPARTMENT Changes brought about by the Mental Health Act, 1964, were of major significance in determining the activities of the Social Service Department. This was particularly evident in the two principal admitting areas of the hospital where, as a result of regionalization of in-patient services, it became necessary to revise considerably existing social-work programmes. Of primary importance was the need to plan in recognition of the growing emphasis on the extension into community of hospital services generally, with specific reference to the provision of adequate pre-admission and after-care social services. In accordance with hospital policy, responsibility for the supervision and maintenance of essential social services at the Burnaby After-care Clinic was assigned to Crease unit social services. The practical advantages of integrating these clinical services under a single unit administration are obvious, in view of the location of the After-care Clinic within the Crease unit catchment area, from which the majority of its clients have been drawn. Plans are presently under way to offer similar outpatient social services from Centre Lawn. The continuing development of community-based services for patients should be of assistancee to the social-work staff in extending its present coverage in family services, including those focused on helping the family as a unit, as well as additional services related to family group therapy. Throughout recent years, individual social workers in various areas of the hospital as well as in after-care have become increasingly engaged with family groups. Social services in long-stay units continued to have as a major focus the community resettlement of patients, either to their own homes when feasible or to such alternative care situations as boarding homes and private hospitals. The office of the Public Trustee was invaluable in many cases in the planning and carrying-out of placement arrangements. Community interest in the boarding-home programme remained high, particularly in such Fraser Valley areas as Mission, Haney, Langley, and Port Coquitlam. This was apparent on the part of both service clubs and individual citizens, and was due in large measure to the responsible attitude displayed by Public Health Nursing and the stimulation provided by the Canadian Mental Health Association. In its more practical aspects, such interest took the form of employment offers, usually on a part-time basis, although in the case of women patients there were also increasing opportunities for full-time work. A quiet corner in the Hillside unit. The unit helps long-term patients to become reestablished in the community. Among other things, they become used once again to living in an informal, relaxed atmosphere where institutional rules are minimal. The kitchen unit of Hillside. For a woman who has been in hospital for years, the thought of preparing meals again may be almost overwhelming. The unit gives her a chance to get used to planning and preparing meals and also to try out all the new equipment and food products which she is likely to encounter upon leaving hospital. RIVERVIEW HOSPITAL G61 As of March 31, 1966, there were 302 patients in supervised boarding homes, the majority of which were located in the Fraser Valley and Lower Mainland. Ninety-one new placements were effected during the year. The statistical summaries for the year reflect the direct-services aspect of the social-work job. In all, the department was active with 5,407 patients in hospital, which total is somewhat higher than that for the previous year (5,075). It is notable that coverage in the Riverside Building increased markedly as a result of the assignment of one social worker full time to that area, with office accommodation in the building. Because of these two factors it was possible to offer service to 297 patients and (or) interested family members, including a growing number of referrals concerned with security patients. As in previous years, educational commitments were fulfilled through field- work supervision of social-work students, orientations and discussion groups with other disciplines and interested people in community. Such contacts are worth while in promoting patient services generally, since their ultimate rehabilitation and adjustment are dependent upon community support and understanding. REHABILITATION DEPARTMENT The Rehabilitation Department has increased its service so that a patient's hospitalization includes the kind of experiences necessary to help him prepare for effective useful living following his discharge into the community. Emphasis has been placed on guided work experience within the hospital as a means of making the patient employable, and therefore more self-sufficient when he returns to community living. During this year, 1,479 placements were made in a variety of hospital work areas and 441 changes in work programmes. These placement programmes were handled by the four job placement officers within the department. In 35 cases, direct placement into employment has been made for patients being discharged but who would be unable to find employment without special help. A total of 174 referrals was made for formal work assessment. These evaluations helped the treatment team to understand the patient's ability to handle work situations and were helpful to the National Employment Service in doing job placement following discharge. The occupational therapist responsible for these assessments has also worked with the Rehabilitation Workshop, which has served approximately 30 long-term patients daily. The rehabilitation residences of Vista and Venture have been active this year, serving a total of 64 patients. An administrative change was made to bring the staff of these residences under the direct supervision of the Rehabilitation Department. This has allowed a more consistent programme based on the needs of the patients who are learning to live and work comfortably in the community. A staff-training programme has been carried out to ensure that the programme maintains an active rehabilitation focus. OCCUPATIONAL THERAPY DEPARTMENT The year has been one of constant change in the Occupational Therapy Department, partly due to frequent staff changes and the reduced number of qualified staff available. In an effort to recruit qualified staff, a more intensive advertising programme has been successful in recruiting some occupational therapists from England, Australia, and South Africa. It has been possible to maintain service in all units and to expand at least one programme significantly. Through the year many programmes have been reviewed G 62 MENTAL HEALTH SERVICES REPORT, 1965/66 Home laundry at the Hillside unit. Good personal grooming is undoubtedly helpful in the rehabilitation of patients. Washers, driers, and ironing-boards are available in an increasing number of wards. and modified to meet new demands arising from changes in policies and priorities in the hospital. In the acute-treatment areas, staff have been assigned to specific wards and have been able to maintain steady contact with the allied medical teams. In the long-term areas a variety of activity groups have enabled the staff to meet some of the specific needs of the patients. Much emphasis has been attached to the development of group identity, and patients have been encouraged to assume responsibilities within the group structure. Special groups such as the " Home- makers," " Interest," and " Boarding Home " groups have pursued a weekly pattern of activities both inside and outside the hospital. Regular excursions have been made to local shopping centres and department stores, where patients have been able to view new products, services, and current fashions. Statistics for the Activities of Daily Living unit show an increase in the number of referrals to the unit throughout the year. Fifty-nine patients, including 1 male, were referred for treatment. Of these, 38 returned home, 5 were discharged to boarding homes or relatives, and the balance were returned to their wards for further treatment. In October the boarding-home visiting programme was expanded to a full-time service, 21 homes being visited on a bi-monthly or weekly basis involving approximately 170 patients. With the assignment of an occupational therapist to this service, it is anticipated that it will be possible to develop the programme further by gradually exploring community resources and forming a closer liaison with local public health personnel. Fourteen students from the University of British Columbia, the University of Toronto, the University of Montreal, and McGill University interned in the department during the year. Working with graduate therapists, they succeeded in organizing a variety of activities for patients. RIVERVIEW HOSPITAL G 63 The Pacific National Exhibition was again successful in interesting a number of patients. Over 40 entries of work were submitted to the Home Arts Building, and 14 of these were awarded prizes. The annual occupational-therapy sale, held in mid-November, was again successful and realized $3,591. During the year, staff were active, with 3,731 patients referred to the department, constituting an average attendance of 614 patients per day, all units; 106,224 treatments were given during the same period. RECREATIONAL THERAPY DEPARTMENT Further progress has been made in making available the values of a comprehensive recreational-therapy programme. Through opportunities on the wards and special recreation areas in Pennington Hall and the swimming-pool and on the extensive grounds, the breadth and quality of the programme has shown steady growth. The Mental Health Act, 1964, and regular work assignments for certain patients brought about a considerable change in the type, age level, and numbers of patients attending daily therapy sessions within the acute-treatment units. Programme changes were made to adjust to the needs of this group of patients, necessitating attendances totalling 34,344 in 1,545 group sessions during the year. The development of more meaningful work programmes through the Rehabilitation Department has made it necessary for this department to provide recreational opportunities for those patients who work during the day. Numerous outings to attend plays, visit industrial plants, and fish the river bars were conducted. Programmes were developed to provide activation and socialization programmes for the older, less able, non-working patients. Daily keep-fit routines were conducted on a number of wards, and swim sessions enabled many hundreds to enjoy this stimulating activity. More than ever before, Pennington Hall has become the recreation centre for the hospital, and greater emphasis has been placed on providing evening and weekend activities. Bowling, roller skating, badminton, gymnastics, volleyball, bingo, dances, movies, concerts, and church activities saw the hall used morning, afternoon, and evening every day of the week. An interesting innovation at Pennington Hall was the establishment of a nominal admission fee for patients to play bingo. This first venture seems to have brought about very beneficial results in helping patients to establish normal concern for the care and budgeting of money they receive from their work assignments. As usual, the seasonal highlights to mark the different recreational activities available throughout the seasons and the special holidays celebrated all found the recreational staff in active participation. PATIENTS' SCHOOL Throughout the year, the school was open from 8 a.m. to 4 p.m. for 227.5 regular school-days. Fifty-one male and 24 female patients were enrolled. These included 42 adolescents with an average age of 15.8 years and 33 adults with an average age of 28.2 years. Daily classes in the schoolroom were conducted for 57 of the students, and individual instruction was provided for 18 patients confined to their wards. Thirty-two patients were discharged during this period, and the average attendance period per patient was 7.6 weeks. There was a perceptible increase in the number of students who began instruction by means of correspondence courses. This was largely due to a growing participation among patients from the Riverside unit. Thirty-nine students undertook one or more of these courses, while the remaining 36 followed the regular G 64 MENTAL HEALTH SERVICES REPORT, 1965/66 school programme of studies. Twenty-two were enrolled in the elementary grades, 33 in the junior secondary grades, and 20 in the senior secondary grades. The school continued to stress a scholastic programme suited to the individual needs of the patient. To this end, emphasis was placed on studies that would prepare the patient for either a resumption of interrupted schooling or for suitable employment after discharge. PHYSIOTHERAPY DEPARTMENT The Physiotherapy Department moved into new quarters on South 1 early in the year. The size and setting of the department is now an ideal one. The total number of treatments that could be given was 5,612 to 644 patients. The number of patients requiring treatment, however, continues to increase gradually due to the increasing average age of patients in the long-stay and infirmary areas. RADIOLOGY DEPARTMENT During the year the Department of Radiology has provided a comprehensive diagnostic service. The year-end report, when compared to the previous year, shows an increase in the number of films taken of 1,117 and an increase of 494 in the number of patients examined. Eleven more pneumoencephalograms were carried out than in the previous year. The radiologists were also required on a number of occasions to do special procedures, such as femoral arteriograms, aortograms, and venograms. A total of 16,138 films was taken, and the number of patients examined was 11,146. DEPARTMENT OF LABORATORIES The number of procedures performed in the Riverview laboratories totalled 78,230 during the year, an increase of 6,480 over the previous year. This increase occurred mainly in the hematology service, where there was a marked increase in the number of white-blood counts, hematocrits, and sedimentation rates performed. In histology there was an increase in the number of special staining procedures carried out on tissue sections. The chemistry division performed an increased number of blood sugars, serum electrolytes, and liver-function tests. There were moderate increases in the number of smears and cultures performed by the bacteriology division. The pathologist and the technical staff continue to contribute to the publication of scientific articles. Two papers were published concerning the association of mental illness and disorders of melanin metabolism. These articles present a new approach to our understanding of mental illness, leading to improvements in our methods of treatment, and they have aroused a great deal of interest in various medical research centres around the world. Our laboratories continue to function as a training-school for laboratory technologists. One student completed her training and was successful in obtaining her certification by examination. Students are now being seconded to us from the British Columbia Institute of Technology for completion of their training as medical laboratory technologists. DEPARTMENT OF NEUROLOGY Clinical neurological consultations during the year totalled 206. A total of 1,006 electroencephalograms were performed, of which 638 were on patients at RIVERVIEW HOSPITAL G 65 Riverview Hospital, 314 at The Woodlands School, and 54 at the Mental Health Centre in Burnaby. Dr. Frank Turnbull continues as the neurosurgical consultant, and during the year performed 27 neurosurgical procedures. Seventy-nine special electroencephalograms were done in co-operation with the Department of Psychology at the University of British Columbia toward a study of organic brain changes in the elderly patient. Most of the patients in this project were residents of Valleyview Haspital. PHARMACY DEPARTMENT As of April 1, 1965, the pharmacy area in East Lawn Building became separated structurally and organizationally into two entities. One section comprises the headquarters pharmacy, which serves as the purchasing and major distributing centre for pharmaceutical supplies for all units of the Mental Health Services, and is organizationally responsible to the Mental Health Services' Business Manager. The remaining area functions as the Riverview Hospital unit pharmacy and provides pharmaceutical service to the Riverview Hospital only. A total of 20,799 prescriptions was filled, of which 11,748 were issued to out-patients. DENTAL DEPARTMENT Dental services for Riverview Hospital patients cover most branches of dentistry. The increasing number of admissions created a larger number of emergency cases to be treated. To conserve technicians' time, ward marking of dentures has been discontinued for short-term patients and is confined entirely to the long-term cases. During the year, 3,139 patients were seen who required a wide variety of treatment procedures, including 2,327 extractions, 832 fillings, 414 prophylactic treatments, 1,250 denture fittings, and 874 initial examinations. Further to this, 246 dentures were completed, 275 repairs made to broken dentures, 140 dentures marked, and 21 gold castings prepared for various appliances. CHAPLAIN SERVICE The work of the chaplain service has been steady throughout the year. Some changes have been made as a result of changing functions of the hospital. The great reduction in the number of patients on the tuberculosis ward resulted in the mid- weekly services being changed to pastoral visiting. After the summer recess it was no longer possible to arrange for the choirs from city churches to assist with the Sunday morning services in Pennington Hall. During the year a minister of the Lutheran Church has been able to visit most of the newly admitted Lutheran patients. A postgraduate theology student of the United Church has worked weekly with the male Order in Council patients. Also during the year, 193 clergy from the community have visited patients in hospital. LIBRARY Efforts were made to improve the 4,000-volume book collection in the Patients' Library. Older books were discarded and almost 500 new books were bought, with emphasis on fiction and poetry. An adequate book budget enables the library to keep abreast with current best sellers and subscribe to 30 popular magazines as well as some book series in art, nature, and geography. The library has been drawing G 66 MENTAL HEALTH SERVICES REPORT, 1965/66 more readers from the patient population than in previous years; over 6,500 books were circulated. The use of patients as library assistants was continued, with benefit to themselves and to the library. In the Medical Library, several projects were undertaken, all dealing with publicizing the library's resources. They not only increased the use of library materials, but engaged much of the professional staff in scanning current journal literature, commenting on worth-while articles, writing book reviews, and forming discussion groups. Over 200 books were purchased, bringing the total number of volumes to nearly 3,600. The figure for current journal subscriptions is almost 200. MEDICAL RECORDS DEPARTMENT The staff of the Medical Records Department felt the impact of many changes in hospital policy and procedures consequent to the implementation of the Mental Health Act, 1964. The transitional period of setting up new admitting routines, modifying office procedures, and becoming acquainted with new forms and terminology to comply with the regulations of the Act was marked by interest and cooperation on the part of all staff, so that the work of the department progressed satisfactorily and services to both patients and medical staff were rendered without interruption. Considerable time and effort were devoted to the introduction of an extensive statistical programme involving the processing of admission and discharge statistical sheets. The responsibility for completing these forms on all admissions and discharges is shared by medical-records staff and medical staff. Pertinent information regarding a patient's illness, treatment, diagnosis, etc., is recorded and later processed on to punch-cards as a permanent source of information easily accessible for reference or research purposes. The medical-records staff also assisted in several statistical surveys conducted by the Riverview Social Service Department, the Superintendent of The Woodlands School, as well as a review of the use of the Magistrate's Warrant (Form A) under the new Act. VOLUNTEER SERVICES During the year 170 Canadian Mental Health Volunteers gave 19,436 hours of service to Riverview Hospital in carrying on such activities as typing classes, grooming and hair styling, discussion and activity groups, shopping trips, luncheons and picnics, dancing classes, and other social and recreational programmes throughout the hospital. The apparel-shops were areas of considerable change and expansion of services. Here volunteers served 2,044 patients individually and gave out 10,658 articles of clothing. In addition, the apparel-shops took care of all requisitions from female patients living in boarding homes in the Lower Fraser Valley. These patients received 3,333 articles of clothing, mostly drawn from the hospital stores. As part of our community education role, the volunteers sponsored two public activities—the first a professional fashion show in the City of New Westminster, and the other an " open house " and reception at the apparel-shop and volunteer centre. One hundred and fifty people visited on this day, and many of them were taken on tours of the hospital. The annual Christmas gift programme again provided gifts for all patients, and a few were left over for prizes during the year. RIVERVIEW HOSPITAL G67 BUSINESS ADMINISTRATION This year has seen many notable physical changes improving the facilities of the hospital. The most significant of these changes has been the near completion of the Hillside Building, a valuable new facility for the Rehabilitation Department; in the Centre Lawn unit (where extensive changes are planned) the renovation of the main dining-room and kitchens, the complete renovation of one of the wards to provide an up-to-date admitting suite, the renovation of the main entrance to the unit, the provision of new duty doctor's quarters adjacent to the admitting suite and the setting-up of a central linen room; in the Crease unit the near completion of a small but beautiful chapel with an office for each of the chaplains, the redecoration and refurnishing of the conference room, and the completion of a post-anaesthetic room; in the East Lawn unit the completion of physical changes to the pharmacy together with the setting-up of a unit pharmacy; and at Colony Farm the construction of a new scullery, thus releasing a valuable area in East Lawn unit for a future central linen room. There is an ever-increasing demand for drapes in the hospital, and this past year reflected extensive installation of drapes, which have done so much to enhance the general appearance of many areas. Emphasis was placed upon furniture for dining-rooms, and this has resulted in the much-improved appearance of these areas. The Safety Committee has been active, and although wider participation by all staff members is sought, much has been accomplished toward making the hospital a safer place for both patients and staff. The responsibility for all staff residences has now been vested in the Education Centre, and due to the increase in female nursing staff and decrease in male staff enrolment, changes have been made in residence allocation in order to reflect changing needs. The beginning of a Housekeeping Department occurred with the appointment of an executive housekeeper at the end of the year. During the ensuing year, in- service training programmes will be developed for present building service workers and for new staff as the department expands to meet the need for a specialized housekeeping service in the various units. The Business Office showed an increase, reflecting increased activity in patients' trust accounts, maintenance collections, direct over-the-counter transactions with patients, and the handling of patients' personal property. DIETARY DEPARTMENT This year has witnessed continued physical improvement in the department, improvements which are bringing our kitchen and dining-room facilities up to date. These include:— (1) The complete redesigning and rebuilding of the dining-room and servery facilities in the Centre Lawn unit, together with radical improvements in the main kitchen area. (2) The complete redesigning and vastly improved facilities for garbage- handling both in the East Lawn and Centre Lawn units. (3) The provision of new dining-room furniture in the patients' dining facilities in the East Lawn unit and in the staff facilities in the Crease unit. Meetings have been held with a Public Works architect in order to design and plan for completely new facilities in the Riverside dining and main kitchen areas. G 68 MENTAL HEALTH SERVICES REPORT, 1965/66 INDUSTRIAL THERAPY DEPARTMENT During the year the Industrial Therapy Department continued to work closely with the Rehabilitation Department in developing manufacturing methods to keep pace with progressive modern trends in patient therapy. The Audio-Visual Department ceased to be separate and became incorporated in the Industrial Therapy Department. The effect of this has been to consolidate the resources of what were these two departments in one location, thus providing a better and more continuous service to patents and staff in the Mental Health Services. A tailoring service previously located within the Industrial Therapy Department was relocated in the Volunteer Centre by the transfer of the tailoress. This change has enabled the volunteers to continue to develop a personal-service programme of clothing issue to patients. Such a service is more personalized and will help to bridge the gap between bulk general stores supply of clothing on one hand the the bulk receipt of orders by the wards on the other. During the year 2,500 patients were employed in the trade shops, the average intake being 40 patients per month. Two hundred patients were discharged from the department in order to gain useful employment outside of the hospital. The changing-over of 35-mm. movie scheduling from two evenings a week to three showings on Saturdays only was well received, reflecting an increase in attendance. The 16-mm. movie programme was reorganized, such that ward movies were discontinued in the intensive-treatment areas, while expanded in the long-term treatment areas. The film library continues to be a widely used resource, with 374 registered borrowers using its facilities. During the year 1,633 films were shipped to these borrowers, who represented a viewing audience of about 50,000 persons. LAUNDRY DEPARTMENT The volume of linen processed through our laundry has continued to rise in volume, such that there were processed during the year 10,284,996 pounds of linen, representing an average daily production of 32,574 pounds. The drycleaning decreased slightly in volume to 127,620 pounds. No new equipment was bought for the laundry during the year, although a new Smith-Grantham tumbler bought in the previous fiscal year was installed. This new machine, together with increased trapping of our flatwork ironers, has enabled the flatwork ironing process to be speeded up. PODIATRY SERVICE The Riverview podiatrist, who provides a service for Riverview and Valleyview Hospitals and, on a limited basis, to The Woodlands School, reports a busy year, with a total number of 3,220 treatments to 1,709 patients. Special attention has been given to preventive foot care by providing special instructions to patients regarding the care of their feet and by attempts to provide proper fittings and types of footwear. This form of preventive service has been especially directed to patients going out to boarding homes, where supervision of foot hygiene is less direct than on hospital wards. ESSONDALE CIVIL DEFENCE DISASTER ORGANIZATION The Essondale Disaster Planning Committee has met regularly throughout the year to review preparedness to meet possible local emergencies and to make recommendations for improvements in facilities and organization. RIVERVIEW HOSPITAL G69 Contact has been maintained as before with the Provincial Civil Defence authorities and the Vancouver Target Zone headquarters. Through these authorities, arrangements were made for Mr. John Borthwick, Riverview Assistant Superintendent, to attend the Provincial Civil Defence Orientation Course No. 34 (Emergency Services Representatives) held in Victoria from January 24 to 27, 1966. Mr. Borthwick has since been appointed as a Deputy Civil Defence Co-ordinator for the Essondale area. On June 17 and 18, 1965, several members of the Planning Committee attended an excellent Disaster Institute held in New Westminster. Regular instruction has been provided to the new students of the School of Nursing regarding Essondale disaster planning and the role of nursing staff in our organization. During the past month the Planning Committee has been reviewing our total organization with a view to bringing this up to date and compiling a master plan for all services and facilities available to meet emergencies, as recommended for municipalities by Civil Defence authorities. STATISTICAL TABLES Table 1.—Movement of Population, Riverview Hospital, Essondale, April 1, 1965, to March 31, 1966 Male Female Total 1,526 112 78 6 1,392 145 152 2,918 257 On extended leave, carried forward from 1964/65— Other 230 6 Total on books as at April 1, 1965. - 1,722 1,689 3,411 Admissions- 976 24 1,037 1,028 40 1,190 2,004 64 2,227 Total admissions* „ 2,037 2,258 4,295 3,759 3,947 7,706 Separations— 2,012 72 15 4 131 80 5 2,239 61 19 5 170 75 3 4,251 133 Died 34 9 On extended leave and still out- 301 Other 155 8 2,319 2,572 4,891 -86 1,440 — 17 1,375 — 103 2,815 i Includes 7 male and 5 female transfers from geriatric facilities, 3 male and 3 female transfers from facilities for the mentally retarded. G 70 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 2.—First Admissions to Riverview Hospital, Essondale, by Health Unit and School District of Residence and Sex, April 1, 1965, to March 31, 1966. Health Unit Male Female Total Health Unit Male Female Total East Kootenay, Cranbrook— Central Vancouver Island, Na School District No. 1 ~~ 4 4 8 naimo— „ 2 1 6 7 School District No. 65 6 3 9 „ 3 4 3 7 „ 66 _ 1 1 , 4 1 1 2 „ 67 2 2 4 „ 5 4 4 8 „ 68 16 6 22 „ 18 4 4 „ 69 2 1 3 Selkirk, Nelson— „ 70 _ 10 6 16 School District No. 7 - 4 6 10 , 79 2 1 3 „ „ „ 8 1 1 Upper Islands, Courtenay— School District No. 71 West Kootenay, Trail— 2 3 5 School District No. 9 6 3 9 „ 72 6 2 8 „ 11 10 5 15 „ 84 1 2 „ 12 ... 3 1 4 „ 85 1 2 „ „ „ 13 1 1 North Okanagan, Vernon—■ School District No. 27 11 5 16 School District No. 19 8 4 12 28 7 15 „ 20 1 2 3 „ 82 1 „ 21 1 Skeena, Prince Rupert—■ , 22 8 8 School District No. 50.. 2 3 „ „ „ 78 1 2 „ „ „ 51 2 2 South Okanagan, Kelowna— „ 52 10 7 17 School District No. 14 2 3 „ 53 8 8 16 „ 15 7 12 „ 54 4 1 5 „ 16 1 „ „ 80 3 2 5 „ 17 1 2 Peace River, Dawson Creek— 23 7 3 10 School District No. 59 5 7 12 „ 77 2 2 „ 60 4 7 11 South Central, Kamloops— Northern Interior, Prince School District No. 24 20 8 28 George— 26 1 1 School District No. 55 1 3 4 „ 29 2 1 3 „ 56 4 2 6 „ 30 3 4 7 „ 57 25 12 37 „ 31 2 2 4 „ 58. — 1 1 2 Upper Fraser Valley, Chilli Greater Victoria Metropolitan wack— Board of Health- School District No. 32 2 2 School District No. 61 _ 36 26 62 ;) 33 18 22 40 62 2 2 4 „ „ 34 17 10 27 „ 63 2 1 3 76 5 5 „ 64 1 1 Central Fraser Valley, Mission Metropolitan Health Committee, City- Vancouver— School District No. 35 10 6 16 School District No. 38 27 36 63 „ 42 13 20 33 , 39 380 446 826 „ 75 8 6 14 , 41 52 86 138 Boundary, Cloverdale— „ 44 _ 34 33 67 School District No. 36 54 64 118 „ 45 - 7 15 22 „ 37 4 9 13 School district not covered by Simon Fraser, New Westmin health unit— ster— School District No. 49 5 4 9 School District No. 40 . ... 17 44 61 3 3 „ 43 16 46 62 36 10 46 Coast Garibaldi, Powell River— 1 9 10 Totals 1,000 1,068 2,068 „ 47 5 8 13 „ 48 - 3 5 8 RIVERVIEW HOSPITAL G71 z n tn i/i a D < h o Q ri I H W s >H pq n w vn h4 vn < o\ Q i—i Z o i—i »1 CO w X U hJ « <1 < H S 0. 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C , 0 t 3 3 S 3 O xi o to u > 9 < 4 C 1 % I U 1 c a c > \ c c I CI I 0 1 i c | 4 .5 £ ! c c 1 V a c 1 > ~ i t 0 i C > it c | Ic c 'c a c X E c s TJ a j 1 B - CT 1 I a Ii s 0 c £ C 0 1 E ID ■ O s H s ° ft--; TJ c Si 1 C 1 a *o cn O OJ ■8.2 U r »x ,* c *> L s i «t is i to " B| S E Si 5 3 •O t-l °g & 5 "2 £ a c ondary or due to accidents ondary or due to other dise id unspecified psychoses— chosis with mental deficien sIkSp^^o.-hS OC •3 ° 0 £ enil hos hoi hos Res Res Sec Sec Sec Sec Sec a u TO to W W gPn 2 § g si Ph H 0 >. 0 >, W 2 i P. p. < Ph 0 RIVERVIEW HOSPITAL G73 -teScsrHONin cscs m tt tn tn in |*S-8G CS en rn Tt Tt cn rn Tt r- cn © © © ON rH © m rH rH (^ Tt rH CS ±1 i I i ! ■*•* >-h c a 4> *j g •a§S 331= is •3 Si O O H o a rt .2 o rt * 2 rj CU rH ro Ph.HSS x « o 1 5= ! g 5J s u a EH TJ ft i OJ _cfl ca VI ri CA a CJ 0 o C O a O a 0 I >> H&.ti S *Jh- o 11 s 1 «i$Ia£l sum _7ti 9 & & " 3 « -5 '3 rS •Ills 111 e 3 "JT'O 5-s a> OoIRhU s3<<5n Zp. i rv u ! Si; Ow fill 61*1 p, o <0 a* ma «biphO o — u §•2:5 J ■tSIJh. B uS « g a 3 o id w a in a 3 2 S ^ .1 g H CO < w o *J H < a vo A vn 0 cn cn OS W n ^H H HI ►J H PC Ph 3 Ph < w > o H co Z o 3 Q < BJ Oh ID W PQ Ib;ox Puejo a > cocncnONTtoocnrHNo cs rn Tt r- no © cn cn rn cn rn cs j cn j rn i rn cn cn I I ! rH | CS rH ! OO ] rH rH I cn j cn >n cn .no CO [ Cn NO CS rH rH rH icscncsrHcsoo ioo nond i O : CSONrHJCS jCN TtTtrH ! ! ! rn i rn cn rn j no ! «n oo 13 J? HHfTjl i «n ! On rn cn CS I CS CS CO 100 |0O TtcS ! es to cn Tt es Tt I NO NO rH PCS to rH I ! rH rH VO m Tt j m CS rH c* rn cn r* t- ■ H © ION rH rH r(H(f,H CS rH rHTt rH »0 M ! I I rH rH rH cn j CS On >n ! tN II I I I rH (S ! CS rH Tt rn i cs cn m III I I'I i S * aS fa '§•38 a ■§ W Sg.« a 2 u d OJ y 03 u > a i> s -.a IB .S • u 2 * a 'Sag" a* _ a -o a c w 5 ■ a a a M s ia B. .a .2 o TJ e a 9 03 -O ft c q F= T3 O 0 x> o a MH H CU >> 2 rt ^ S ft « 5 "° 2 ' I II I 2 B <8,2-2 o o ■ j-a I SIJJ >, >> a >. a fc» < Ilia > o g a a )I)t1 H b i = « £ S3 „, _H |H u 9 ft o q o o u -g « CD . .. ft P" T3 •rj o - B •O T3 -o O . £ Z o.a-2.2 QO :.y.S2 3oo a a « c o a o a ra u o o > S B >-ii >» C W U w "1 w £fxcna< < Ch cn to tn cn ft [ m s "i a tj 3 o o 0 TJ J3 J-1 o a o u O (3 >N >N fli c« wa sp,p. K-a RIVERVIEW HOSPITAL G75 rH NOr-D CS On © i cs rn r- in m cs ■ r- r- o ^ cn Cn C- Tt © rH i i i Mill ' I I i Tt Tt j j Tt cn rH rH , rH cn rH rH h : oo I res no rH NO " ! rH | rn es I ! j cn j rH CS rH rH BxT _ S CU .« ft to .B a § .2 a« 8 ^£-5 H s £ "S 5 & u » n j 3 -2 5 a lift a s -a a W O U a&= ]: of aS £ ?0'-3 j ° ft P 2 > .2 3 ' it-ell 9 a a .2 a 9 8 8 o " CU OJ 2 2 •3 a ■ 2 a | i a i a a k i ; m a oj ! ft " If* a := -a ° c «5cSg g§So,S £5S.Sa g,»a§.«S a-oSf g o'a Ili3 ii Th « i> o % _ ft o g « &-S S cs c« a <» 0 ft c to -h cu tu u « ^ > .2 II < < tn c o '*2 § i « k|9 a o3 of « WPh-< HiS, /a a a Hi O u .jh 0 55 * &'£ cd W r- * 5 * a O B IPS «D UUB O a O G 76 MENTAL HEALTH SERVICES REPORT, 1965/66 X Pi to a z < tn O H < H to ►J < H 2 <: tn tn O Z VO O NO < Os 1-1 rt ■< cn z B « o «H„ B os o „ cn ri 3 Oh S< Ph tn O M i-i. > o H Cn Z O < P4 NO Bh w Ph 1-1 < pq H < H no ^o c^ a u PC < o H in Os ►J 2 Ph < x" M 00 a z < z o W K >< 05 bT i-i < a z o cn cn w i-T < O ffl > PC bi > o H cn Z o S a < H cn PC BJ Oh D cr a o TJ c X) o X> 03 XI cs CD > o X) D cS 1-1 O 4-1 S3 ,2 cs S t- o a TJ O ra os U Q to a z < pT P o pc o 1 W o o z o < < H z s; P5 uf < a z o cn cn W c5h 3 oc w Ph CO 8 | ^ Q S > PC 5 > (3 < SI u z Bh a cn W Pi z o H Hi ►J P Ph O P-. W 1-1 go r- cs r- loorHTtcnNOcnTt © to cs es r-1 too\cnrHTteSTtrHr-NO jninrn icnrHcn©to to no oo rn ; m oo cn to oo es I rH Tt Cn NO NO rH OMNn i es t* in i es . ON NO Tt rH ! rH NO rH i es in cn rn in rH I rH I i i I ' ' ' - '■- I I I I 1 II ft g s & ft a .2 2 il rt o B B tj a y M «•« a s ! CU w O U ' a o 2,2 i ca 5? £ oj a .a'lS o , & w "SB '&&2 sj.28 : O. o 3 i o.« a 3 a'« b > o o « i a a v. i O o u _ ■, o >.a cn2HHP a § » fe: S S J3. .5 o .s ■ Shi 3 S t ■*■ 9? Ml — £■ U / o & 2 rt § a> '3oo *C 9 ^ CD 3*' fS ; ■-.•'h w^h a | ■§ 1 a a y <||I|PhOZPh Ph RIVERVIEW HOSPITAL G77 cn on © r- >n r- Tt CS rH rH m oo Tt cn © on tn cn es CS cn m t- Tt cn co cn cs cn cs rn in *■» cs tn tn © es es cs m m no r-i rn m r-i : i* I J J j r- es rn i 1 f" iTt j irH " i rn oo cn , cn I es "Too I Tt cn : rn cn cn ! rn es cn i in i oo i CS i Cn I i rH I I ! rH rH I 00 | j CO Tt rH rH rH i es cs es es cs j rn i m cs es rH rH I CS rH I rH rH | CSi i rH ! Tt CS rH IH ss \*sl ft. U tnft, > rH B §£ : •rj TJ ! CJ I st i TJ J3 C w 3 l_ M w in SJ-.ig.a' coiSo TJ 1 CD 03 1 CJ ft V3 **•* c ^ 1 O a £ u TJ CD E tn CD u a c T C C i aC o tH CU (h O <*H a OJ ip 1* aj of a *3 XJ u CD ft a S s 3 0 o s E >0 a Jj a a i « in S.S.B u b 1 £ "" UI gence d onic bra onic bra epsv cu o. la ervation atric) c er, unkn To U U w 0 O 0 G 78 MENTAL HEALTH SERVICES REPORT, 1965/66 cn O Z o < ►J < H Z Pi Ph C/f M o o z a in PC vo a on O ^H O PC z w a 3 cn nj pci w «°, X B4 ►J < - a M - a z PC w > Bh o 05 H Z w H <: Ph ■-I 35 < OH 5 3 so tooocneso\Tti>cscscNcntoCNrHTtcs»n. inTtcniTteStorHrHeSeSCSrHrHtH Ir-l! rH Tt j eS in CS rn rH rH I rn Tt rH 1 r^ CS Tf i ! "i j j I I i ] I f i ! i i ■ I I C- rH I rH I I rH CS I I I I I I rH | cn I rH i ! ! I On rH ! 1 ! rH eS I j I rH rH | | rH | CS I I ! I I I I ! ! i i S u 2 a « a u u _ 3 a u a 5 0536 *-■ 5 o o O = M o ■3* CJ 1> S an *-> O u !£< 3 § s O CD ■£ &£ a .o ft.O <0 ^ J? s s •a -2 .a «=g o a a a Sa as ZOw< a.2 0 I 2 .2 & a u. 03 a ft l? u a ° -2 u ajja'aa 02CJS10 o 2 RIVERVIEW HOSPITAL G79 Ph P o PC o I B5 o < o z o < < z Bl 35 w > < W a Bh B m Z vo £c* xrt W *h rn z o H P O w ij | z o cn cn w < H 2 cn O W I pa > Bh O cn H z 2 H < Ph PC BJ 35 3 w o BJ O x" BJ a z < B-1 i-l 35 < a« a « go OH 8| so _h?_ It IT Bh IT Bh A Bh Bh Ph toc^TtrHestocntocnrHTtcNTtTtr^es ncn ©InrHrHCSrH j Tt IrHTtCSCSmcncS NOcscn i iincncscn i i icSrHTt I I I I I I I' I I ! ! i I ! CM l^H j IHH.H j | | | | II 111!! ! ! i ! ! I I rH | rH ! rH rH | | | | MM i I i I I I V sfi u 2 u o oj C rn .. rr w js rC « O „ ■ ■ ft V 13 & 55 to 0 '§•2 >\ ta to < ■ £■5 P 2 if a « >i CJ (J « II O "-W r/3 O j «i o a sills • V B S .2 o o ■-" ft O cj ii | o « ft I ?> iri'^S ■-h a o ™ w o cj 43 3 > a >>o >> cn .< r-3 cn Ph < Ph I ill' w 03 03 ^i -^ a u u g o a fc b a e 8 a s 2 a a >. S a "a o « a b" OBJO cn O G 80 MENTAL HEALTH SERVICES REPORT, 1965/66 HI < J H l « S >H a z 05 < PC >« ,. Pi 05 PC Ph a „ BJ CD z BJ > 5 P a z < H O < O H Bh o O Z ON O cn V5 Tf "O PC < BJ in < VO 35 ON i—1 W i ►J rH < CO W x 4 x" W x" 4-J - BJ 3 BJ j BJ CO Pool i-l to H C/3 < C/i 0 S a r z 2 a S3 Z H Oh a z cr tH CO < ft < BJ H BJ O cn o X < •< a o rf £ . H & C/5 a Bh > O 1 % H to Bh O g H-H o °^ 05 w BJ « C o (2 H 7 o BJ > 1—1 Pi SB H 0 o o 5 pc PC 0h Pi z & z z s-> BJ O BJ Ou BJ w fc 1-1 o M cn E2 co J X „ O co O Jo o_i Be" t» X co o cn *j 2 2 pq o n O 3 o z < o M pq Z H-i o W o <3 CD PC < §5 Z o z > O 1 Bh CO BJ z H o o o o < I—1 H J3 PC i-l +3 < i-l P Oh O Ph < HI p U O <*H X CJ CO D Ph 0 a o 0 O i-l Ph Ph < H o HI < es s BJ > rj) < H O T (2 tH H i >o | I T3 *—i 1. oi r-1 BJ >J Tf T—1 O "3 BJ t-1 35 < 05 BJ o H ►J £ rl 35 P 05 ,< £ H IE50X PUEIO S P 03 > oO j *-i es in ^ cs i cc m -i r~ i-i ! 5 to cs , ndh" idm On cn . cn cn j rH CS cn rH CN © © On , to cn Tt CS. rH CS rH * o\ cn | \o cs On , in cn cn Tt rH m cs cn rH in On no rH r- cs rn tn to on cs to I I NO I NO CS cn rH o\ no I cn *n Tt cs no cn Tt cn cn cn rn oo cn rn no m m rn Tt as- ^ N , l> CJ OlTHIH Wl NUlO iOl f I) a o & 3na- WJliS ■ Scoffiu a 2 ft >i N 5 " ed a Ph< o o « a o a o3 u a u if &Ii a & a § N o a 3 «r9 J=5 ™ cj cj ±; hcowO CD "cj ■h-h O « ?- > CO 5 -in U fl UI ft .3 I J a •' c It HJ •2SQO S o " o o O « "5 u 0 cfl -rj RIVERVIEW HOSPITAL G81 CS rH CSONOOcn CSO\ rH ON rH rH to 00 rn Tt cn On CS « ; to Tt CN i CO I I | rH I NO NO I I cS m m cS rn rn in 00 rH cS rH CS © i r- co rn , cs or cn cn I eS no " HrHrH r< OO m h tN H IT. ■ rH rH rH I m cs oo rn Tt I es to ] rH 00 Cn I rH in cn Tt © Tt CS no » CS I NO rH fN rH rH I ON rH CN tn tn i cn no cn i r- es : ^o © rn eS cn cn cn iriH TfrH IrHOOCSlnrH ON CO 5 , TJ OSS si to r> ft a r- ?ft* •S3 '3 .2 .2 e —! -3 J3 cu I n S h « C 4-1 i in a 3 10 15 2 I §6 a.* a 03 1 B _, 2 1 £ Ell • >. >i CO iH CO O 4) « O -^ *-"? -9 to d CS CD I Bjf CJ 0 TJ I i8 ft W .2 EBB .2 "a es cu O 0 0 2 .ft ■> a a a o a o OJ j£ 03 S.S a a ■3 rt rt 3 aaaa^oooj U Oh 1 a -a a j o a CJ > o rt >i '« SO. 1 a ?. >, .2 ■ P..2 Sic g -s-o S«a 1 ii *H 1 V 3 o 2 1 a S ' n o ill .3 3 a 3 .a 3 ■ 8 ™ 8 Rig's .a in a £• a -a t-c o o P a o >, >, s ft a a, p, o co D S >» £? & a 03 a a a a o a oj a a 03 s o ■j 111 s. s "S -a 1111 w jja 2 u ^ o a o 03 ^ a 3 COP.OS &S 2« S P a ° ft M 03 i 1 fta S -a ft cfl *3 a 3; w £3 .-. 3 O "* ft 3 W —J OJ —j u. 03 T. y III 5 8 g- 2 a a a ft 2 S a ' -a ai a .ft In a 43 g „ 8 o 8 «.9 -a g fl sa eo ^5 ?—1 H J3 B ° a < G 82 X BJ tn a z < Ph" p o PC cs BJ o < tn O Z O < g § c "a ^ S -1 3 vo z ^ CO CO w a r]*S ££ Ph ^ o CO O VO BJ ON HH 1 1 > „ PC rt" BJ > hJ H *-i H> Pi " Ph o PC Bh CO BJ o PC < CJ CO BJ > BJ i-l « < MENTAL HEALTH SERVICES REPORT, 1965/66 cn tn NO OO Tt 0\ r - no r- cn IBiox pneJO rH rH cn oo no tNlH cjv es Tt rH VO B. CS D es t- to rH 00 , ON CS rH " s © cs H : rH rH O is 1?° Bh OO S i ; 1 1 1 . OC 1 1 ! © I j j j CS ! . CNTt ! 7 m Bh ! »> s j i . 00 C— 1 NO 1 '• '' 1 ! m Tt © Bh ! On £' rH i , NO es | t- rH ' B. >n • V rn S 1 rH i i i in m ! 1 I 00 m 1. IJ i ! | cn ■ i 1 rH ! rH ; cn m [ 5 Bh IT 1 i ! to ! CS ^-> ; m 1 1 *° 7 in Bh i 1 j 1 00 1 1 CS 6) cS >< s ; j ! es rn m cn i tn i ■ ! 1 cs — rH 1 | T B. | j ! CO 1 CS P O tH OO © Tt s OO | i | CS 00 cs cS u •a 6 CD co >> TJ CU s ca C 0 co TJ 3 O Q> TJ co 3 -a c O XI > O 0 M cS a 1 3 O 1 CD * i 1h "•£ u 3 O '> .a cS CS E a PhS o c 2 cu IC fu -a tu Ih ft TJ S - 3 o «B (S tH gence disor Adjustment reac Adult situationa Other and unsp onic brain syndr onic brain syndr er diseases of tl 3 0 s S a o o) > I) a 0 CJ G B C CS i 4 o « a M 3 Ih" M *££ £ J= 0 O u u o 0 o RIVERVIEW HOSPITAL G83 X BJ tot X Q BJ z to < Q $ Z < H ^ oo Ph 8 o PC ffi o H BJ O o z BJ < ►J tn CO O CO z O o Z < § P P < ►J H < Z H BJ Z BJ VO VO 5 vo l*H VO s >H CJ\ PJ ^ !h n M .—1 BJ~ *H ,. Cl 3 <^ BJ iJ < X o PC H-3 CO & s BJ PC > PJ > -2 3 Pi s cd H-3 z § o o z PC Bh cd PC PC CO u D BJ ■a u O o PC < K O X <4-l CO CJ « X o H Q € < BJ BJ > a 9 J 1 • rH 1. VO BJ hJ BJ HI OJ cd -4-3 n CO < < OH_ go I S ONTtCSrHCnrHlnNO©CnrHrHtoTtrHrHrHTtrHt^ © ioocS irHcncs IthhionD ■iCSCSrHcnrHtnNOcSrHrH I rt tN H H I It) NO rl - rH CN [ CS ! cn MM I ! C :- ^ (Jill ! i I !' til I t t I Ii I II I Mill ! I MM S3 S§ Sia' u. OJ ~ o >H a U 1) n a > "u H 8- -O "55 eS O Ii >-> (J CO -H a w O <-H M O e a 2 <= a o> B E b -1.9 iftg-S H "cO tH •-? 1 o ti 9, ^■S^ft 5 h° a ft O 3 B3.2 sal ga« a % - leg &•• alii " o o » : 03 iftSSS a, .So 0, feu.2.2.9 0.7 a a c o ■S .3 > £SiS e.o>S.g 1 n!3 » u . m a © & ■ a o t« « h Ph w Ph Ph og5 -a ,3 >- o o « > 03 r 1 III *o a M ' *3 .S a ■ rt tJ "3 " Ma 2 '< P42a. Ca s £ COS6 UO BJ to 0 z < < H cn Bh o X H O z BJ 1-1 o z ES < < EH Z vo BJ VO >H « co r; CO 2 a co o W H J" >o" < vo H Ov s ^ CO - O -1 PC j PC BJ > 3 cr1 Hi C O •a CD el P< o z 5 PC D u CJ O J3 O S 4h C3 H-» u C3 O CO i-i 0 < BJ cd s P 0 CM ca OO T-H BJ ■J cd 05 S G 84 MENTAL HEALTH SERVICES REPORT, 1965/66 X BJ to a z < P o PC o I BJ o < X H < BJ P Bh o BJ CO -9| U NO £ ON 03 rt BJ i-l t z o co co w a u PC < o H Ph VO 55 C7\ fin 8- 5 BJ > PC Ph o z PC PC CJ CJ O co X H < BJ P BJ i-l ca 3 qH g6 Bh "J" Bh Bh ft "a" B. sf TtrHCS»neSrHrHrHrHtnrHCnrHCnrHCneSt^cneSrHrHTtTtTt ITt |rl»Hr.r.mHtNn(r)rtHHtNtN' I rH rH rH CS Tt rH CS rn CS ]wop1 a M J3 03 a 'g 03 43 > .E2 03 *j a a 2 = » J. n jj S 2a'C •a-gf S o o > 0 cu a 5 BJ CS or* «M 1 S § °.a iff II C ^H S cs £ ai CD SC ni a ■w ,a ft S, cd ^i- /^ HH ("1 (T CB S 2 03 (fl ■a^H _ ft o Z 03 o 3 ! 'J a a I a S M I T5 a 03 ' u e a _ 3 03 *3 a a ss 12 os IA a , 03 •S'C o"3 — w OS I 03 O tC 5 >. .3 a < o a o - O0 H s .B o ifi : 03 w 03 t3 O a s a o '3 £o£<5 X BJ CO Q Z -" < H co Bh o fa H O z BJ h-l ri < BJ P Bh O BJ CO P vo < vo U on >- ^ « -H On?" ri K 5 u 9 oc z j< m o h[«0 H £ J-H ON Oh i—i CO Ss BJ > z l-H O z 3 PC u u O CO X H 3 S ■a tH o cd TJ u '« H-» p THE WOODLANDS SCHOOL G 85 PART III.—THE WOODLANDS SCHOOL, NEW WESTMINSTER REPORT OF THE SUPERINTENDENT J. S. Bland, Superintendent The main events of the past year have been the reorganization of The Woodlands School into separate functional units and the integration of the male and female nursing departments under one director. The school is now divided into three in-patient units. The Hospital Unit caters for those whose prime need is for medical and nursing care, the Training Unit houses those who require training and education rather than medical treatment, and the Psychiatric and Rehabilitation Unit looks after those suffering from major psychiatric disorders, together with the mildly retarded whose rehabilitation is the main objective. Each unit has a specialized clinical team which supervises the individual programmes. In almost all wards there is a mixed staff of both male and female nurses, and in selected wards the patients are also of both sexes. As stated in last year's report, the waiting list has been redefined and consists of those who are actively awaiting admission now. There were slightly more admissions from the waiting list than there were applications, so that some progress was made. The Mental Health Act, 1964, although welcomed, did not markedly alter admission policy, and the majority of patients were admitted involuntarily. There were, however, a small number of informal admissions, and the number of 30-day admissions was reduced. The statistical tables show the exact movement of population during the year. The medical staff are divided into two separate sections; they have maintained their previous high standard. Both the doctors working in the Hospital Unit and those in the Psychiatric Unit provide medical coverage to the Training Unit areas. Regular medical staff meetings have continued, and during the year each physician has presented an important topic for discussion at a monthly medical grand rounds. The Out-patient Department saw 246 new patients during the year. The age range was from a few months to 56 years, but over 60 per cent of the patients were between the ages of 2 and 12 years. The majority were referred from metropolitan and other local areas, but 24 per cent came from more outlying parts of the Province. The functional level of the patients was evenly distributed, but it is of interest that 4 per cent showed no evidence of mental retardation. We were again fortunate in having no major epidemics during the year, and were thus able to complete biochemical screening tests on the whole population. A number of abnormalities were found, and paper chromatographic investigation of these is proceeding. In addition, the buccal smear test for sex chromatin was completed on all patients, and abnormalities are receiving chromosomal studies. The latter are being processed by the Chromosomal Laboratory, which was set up at the school during the year, and which is presently under the auspices of the Department of Paediatrics at the University of British Columbia. The various medical ancillary departments are now part of the Hospital Unit. They have continued their previous work. The laboratory, as mentioned above, has managed to extend its activities. The Dental Department has dealt with the dental emergencies as well as most of the routine work. The Physiotherapy Department has continued a high standard, particularly in teaching physiotherapeutic tech- G 86 MENTAL HEALTH SERVICES REPORT, 1965/66 niques to both our own staff and to visiting nursing staff. The Hospital Unit Director has maintained a close liaison with the University of British Columbia Department of Paediatrics, has been responsible for teaching medical students during their pediatric rotation, and has collaborated with members of the department in publishing several research papers. The Education, Recreation, and Occupational Therapy Departments are now part of the Training Unit and under the supervision of its Director. There have been various changes made in their functions, the most important being the utilization of the senior staff as chairman of various ward meetings, thus bringing them into closer contact with the ward situations. The academic school has laid particular emphasis on community liaison, and an increased number of field trips were arranged for the students. The Occupational Therapy Department extended its sheltered workshop activities as well as broadening its programme to all areas of The Woodlands School. The recreational-therapy staff were successful in promoting community participation in their activities, together with increasing outside facilities such as bowling, ice skating, and square dancing. The Director of the Training Unit, who arrived only half-way through the year, did an excellent job in providing goals and training programmes for many areas which were relatively neglected previously. The Psychiatric Unit comprises the wards for the mildly retarded, together with the wards for the seriously psychiatrically disturbed. With selective admissions, with increased placements into boarding homes, and with selective transfers to The Tranquille School, the problems in this area increased during the year. There was a much greater proportion of patients suffering from severe personality disorders, and a much smaller proportion who were able to play a major role in their own care. These facts placed a marked strain on therapeutic efficiency, but there was progress in some aspects. The major event during the year was the opening of a small unit for boys suffering from childhood psychosis. This ward had the advantage of a relatively high staff-patient ratio, and was thus able to carry out increased programming. The addition of an extra psychiatrist also enabled more specialized treatment to be given. The Unit Director was able to make a start in introducing a " therapeutic milieu " into the various wards of the unit. The integration of the nursing services proceeded smoothly during the year. In addition to integration, unitization also took place, so there were major nursing administrative changes. These changes highlighted the need for adequate staffing patterns, and one analysis was carried out during the year. The changing role of The Woodlands School makes it imperative to have agreed standards of care in the form of staff-patient ratios for all areas. The standard of nursing care has remained very high, and the enthusiasm of the staff in embracing new programmes was most commendable. The Psychology Department has managed an increasing number of requests for assessment. The Director encouraged continuing education, which increased standards of all members of the department and played an active role in team programming. The Social Service Department was unitized, and for the first time all areas of The Woodlands School were covered by social services. Individual members of the department played major roles as part of the clinical team in each unit, whereas others were primarily concerned with pre-admission and follow-up cases. The foster-home project was completed during the year with the placement of another 12 children. Further boarding-home placements were also made, and 18 older patients were transferred to a private nursing home. The department was largely THE WOODLANDS SCHOOL G 87 responsible for the excellent community liaison in these various projects, which have proved mutually satisfactory. The supervisor encouraged the department's participation in a large number of orientations for outside professional staff, as well as playing a major role in teaching workshops. The Business Administrator completed a number of projects during the year, and the various departments under his care all increased their efficiency. The emphasis on in-service training and the encouragement given to personnel in furthering their own education showed marked dividends in promoting professional standards. The continued enthusiasm of the staff in all service areas has ensured the smooth running, without which therapeutic and training programmes cannot function. Volunteer services were yet again increased during this year. Over 100 persons contributed more than 5,665 hours of personal service to The Woodlands School. Volunteers now work in many different departments, and their participation is competently organized by the Co-ordinator of Volunteer Services. We are grateful to them and to the Provincial auxiliary for their continued support. The chaplains increased their services to us during the year, and an active Religious Committee was of benefit to both patients and staff. Participation by some of the patients in community religious activities was expanded. In summary, the year was more one of reorganization and consolidation than advance. Progress was, however, made in liaison with university departments and in achieving more understanding in the community. We extend thanks to the many departments of Government and private agencies that have helped us, and we look forward to increasing our own efficiency. STATISTICAL TABLES Table 1.—Movement of Population, The Woodlands School, New Westminster, April 1, 1965, to March 31, 1966 Male Female Total In residence, April 1, 1965 On extended leave, carried forward from 1964/65- Boarding home Other. Total on books as at April 1, 1965 Admissions— First admissions to Mental Health Services.. Readmissions to a different institution of Mental Health Services.. Readmissions to the same institution Total admissions 1- Total under care Separations— Discharged in full.. Died _ Transferred to The Tranquille School- Transferred to Riverview Hospital Transferred to Skeenaview Hospital On extended leave and still out— Boarding home Other Total separations- Net increase In residence, March 31,1966- 10 16 53 16 5 2 6 37 10 129 +24 766 26 8 33 12 19 3 60 3 130 +23 563 36 24 768 574 1,342 86 4 37 58 24 37 144 28 74 127 119 246 895 693 ' 1,588 86 28 24 5 6 97 13 259 +47 1,329 i Indues 2 male and 21 female transfers from The Tranquille School, 3 male and 4 female transfers from Riverview Hospital. G 88 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 2.—First Admissions to The Woodlands School by Health Unit AND School District of Residence and Sex, April 1,1965, to March 31, 1966 Health Unit Male Female Total Health Unit Male Female Total East Kootenay, Cranbrook— Central Vancouver Island, Na School District No. 1 1 1 naimo— „ 2 1 1 School District No. 65 . 2 2 ii „ „ 3. . ... .. . 1 1 2 „ „ „ 67 2 2 „ 18 1 1 „ 68 3 3 6 „ 69 ._. 1 1 School District No. 7 1 1 70 2 2 „ 79 1 1 School District No. 11 3 1 4 Upper Island, Courtenay— „ 12 1 1 School District No. 71 1 1 2 „ 13 - 1 1 „ 72 2 2 4 North Okanagan, Vernon— „ 85 2 1 3 School District No. 20— 2 2 Cariboo, Williams Lake— „ 22 — 1 1 School District No. 28 1 1 2 South Okanagan, Kelowna— Skeena, Prince Rupert— School District No. 14.. . 1 1 2 School District No. 51 1 1 „ „ 52 1 1 School District No. 24 1 1 1 2 53 1 1 2 » 26 1 1 „ 54 1 1 2 „ 29 - — 1 1 „ 80 1 1 „ 31 1 1 Peace River, Dawson Creek— Upper Fraser Valley, Chilliwack— School District No. 59- . 1 1 Northern Interior, Prince School District No. 32 2 1 3 George- „ „ „ 33 4 2 6 School District No. 56 _ 1 1 „ 34 _ 1 2 3 57 4 1 5 Central Fraser Valley, Mission Greater Victoria Metropolitan City— Board of Health— 2 2 School District No. 61 6 5 11 „ „ 42 3 3 „ 62 _ 1 1 „ 75 2 2 63 1 1 2 Boundary, Cloverdale— Metropolitan Health Committee, School District No. 36 6 9 15 Vancouver— 37. 1 1 School District No. 38 1 1 2 „ 39 13 16 29 ster—■ , 41 4 5 9 School District No. 40. 2 4 6 „ 44 4 2 6 „ 43 - 3 3 6 „ 45 — | 3 3 Coast Garibaldi, Powell River— School District No. 48 1 1 Totals 1 90 | 82 1 172 . „- . THE WOODLANDS SCHOOL G 89 vo vo X O S o H irT VO 5 Ph G 90 MENTAL HEALTH SERVICES REPORT, 1965/66 tn Q 2 < p o PC o I M O < co O w VO VO -1 c^ o -—i 0 X -—i u m (/l 6 2 X o PC £ n o 0 H £ lO a VO m eft H 0 -H H hJ l/l 5^ PC O Ph 55 < w co z o H CO (5 « -I •o.-. OOlnHTj-r ri *h fN r- rn i-H rn »- l> OH *e3 Bh 0\ r^ Tt Q\ !Nh rH rH fN rH | CO r- r- o Tt en O I-l a o oo r- fi *h i i cNCNiHM I i |os cn 1» ft i-t j \o tn j ;h cn l im I cn su a 1 r-t 1 1 ! ! t ^ i ! 1 1 i 0\ A — N* | | | to j WrH 1 CJ A cn a lN ! ! i ! 1 ! 1 !"" O & HtNNH j j | VO i l« i tn a s a 1 tn i fN | | | in ! I~ CN «\ * f cn Tt oo i eN j VO *N | ■-* eN 00 to A a" i [*•»■* ! 1 ! - CN rH VO fN J* tt tU g «t ft c4 ■<* vo fN | 1 | Ta j en cn cN 00 O ""J1 o a tsomviH i [ rn •N 1 fN rH tn ft cn CS r-l tN ! 1 00 i fN rH | m < 5 a" r* vo ** eN j | | "* [VOtSlH 0\ . m m m 1 1 i I -H VO <* ft 1-1 a _ *H | ill ft VO fN 1 ! j ; ! CO MM 1 cn a g ,_, *H III! CN ! i i ,_, ft i MM! tu •a a U i i ! i ! 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D [j II c r R CI « Q • C n h a tu t3 ft V- rain ficie of a a»f -H c 3 £ > c tU y- C0 £ i '3 a C KG a (J a X w Q Z < D O O i BJ O < CO O Z o < Hj < H Z BJ >H pa to w a o W a z 3 PC < o CO in vo ON BJ o o I o to C 2&£$ a 3 a i G 92 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 8.—Patients of The Woodlands School Out on Extended Leave by Mental Diagnosis, Age-group, and Sex, December 31, 1965 3 Age-group (Years) Total o H •o Mental Diagnosis Under 1 1-3 4-6 7-9 10-14 15-19 20-29 30-39 40 and Over es o M. F. M. F. M. F. M. F. 1 M. F. M. F. M. F. M.l F. M. F. F. M. F. Mental deficiency1— Profound - 1 1 1 1 Severe 1 1 | 1 1 2 2 4 Moderate 1 1 1 .4 2 7 1 8 Mild — — _ |-— — 1 1 2 — 4 — 4 Totals | 1 II __| 1| Zl—I 1 1 6| 31 1| 3 14| 3| 17 1 Includes 5 males with epilepsy, 1 male and 1 female with mongolism. Table 9.—Total Population on Books of The Woodlands School by Mental Diagnosis, Length of Stay, and Sex, December 31, 1965 Detailed information for the above table may be obtained on request. Table 10.—Live Discharges from and Deaths Occurring in The Woodlands School by Mental Diagnosis, Age-group, and Sex, April 1, 1965, to March 31, 1966. Age-group (Years) Mental Diagnosis Under 1 1-3 4-6 7-9 10-14 15-19 20-29 30-39 40 and over Grand Total M. < F.' i m.; F. M. F. M. i F.< 1 M. F. M. F. m.|f.'; M.' F. M. F. M. F. Live Discharges Mental deficiency i— Profound 2 2 2 1 1 1 1 4 1 3 2 1 3 2 7 3 3 1 1 1 1 2 2 1 1 4 1 1 2 7 3 1 3 5 1 2 5 1 _ 7 7 2 2 ~2 2 5 3 2 2 1 4 19 22 21 6 7 21 17 2 1 1 10 26 Moderate .. Mild Schizophrenic disorders Mental deficiency with psychosis Chronic brain syndrome, N.O.S 43 38 2 1 1 1 1 Totals - 1 1 6 3| 9| 8 13 3| S\ 7 13 9 8 17| 2| 3 10| 5 66 55 121 Deaths Mental deficiency2— 1 1 2 1 2 1 1 2 2 1 3 1 — 2 1 2 — 2 1 1 1 5 7 3 1 8 4 13 11 Moderate Schizophrenic disorders — 3 1 Totals 1 1 1 3 3 1 2 3 3 1 — 2 1 2 -.1 3 2 16 12 28 1 Includes 15 males and 13 females with epilepsy, 7 males with mongi 2 Includes 7 males and 7 females with epilepsy, 1 male and 2 females olism. with mongolism. THE WOODLANDS SCHOOL G 93 Table 11.—Live Discharges from and Deaths Occurring in The Woodlands School by Mental Diagnosis, Length of Stay, and Sex, April 1, 1965, to March 31, 1966. Detailed information for the above table may be obtained on request. Table 12.—Deaths Occurring in The Woodlands School by Cause of Death, Age-group, and Sex, April 1, 1965, to March 31, 1966 Age-group (Years) Cause of Death Under 1 1-3 4-6 7-9 10-14 15-19 20-29 30-39 40 and Over Total Grand M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. — 1 1 3 __ 1 1 3 1 1 1 —■ 1 1 1 1 1 1 2 1 1 1 5 1 2 1 5 1 2 4 1 3 1 1 1 Diseases of the nervous system and sense 7 Rheumatic heart disease Pneumonia _ Diseases of the genito- 1 6 2 Congenital malformations 1 1 1 8 2 Symptoms, senility, and ill-defined conditions- 1 Totals — 1 1 3 3 1 2 3 3 1 — 2 1 2 3 2 16 12 28 Table 13.—Deaths Occurring in The Woodlands School by Cause of Death, Length of Stay, and Sex, April 1, 1965, to March 31, 1966 Detailed information for the above table may be obtained on request. G 94 MENTAL HEALTH SERVICES REPORT, 1965/66 PART IV.—THE TRANQUILLE SCHOOL, TRANQUILLE REPORT OF THE SUPERINTENDENT F. G. Tucker, Acting Superintendent The past year has been one of consolidation in The Tranquille School programme with the elaboration and expansion of existing services. In spite of changes in the senior administration, divisions and departments have maintained a high level of care in all areas of the institution. On August 31, 1965, Dr. A. J. Bennee resigned as Superintendent to take up private psychiatric practice in Vernon and provide services on a sessional basis to the area covered by the Mental Health Centre, Kelowna. Dr. Bennee has been a dedicated and imaginative leader during his years at the school, and his resignation was accepted with considerable regret. Dr. R. G. Foulkes, Deputy Superintendent of The Woodlands School, assumed the additional responsibility of Acting Superintendent of The Tranquille School from September until lanuary, when he resigned from the Provincial Mental Health Services. At that time Dr. F. G. Tucker, Deputy Director of Mental Health Services, was appointed as Acting Superintendent in addition to his existing responsibilities. On November 18, 1965, Dr. Margaret Neave was appointed as Clinical Director and assumed responsibility for the clinical departments, whilst Mr. Merrick remained in charge of business administration. In the absence of a full-time Superintendent, considerable responsibility has fallen upon the shoulders of these two senior staff members, which they have discharged with great effectiveness. There has been relatively little change in the patient population. Thirty patients were transferred to the school and 34 patients separated, so that the number of patients on the register was reduced from 580 to 576. The number of patients in boarding homes on extended leave increased from 6 to 16, and on extended leave in other resources, from 3 to 4. All admissions continue to be processed through The Woodlands School. The health of the resident students remains at a high level, with a relatively low incidence of staphylococcal infections. The average occupancy of the 10-bed infirmary ward has been 6, exclusive of March, 1966. During the year, 5 deaths occurred, giving a mortality rate of 8.6 per 1,000, which is similar to that for the Interior of the Province. During March a high incidence of virus illness occurred, especially amongst the physically handicapped. However, no deaths resulted. An X-ray machine was installed in luly, 1965, which permits routine chest X-rays to be taken at the school, together with other simple procedures. More specialized radiological investigation is carried out at the Royal Inland Hospital, Kamloops. Simple hsematological and urinalyses are performed at the school, with other laboratory tests undertaken in the Department of Pathology at the Royal Inland Hospital. The Nursing Division functioned effectively under Mr. Alexander Mcintosh. Complete integration of male and female nursing staff has occurred during this year with the appointment of male charge nurses in some of the female wards and the placing of " house mothers " in the male areas, thus providing a more normal family setting. The role of the psychiatric nurse in the school is gradually evolving with increasing emphasis on training. They actively participate in such events as the May Day and Carnival Day programmes and assist in the camping, scouting, gardening, and other recreational activities. THE TRANQUILLE SCHOOL G 95 Mr. H. F. Hayes was appointed as Co-ordinator of Habilitation in October, 1965, and has been assisted by two job placement officers. In addition, he is responsible for the recreational-therapy, occupational-therapy, and volunteer programmes. Swimming classes were held at McDonald Park, and male trainees organized into ball teams with a league schedule. Physical activity groups have been carried out in the recreational hall, with an average monthly attendance of 4,861. Weekly socials with dances at special times such as Hallowe'en and St. Valentine's Day have been organized, together with other special events. The Occupational Therapy Department was well attended, with an average monthly attendance of 1,235. Special classes in sense training were also organized. The male handicraft area had an average monthly enrolment of 170 male trainees, who are taught such skills as leatherwork, weaving, lapidary work, and woodworking. There have been 28 active Scouts in the school troop and 17 girls in the Guide company. Mrs. M. Mcintosh was selected and sponsored to attend a month's course in guiding for handicapped girls in Australia in the spring of 1966, being one of two selected in Canada. Camp Kiwanis has also been well used throughout the summer of 1965, with 325 students spending one week's holiday there. The volunteers continue to provide valuable and varied services to the school, ranging from the escort of trainees to the Lower Mainland during the holiday period to the operation of a clubroom in Kamloops for trainees and the provision of an apparel-shop within the school. A dinner in honour of the volunteers was given at the school in March, 1966, and was attended by 234 persons. As Director of the Department of Social Work, Mr. R. Atkinson, M.S.W., has initiated and carried out an intensive programme of community education. Twenty- six different organizations attended by some 900 people plus innumerable persons of a radio audience were introduced to The Tranquille School's increasing emphasis on resettlement of trainees in the community. New and meaningful relationships were established with the local Association for Retarded Children, and a high level of co-operation has been maintained with the Department of Social Welfare and the Department of Public Health, enabling new avenues of preventive institutionalization to be explored. Increased contact between parents and students has been promoted and resulted in three to four trainees per year returning to their homes. The agreed quota of 10 boarding-home placements in the Kamloops area was filled, and this is to be increased by 20. Over and above this quota, 20 trainees were transferred to The Woodlands School for placement in Lower Mainland boarding homes. A total of eight trainees is residing in the Provincial Home at Kamloops. Such community programmes make heavy demands upon the Social Service Department of the school. Community employment of mildly retarded trainees is also increasing. Ten male and female trainees have been employed in the community five days a week whilst living at the school. The resignation of our Protestant chaplain, Rev. Robert McRae, M.S.W., L.Th., was reluctantly accepted on February 7, 1966. The Very Rev. J. C. lolley, M.A., D.D., Dean of St. Paul's Cathedral, kindly assented to assume the duties. The Most Rev. M. A. Harrington, Bishop of Kamloops Diocese, and the Sisters of St. Martha ministered to the Roman Catholic students at the school. The Department of Public Works completely remodelled the East Pavilion to provide areas for habilitation, Social Service Department, and volunteer services, together with a staff common room and lecture room. Changes were also made to G 96 MENTAL HEALTH SERVICES REPORT, 1965/66 the business offices, recreational hall, Central and Beaverdell Buildings. The new 104-bed unit and the first phase of the kitchen/dining-room complex at the end of the fiscal year was nearing completion. STATISTICAL TABLES Table 1.—Movement of Population, The Tranquille School, April 1, 1965, to March 31, 1966 Male Female Total In residence, April 1, 1965 On extended leave, carried forward from 1964/65— Boarding home Other _ - 329 242 571 Total on books as at April 1,1965 Admissions— First admissions to Mental Health Services Readmissions to a different institution of Mental Health Services.. Readmissions to the same institution Total admissionsi _ „ Total under care _ „ Separations— Discharged in full Died _ Transferred to The Woodlands School _ Transferred to Riverview Hospital. _ On extended leave and still out— Boarding home Other _ _ 337 | 243 580 6 1 3 20 3 26 1 7 23 30 344 266 610 3 5 2 1 13 1 On escape but not discharged.. Total separations Net decrease - _ 2 21 5 5 23 1 16 4 1 25 30 55 In residence, March 31, 1966. —10 319 —6 236 — 16 555 i Includes 5 male and 19 female transfers from The Woodlands School, 1 male and 1 female transfer from Riverview Hospital. Table 2.—First Admissions and Readmissions to The Tranquille School by Mental Diagnosis, Age-group, and Sex, April 1, 1965, to March 31, 1966. Age-group (Years) Mental Diagnosis Under 1 1-3 4-6 7-9 10-14 15-19 20-29 30-39 40 and Over Grand Total 1 M.IF. M. F. 1 M.|F. M. F. M. F. M. F. M. F. M. F. 1 M. F. M. F. First Admissions Mental deficiency i— Idiocy and imbecility- — — ...... 1 1 —■ 1 2 1 1 1 1 2 2 1 1 2 5 — 3 — 3 1 2 1 2 1 4 7 11 1 6 8 Border-line intelligence Mongolism — 13 2 Totals |. | | | __| 21—| I] 5 5 1 8| | 3 __| 4 6| 23 29 Readmisisons Mental deficiency— Moron ! ! ! 1 LLLL MM 1 \ \ 1 1 1 1 1 1 1 Totals. 1 1 __ — 1 1 ■ 1 -—j — —- 1 1 i Includes 1 male and 8 females with epilepsy. THE TRANQUILLE SCHOOL G 97 2 ""> X vo r/3 —i W ^H ►J co C CD z w o w H Q < PS H r W Q Z < o W z o 2 o ri 22 ►J w Ph O oo i i TH CN ! 1 in s cn o o ■8 D Vh «S d o ■ i-H a ^H O TJ U rd 03 H-> U Q G 98 MENTAL HEALTH SERVICES REPORT, 1965/66 PART V.—GERIATRIC DIVISION REPORT OF THE SUPERINTENDENT J. Walsh, Superintendent During the year a total of 2,097 elderly persons received special care and treatment in the three hospitals of the Geriatric Division, an increase of 64 over the previous year. Six hundred and five applications for admission were received, an increase of 129. Of this number, 487 were for Valleyview Hospital, 103 were for Dellview, and 15 were for Skeenaview Hospital. Actual admissions to the three hospitals totalled 612, an increase of 53 over the previous year. Of this number, 572 were direct admissions from the community. In addition, 40 geriatric patients were received on transfer from other Provincial mental health facilities. Separations due to death totalled 482. A total of 229 patients was returned to the community (an increase of 55). The resident population of the three hospitals as of March 31, 1966, numbered 1,262. To this may be added 214 patients who, although resident in the community, are still on the hospital register, making a total of 1,476. VALLEYVIEW HOSPITAL, ESSONDALE Valleyview Hospital is the largest of the three hospitals of the Geriatric Division, and the majority of patients admitted are from the Lower Mainland and Vancouver Island. The total complement of beds is 791, with a staff complement of 432. A total of 487 applications for admissions were received, an increase of 89 over the previous year. Four hundred and fifty-seven patients were admitted directly from the community (an increase of 51 over the previous year). In addition, 30 recently admitted geriatric patients were received on transfer from Riverview Hospital and 13 patients were transferred from other geriatric units. As the demand is persistently in excess of beds available, a pre-admission service is able to advise and help inquiring relatives. Assistance was given in placing 81 elderly persons in alternative accommodation in the community. These placements have invariably been successful and have obviated the necessity for admission to hospital. During the year, 195 patients were returned to the community (an increase of 51 over the previous year). Of those patients who left hospital, approximately one-third (64) went to the care of spouse, relatives, or to their own private arrangements. Approximately one-third (67) went to licensed boarding homes, and approximately one-third (64) went to private hospitals. Of the total number of patients who left hospital during the year, 20 were returned to hospital. Of those who returned to hospital, seven were again able to return to the community within the year. Care in the placement of elderly people in the community is of the utmost importance. The medical care of these patients is undertaken by physicians practising in the area, and these patients are well cared for. There were 295 deaths in hospital. Of the total number of patients released on leave to the community, 44 died. Some had been out of the hospital since 1962. GERIATRIC DIVISION G 99 In the hospital an active-treatment and rehabilitation programme utilizing modern techniques is maintained. Simple procedures such as correcting dietary and other deficiencies, stabilizing physical treatments, and eliminating toxic factors form a large part of treatment in the geriatric group. Where a social situation precipitates admission to hospital, satisfactory adjustments can be made. There is a particular need to reactivate interest and initiative and to re-establish self- confidence. The services of consultants are available from Riverview Hospital, and all surgical procedures are performed there. A high standard of medical care is provided for patients. The Dental Department has provided satisfactory dental services. It is planned to introduce a new denture service, whereby the services of dental laboratories in the community will be used. This should expedite the service considerably. The nursing staff have provided a good standard of nursing care. In-service education and involvement in more active-treatment programmes provides a stimulus toward a better orientation for the geriatric nurse. Two senior nurses attended an Institute of Psychiatric Nursing Problems at the University of Washington. Five nurses attended an Institute on Psychiatric Nursing at the University of British Columbia. One nursing supervisor joined the staff. The incidence of staff illness has been high throughout the year. Knee and back injuries are a constant feature, and several staff members have been absent through illness for prolonged periods. The Social Service Department has had an active year. Emphasis has, of necessity, been placed on post-admission services. Preparation and placement of those patients referred by physicians for discharge from hospital constitutes the prime objective. The advent of a social worker into the admissions area of the hospital has been particularly advantageous. The reception of patients is improved, and where relatives or friends accompany the patient, a social history is obtained. This has overcome, to a considerable extent, the lack of information available on newly admitted patients. Relatives also appreciate understanding and advice at this time. Nearly 200 persons, mainly social workers and trainees, public health nurses, and relatives of prospective patients, were shown over the hospital and oriented to its facilities and programme. The X-ray Department, under the supervision of a visiting radiologist, has provided the necessary diagnostic services. In addition to services to patients, staff chest X-rays are taken annually. The laboratory, under the supervision of the pathologist at Riverview Hospital, has been kept busy in accordance with increased admissions. Bacteriology continues to be done at Riverview Hospital. The Recreational Therapy Department has provided a varied programme in accordance with the needs and abilities of the patients. The more active patients provide some of their own group entertainment. Several outings were arranged during the summer months. Feature films are shown regularly. Special concerts have been arranged with the help of volunteer artists. The Occupational Therapy Department plays an active role in the reactivation of interest and initiative in the patients. An average of 230 patients are actively engaged. There is an improvement in the regularity and frequency of attendance. Three first-year students and two second-year students from the School of Rehabilitation Medicine of the University of British Columbia spent four to six weeks in the department as part of their clinical practice. G 100 MENTAL HEALTH SERVICES REPORT, 1965/66 A sale of work was held in December, at which practically all articles offered were disposed of. The Vancouver Dahlia Society has been a friend to our patients for several years, and its efforts are much appreciated. Activities include a visit to its annual show in Vancouver, talks and film shows, as well as planting and tending dahlias in the garden. Monthly meetings (except for December and January) have been held. A podiatry service is maintained for two days per week. Mr. D. M. Bartlett, auditor for the Division of Narcotic Control, inspected the pharmacy and wards of the hospital with regard to drug-control procedures. Some minor improvements in procedure were suggested. DELLVIEW HOSPITAL, VERNON This hospital, with a complement of 239 beds and a staff of 89, operated with a 95-per-cent capacity during the year. A total of 99 patients was admitted directly from the community, and 13 were received on transfer from other units of the geriatric service, as well as three from the Riverview Hospital. Eight patients were discharged in full, and 18 patients were released on leave to the community. Of those on leave in the community, three were returned to hospital. During the year a total of 105 patients died. The general health of the patients was maintained, except for two periods during which influenza was prevalent. Medical care is provided by a local physician on a part-time basis. The facilities of the adjacent Vernon Jubilee Hospital are available for surgery and other special procedures. A visiting dentist, podiatrist, and ophthalmologist provide satisfactory service in these areas. An annual chest X-ray survey was conducted by a mobile unit of the Division of Tuberculosis Control for the patients and staff. A senior instructor, In-service Education, conducted refresher courses for nurses and aides. Fire drills are held regularly. Mr. D. M. Bartlett, auditor for the Division of Narcotic Control, inspected control of drug procedures and was satisfied with the method in use. Occupational- and recreational-therapy activities, supported by Canadian Mental Health Volunteers and fraternal and service organizations in the Vernon district, have been much appreciated by patients. A centrally operated audio sound installation capable of supplying radio or recorded music, with individual ward volume control, is a valuable addition. The various departments of the hospital report satisfactory functioning. Satisfactory repair and maintenance work has been accomplished. SKEENAVIEW HOSPITAL, TERRACE This hospital has a complement of 300 beds, all for male patients. There is a staff of 71. A total of 350 elderly men received care and treatment. Sixteen patients were received or admitted directly from the community. Thirty-four patients were received on transfer from other facilities. Thirty-six patients died during the year, and seven patients were discharged from hospital. Eleven patients were transferred to Valleyview Hospital for rehabilitation and placement in the community. One patient was transferred to Riverview Hospital. Medical care for these patients is provided by a visiting physician. Patients are referred to the local general hospital for surgical or other special procedures. GERIATRIC DIVISION G 101 Diagnostic X-ray and laboratory services are supplied by the Terrace Mills Memorial Hospital. The travelling clinic of the Division of Tuberculosis Control conducted its regular twice-yearly X-ray survey of staff and patients. Minor structural alterations have provided means for improved care of the physically ill as well as extending the open-ward areas. In-service educational programmes for nursing staff have been maintained through the senior training instructor, Education Centre, Essondale. Occupational- and recreational-therapy programmes are supported by volunteer groups from the local community. An area formerly used for staff recreation has been converted to a woodworking shop. An " open house " was held on July 7, 1965, and approximately 150 people took the opportunity to visit and inspect the hospital. All departments of the hospital report satisfactory functioning. A volunteer fire department has carried out regular drills and practices under the direction of the local fire department. G 102 MENTAL HEALTH SERVICES REPORT, 1965/66 STATISTICAL TABLES VALLEYVIEW HOSPITAL Table 1.—Movement of Population, Valleyview Hospital, Essondale, April 1, 1965, to March 31, 1966 Male Female Total In residence, April 1, 1965 ... On extended leave, carried forward from 1964/65— 268 66 491 83 759 149 Other Total on books at at April 1, 1965 - . 334 574 908 Admissions— 209 32 2 217 34 6 426 66 8 243 257 500 577 831 1,408 Separations— 32 162 40 5 79 26 179 __ 124 58 niprt 341 40 10 On extended leave and still out— 203 Other . 318 334 652 -9 259 +6 497 —3 756 i Includes 12 male and 1 female transfers from other geriatric facilities, 12 male and 18 female transfers from Riverview Hospital. GERIATRIC DIVISION G 103 Table 2.—First Admissions to Valleyview Hospital, Essondale, by Health Unit and School District of Residence and Sex, April 1, 1965, to March 31, 1966. Health Unit Male Female Total Health Unit Male Female Total East Kootenay, Cranbrook— School District No. 1 1 1 2 1 2 1 3 4 5 5 7 14 1 17 7 4 2 1 1 1 1 2 1 5 1 1 1 5 4 10 2 16 6 1 4 1 2 1 1 i 2 1 2 2 1 1 8 5 1 6 10 11 24 3 33 13 5 6 Central Vancouver Island, Nanaimo— School District No. 65 1 1 4 2 1 1 1 1 17 2 11 80 23 10 6 3 2 1 1 1 1 1 6 1 4 130 25 13 1 1 1 „ „ „ 4 - , 66— 68— . , 69 „ „ 70 Upper Island, Courtenay— School District No. 711 1 Selkirk, Nelson— School District No. 7 6 3 „ 8 West Kootenay, Trail- School District No. '11 _ 1 il North Okanagan, Vernon— „ 72 2 School District No. 20 Cariboo, Williams Lake— School District No. 28 South Okanagan, Kelowna— >1 School District No. 14 „ 23 South Central, Kamloops— School District No. 29 Skeena, Prince Rupert— School District No. 52 „ 53— Northern Interior, Prince George— School District No. 57 Greater Victoria Metropolitan Board of Health- School District No. 61. 1 1 „ „ 341 Upper Fraser Valley, Chilliwack— School District No. 33 1 „ 34 76 23 Central Fraser Valley, Mission „ 63 1 City- School District No. 35 , 64 Metropolitan Health Committee, Vancouver— School District No. 38. 39 „ 41 „ „ 44 - 2 „ „ „ 42— 75-_ Boundary, Cloverdale— School District No. 36 , 37 Simon Fraser, New Westminster— School District No. 40 „ 43.. 15 210 48 23 „ 45 School district not covered by health unit— School District No. 49 6 1 River— School District No. 46 „ „ „ 47 Unknown ._ Totals 4 241 251 492 Table 3.—First Admissions and Readmissions to Valleyview Hospital, Essondale, by Method of Admission, Age-group, and Sex, April 1, 1965, to March 31, 1966. Age-group (Years) Method of Admission 20-29 30-49 50-59 60-69 70-79 80-89 90 and Over Grand Total M. F. M. F. M. F. M. F. M.|F. 1 M. F. M. F. M. F. First Admissions 14 8 3 91 13 104 3 115 6 104 15 13 6 235 19 232 25 467 Involuntary_ 2 1 Totals _ | 2( 1 1 1— 14] 8| 94|117 118|110| 15| 13 Readmissions 1 —-|__.| 4 1 1 1 1 2 4 Involuntary 5 Totals 1 11 1 d 1 1 ">! tt g G 104 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 4.—First Admissions to Valleyview Hospital, Essondale, by Mental Diagnosis, Age-group, and Sex, April 1, 1965, to March 31, 1966 Age-group (Years) Mental Diagnosis Under 60 60-69 70-79 80-89 90 and Over Grand Total M. F. M. F. M. F. M. F. M. F. M. F. — 1 1 1 2 1 1 1 2 ~5 2 1 1 1 2 3 4 3 1 1 16 2 1 7 54 1 4 3 5 10 4 5 ~"1 10 ~i 2 64 12 4 2 2 1 11 1 1 9 1 79 4 3 -1 6 2 3 1 8 1 1 2 72 10 3 1 12 11 2 10 6 3 3 1 29 1 ~~2 2 17 ~~2 4 150 7 7 5 6 16 6 1 9 ~"3 1 1 18 1 2 ~~1 4 150 24 3 15 12 19 9 2 38 1 3 3 Anxiety reaction without mention of somatic symptoms 3 35 Chronic brain syndrome with neurotic reaction _ 1 2 2 1 Other and unspecified character, behaviour, and intelligence disorders — Chronic brain syndrome with behavioural reaction... 5 300 31 Diagnosis deferred— - 10 Totals .. 3 14 8 94 ■117 118 110 '15 13 2411251 492 Table 5.—First Admissions to Valleyview Hospital, Essondale, by Mental Diagnosis, Marital Status, and Sex, April 1, 1965, to March 31, 1966 Table 6.—First Admissions to Valleyview Hospital, Essondale, by Religion and Sex, April 1, 1965, to March 31, 1966 Detailed information for the above tables may be obtained on request. geriatric division G 105 Table 7.—Population in Residence at Valleyview Hospital, Essondale, by Mental Diagnosis, Age-group, and Sex, December 31, 1965 Age-group (Years) Mental Diagnosis 20-39 40-49 50^59 60-64 65-H69 70-74 75-79 80 and Over Grand Total M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 5 2 1 1 4 8 1 i 2 1 1 3 7 1 1 1 1 1 4 1 2 1 1 1 1 4 1 " 1 ~3 4 1 ~~1 1 6 1 1 2 4 1 2 14 2 3 6 ~2 4 1 1 ~3 1 24 7 5 1 il 1 15 2 1 6 12 8 2 2 9 18 2 5 52 34 ~4 2 144 23 4 42 5 3 12 2 28 3 1 1 ~~9 3 4 1 131 9 1 6 44 5 1 11 66 1 51 2 3 2 1 11 2 1 1 9 1 231 39 5 86 10 1 Paranoia and paranoid states 14 78 3 Psychosis with cerebral arteriosclerosis — 9 1 1 35 4 1 1 12 2 1 4 1 1 57 9 1 13 2 1 1 76 3 2 79 5 Psychosis of other demonstrable etiology Other and unspecified psychosis Anxiety reaction without mention 4 3 1 Neurotic-depressive reaction Chronic brain syndrome with 20 2 3 1 6 13 Other and unspecified character, behaviour, and intelligence disorders Chronic brain syndrome with behavioural reaction Chronic brain syndrome, N.O.S-. 2 362 48 1 Diagnosis deferred 11 Totals 7 6 ii 7 9 3 10 1 13 9 31 49 60 124 125 288 266 487 753 G 106 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 8.—Patients of Valleyview Hospital, Essondale, Residing in Boarding Homes, by Mental Diagnosis, Age-group, and Sex, December 31, 1965 Age-group (Years) - Mental Diagnosis 20-39 40-49 50-59 60-64 65-69 70-74 75-79 80 and Over Grand Total M. F. M. F. M. F. M. F. M.IF. M. F. M.IF. 1 M. F. M. F. Schizophrenic disorders Manic-depressive reaction Involutional melancholia Paranoia and paranoid states 1 — 2 2 — — 1 1 1 1 2 2 1 2 2 1 ~1 3 1 2 1 1 7 1 2 2 1 1 5 2 1 2 3 1 2 1 1 2 2 1 1 2 6 1 2 2 4 16 8 1 7 4 1 1 3 15 1 1 5 2 1 1 33 4 2 3 9 2 4 21 10 1 2 1 2 2 53 6 1 3 16 6 1 5 24 Psychosis with cerebral arterio- 25 1 Psychosis of other demonstrable — ~T 1 Anxiety reaction without mention 1 Neurotic-depressive reaction Psychoneurosis with somatic symptoms (somatization reaction) affecting digestive system- Chronic brain syndrome with 7 1 2 3 — 1 2 1 6 1 3 Chronic brain syndrome with 16 3 1 1 20 2 1 33 2 2 86 Chronic brain syndrome, N.O.S 10 3 6 Totals 1 2 2 — — 1 3 3 11 13 28 29 40 68 841117 201 GERIATRIC DIVISION G 107 Table 9.—Live Discharges from and Deaths Occurring in Valleyview Hospital, Essondale, by Mental Diagnosis, Age-group, and Sex, April 1, 1965, to March 31, 1966. Mental Diagnosis Age-group (Years) Under 60 M. F. 60-69 M. F 70-79 M. F 80-89 M. F 90 and Over M. F, Total M. F Grand Total Live Discharges Schizophrenic disorders Manic-depressive reaction Paranoia and paranoid states Senile psychosis- Psychosis with cerebral arteriosclerosis- Psychosis of other demonstrable etiology.. Anxiety reaction without mention of somatic symptoms.. Neurotic-depressive reaction Syphilis and its sequelas Pathological personality— Immature personality Alcoholism Mental deficiency Other and unspecified character, behaviour, and intelligence disorders- Chronic brain syndrome with behavioural reaction . Chronic brain syndrome, N.O.S— Other, unknown, and unspecified conditions.. Totals 281 16 Deaths Schizophrenic reaction Manic-depressive reaction.. Paranoia and paranoid states.. Senile psychosis- Psychosis with cerebral arteriosclerosis- Psychosis of other demonstrable etiology.. Other and unspecified psychoses Neurotic-depressive reaction Pathologicai personality— Mental deficiency- Chronic brain syndrome with behavioural reaction Chronic brain syndrome, N.O.S.. Other diseases of the central nervous system not associated with psychosis Totals.. 54 36| 9 101 II 77] 31 29 162 179 11 5 4 6 9 2 4 9 2 1 1 1 1 2 43 6 1 108 6 1 4 36 33 1 1 8 1 1 228 20 341 Table 10.—Live Discharges from and Deaths Occurring in Valleyview Hospital, Essondale, by Mental Diagnosis, Length of Stay, and Sex, April 1, 1965, to March 31, 1966. Detailed information for the above table may be obtained on request. G 108 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 11.—Deaths Occurring in Valleyview Hospital, Essondale, by Cause of Death, Age-group, and Sex, April 1, 1965, to March 31, 1966 Age-group (Years) Cause of Death 50-59 60-69 70-79 80-89 90 and Over Grand Total M. F. M. F. M. F. M. F. M. F. M. F. 1 ~~3 1 1 15 57 1 1 2 1 1 3 1 4 1 1 1 26 115 1 2 7 3 .1 4 8 1 2 11 127 2 7 12 1 3 1 1 3 1 8 1 1 2 8 70 1 5 7 1 1 1 3 2 17 1 2 22 1 1 3 1 1 1 2 8 39 33 1 2 4 2 1 37 1 — 242 3 —- 2 1 2 2 9 19 4 a i 2 Accidental deaths 1 7 Totals - 1 4 3 54 46 83 101 20 29 162 179 341 Table 12.—Deaths Occurring in Valleyview Hospital, Essondale, by Cause of Death, Length of Stay, and Sex, April 1, 1965, to March 31, 1966 Detailed information for the above table may be obtained on request. GERIATRIC DIVISION DELLVIEW HOSPITAL G 109 Table 1.—Movement of Population, Dellview Hospital, Vernon, April 1, 1965, to March 31, 1966 Male Female Total 98 126 224 Admissions—■ 44 17 1 51 1 1 95 Readmissions to a different institution of Mental Health Services 18 2 62 53 115 Tnfal under rare 160 179 339 Separations— 4 52 1 1 3 4 53 1 8 8 Pisrt 105 2 1 On extended leave and still out—Boarding home 11 61 66 127 + 1 99 —13 113 — 12 212 i Includes 13 male transfers from other geriatric facilities, 2 male and 1 female transfers from Riverview Hospital. Table 2.—First Admissions to Dellview Hospital, Vernon, by Health Unit and School District of Residence and Sex, April 1, 1965, to March 31, 1966. Health Unit Male Female Total Health Unit Male Female Total East Kootenay, Cranbrook— School District No. 2 . „ 4 Selkirk, Nelson— School District No. 7 1 2 3 1 2 2 2 1 16 3 2 6 4 2 1 1 1 1 6 20 1 1 6 1 1 1 2 2 4 1 1 1 2 2 8 1 36 4 3 12 1 1 5 2 South Central, Kamloops— School District No. 24 „ 31 Upper Fraser Valley, Chilliwack— School District No. 76 Coast Garibaldi, Powell River— School District No. 47 Cariboo, Williams Lake— School District No. 27 Skeena, Prince Rupert— School District No. 52 3 1 1 1 1 7 4 1 1 1 1 3 7 1 „ 8 1 West Kootenay, Trail— School District No. 9 „ 11 „ 12 „ 13... North Okanagan, Vernon— School District No. 20 1 1 1 „ 21 — „ 22 „ 78 .„ Northern Interior, Prince George— School District No. 56 . . . 1 South Okanagan, Kelowna— School District No. 14 — 15 „ 16 - 17— .. .. „ 23 77 „ 57 Greater Victoria Metropolitan Board of Health— School District No. 62 Metropolitan Health Committee, Vancouver— School District No. 39 Totals 4 1 7 61 52 113 G 110 MENTAL HEALTH SERVICES REPORT, 19*65/66 Table 3.—First Admissions and Readmissions to Dellview Hospital, Vernon, by Method of Admission, Age-group, and Sex, April 1, 1965, to March 31, 1966. Age-group (Years) Mental Diagnosis 50-59 60-69 70-79 80-89 90 and Over Grand Total M. F. M. 1 F. M. F. M. F. M. F. M. F. First Admissions involuntary 2 - 3 4 15 20 1 38 1 26 3 2 61 1 52 1 113 Readmissions Involuntary .. , 2 Table 4.—First Admissions to Dellview Hospital, Vernon, by Mental Diagnosis, Age-group, and Sex, April 1, 1965, to March 31, 1966 Age-group (Years) Mental Diagnosis 50-59 60-69 70-79 80-89 90 and Over Grand Total M. F. M. F. M. F. M. F. M. F. M. F. Schizophrenic disorders — - 1 2 1 3 1 1 1 11 1 20 1 1 36 26 - — 2 1 1 1 1 54 1 1 51 3 1 1 1 .... 3 2 1 Chronic brain syndrome with behavioural 2 | — 105 1 Totals 2 — 3 4 15 20 38 76 3 2 61 52 113 Table 5.—First Admissions to Dellview Hospital, Vernon, by Mental Diagnosis, Marital Status, and Sex, April 1, 1965, to March 31, 1966 Table 6.—First Admissions to Dellview Hospital, Vernon, by Religion and Sex, April 1, 1965, to March 31, 1966 Detailed information for the above tables may be obtained on request. GERIATRIC DIVISION G 111 Table 7.—Total Number of Patients on Books1 of Dellview Hospital, Vernon, by Mental Diagnosis, Age-group, and Sex, December 31, 1965 Age-group (Years) Mental Diagnosis Under 60 60-64 65-69 70-74 75-79 80 and Over Grand Total M. F. M. F. M. F. M. F. M. F. |M. 1 F. M. F. 2 T 4 1 1 3 2 8 1 1 5 1 2 " 8 6 1 1 10 2 1 17 1 2 4 3 38 5 7 11 1 60 14 18 1 4 5 1 1 60 7 12 11 1 1 93 15 30 1 1 1 4 15 Psychosis with cerebral arteriosclerosis 6 1 Neurotic-depressive reaction. .„ 1 1 Chronic brain syndrome with behavioural reaction Chronic brain syndrome, N.O.S 153 22 Totals 2 i 5 4 4 4 16 ■10 18 21 52 93 97 133 230 i Of this total, 3 males and 8 females were in boarding homes at December 31, 1965. Table 8. — Live Discharges from and Deaths Occurring in Dellview Hospital, Vernon, by Mental Diagnosis, Age-group, and Sex, April 1, 1965, to March 31, 1966. Age-group (Years) Total Mental Diagnosis 50-59 60-69 70-79 80-89 90 and Over Grand Total M. F. 1 M. F. M. F. M. F. M. F. M. F. Live Discharges Chronic brain syndrome with behavioural _|_ 1 1 2 2 1 2 1 1 .._ 3 3 4 1 7 Chronic brain syndrome, N.O.S. 4 Totals .... | .... 1 ■1 | 2 3 2 | 1 1 |- 6 5 11 Deaths Chronic brain syndrome with behavioural 1 3 3 12 2 14 2 28 1 24 3 5 7 49 3 48 5 97 8 Totals 1 1 .... 3 3 1 14 16 29 27 5 7 52 S3 105 G 112 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 9. — Live Discharges from and Deaths Occurring in Dellview Hospital, Vernon, by Mental Diagnosis, Length of Stay, and Sex, April 1, 1965, to March 31, 1966. Detailed information for the above table may be obtained on request. Table 10.—Deaths Occurring in Dellview Hospital, Vernon, by Cause of Death, Age-group, and Sex, April 1, 1965, to March 31, 1966 Age-group (Years) Cause of Death 50-59 60-69 70-79 80-89 90 and Over Grand Total M. F. M. F. M. F. M. F. M. F. M. F. Vascular lesions affecting the central nervous 1 - 2 1 3 14 1 15 29 2 25 5 6 1 51 1 3 49 ■1 3 100 2 Totals 1 — 3 3 14 16 29 27 5 7 52 53 105 Table 11.—Deaths Occurring in Dellview Hospital, Vernon, by Cause of Death, Length of Stay, and Sex, April 1, 1965, to March 31, 1966 Detailed information for the above table may be obtained on request. GERIATRIC DIVISION SKEENAVIEW HOSPITAL1 G 113 Table 1.—Movement of Population, Skeenaview Hospital, Terrace, April 1, 1965, to March 31, 1966 In residence, April 1, 1965 On extended leave Total on books 299 1 300 Admissions— First admissions to Mental Health Services 15 Readmissions to a different institution of Mental Health Services 34 Readmissions to the same institution 1 Total admissions2 50 Total under care 350 Separations— Discharged in full Died 8 36 Transferred to other geriatric facilities 11 Transferred to psychiatric facility 1 Total separations. Net decrease In residence, March 31, 1966 56 -5 294 1 This institution cares for male patients only. 2 Includes 27 transfers from other geriatric facilities, 1 transfer from Riverview Hospital, 6 transfers from The Woodlands School. Table 2.—First Admissions to Skeenaview Hospital, Terrace, by Health Unit and School District of Residence, April 1, 1965, to March 31, 1966 Health Unit No. Health Unit No. East Kootenay, Cranbrook— Cariboo, Williams Lake— School District No. 1.._ 2 School District No. 28 2 North Okanagan, Vernon— Skeena, Prince Rupert— School District No. 22 1 School District No. 51 1 South Okanagan, Kelowna— School District No. 52 4 School District No. 17 1 School District No. 53 6 South Central, Kamloops— School District No. 54 _ 1 School District No. 24 1 Peace River, Dawson Creek— Upper Fraser Valley, Chilliwack— School District No. 59 _ 2 School District No. 32 _ _. 1 Northern Interior, Prince George— Central Fraser Valley, Mission City— School District No. 55 I School District No. 35 1 School District No. 56 2 School District No. 42 _ 1 Greater Victoria Metropolitan Board of Health— Boundary, Cloverdale— School District No. 61 8 School District No. 36 _ 1 Metropolitan Health Committee, Vancouver— Simon Fraser, New Westminster— School District No. 39 9 School District No. 40 _. 3 School District No. 41 _ 1 Total . 49 G 114 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 3.—First Admissions and Readmissions to Skeenaview Hospital, Terrace, by Method of Admission and Age-group, April 1, 1965, to March 31, 1966. Age-group (Years) Total Method of Admission 30-49 50-59 60-69 70-79 80-89 90 and Over First Admissions Informal Involuntary 1 | "2 5 17 1 21 2 1 48 Totals - 1 j 2 | 5 | 17 | 22 | 2 | 49 Readmissions .... 1 -- 1 Table 4.—First Admissions to Skeenaview Hospital, Terrace, by Mental Diagnosis and Age-group, April 1, 1965, to March 31, 1966 Mental Diagnosis Age-group (Years) Total Under 60 60-69 70-79 1 80-89 1 90 and Over 2 1 2 3 6 2 1 2 4 2 1 3 1 10 6 1 1 1 8 1 3 3 1 Syphilis and its sequelas. - — 2 5 Chronic brain syndrome with behavioural reaction 15 8 Diagnosis deferred . — .... 3 Totals ' 3 5 17 22 2 49 Table 5.—First Admissions to Skeenaview Hospital, Terrace, by Mental Diagnosis and Marital Status, April 1, 1965, to March 31, 1966 Table 6.—First Admissions to Skeenaview Hospital, Terrace, by Religion, April 1, 1965, to March 31, 1966 Detailed information for the above tables may be obtained on request. GERIATRIC DIVISION G 115 Table 7.—Total Number of Patients on Books of Skeenaview Hospital, Terrace, by Mental Diagnosis and Age-group, December 31, 1965 Mental Diagnosis Age-group (Years) Total Under 60 60-64 65-69 70-74 75-79 80 and Over 11 4 24 1 1 3 1 3 5 22 1 ~4 3 1 1 1 1 3 29 1 1 5 1 1 2 1 2 ~~3 1 1 37 1 10 4 "T ~1 ~7 5 2 2 31 1 1 23 8 1 1 1 13 8 i 154 Manic-depressive reaction 4 1 Senile psychosis 35 22 7 Psychosis of other demonstrable etiology 4 2 1 Alcoholism. 6 8 Chronic brain syndrome with behavioural reaction 24 15 Syphilis and its sequelae 11 Other, unknown, and unspecified conditions . 4 Totals .. 15 38 37 48 70 90 298 Table 8.—Live Discharges from and Deaths Occurring in Skeenaview Hospital, Terrace, by Mental Diagnosis and Age-group, April 1, 1965, to March 31, 1966. Mental Diagnosis Age-group (Years) Total Under 60 60-69 70-79 80-«9 90 and Over Live Discharges Schizophrenic disorders 1 5 2 2 2 2 .... 4 1 1 — 12 Psychosis with cerebral arteriosclerosis. — 2 Alcoholic psychosis 2 Chronic brain syndrome with behavioural reaction 1 Chronic brain svndrnmp, N D S 2 Observation without further need of psychiatric care. 4 Totals a |. 9 4 6 20 Deaths — 1 2 1 6 1 1 2 1 2 6 3 1 1 2 1 2 1 1 "tt 10 1 3 2 2 2 2 1 5 8 Tnfjils -- 4 19 12 1 36 Table 9.—Live Discharges from and Deaths Occurring in Skeenaview Hospital, Terrace, by Mental Diagnosis and Length of Stay, April 1, 1965, to March 31, 1966. Detailed information for the above table may be obtained on request. G 116 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 10.—Deaths Occurring in Skeenaview Hospital, Terrace, by Cause of Death and Age-group, April 1, 1965, to March 31, 1966 Cause of Death Age-group (Years) Uj$er 60-69 70-79 80-89 90 and Over Total Malignant neoplasms- Allergic disorders- Vascular lesions affecting central nervous system . Arteriosclerotic and degenerative heart disease Diseases of arteries Pneumonia Other diseases of the respiratory system- Diseases of the digestive system Totals... . 19 12 6 1 8 11 3 3 3 1 36 Table 11.—Deaths Occurring in Skeenaview Hospital, Terrace, by Cause of Death and Length of Stay, April 1, 1965, to March 31, 1966 Detailed information for the above table may be obtained on request. COMMUNITY MENTAL HEALTH SERVICES G 117 PART VI.—COMMUNITY MENTAL HEALTH SERVICES MENTAL HEALTH CENTRE, BURNABY K. J. Davies, Director During the year this clinic has continued to make efforts at better community liaison. The intake, treatment, and travelling clinic teams have all provided a more immediate consultation and treatment service to the referring physicians, as well as consultation with the community professionals (social workers, public health nurses, probation officers, teachers, clergy). This has been made possible by all the staff increasing their patient load in intensive, brief, and community consultation. The total numbers of families being seen has progressively increased in all these areas. The staff has also given increased indirect service by professional education, public education, and involvement in a variety of professional and lay committees in the local community, as well as different areas in the Province being serviced by travelling clinics. OUT-PATIENT DEPARTMENT Individual psychotherapy is still the principal approach, although increasing time is being used in joint interviews, family group therapy, and group therapy for adolescents, adults, and parents of children being seen. The Social Club and its patients' executive have also had an active programme on Tuesday evenings. Of the patients treated, neurotic reactions outnumber the psychotic ones by about two to one, but the personality disorders have increased to about the level of neurotic reactions. This seems to be the result of younger people being referred, with the peak age of treated patients being in their late teens and early twenties. CHILDREN'S DAY CENTRE During the past year the Day Centre expanded to offer services in three distinct programmes. The morning programme is a continuation of last year's group of autistic children, with five to seven children attending four mornings a week. The afternoon programme was started to include six pre-school children attending five sessions a week. The children selected for this programme require carefully planned and guided social and peer group experiences. The most recently started programme is that combined with Day Hospital. The mother attends the Day Hospital daily, and the child or children attend the Day Centre daily from 8.30 a.m. to 4 p.m. The goal with these children is initially for observation and assessment, following which further treatment plans are formulated as appropriate. Continued interest is shown by the community in these various programmes, and students in nursing, education, and social work are among the many regular observers in the Day Centre during the year. A nurse functioning as a child-care worker has been placed full time in the Day Centre this year for the first time, and this has assisted the nursing staff greatly in their efforts to maintain continuity of a person for the children and communication with other departments. LEARNING CLINIC A special programme has provided a service for children with perceptual problems as basic to their learning disability. This programme was begun at the Mental G 118 MENTAL HEALTH SERVICES REPORT, 1965/66 Health Centre because the schools were not able to provide this service to the children. Since children with learning problems develop behaviour disturbances following the frustration experienced from repeated failure, such difficulties can be considered a mental health problem. The school area concentrated upon was Burnaby, due to its proximity and hope that such a programme could be integrated into the school system. The experimental venture proved so effective that Burnaby will be starting three specialized classes for children with perceptual disorders in September of 1966. The activities of the Learning Clinic during the past year have included assessments, consultation to the schools, and direct treatment here. The assessments involve from 2 to 6 hours, and results were interpreted directly to the school involved. A group of five children was seen in a local Burnaby school on a daily basis for 2Vi hours each morning. In addition, 12 children were seen at the clinic for two sessions a week of 2 hours' duration. Consultation and community education has taken the form of demonstrations, lectures, and workshops. ADOLESCENT AND ADULT DAY HOSPITAL The Day Hospital staff continues to refine their concepts and practice of milieu therapy. The emphasis has been on group rather than individual therapy, with more patient self-government assisted by the establishment of three patient committees. The senior psychiatrist has deployed about one-half of his time to be available as direct consultant to the Day Hospital programme and thus channel and streamline lines of authority and communication. Population in the Day Hospital has ranged between 20 and 35 patients, with a noticeable decrease in the average length of stay during the past year. GROUP-LIVING HOMES The group-living homes in Burnaby, Surrey, Kamloops, Prince George, and Prince Rupert, as well as the new unit at New Denver operated by the Department of Social Welfare, have been provided a screening and consultation service. Individual and group therapy have also been used for the adolescent boys in the group- living homes in Burnaby and Surrey. The demand for this service is increasing throughout the Province and necessitated a much closer liaison between our clinic and the Special Placement Division of the Child Welfare Department, which has established its offices within our building. This type of service will become increasingly important with the expansion of services to adolescents when the new residential treatment unit is completed here in 1967. LOCAL AGENCY CONSULTATION SERVICE Consultation and psychiatric treatment when appropriate have been provided by a child psychiatrist making a weekly visit to the Health Centre for Children, Children's Aid Society, Catholic Children's Aid Society, Juvenile Courts of Vancouver and Burnaby, and the Willingdon School for Girls. TRAVELLING CLINICS Fifteen towns throughout the Province have received a regular frequent service from a psychiatric team seeing a large number of families but with considerable emphasis on co-ordinating communities' professionals. This sharing in dealing with local community mental health problems has been quite productive. Mental health nurses have joined the travelling clinic teams to two areas of the Province in the past year. The function of the nurse is particularly to assist public health nurses with COMMUNITY MENTAL HEALTH SERVICES G 119 psychiatric nursing concepts related to team recommendations and to assist the unit nursing supervisors in improving their staff interviewing techniques. RESEARCH The role of research in the clinic is becoming more apparent, and it is stressed as constituting part of the duties of staff, especially psychologists. The elaborate investigation into the causes of infantile autism is now completed and in the process of being written up. One of the summer psychology interns wrote up his contribution on this investigation, which was accepted as his thesis for his master's degree. Another psychologist summer intern working on a different section has submitted papers for publication. A study into the interaction between marital partners and the effect they have on each other on the decision-making process is currently in progress. The Sociometric Investigation of the Day Hospital Interaction also is being written up for publication. An evaluation of the effectiveness of the travelling clinic service to the Chilliwack area has been completed. TRAINING During the past three years an internship programme has been undertaken for the training of clinical psychologists. There were two purposes for this venture, and both have been realized in part. Of prime concern to the Mental Health Services is recruitment of new staff. There have been some psychologists remaining with the Mental Health Services Branch following the internship, so it has served the function of recruitment. However, a far greater role of the internship has been the training of clinical psychologists so they could be more productive when employed. Study of the methods involved and training for added skill are important in improving our own standard of service and also in fulfilling an education role in development of community services for mental health. Social workers here have participated in the training of quite a large number of staff from other units and community services, and these aids are being increasingly requested. The institutes we have sponsored have fulfilled some of the role, and our staff has gone out on request to discuss the application of newer methods. Many professionals have been able to use at least some opportunity to come into the centre for observation and learning experience, especially in regard to family group therapy and group therapy. The centre has continued in this year to train seven social-work students in field placement, and an additional seven students in after-care have made use of experience in the centre's programme. Social-work students from other field agencies have also been using much increased opportunity to visit and observe. If we are to fulfil the educational role that community mental health concepts require of a facility such as this clinic, it is important that this aspect be administratively acknowledged and planned. It will become even more important as residential treatment is established in conjunction with this centre. There have been four important institutes held during the past year. In April, 1965, a group of 102 professionals (psychiatrists, social workers, psychologists, and nurses) attended a two-day Workshop on Family Group Therapy led by the Director of Training at the Palo Alto Research Institute, Virginia Satir. In June of 1965, 110 professionals (psychiatrists, psychologists, social workers, and clergy) attended a two-day Symposium on Religion and Mental Health. In March, 1966, 41 therapists (psychiatrists, psychologists, social workers, and nurses) attended a three-day Workshop in Group Psychotherapy led by the Director of Training of Group Psychotherapy for the American Psychiatric Association, Dr. Milton Berger. G 120 MENTAL HEALTH SERVICES REPORT, 1965/66 A very active in-service training programme is offered here for all professional staff. Every Wednesday from 12.30 p.m. to 2 p.m., 50 to 60 professionals attend the staff development with outside speakers or demonstrations given on treatment techniques or subjects related to the mental health field. Every Thursday from 4 p.m. to 5 p.m., 10 to 15 of the staff meet to discuss various presentations on day-hospital milieu treatment. Each Friday from 4 p.m. to 5 p.m., approximately 15 staff discuss theories and techniques of child psychiatry in day-centre treatment. Each Friday from 9 a.m. to 10 a.m., all the psychiatrists attend a journal club for the presentation in review of various articles on psychiatric treatment. All the social workers during their first year of employment here attend a weekly 2-hour supervision conference. Each Friday from 8.45 a.m. to 10 a.m., there is a staff-development programme, which has now expanded to include all the mental health services as well as clinical psychologists from School Boards and rehabilitation, university, and vocational counselling for a seminar and discussion on current issues and recent advances in psychology. Each Wednesday from 9 a.m. to 10 a.m., approximately 15 therapists attend a multi-disciplinary meeting to discuss current family group therapy techniques. Table 1. STATISTICS -Summary of Operations, Mental Health Centre, Burnaby, Adult Clinic, April 1, 1965, to March 31, 1966 Male Female Total Brought forward, April 1,1965 160 289 281 436 441 725 449 717 1,166 222 227 310 407 532 634 Table 2.—First Admissions to Mental Health Centre, Adult Clinic, by Health Unit and School District of Residence, April 1, 1965, to March 31, 1966. Detailed information for the above table may be obtained on request. COMMUNITY MENTAL HEALTH SERVICES G 121 X w to Q z < Oh" g o I w a < tn O Z O < iJ < H Z w ..on Q «-H i-l c^> *- y 3s o H 'O t- °° M ! ! ! Mill i i <« | ! I ! "i I*" i I" i in r -H i C\ ^ ^H rH | o .H-C rt \o 1 i I I I I I " "■J CI ^J- tn |TfvH 18^ St3o2 »-< g y s » 2§ lis II fi" M «S q h n u ■33 Sja a — •^ & § § «.S| ■■goo ■ S2S3? Sp1«5 OB _ .21 g rt M 1 ^^ 1 c o « s a o *o u tfl « o o Oh w a 3 •d i el cd P « fci O (« * E fl o a> 0 ta $b •a is :>> 9 a a « u*a a S W W H u w o ■ H M B u Oh tn u< «3 u x M o ... zo G 122 MENTAL HEALTH SERVICES REPORT, 1965/66 CO O z tt < Q hJ < H z n S VO ^ VO fq OV ^ ^H U z 0 H pS ►J < D S 3 o H W PS H Z w VO Ov l-H U ^h" K J H ►J Pi J BJ < to Z p BJ z 2 on TT g8 2g B » CO -Sh tO ci3 i i g t>3 O UH 1/3 O .2 I vs-S "0 .> o ^ B a g *i .5 Si ca o g o 8*83* a ° 1 2 o. ft o o a 5 w a S 3 M k . - "O u nj u .2 C . u >h o n StJ o H u. o) a> *a Hit's Sag 3 >>J3 PhO c : 0 a o Tl CJ n a o w ti a fl >, o c r o fi s e >, .2 S OZ * 5 & fc co : E ii -a o ja-o E ! .a o .a s, !•§ gSM 1 U U 2 M ! C CJ B o s g Pa i o <» tz •a o 3 2 £ -a S -O iq n O *■> §°& ifl S 2 ih o IIjs ISo -§ . S * •§ c o S Sco 21 o n 1ZO o z tt < p. Q z < „ X BJ to tn D H < H oo H < H PS < 2 >< pq vo .r vo y ov Z '-i ►J « U£ C/3 5 « p 5 < rr o H Xl 00 C3 Z (U 0 hC O 8 -^-: Q a <: o H BO Fl PS H Ph .2 | .9 w-i (1) BJ C3 i-l pq (v|{f,Hi I I I I i I ! i I i 11 rn r 11 r i i i r' 4 I ~ i nr j i TIT ! ! ! or* hi rH I IH I I Ht ! ! I' IN I I I I I ! cn i-H i-H I I I I* i^^^o i-H itHCrjl I I I'M i t '• ^ I ' CO i-H CO ID CS ri i-H I W-l I I I ! 53 a IH ?> O >H .a © •3.5 .2 W o3 h3 S h co '« 3 5 b S & o a gs o ft 5 I E & &.a a s II O hH W O II w O 5 g TJ H o fl B 2 B c tE3 ■g -a * cj g is H-g s? i, % ca ! .2 .3 Sft I % a u - 9 w b a - ft o o g .2 a o tJ.2- » a b co ih a ill! 3 O nj O '■a £-3 I a >, a h ^i? 2 cj 8 a >jx O *r5 e ft " -5 B ^ a •§ o <3 3 g a b o a.a;3 8 0 s s" OOOO G 124 MENTAL HEALTH SERVICES REPORT, 1965/66 Table 7.—Movement of Population, Day Hospital, Mental Health Centre, Adult Clinic, April 1, 1965, to March 31, 1966 Male Female Total Tn flay hospital, April 1, 1965 6 63 18 15 98 2!8 21 161 46 Total's 87 76 141 121 228 Less discharges 197 111 00 311 Total patient-days of those discharged.. Total discharges- Average stay in day hospital ~ 4,545 197 23.07 days Table 8. — Summary of Operations, Mental Health Centre, Burnaby, Children's Clinic (Travelling Clinic and Direct Cases), April 1, 1965, to March 31, 1966. intake section Total Total number pending at April 1,1965- Plus assessments—■ Mental Health Services Medical units Public health units Correctional agencies- Social agencies- General practitioners- Private psychiatrists— Totals- Disposition of assessments— O.P.D. activated Day-hospital admissions Social agency recommended- Other medical care Assessment and advice Total pending at March 31,1966- TREATMENT SECTION Report of service:— Active cases brought forward, April 1, 1965_ Cases activated, April 1, 1965, to March 31, 1966- Total Less cases closed- Total under treatment as of March 31, 1966.. Under treatment at Mental Health Centre, Burnaby.- Under treatment, travelling clinic Plus cases pending, March 31, '1966- Total _ 270 1,019 1,289 684 605 297 285 582 23 605 COMMUNITY MENTAL HEALTH SERVICES G 125 Table 9.—Referrals to Children's Clinics by Health Unit and School District of Residence, April 1, 1965, to March 31, 1966 Health Unit Travelling Clinic Direct Total 15 13 28 32 9 13 95 14 43 2 8 33 26 24 14 8 8 7 1 1 1 7 1 2 14 2 21 255 178 25 7 34 41 18 1 1 3 3 7 1 3 1 North Okanagan, Vernon—School District No. 20 Cariboo, Williams Lake— School District Nn 9.7 1 16 School District No. 9:R ! 13 Northern Interior, Prince George—School District No. 57 Upper Fraser Valley, Chilliwack— School District No. 33 28 39 School District No. 34 10 Boundary, Cloverdale— School District No 35 15 School District No, 36 109 School District No. 37 16 Metropolitan Health Committee, Vancouver— School District No. 38 School District No. 39 (Unit No. 1, 34; Unit No. 2, 3®; Unit No. 3, 47; Unit No. 4, 68; Unit No. 5, 68) 21 255 School District No 41 178 25 School District No 45 7 Simon Fraser, New Westminster— School District No. 40- ... 34 84 North Fraser Valley, Mission— School District No. 49. 20 School District No. 75 School District No 76 9 1 Skeena, Prince Rupert— School District No ^ 33 29 School District No. 80 24 Peace River, Dawson Creek— School District No 59 -14 School District No 60 8 Coast Garibaldi, Powell River— 11 School District No 47 7 School District No AX 7 Central Vancouver Island, Nanaimo—School District No. 70 School districts not covered by health units—School District No. 49 1 3 Totals 392 627 1,019 G 126 MENTAL HEALTH SERVICES REPORT, 1965/66 MENTAL HEALTH CENTRE, VICTORIA C. Gregory, Director STAFF AND ORGANIZATION Organization of work in any mental health centre depends on three main factors: the physical plant available, the number of staff and their levels of training and experience, and the general policy to be followed. (a) Physical Plant.—This was the first year of operation in the new building occupied in January, 1965, and after the initial settling-jn period the vast improvement in accommodation became reflected in the marked increase in both quality and quantity of service offered to the community. Its proximity to the Royal Jubilee Hospital has proved most useful for both hospital and centre, and has been an important factor in the promotion of closer working relationships with the medical profession. The availability of more than adequate space has not only enabled us to offer a wider range of activities than before, but has promoted an atmosphere of ease of access for the workers in the various social agencies, thereby encouraging a free, less inhibited use of the centre by them. (b) Staff.—Establishment increased with the provision of a new building but the actual recruiting took place during this year, in which we achieved complete establishment. (c) Policy.—The basis of policy is the provision of a comprehensive mental health service for the community of Greater Victoria, and by far the most important and difficult single problem facing us is the attainment of the optimum integration and co-operation between all the various agencies which are concerned with mental health, directly or indirectly. A number of significant steps were taken toward this end:— (1) A conference was held in September, 1965, under the sponsorship of the University of Victoria, to which all agencies and individuals working in this field were invited, the immediate objective of which was to ensure exposure of those from each discipline to the viewpoints of those from other disciplines. This was eminently successful, and a follow-up conference is being planned to discuss both the immediate steps which can be taken to promote inter-agency co-ordination and to consider the objectives of a long-term plan for the development of mental health facilities in this community during the next 10 to 20 years. (2) Since that conference, a series of discussions has taken place involving the full staff of the centre in each case, and those of the major agencies in turn, the object in each case being to explore the overlaps and gaps in service, the mutual problems faced, and ways in which we might more effectively co-operate with one another. These discussions have been most valuable, and have had quite a dramatic effect in improving both the services we all offer and the atmosphere in which we all operate. (3) Liaison committees consisting of one professional worker from the centre and one from each agency have been established to put into practice the proposals which emerged from the meetings. Thus we have a regular liaison meeting with each of the agencies weekly, to ensure quick and effective handling of problem cases, to discuss management of cases carried mutually, to facilitate inter-agency referral, etc. (d) Organization.—These staff increases, new physical facilities, and the first steps in the direction of the goal we aim for necessitate changes in organization if COMMUNITY MENTAL HEALTH SERVICES G 127 we are to realize our potential. Thus the old dichotomy of the centre into adults' and children's clinics has been abandoned as unwieldly and irrational, the procedures for referral, assessment, and disposition of case completely changed and clarified, and a flexible system adopted which can be, and has been, modified whilst the centre is operating at full pressure, to meet changing conditions. ACTIVITIES OF PROFESSIONAL STAFF All of the above factors have played a part in determining the kind of service, as well as the quality and quantity, we offer, but paramount is the decision to spend more professional time and effort in indirect as against direct service. By direct service is meant acceptance of full and exclusive responsibility for any patient by the centre, whereas indirect service involved the centre as the major mental health resource in the area which offers a range of professional service to agencies which require them, in cases for which the primary responsibility will remain with the agency rather than the centre. 1. Direct service includes:— (a) Psychotherapy carried out on an individual, group, and family basis, and although the first is still available for those who need it, ever greater emphasis is being placed on group, and particularly family group, therapy, which, as the experience of the staff increases with these techniques, is assuming a most potent therapeutic importance, a tendency which is entirely in keeping with current concepts. (b) Pharmacotherapy, which, when taken in conjunction with concern for the general welfare of the individual, plays a paramount role in sustaining patients in the community who, only a few years ago, would have been consigned to a large mental hospital, far from their relatives and friends. In terms of sheer economic investment, the provision of drugs to patients who need them brings great returns. (c) After-care programme, which caters for those patients who have been discharged from the Riverview Hospital. Many of these are found boarding homes in which to live, and are then seen in the boarding home regularly, sometimes jointly with the welfare agencies. This is likely to develop into a major aspect of our work. (d) Electro-shock treatment on an out-patient basis. This was started early in 1966, and in the few cases we have treated in this way, improvement has followed, with complete remission in most. There will be more demand for this service now it has started. 2. Indirect service covers a wide and growing range of activities in the areas we serve, which is roughly equivalent to that of the Greater Victoria Metropolitan Board of Health, but which also includes service to the Brannan Lake School. (a) Assessment of cases, both psychiatric and psychological, is performed for a number of agencies, including the medical practitioners, social agencies, the various School Boards, the Courts. This by itself is, of course, not enough, and we therefore provide— (b) Consultation and, where necessary, joint management of cases with agencies who so desire. Case conferences frequently involve a number of different agencies, and for those cases where the emotional factors are most pressing, we asume a major role without taking over direct reponsi- bility for management. (c) Education is one of our most important functions, whether for professionals or for the general public. G 128 MENTAL HEALTH SERVICES REPORT, 1965/66 (i) Medical Profession.—As a harbinger of things to come, we have tried the experiment of having an interested general practitioner attend the centre and manage one of the patients whom he had referred to us, under the supervision of a psychiatrist. He also attended some of our staff-training sessions, and has declared himelf highly pleased with the results, both for the patient and for himself, in his own enhanced ability to deal with such cases. This has now been extended to include several practitioners, and will almost certainly continue to expand as its usefulness becomes more widely demonstrated. Other ways in which the medical profession has been involved are by means of lectures to the medical staffs of both the Royal Jubilee and St. Joseph's Hospitals, and the Victoria Medical Society has reciprocated our attempts at closer cooperation by demonstrating a more active interest in the practice of psychiatry in the community. (ii) Nursing.—We have continued the course of lectures for the nurses at the Royal Jubilee Hospital, who are doing their three months' training in psychiatry, and regularly have orientation lectures to nurses from St. Joseph's Hospital and other places. (iii) Family Group Therapy.—In conjunction with the consultation service we provide to the various welfare and family agencies, we offer instruction in family group therapy, the practical results of which have been most encouraging, according to the agencies, measured in terms of their increased ability to manage difficult cases. (iv) The General Public.—In spite of the greatly increased demand for talks to various community groups, these have been met by the influx of new staff to the centre, and we are now reaching a fairly large number of people. However, this is not yet sufficient, and a more organized plan for public education and information is now under consideration. (v) Participation in Community Activity.—This has increased, and the centre is represented on a variety of committees which represent organizations involved in some aspect of mental health. (vi) Staff-training.—Continuation of one's professional education is essential if maximum effectiveness is to be sustained, and a regular programme has been carried out since the absorption of new professional staff was completed. 3. Research.—We have decided to examine two questions which we have been compelled to ask, by our experience at the centre over the past several years, both of which have great practical significance. The first relates to what we consider to be an inordinately large percentage of referrals from armed forces families, and will, we hope, enable them to be dealt with more appropriately and effectively. The second is an attempt to clarify the major reasons for referral of young children to the centre, with a view to formulating more clearly possible measures of prevention of emotional disturbances. COMMUNITY CO-OPERATION FOR CHILDREN A fine example of co-operation in the community is the class for emotionally disturbed children which is operated jointly by the Association for Emotionally Disturbed Children, the School Board of District No. 61, and the Mental Health Centre. There are up to eight children in the class, between 6 and 8 years old, and the object is to take them to the point where they can return to ordinary school COMMUNITY MENTAL HEALTH SERVICES G 129 class. This necessarily excludes retarded and severely brain-damaged children, for whom separate facilities are planned. So far results have been good, in spite of some initial difficulties, and several children have returned to their normal classes. SUMMARY OF OPERATIONS Adult Children Total 108 341 72 223 180 564 449 187 295 137 744 324 Cases carried forward at March 31, 1966 262 158 420 Total patient interviews— Psychiatric 2 527 647 574 866 Psychological „,. .. Social worker- 1 Nurses G 130 MENTAL HEALTH SERVICES REPORT, 1965/66 OKANAGAN MENTAL HEALTH CENTRE, KELOWNA F. E. McNair, Director A regional service is set up to meet the needs of a selected population group, the selection being determined by natural geographic boundaries or commercial groupings. The emphasis is on service with direct office consultation and hospital consultation being offered patients without regard to economic standing, chronicity of disorder, or the obstreperousness of the patient. Direct treatment of cases must also be undertaken, and the consultant in psychiatry has to be available at all times in case of emergency. The task of treating emotional disturbances in a community is far more than a specialist group can undertake, however. More than half of the problems of emotional disorder are looked after by family doctors, social agencies, and other resources, and the professional people so engaged need help from the specialist group both in case consultation and in provision for on-going education. Together all persons concerned for the mental health of the community need to strengthen the community resources by identifying special areas of need, by providing for specific educational opportunities and projects, and by taking initiative to start new services. A regional service is community based and depends upon personnel rather than a special building. Many more qualified people are needed in the various regions of the Province before a comprehensive regional service is possible. The part-time employment of qualified personnel within this district has increased considerably the amount of coverage that is given. This is true both with regard to the sessional employment of the private psychiatrist in Vernon and also of the utilization of the pharmacy services in Kelowna and Vernon to provide a prescription service and the laboratory services in Kelowna, Vernon, and Penticton for periodic blood tests. It has been indicated in some studies that the well-integrated community manifests a lesser degree of mental illness and emotional disturbance than a poorly integrated community. This theory parallels experience and theory about groups, families, and individuals. A regional mental health service relies on and contributes to community integration to better meet the needs of its citizens. In the past year we have been involved with the clergy and adult education in a marriage course, initially in Kelowna and later in Vernon and Penticton. We have been called upon to assist in training homemakers and in the formation and training of a volunteer group to visit lonely persons in boarding homes. There has been a continued liaison with the Canadian Mental Health Association both in regard to present services and future programmes. Professional collaboration is an essential aspect in providing services in an integrated manner. Co-operation in this area has been excellent. There is an ongoing dialogue with the Department of Social Welfare in regard to a group-living home for disturbed adolescents and the provision of specialized boarding-home care for the improved mentally ill. We are exploring with the Courts and probation branches, schools, the Public Health Branch, and the Department of Social Welfare how our combined services can be better utilized to meet the needs of the people we serve. We feel that the regional mental health centres must encourage groups and individuals in the communities to build on their strengths in a preventive as well as a recuperative manner. Improved recreational, educational, and employment services provide an atmosphere which makes for the prevention of illness as well as for recovery. A Directory of Community Services, compiled this year by the local COMMUNITY MENTAL HEALTH SERVICES G 131 University Women's Club, required the active participation of many community agencies. It is hoped the directory will stimulate the formation of a community information centre and promote the establishment of a community service council. In this regard we are part of a local group working on the Canadian Conference on Children and are examining the needs of our senior citizens. Early case findings have not altered the incidence of mental disorder. On the other hand, early treatment can reduce the amount of suffering and increase the success of rehabilitation planning and follow-up treatment and reduce the severity and the frequency of relapse. There is room for a new concept of prevention. When children become emotionally ill, diagnosis is made of the nature of the child's disorder and the nature of the family and school setting in which the disorder has occurred. For the most part, treatment is administered through parents but also through school personnel to improve the emotional climate in which the child lives, to promote a change in the attitudes of the people who are dealing with him day in and day out. The implication is that these persons who have the most authority with the child and spend the most time with the child are the ones most likely to influence his life one way or another. We believe earnestly that family life can be strengthened by any service that will help parents do their job better. We have been co-operating with other community resources to develop a family life education programme within the schools which will be beyond the provision of elementary biological facts at puberty to help the teen-ager understand his own emotional growth better and find acceptable standards of conduct, and to help him as an emerging adult to be better prepared to enter marriage and face responsibilities of parenthood. Such a programme requires collaborative effort of teachers, doctors, nurses, social workers, and, most important of all, parents who so often want to help but are not prepared to be considered sick in order to get the kind of help they need. There was a slight decrease in the number of patients treated in the Psychiatric Unit of the Kelowna General Hospital during the year, reflecting a utilization of the ward setting for the treatment of patients requiring a modified therapeutic environment for a somewhat longer period of time. Some of the patients who were previously requiring hospital care for electric treatment are now being managed as out-patients. It is also noted that the development of a treatment service under Dr. W. H. N. Bennee in private psychiatry at Vernon in September, 1965, has reduced the number of patients treated on the ward from Vernon and district from 30 to 16. Although last year there was a fair balance between Kelowna and Penticton utilization of the ward, there is now an increased number of Kelowna cases and a corresponding decreased number of Penticton cases. At first glance it might appear that preference is given to cases closer to the headquarters of the service. One should note, however, that there are still over 50 cases a year being certified to the Riverview Hospital from this total area, though only six have been certified from the Psychiatric Unit. The 93.3 percentage bed occupancy means that it is rare that a bed is available immediately, hence the deferring of admissions is more easily withstood in the area immediately adjacent to Kelowna; on the other hand, a deferred admission from a more distant point may often result in certification and admission to Riverview. The number of cases seen in consultation is shown in the accompanying tables. There is a 34-per-cent increase in the number of children seen and approximately the same number of adults. The big increase is in the amount of treatment given, which is almost double that given the previous year. Increased service reflects the additional personnel—namely, a psychiatric social worker attached to the clinic at Kelowna and a psychiatrist employed on a sessional basis with headquarters in G 132 MENTAL HEALTH SERVICES REPORT, 1965/66 Vernon. Many adults have been seen in private consultation in the North Okanagan area by Dr. Bennee, and these figures, of course, are not shown in these tables, but, none the less, the service has been given and that is what counts. CONSULTATIONS BY AREA, APRIL 1, 1965, TO MARCH 31, 1966 Adults Children Male Female Total Male Female Total Kelowna 70 17 28 10 4 6 94 33 26 7 10 3 164 50 54 17 14 9 54 25 23 33 4 9 24 8 10 5 3 2 78 33 Kamloops 33 38 7 Revelstoke 11 Totals 135 173 308 148 52 200 PATIENTS RECEIVING REGULAR TREATMENT, APRIL 1, 1965, TO MARCH 31, 1966 Kelowna . - - Adults 186 Children 60 Penticton . - - - 97 31 Kamloops - _ 49 19 Vernon - - 31 34 Salmon Arm - 11 7 Revelstoke - 18 8 Totals 392 159 COMMUNITY MENTAL HEALTH SERVICES G 133 VANCOUVER ISLAND MENTAL HEALTH CENTRE, NANAIMO S. E. Jensen, Director The Vancouver Island Mental Health Centre is a community-oriented and family-oriented centre for the control of mental illness through prevention, education, and treatment. The main functions of the clinic are:— (1) The programming of services for the prevention and control of mental disorder through consultation to community care-giving agencies and individuals through preventive intervention directed toward selected high- risk groups within the population of the area served and through screening and early case finding. (2) Consultation to schools, management, and community leaders, to assist them in dealing with communities as dynamic entities rather than as a group of single individuals, and in the interpretation of mutual adjustment processes and in effectively minimizing conflict and competition among agencies. (3) Education of lay persons, as well as professionals and semi-professional personnel, in techniques of healthier personal relations and in prevention of primary and secondary maladjustment and mental illness. The Mental Health Centre began operation in April, 1964, in a hereto un- serviced area of British Columbia—namely, that part of Vancouver Island north of the Malahat and constituted by the combined Central Vancouver Island Health Unit and Upper Vancouver Island Health Unit. During the year 1965/66, the centre has been served by a staff consisting of a psychiatrist, a psychiatric nurse, a social worker, and a receptionist. The clinic is located at the Public Health Centre, in Nanaimo, and travelling clinics serving Duncan, Alberni, Courtenay, and Campbell River work out of offices in the local public health unit. Beds in the Nanaimo Regional Hospital have been available for those patients who require hospital care, and, as a result, few patients have needed to be certified to Riverview Hospital, Essondale. The objective has been to provide as comprehensive a service as possible in Nanaimo and to extend the scope and usefulness of the centre by travelling each month to the other principal centres in the district. While selected patients have been accepted in treatment, this is basically seen as a function belonging with the privately practising psychiatrist, the family doctors, and other professions skilled in counselling (welfare workers, nurses, school counsellors, clergy, etc.), and our aim has been to guide these groups in their management of the patients. During the year a total of 412 patients was seen. Attendance has been excellent, missed appointments have been rare, and there have been few drop-outs. It has been usual for both parents to accompany a child to the centre and for the spouse to accompany an adult. In the main, service to children has had to be limited to assesment and a few hours of counselling to the parents in selected cases. Conferences with school officials are conducted weekly in Nanaimo and monthly in the centres to which the clinic travels. Closeness is also maintained with the Department of Social Welfare and with the probation services. Lecture series on counselling and other relevant aspects of psychiatry have been held for G 134 MENTAL HEALTH SERVICES REPORT, 1965/66 the Ministerial Association, Registered Nurses' Association, and Medical Societies in Nanaimo, Duncan, Alberni, Courtenay, and Campbell River. MENTAL HEALTH REFERRALS IN 1965 Patients Confer- enced Only Adults Children School District or Metropolitan Health Unit New Repeat New Repeat M. F. M. F. M. F. M. F. Central Vancouver Island Health Unit— Duncan, No. 65 Nanaimo, No. 68 Qualicum, No. 69 . Alberni, No. 70 _ _ . ... Upper Island Health Unit— 2 6 4 3 1 7 8 3 4 3 6 17 1 1 4 7 4 1 5 22 6 10 4 14 7 13 1 1 4 1 ~2 ~2 Campbell River, No. 72 Totals - _ 16 I 25 29 7 5 61 27 1 2 2 TOTAL NUMBER OF INTERVIEWS BY THE CLINIC IN 1965 Staff Member Psychiatrist _ Psychiatric social worker (since April, 1965). Psychiatric nurse Total number of referrals in 1965—412. Number of Interviews __ 1,820 .___ 520 .___ 988 COMMUNITY MENTAL HEALTH SERVICES G 135 KOOTENAY MENTAL HEALTH CENTRE, TRAIL G. R. Mansfield, Director The Kootenay Mental Health Centre, serving the East and West Kootenay regions, was opened June 1, 1964. This second annual report covers the first full year of operation. The first 10 months was chiefly devoted to integration with other existing community and regional resources. The 12 months covered by this report reveal considerable expansion of service and concentration on developing programmes in co-operation with other agencies. STAFF The present staff consists of one full-time and one half-time clerk-stenographer, one psychiatric nurse who was with us for five months, a psychiatric social worker, and a psychiatrist-director. It is anticipated that the position of psychologist will be filled on a part-time basis next year. EDUCATION The staff have participated in over 30 major educational functions and a host of minor ones involving over 100 meetings. Noteworthy was a regional workshop on the emotionally disturbed child for teachers and public health nurses, a counsellors' workshop, a family life lecture-discussion series, a panel on family and society, and a panel on youth in a changing world. TRAIL DISTRICT YOUTH LIAISON COMMITTEE The psychiatric social worker is a member of this committee, which meets monthly for discussions on children and youths with particularly complex problems. Represented are all the agencies in the community which deal with young people. It has proved a valuable means of communication, pooling of knowledge, and the development of a co-ordinated treatment and rehabilitation programme eliminating overlapping of service. TRAINING FOSTER-PARENTS An initial group of carefully selected couples are undergoing training by weekly lecture-discussion meetings with the psychiatric social worker. A second group will be started in September, 1966. The Department of Social Welfare is co-operating by furnishing a list of prospective foster-parents, from which we select those with the most potential. The school is undertaking to set up a special class for emotionally disturbed children. This is envisaged as a treatment resource for the more severely disturbed child, who is usually treated in an institution. It will probably be several years before this project is fully operational, but a good start has been made. PROGRAMME FOR THE NEUROLOGICALLY IMPAIRED CHILD In co-operation with the schools, public health, and a local optometrist, the neurologically impaired child is receiving special attention. This is the child with specific learning defects involving the acquisition of language function. The majority of these suffer from congenital dysphasia of various types. The most common is dyslexia. Over 50 of these children have been identified in the past year. These G 136 MENTAL HEALTH SERVICES REPORT, 1965/66 children require special remedial teaching techniques. In September, 1966, two special classes for these children will be established in the Trail area with teachers trained in this field. PREVENTION In accordance with the philosophy of development adopted by the Mental Health Services Branch, prevention of mental ill health by working with the public health nurses has been given due consideration. Every Friday is devoted to conferences, and 2 hours are allotted for formal teaching and discussion of cases carried by the nurses. This has proved quite rewarding as the nurse's knowledge of mental hygiene has permitted her to approach families with a member ill or emotionally disturbed with greater confidence and effectiveness. TRAVELLING CLINIC A consultative service to the East Kootenay is rendered by a travelling clinic 2 days each month to Cranbrook. This has served to develop an enthusiastic climate of acceptance in the East Kootenay region. REGIONAL SERVICE The total number of patients seen was 401, of which 379 are covered in the detailed statistical tables following. This difference is due to the fact that the 23 cases seen by the psychiatric nurse are not included in the annual statistical case load. These cases involved 87 interviews, chiefly to ex-patients from Riverview Hospital in boarding homes. There were 901 interview hours by the social worker, of which 80 per cent was spent in casework. The psychiatrist participated in 1,021 psychotherapeutic hours and in addition carried out psychological testing on 83 children. Treatment offered is child guidance, adult psychotherapy, family-centred group psychotherapy, pre-marital counselling, marital counselling, and pharmacotherapy. Consultations are carried out chiefly on the travelling clinic, for the Department of Social Welfare and the Attorney-General's Department, but family doctors also avail themselves of this service. A detailed breakdown of referrals and service to various areas follows in the statistical tables. Referrals Source Total Area Adults Children 195 82 38 36 28 379 Trail 130 8 1 2 1 10 4 2 1 8 2 39 16 1 Referrals initiated by schools — Trail... , 54 Referrals initiated by Department of Social Welfare Nelson Trail 3 14 7 3 Trail 19 12 Nelson Trail 2 14 4 Totals _. ... 169 210 COMMUNITY MENTAL HEALTH SERVICES Service G 137 Mental Health Centre, TraiL Consultations Travelling Clinic, Cranbrook- Directly to Mental Health Centre from East Kootenay- Travelling Clinic, Nelson— Directly to Mental Health Centre from Nelson area- Total assessments Treatment Mental Health Centre, Trail- Adults 63 16 22 1 24 Children 126 67 33 60 14 9 22 Patients 96 112 56 138 | 264 72 139 STATISTICAL TABLES Table 1.—Summary of Operations, Kootenay Mental Health Centre, Trail, April 1, 1965, to March 31, 1966 Adults Children Total Brought forward, April 1, 1965 14 169 19 210 33 379 183 229 412 168 201 15 9.R 369 43 G 138 MENTAL HEALTH SERVICES REPORT, 1965/66 w to a 2 < D O o I w o < tn O Z O < ►J < H Z w a o\ « ., Z I u^ S3 O H H w vo ffi Ol " I—I iJ ~ < ri zri < Z U4 H 8 M o H Z o S H K W i-l ca d « go ZS so ^miNNrtcoH^ th cs cn vo Tt cs Mcoinm« ii-»i-t o\ cs tncs cn cs T-inmcs Nr> fe*"* | t | r» j *h cs If* ** ri «n o y-t <-< m t- ^ ! i cs *-i i i i ii i i i i iii i i i i i i es i-t i-i CS rt IN i I < I I I I 1 I to .a ; OJ u i- d> ' o ft .2 « , ■O.E5 o o fl e3 « 2 to —i ess ■M o a o « «3 B 3 8 g M O 2 S-ss 9So e> a) P (i If IJ & "S3 2 y w xi n fl '£ a -^ 6. 1 a ! 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