@prefix ns0: . @prefix edm: . @prefix dcterms: . @prefix dc: . @prefix skos: . ns0:identifierAIP "861be041-17f6-48ab-9569-cd317a8d53d9"@en ; edm:dataProvider "CONTENTdm"@en ; dcterms:alternative "MENTAL HEALTH SERVICES REPORT, 1954-55"@en ; dcterms:isReferencedBy "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198"@en ; dcterms:isPartOf "Sessional Papers of the Province of British Columbia"@en ; dcterms:creator "British Columbia. Legislative Assembly"@en ; dcterms:issued "2017-07-11"@en, "[1956]"@en ; edm:aggregatedCHO "https://open.library.ubc.ca/collections/bcsessional/items/1.0348913/source.json"@en ; dc:format "application/pdf"@en ; skos:note """ DEPARTMENT OF PROVINCIAL SECRETARY Mental Health Services PROVINCE OF BRITISH COLUMBIA ANNUAL REPORT FOR TWELVE MONTHS ENDED MARCH 3 1st 1955 VICTORIA, B.C. Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majest> 1955 To His Honour Frank Mackenzie Ross, C.M.G., M.C., Lieutenant-Governor oj the Province oj British Columbia. May it please Your Honour: The undersigned respectfully submits herewith the Annual Report of the Director of Provincial Mental Health Services for the fiscal year ended March 31st, 1955. W. D. BLACK, Provincial Secretary. Provincial Secretary's Office, December 16th, 1955. The Honourable W. D. Black, Provincial Secretary, Victoria, B.C. Sir,—I have the honour to submit the Annual Report of the Provincial Mental Health Services for the twelve months ended March 31st, 1955, being the Eighty-third Annual Report. Of particular significance during the year under review has been the following:— (a) The gratifying changes in the community attitude toward mental illness and mental institutions, and the organization of a volunteer programme developed with the help of the British Columbia Division of the Canadian Mental Health Association, as a result of which teams of visitors make regular visits to patients in the hospital. Amongst the volunteers are members of several nationalities, thus enabling our patients of foreign extraction to converse in their own language with visitors. Similarly, the British Columbia Society for Handicapped Children is being of great assistance in developing community interest in the welfare of physically and mentally handicapped children, both within and without The Woodlands School. (b) The accelerated treatment programme directed toward the more-prolonged treatment areas of the Mental Hospital, which is being reflected in the increasing number of patients being discharged from these wards. (c) As will be noted in the statistical tables included in the report of the Director of Mental Health Services, the increase by eighty-eight in the patient population is the lowest in the last ten-year period, although it must be borne in mind that a considerable waiting-list for applicants to The Woodlands School and to the Homes for the Aged is accruing. However, this very satisfactory result does reflect the influences of the early active treatment programme of the Crease Clinic, for which such high hopes were created when the Clinic was first opened in 1951, and of the increased treatment programme being carried out in the Mental Hospital itself. I cannot commend to you too highly the high devotion to duty and to the welfare of our patients on the part of the staff of the Provincial Mental Health Services in all its branches under the able administration and leadership of Dr. A. M. Gee, the Director of Mental Health Services. The members of the staff carry out their duties efficiently and with the utmost understanding and patience. I have the honour to be, Sir, Your obedient servant, R. A. PENNINGTON, Deputy Provincial Secretary. Deputy Provincial Secretary's Office, December 14th, 1955. TABLE OF CONTENTS Page Officers and Staff, List of 13 PART I.—HEADQUARTERS Report—Director of Mental Health Services 17 Table Showing Movement of Population in Individual Institutions of Mental Health Services 34 Report—Business Manager 35 Financial Tables— Table A.—Average Number in Residence, Maintenance, and per Capita Cost Individual Institutions for Past Ten Years 38 Table B.—Summary of Gross and Net per Capita Cost of Patients in All Mental Health Services Institutions 39 Table C.—Expense Statement, The Woodlands School, New Westminster 40 Table D.—Expense Statement, Provincial Mental Hospital, Essondale 40 Table E.—Expense Statement, Provincial Mental Home, Colquitz 41 Table F.—Expense Statement, Home for the Aged, Port Coquitlam 41 Table G.—Expense Statement, Home for the Aged, Vernon 42 Table H.—Expense Statement, Home for the Aged, Terrace 42 Table I.—Expense Statement, Crease Clinic of Psychological Medicine, Essondale 43 Expenditures under Federal Health Grants 44 Report—Personnel Officer 45 PART II.—CREASE CLINIC OF PSYCHOLOGICAL MEDICINE AND PROVINCIAL MENTAL HOSPITAL Report of Crease Clinic—Dr. A. E. Davidson 48 Report of Mental Hospital—Dr. T. G. Caunt 50 Report of Treatment Services—Dr. F. E. McNair 54 Report of Occupational Therapy, Women's Division—Mrs. K. Feltham 60 Report of Occupational Therapy, Men's Division—R. Herring 64 Report of Recreational Therapy—R. L. Ramsay 67 Report of Audio-Visual Department—G. H. Walker 70 Report of Library—Miss H. M. Walsh 72 Report of Department of Physical Medicine—Dr. F. E. McNair 73 Report of Dental Department—Dr. H. O. lohnsen 74 Report of Optician—H. H. Woodbridge 75 Report of Beauty-parlour—Mrs. M. Townsend 75 Report of Department of Dietetics—Miss C. Neighbor 76 Report of Department of Neurology—Dr. W. P. Fister 77 Report of Laboratory—Dr. H. E. Wilson 78 Report of Department of Radiology—Dr. J. M. Jackson 82 Report of Department of Psychology—Miss A. J. Elart 83 Report of Social Service Department—Miss A. K. Carroll 86 Report of Chaplain—J. F. O'Neil 97 Report of Department of Nursing, Women's Division—Miss E. M. Pullan 99 Report of Department of Nursing, Men's Division—R. H. Strong 101 Report of Department of Nursing Education—Miss O. J. Smith 102 Report of Rehabilitation Service, Women's Division—Dr. F. E. McNair 103 Report of Rehabilitation Service, Men's Division—J. D. Addison 104 7 M 8 MENTAL HEALTH SERVICES REPORT, 1954-55 Statistical Tables— page Crease Clinic of Psychological Medicine— Table No. 1.—Movement of Population 106 Table No. 2.—Summary of Operations since Inception 106 Table No. 3.—First Admissions by Health Unit and School District of Residence and Sex 107 Table No. 4.—First Admissions and Readmissions by Method of Admission, Age-group, and Sex 108 Table No. 5.—First Admissions by Mental Diagnosis, Age-group, and Sex 109 Table No. 6.—Readmissions by Mental Diagnosis, Age-group, and Sex .... 112 Table No. 7.—First Admissions by Mental Diagnosis, Marital Status, and Sex 114 Table No. 8.—Readmissions by Mental Diagnosis, Marital Status, and Sex 115 Table No. 9.—First Admissions by Mental Diagnosis, Years of Schooling, and Sex 115 Table No. 10.—Readmissions by Mental Diagnosis, Years of Schooling, and Sex 115 Table No. 11.—First Admissions by Citizenship, Age-group, and Sex 115 Table No. 12.—First Admissions by Religion and Sex 115 Table No. 13.—First Admissions by Previous Occupation and Sex 115 Table No. 14.—Live Discharges by Condition on Discharge, Disposition to, and Sex 116 Table No. 15.—Live Discharges by Mental Diagnosis, Condition on Discharge, and Sex 116 Table No. 16.—Live Discharges by Mental Diagnosis, Age-group, and Sex 117 Table No. 17.—Live Discharges by Mental Diagnosis, Length of Stay, and Sex 120 Table No. 18.—Deaths by Mental Diagnosis, Age-group, and Sex 121 Table No. 19.—Deaths by Cause of Death, Age-group, and Sex 121 Provincial Mental Hospital— Table No. 1.—Movement of Population 122 Table No. 2.-—Summary of Operations since Inception 123 Table No. 3.—First Admissions by Health Unit and School District of Residence and Sex 125 Table No. 4.—First Admissions and Readmissions by Method of Admission, Age-group, and Sex 126 Table No. 5.—First Admissions by Mental Diagnosis, Age-group, and Sex 127 Table No. 6.—Readmissions by Mental Diagnosis, Age-group, and Sex... 129 Table No. 7.—First Admissions by Mental Diagnosis, Marital Status, and Sex 131 Table No. 8.—Readmissions by Mental Diagnosis, Marital Status, and Sex 132 Table No. 9.—First Admissions by Years of Schooling, Mental Diagnosis, and Sex 132 Table No. 10.—Readmissions by Years of Schooling, Mental Diagnosis, and Sex 132 Table No. 11.—First Admissions by Citizenship, Age-group, and Sex 132 Table No. 12.—First Admissions by Religion and Sex 132 Table No. 13.—First Admissions by Previous Occupation and Sex 132 Table No. 14.—Live Discharges by Condition on Discharge, Disposition to, and Sex 133 Table No. 15.—Live Discharges by Mental Diagnosis, Condition on Discharge, and Sex 133 TABLE OF CONTENTS M 9 Statistical Tables—Continued Page Provincial Mental Hospital—Continued Table No. 16.—Live Discharges by Mental Diagnosis, Age-group, and Sex 134 Table No. 17.—Live Discharges by Mental Diagnosis, Length of Stay, and Sex 136 Table No. 18.—Deaths by Mental Diagnosis, Age-group, and Sex 137 Table No. 19.—Deaths by Mental Diagnosis, Length of Stay, and Sex 138 Table No. 20.—Deaths by Cause of Death, Age-group, and Sex 139 Table No. 21.—Deaths by Cause of Death, Length of Stay, and Sex 140 PART III.—THE WOODLANDS SCHOOL Report of Medical Superintendent—Dr. C. E. Benwell 141 Report of Educational Department—Mrs. H. M. Davy 144 Report of Occupational Therapy, Girls' Division—Miss F. M. Robertson 145 Report of Occupational Therapy, Boys' Division—H. Mercer 147 Report of Recreational Therapy—J. A. Lynes 148 Report of Dental Department—Dr. S. J. Gallagher 149 Report of Department of Dietetics—Miss J. Ing 150 Report of Laboratory—Dr. H. E. Wilson 150 Report of Department of Radiology—Dr. J. M. Jackson 152 Report of Beauty-parlour—Mrs. J. DeCoene 153 Report of Department of Nursing, Women's Division—Miss V. M. Sanders 153 Report of Department of Nursing, Men's Division—J. N. Elliot 154 Report of Department of Nursing Education—Miss E. M. Pullan 154 Report of Department of Physiotherapy—Mrs. J. M. Granberg 155 Report of Department of Psychology—Dr. T. T. Coulter 155 Report of Social Service Department—Miss A. K. Carroll 156 Statistical Tables— Table No. 1.—Movement of Population 162 Table No. 2.—Summary of Operations since Inception 162 Table No. 3.—First Admissions by Health Unit and School District of Residence and Sex 162 Table No. 4.—First Admissions by Mental Diagnosis, Age-group, and Sex 163 Table No. 5.-—First Admissions by Years of Schooling, Mental Diagnosis, and Sex 163 Table No. 6.—First Admissions by Citizenship, Age-group, and Sex 163 Table No. 7.—First Admissions by Religion and Sex 163 Table No. 8.—First Admissions by Previous Occupation and Sex 163 Table No. 9.—Live Discharges by Mental Diagnosis, Condition on Discharge, and Sex 163 Table No. 10.—Live Discharges and Deaths by Mental Diagnosis, Age-group, and Sex 164 Table No. 11.—Live Discharges and Deaths by Mental Diagnosis, Length of Stay, and Sex 165 Table No. 12.—Deaths by Cause of Death, Age-group, and Sex 166 Table No. 13.—Deaths by Cause of Death, Length of Stay, and Sex 167 PART IV.—PROVINCIAL MENTAL HOME, COLQUITZ Report of Medical Superintendent—Dr. L. G. C. d'Easum 168 Report of Occupational Therapy Department—H. Helander 169 Report of Recreational Therapy Department—J. Lowndes 170 M 10 MENTAL HEALTH SERVICES REPORT, 1954-55 Page Report of Dental Department—Dr. W. G. Dempsey 171 Report of Department of Nursing Services—P. T. McLeod 171 Report of Training School—J. Lowndes 172 Statistical Tables- Table No. 1.—Movement of Population 173 Table No. 2.—Transfers by Health Unit and School District of Residence 173 Table No. 3.—Transfers by Mental Diagnosis and Age-group 173 Table No. 4.—Transfers by Mental Diagnosis and Marital Status 174 Table No. 5.—Transfers by Years of Schooling and Mental Diagnosis 174 Table No. 6.—Transfers by Citizenship and Age-group 174 Table No. 7.—Transfers by Religion 174 Table No. 8.—Transfers by Previous Occupation 174 Table No. 9.—Live Discharges by Mental Diagnosis and Condition on Discharge 174 Table No. 10.—Live Discharges from and Deaths Occurring by Mental Diagnosis and Age-group 174 Table No. 11.—Live Discharges from and Deaths Occurring by Mental Diagnosis and Length of Stay 175 Table No. 12.—Deaths by Cause of Death and Age-group 175 PART V.—GERIATRIC DIVISION Report of Medical Superintendent—Dr. B. F. Bryson 176 Statistical Tables— Home for the Aged, Port Coquitlam— Table No. 1.—Movement of Population 184 Table No. 2.—First Admissions by Health Unit and School District of Residence and Sex 184 Table No. 3.—First Admissions by Mental Diagnosis, Age-group, and Sex 185 Table No. 4.—First Admissions by Mental Diagnosis, Marital Status, and Sex 185 Table No. 5.—First Admissions by Mental Diagnosis, Years of Schooling, and Sex 185 Table No. 6.—First Admissions by Citizenship, Age-group, and Sex 185 Table No. 7.—First Admissions by Religion and Sex 185 Table No. 8.—First Admissions by Previous Occupation and Sex 185 Table No. 9.—Live Discharges by Mental Diagnosis, Condition on Discharge, and Sex 186 Table No. 10.—Live Discharges and Deaths by Mental Diagnosis, Age- group, and Sex 186 Table No. 11.—Live Discharges and Deaths by Mental Diagnosis, Length of Stay, and Sex 187 Table No. 12.—Deaths by Cause of Death, Age-group, and Sex 188 Table No. 13.—Deaths by Cause of Death, Length of Stay, and Sex 189 Home for the Aged, Vernon— Table No. 1.—Movement of Population 190 Table No. 2.—First Admissions by Health Unit and School District of Residence and Sex 190 Table No. 3.—First Admissions by Age-group, Method of Admission, and Sex 190 TABLE OF CONTENTS M 11 Page Statistical Tables—Continued Home for the Aged, Vernon—Continued Table No. 4.—First Admissions by Mental Diagnosis, Age-group, and Sex , 191 Table No. 5.—First Admissions by Mental Diagnosis, Marital Status, and Sex 191 Table No. 6.—First Admissions by Mental Diagnosis, Years of Schooling, and Sex 191 Table No. 7.—First Admissions by Citizenship, Age-group, and Sex 191 Table No. 8.—First Admissions by Religion and Sex 191 Table No. 9.—First Admissions by Previous Occupation and Sex 191 Table No. 10.—Live Discharges by Condition on Discharge, Disposition to, and Sex 192 Table No. 11.—Live Discharges by Mental Diagnosis, Condition on Discharge, and Sex 1 192 Table No. 12.—Live Discharges and Deaths by Mental Diagnosis, Age- group, and Sex 192 Table No. 13.—Live Discharges and Deaths by Mental Diagnosis, Length of Stay, and Sex 193 Table No. 14.—Deaths by Cause of Death, Age-group, and Sex 193 Table No. 15.—Deaths by Cause of Death, Length of Stay, and Sex 194 Home for the Aged, Terrace— Table No. 1.—Movement of Population 195 Table No. 2.—First Admissions by Health Unit and School District of Residence 195 Table No. 3.—First Admissions by Mental Diagnosis and Age-group 195 Table No. 4.—First Admissions by Mental Diagnosis and Marital Status___ 196 Table No. 5.—First Admissions by Mental Diagnosis and Years of Schooling 196 Table No. 6.—First Admissions by Citizenship and Age-group 196 Table No. 7.—First Admissions by Religion 196 Table No. 8.—First Admissions by Previous Occupation 196 Table No. 9.—Live Discharges by Mental Diagnosis and Condition on Discharge 196 Table No. 10.—Live Discharges and Deaths by Mental Diagnosis and Age-group 197 Table No. 11.—Live Discharges and Deaths by Mental Diagnosis and Length of Stay 197 Table No. 12.—Deaths by Cause of Death and Age-group 197 Table No. 13.—Deaths by Cause of Death and Length of Stay 198 PART VI.—CHILD GUIDANCE CLINICS Report of Director—Dr. U. P. Byrne 199 Report of Social Service Department—R. W. MacDonald 206 Report of Psychology Department—Miss M. Munro 209 PART VII.—COLONY FARM Report of Business Manager—F. A. Matheson 212 OFFICERS AND STAFF PROVINCIAL MENTAL HEALTH SERVICES Department of the Provincial Secretary Hon. W. D. Black, Provincial Secretary. R. A. Pennington, O.B.E., F.C.I.S., Deputy Provincial Secretary. HEADQUARTERS STAFF A. M. Gee, M.D., CM., F.A.P.A., Director of Mental Health Services. A. E. Davidson, B.A., M.D., F.A.P.A., Deputy Director of Mental Health Services. F. A. Matheson, Business Manager. C. B. Watson, M.A., Administrative Assistant. J. Dowling, Administrative Assistant (Personnel). Miss A. K. Carroll, B.A., M.S.W., Provincial Supervisor, Psychiatric Social Work. Miss E. M. Pullan, R.N., B.A.Sc, Director of Nursing. PROVINCIAL MENTAL HOSPITAL AND CREASE CLINIC OF PSYCHOLOGICAL MEDICINE, ESSONDALE T. G. Caunt, M.D., F.A.P.A., F.A.G.S., Medical Superintendent. F. E. McNair, B.A., M.D., CM., Clinical Director. J. M. Jackson, M.D., Director of Radiology. G. A. NlCOLSON, B.A., M.D., Director of Laboratories. W. P. Fister, M.D., M.R.C.P.{Edin.), F.R.C.P.(C), Director of Neurology. W. E. Powles, B.A., M.D., CM., Assistant Clinical Director. N. L. Richardson, M.D., CM., Assistant Clinical Director. G. H. Stephenson, M.D., Assistant Clinical Director. J. Walsh, M.B., B.Ch., D.P.M., Assistant Clinical Director. R. Halliday, M.B., B.Ch., D.P.M., Assistant Clinical Director. C. E. Derkson, M.D., CM. I. S. Kenning, B.Sc, M.D., CM. T. Dobreva, M.D. F. G. Tucker, M.B., B.S. M. O. Calverley, B.Sc, M.D. L. T. Jordan, B.A., M.D., CM. A. M. Creamer, M.B., B.Ch., D.P.M., D.P.H. 0. Karabanow, M.D. F. H. G. Mills, M.D. J. E. Miles, B.A., M.D., CM. H. L. Sussman, M.B., Ch.B. R. R. McLeod, B.A., M.D. 1. TlSCHLER, M.D. A. M. Beach, B.A., M.D., CM. W. Lazorko, M.D. H. O. Johnsen, D.D.S. G. D. Campbell, D.D.S. Miss A. J. Elart, B.A., Psychologist. R. L. Ramsey, B.Sc, Director of Recreation. K. Woolcock, Pharmacist. G. H. Walker, Audio-Visual Department. W. Creber, Chief Male Psychiatric Nurse. Miss O. J. Smith, B.A., R.N., Instructor of Nursing. Miss C L. Neighbor, B.Sc. (H.Ec), Chief Dietician. Mrs. K. Feltham, B.A., O.T.Reg., Supervisor, Occupational Therapy (Women's Division). R. Herring, Supervisor, Occupational Therapy (Men's Division). J. D. Addison, Rehabilitation Officer (Men's Division). Miss H. Walsh, B.A., B.L.Sc, Librarian. Miss A. D. Dingle, Senior Stenographer. Consultant Staff: F. A. Turnbull, B.A., M.D., F.R.CS.(Can.), Neurosurgery. James W. Wilson, M.D., CM., F.R.CS.(Can.), M.S.(Minn.), General Surgery. George T. Wilson, B.A., M.D., CM., F.R.CS.(Can.), General Surgery. R. E. Outerbridge, M.D., F.R.CS.(C), F.A.C.S., Orthopcedic Surgery. Business: J. G. Anderson, Assistant Business Manager. W. Gueho, Cashier. G A. Grieve, Cost Accountant. R. Boulter, Steward. Miss A. Mikita, Business Stenographer. Rev. John F. O'Neil, Protestant. Chaplains: Rev. Father J. P. Kane, Roman Catholic. Colony Farm: W. B. Richardson, B.Sc(Agriculture), Superintendent. 13 M 14 MENTAL HEALTH SERVICES REPORT, 1954-55 THE WOODLANDS SCHOOL, NEW WESTMINSTER C. E. Benwell, M.B., Medical Superintendent. A. Gallinger, M.D., CM. M. C. Ellis, B.Sc, M.D., CM. B. Tischler, M.D. S. J. Gallagher, B.Sc, D.D.S. Mrs. T. Coulter, B.A., M.A., Ph.D., Psychological Clinic Assistant. Miss V. M. Sanders, R.N., Superintendent of Nurses. Miss J. Ing, B.Sc. (H.Ec), Dietician. Miss M. C. Hardy, Supervisor, Psychiatric Social Work. Mrs. H. M. Davy, School Principal. H. Mercer, Industrial Arts Instructor. J. Lynes, Recreational Instructor. Miss F. Robertson, Occupational Therapist. J. Elliot, Chief Male Psychiatric Nurse. R. Nash, Instructor, Male Psychiatric Nursing. Mrs. J. Cliffe, Clerk-Stenographer. Business: W. O. Booth, Deputy Business Manager. Rev. P. C. McCrae, Protestant. Chaplains: Rev. Father D. J. McIntosh, Roman Catholic. PROVINCIAL MENTAL HOME, COLQUITZ L. G. C. d'Easum, M.B., Medical Superintendent. H. C. Yardley, Deputy Business Manager. P. T. McLeod, Chief Male Psychiatric Nurse. GERIATRIC DIVISION B. F. Bryson, B.A.. L. W. Fox, Supervisor, Vernon. M.D., CM., Medical Superintendent W. E. Skillicorn, Supervisor, Terrace. CHILD GUIDANCE CLINICS U. P. Byrne, M.D., D.P.H., D.I.H., F.A.P.H.A., F.A.P.A., Director. Miss M. Munro, B.A., M.A., Supervisor, Psy- D. B. Ricketts, B.A., A.M., Supervisor, Social chology. Work. Mrs. M. Harvey, B.A.Sc, R.N., Supervisor, Public Health Nursing. Vancouver and Travelling Clinics: G. M. Kirkpatrick, B.A., M.D., Psychiatrist. F. E. Broughton, B.A., M.D., Psychiatrist. Mrs. O. McRae, B.A., D.C.S., Psychologist. Mrs. D. Reeves, B.A., Psychologist. Miss M. Hopkins, B.A., Psychologist. Miss R. Stokes, B.A., M.A., Psychologist. Mrs. S. LePage, B.A., Psychologist. Miss A. Cameron, B.A., Psychologist. H. J. Heilbron, B.A., Psychologist. Miss S. Carmichael, R.N., C.P.H., Nurse. Mrs. A. Artman, R.N., C.P.H., Nurse. Miss E. Mackenzie, L.C.S.T.(Eng.), Speech Therapist. Miss J. Maza, Senior Stenographer. R. W. Macdonald, B.A. B.S.W., Acting Supervisor. Mrs. E. Chave, B.A., M.S.W., Casework Supervisor- Miss K. Daly, B.A., B.S.W., Casework Supervisor. Miss B. Sanderson, B.A., B.S.W., Social Worker. G. W. Pepper, B.A., M.S.W., Casework Supervisor. M. Sutherland, B.A., M.S.W., Acting Casework Supervisor. Mrs. V. Ellis, B.A., M.S.W., Social Worker. S. E. Kerslake, B.A., B.S.W., Social Worker. W. J. Camozzi, B.A., B.S.W., Social Worker. Mrs. D. Beck, B.A., M.S.W., Social Worker. Mrs. P. Coyle, B.A., B.S.W., Social Worker. Mrs. M. Christensen, B.A., M.S.W., Social Worker. Mrs. J. Lee, B.A., B.S.W., Social Worker. Mrs. E. Webster, B.A., B.S.W., Social Worker. V. Hromadka, M.P.Sc.Soc, M.S.W., Social Worker. Vancouver Island Clinics: W. L. Valens. Miss F. Macdonald, B.A., M.A., Psychologist. P. Laeser, B.A., Psychologist. Mrs. M. Duncan, R.N., C.P.H. Mrs. A. Allen, B.A M.D., CM., Director. Mrs. A. Newton-White, B.A., M.S.W., Casework Supervisor. J. Allman, B.A., B.S.W., Social Worker. M.S.W., Social Worker. School of Psychiatric Nursing graduation exercises, May 13th, 1954, REPORT OF MENTAL HEALTH SERVICES For the Twelve Months Ended March 31st, 1955 PART I.—HEADQUARTERS REPORT OF DIRECTOR OF MENTAL HEALTH SERVICES R. A. Pennington, Esq., O.B.E., F.C.I.S., Deputy Provincial Secretary, Parliament Buildings, Victoria, B.C. Sir,—In compliance with the "Mental Hospitals Act," the Eighty-third Annual Report of the British Columbia Mental Health Services is submitted herewith. INTRODUCTION Mental illness still remains the greatest single problem in the national health picture to-day. More than half of the nation's hospital beds are devoted to the care of the mentally ill. However, there is every hope that this picture may be changed during the next decade if governments are prepared to make the necessary expenditures to advance preventive programmes, active treatment, and research. The present upsurge of public interest in matters pertaining to mental health indicates that the public are prepared to bear the necessary expense to deal adequately with the problem. We are all encouraged by the statement of Dr. lonas Salk, who recently developed the polio vaccine, that science should now turn its attention toward mental illness as the next major health problem of preventive medicine. During the coming year some 18,000 Canadians will be admitted for the first time to Canada's seventy-seven mental institutions and 9,000 additional citizens will seek readmission. In our own Province 2,000 persons will be admitted for the first time and 1,000 will be admitted as readmissions. The degree to which the public's attitude has changed toward mental illness and mental institutions in recent years is exemplified in the fact that over 40 per cent of our admissions and readmissions will be made voluntarily. A large number of these individuals will be young. A large number will be admitted in their declining years. A great many will be of superior intelligence, and another large number will be of limited intellectual capacity. Over 50 per cent of these 3,000 prospective patients will be suffering from mental illness of an acute nature. Their illness will be amenable to treatment, and 94 per cent of this group will be back in their homes within a four-month period. Two-thirds of the total group of 3,000 will be back in the community some time during the first year following their admission. The remaining third, for the most part, will be constituted by a group of mental defectives, mostly children, who will require years of education and training, together with another large group whose mental symptoms are dependent upon cerebral degenerative changes associated with their advanced years. This remaining third accounts for the increase in the resident population of our mental hospitals. This annual increase in resident population averages over the past ten years 1,393 patients for all Canadian mental hospitals. This increase is the result, not so much from an increase in the incidence of mental illness, but rather from the growth of the whole population and the larger number and proportion of older people. This last factor is of great significance in our own Province, where 11 per cent of the population is over 65 years of age, against a national average of 7.75 per cent. 17 M 18 MENTAL HEALTH SERVICES REPORT, 1954-55 Great changes are now taking place in the community attitude toward mental illness and mental institutions. As a result of this moderation in public attitude, great improvements have resulted in the internal management of the mental hospital. Hospital wards which were previously double locked, on the inside to keep the public out and on the outside to keep the patient in, are now shedding some of their locked doors. Mental hospitals are now becoming respectable places in which to visit your friends and relatives, even respectable enough to consider admitting yourself as a patient if the need should arise. Increasingly we are moving toward a community-centred type of psychiatry in which it is realized that the community in which the patient lives has a responsibility, that any resident may at any time require hospitalization during a phase of his illness, and that when hospitalization is no longer required he has a right to return to the community with his former status as a resident. Communities are now asking that psychiatric facilities and services be provided in their locality, where formerly overtures in this direction would have met with rejection. Keeping pace with these improved community attitudes, even greater changes are occurring within the hospital. An atmosphere of greater freedom has been developed with the increase in the number of " open wards " in which locked doors have been removed. Two additional large wards in the Mental Hospital have been classified as " open wards " during recent months. Five such wards are now functioning in the Mental Hospital and two in the Crease Clinic, serving a total of 537 patients. In addition, several hundreds of other patients have been granted freedom privileges within the grounds. It will be noted that the Annual Sports Day event was attended by 1,500 patients in the open playing-fields. I would like to speak favourably of our accelerated treatment programme which is being continued in the more prolonged treatment areas of the Mental Hospital. I would refer you to the increasing numbers of patients that are being discharged from these wards. These present-day changes in psychiatry are being reflected architecturally in our building programme. No longer will you be confronted in our new structures with a multiplicity of small panes of glass surrounded by steel sash. Our new buildings will present a more pleasing exterior, from which all obvious signs of restraint have been removed. The buildings will be planned around small functional nursing units adapted to treatment purposes rather than for the domiciliary care of large groups of patients. These changes in what might be summarized as environmental therapy are probably the greatest single advance in our therapeutic programme. Great strides have also been made in more specific instances. General paresis, which formerly constituted 10 to 12 per cent of our admissions, has now been practically eliminated from the field of psychiatry and is now an aspect of preventive medicine dealing with the prevention and early treatment of syphilis. Agitated depressions of middle life together with other depressive reactions respond dramatically to appropriate treatment. Schizophrenia is no longer the completely hopeless condition that it was in former years. Over 50 per cent of these patients can be assisted back to the community after a relatively short period of active treatment. Epilepsy, which formerly contributed a large number of long-stay patients, has been brought under control to the point that the majority of this group can continue to live relatively normal lives while under continued medical supervision. A glance at our statistical tables will show that each year there is a widening of the horizons of psychiatry. More and more patients are being given service for shorter periods of time. But fewer and fewer patients, other than the mentally defective and elderly groups, are being retained for lengthy periods of time. An active-treatment programme of this nature is costly, particularly during the present transition stages, where we are still dealing with large numbers of our former treatment failures in greatly overcrowded buildings. The most serious bottleneck in the provision of proper treatment for the mentally ill is the shortage of trained personnel. This situation is gradually improving, with the exception of trained psychiatric nurses, in so far as availability is concerned, but HEADQUARTERS M 19 governments must be prepared to provide salary levels that will attract and hold well- trained people. The furtherance of a community-oriented type of treatment programme requires the development of a number of bridges to span the gap between the community and the hospital. Chief among these is a well-integrated social service department giving assistance to the patient and the family during both the hospitalization phase of treatment and the post-discharge period. Closely allied to this service and equally important is the rehabilitation period. This may involve the securing of employment and job placement suitable to the individual's needs. It may involve trial visits by the patient in his home surroundings. It may involve the placement of mentally retarded children in foster-home care or the placement of the partially disabled mental patient in boarding-home care. Another more recently developed bridge between the hospital and the community is our volunteer service. This group of citizens is recruited, trained, and sponsored by the British Columbia Division of the Canadian Mental Health Association. Our active-treatment programme will move a step closer to the community with the coming development of the Mental Health Centre for adults, which is now under construction in the Burnaby area. Here an active-treatment programme will be carried out which will allow the patient to remain in his home setting. Earlier discharges from the Crease Clinic and Mental Hospital may be anticipated with follow-up periodic supervision and treatment on a day-care basis. Coincident with the development of the day-hospital care, new and expanded services of the Child Guidance Clinic will be possible. The Child Guidance Clinic will move into its new quarters as soon as construction is completed. These changes in attitudes and services will, we hope, lead to a closer integration of psychiatry with all other health and welfare activities within the community. STATISTICAL COMMENTS The statistics contained in this Report have been compiled by the Division of Vital Statistics, Health Branch, Department of Health and Welfare. We are particularly indebted to members of the Division who have produced the very fine charts and graphs appearing in this Report. Table I indicates that we were able to conclude the year with a net increase of eighty- eight patients in all institutions. This total may be further reduced by disregarding the additional twenty-five patients who happened to be in the Crease Clinic at the conclusion of the year. By Statute all patients are discharged from the Clinic at the conclusion of a four-month treatment period. Any population increase at any one time merely reflects the normal fluctuation that occurs. The population of the Mental Hospital was increased by forty-three patients, almost equally divided between men and women. Provision for these additional patients was made by further overcrowding. The population of the branch mental hospital at Colquitz was static. The Woodlands School has been operating at full capacity throughout the year and concluded the period with an additional nineteen patients. This does not in any way indicate the demand for admission to the School. For some years it has been necessary to establish a waiting-list of applicants and admit only as space becomes available. At the end of the fiscal year 202 applications for admission were on file. No change was recorded in the total population of the three branches of the Home for the Aged. This does not indicate the demand for services in this particular division. Here again it has been necessary to establish a waiting-list of applicants who are admitted as space becomes available. At the conclusion of the year, 110 applications for admission were on file. The fact that the year was concluded with the smallest increase in population occurring over the past decade (see Table II) is attributable to several factors:— M 20 MENTAL HEALTH SERVICES REPORT, 1954-55 (1) The influence of the early active-treatment programme of the Crease Clinic. (2) The influence of the increased treatment programme being carried out in the Mental Hospital. (3) No increased accommodation was provided during the year. It was therefore necessary to limit in some degree the admissions to The Woodlands School and the Homes for the Aged. Table I.—Showing Patients in Residence in the Various Institutions of the Provincial Mental Health Services, April 1st, 1954, and March 31st, 1955, together with Increase or Decrease. Institution In Residence, Apr 1, 1954 In Residence, Mar, 31, 1955 Increase (+) Men Women Total Men Women Total Decrease (—) 110 1,832 287 692 136 109 298 132 1,649 497 372 129 242 3,481 287 1,189 508 238 298 121 1,852 288 706 139 99 285 146 1,672 502 396 125 267 3,524 288 1,208 535 224 285 +25 +43 + 1 + 19 +27 14 Mental Hospital, Essondale - Mental Hospital, Colquitz __ The Woodlands School Home for the Aged, Port Coquitlam Home for the Aged, Terrace -13 Totals 3,464 2,779 6,243 3,490 2,841 6,331 +88 Table II.—Showing in Summary the Admissions and Population Increase oj the Provincial Mental Health Services jor the Ten-year Period April 1st, 1945, to March 31st, 1955 Year Total Admissions Admissions 65 Years and Over Admissions under 15 Years Voluntary Admissions Population Increase Index of Increase1 1945-46 1946-47 1947-48 1948-49 .. . . 834 880 1,111 1,260 1,415 1,811 2,175 2,518 2,437 2,492 206 207 225 270 230 262 306 357 347 348 49 52 69 63 72 148 97 179 169 71 33 40 91 165 297 504 637 768 834 884 147 140 316 354 306 235 285 290 215 88 17.62 15.91 28.44 28.09 1949-50 21.62 1950-51 12.98 1951-52 _ - 1952 53 _.— 13.05 11.54 1953-54 8.82 1954-55 3.53 Totals 16,933 2,758 969 4,253 2,376 1 Percentage ratio of increase in population to admissions. On the whole, admission rates to Provincial Mental Health Services in British Columbia from 1921 to 1946 remained relatively constant. Graph A, which depicts the number of admissions per 100,000 population, shows an increasing rate from 1926-27 to 1939-40, at which time it began to decline until 1946-47, reaching a rate which was not significantly higher than that for 1925-26. In the immediate post-war years, the admission rates increased rapidly and were,later accelerated, in 1950, with the opening of the Crease Clinic of Psychological Medicine. The first three years of operation for Crease Clinic increased the admission rate for the Mental Health Service from 106.4 per 100,000 population to 213.0, a twofold increase. This, of course, was the result of introducing a short-term hospital into the Services. As far as admissions are concerned, the introduction of Crease Clinic into Mental Health Services has released the pressure considerably on the long-term mental hospitals in the Services. It may be noted on the graph that the admission rates to these hospitals have been declining since 1950-51. It is premature to state the ultimate effect of the treatment received at Crease Clinic on the mental-health status of people of British Columbia, but the indications given by the declining admission rates for the long-term institutions is favourable toward a much-improved status. HEADQUARTERS M 21 The number of admissions to Mental Health Services are mainly governed by the available beds and the number of separations; separations consist of live discharges and deaths. Graph A shows that the admission rates increased with the introduction of the Home for the Aged at Port Coquitlam into Mental Health Services in 1935, and again in 1950 with the introduction of Crease Clinic. Graph B, depicting separation rates per 1,000 patients under treatment for the Provincial Mental Health Services, plainly displays that a change in the trend of separations affects the admission rates. In 1945-46 the separation rate, which had been gradually declining since 1921-22, began to increase. It was in the following year that the admission rate commenced its rapid climb. Likewise in 1951-52 the upward trend ended, and it was in the following year that the admission rate began to decline. A close study of the two graphs will reveal other examples. Graph A.—Admission Rates, Provincial Mental Health Services, British Columbia, 1921-54 (Fiscal Years) (Rate per 100,000 population.) ——— Mental Hea th Services .— ^™ Mental Health Services cxcludin ; Crease Clinic / A l'\\ / \\ / \\ \\ \\ 1 1 1 I 1 1 1 1 III! 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Admissions to mental institutions are of two general types, which are:— (1) First admissions—people being admitted to mental institutions for the first time. (2) Readmissions—people who have been admitted to a mental institution previously, then discharged and readmitted at a later date. It is customary to base the readmission rates on the general population in order to determine their incidence. Consequently, for areas where the number of live discharges is proportionately high in relation to the population, then the readmission rate will be high. Such a readmission rate creates a false impression of the effect of treatment within a given area or of a M 22 MENTAL HEALTH SERVICES REPORT, 1954-55 specific mental-health service, because it is thought that patients are discharged only to be readmitted at a later date. Therefore, in order to get a truer measure of the effect of treatment, the readmissions must be shown in relation to the number of live discharges. Patients who are being readmitted to mental institutions will have spent varying lengths of time in the community before returning to the institution. For this reason, it would be more meaningful to relate the number of readmissions to the number of live discharges for a period previous to the year under study. That is to say, for the given Graph B.—Separation Rates, Provincial Mental Health Services, British Columbia, 1921-54 (Fiscal Years) (Rate per 1,000 patients under treatment.) Rate 300 / / / / / / / / /-J ' / / \\ v /N /'\\ y^Total y i i i / / \\ / Live Discharges / ,**\\ _ .'" V / \\ Deaths -*** *> — —-.S *•-_».. *~~~ 0 i i i i 1 I.I 1 1 1 1 1 I 1 1 1 1 1 1 1 i i i i i year of 1954 use the number of live discharges in the four previous years—1953, 1952, 1951, and 1950. This will give a representative group which will cover the majority of readmissions. Graph C shows the rate of readmissions per 1,000 live discharges, occurring in the previous four-year period, for Canada (excluding British Columbia), British Columbia Provincial Mental Health Services, and other mental institutions in British Columbia for the years 1945 to 1954. There are two points of interest displayed on this graph. First, you may note that the readmission rates for the Provincial Mental Health Services compared favourably with the rates for Canada exclusive of British Columbia, and, second, that the rates for other mental institutions in British Columbia were comparatively high for six out of the ten years shown. In only two out of the ten years shown, 1949 and 1950, did the Provincial Mental Health Services have a higher rate than the remainder of Canada. From this it is apparent that the standard of treatment received at the Provincial Mental Health Services has been of good quality as far as recurring illnesses. On the other hand, the other mental institutions in British Columbia, which are all short-term hospitals, have been experiencing a high readmission rate, more especially for the year 1954. The rate in this year was 179 per cent higher than it was for Canada exclusive of British Columbia. However, this higher rate was expected, as these hospitals, in the main, are J HEADQUARTERS M 23 "o I "-. On s 0 Is) J5 Cfl H -k_ K CD 05 i>< ■e 3 5 0 '3 MH O sc > a HI U 1-4 =o g e 6 c/> •*2 QJ s RI tn -C I* 0 *^ .-»» Tt ct OJ S ► 1 O 0 O O to tj) ^-. 0 CU cd U, s -4-» 0 8. '5! Pi <-n ? •g a 4) f l * «, a >~ O Pi M 24 MENTAL HEALTH SERVICES REPORT, 1954-55 treatment centres for mental conditions quite different than the mental conditions of the patients admitted to the Provincial Mental Health Services. Readmission Rates to Mental Institutions, Canada and British Columbia, 1945 to 1954 (Rate per 1,000 live discharges in previous four years.) Canada (Excluding British Columbia) British Columbia Provincial Mental Health Services Other Mental Institutions Year Readmissions Live Discharges in Previous Four Years Rate Readmissions Live Discharges in Previous Four Years Rate Readmissions Live Discharges in Previous Four Years Rate 1945 2,510 2,715 2,911 3,109 3,354 3,737 3,967 5,077 5,751 6,553 25,289 27,508 28,769 30,278 31,180 32,541 34,723 37,590 42,868 48,064 99.3 98.7 101.2 102.7 107.6 114.8 114.2 135.1 134.2 136.3 133 174 173 210 318 399 286 2,015 2,015 2,102 2,215 2,624 3,113 3.787 66.0 86.4 82.3 94.8 121.2 128.2 75.5 93.6 136 255 251 270 248 363 338 376 722 806 934 1,214 1,516 2,260 2,898 3,410 3,908 3,703 168.7 1946 1947... 273.0 206.8 1948.. 1949 178.1 109.7 1950. 125.3 1951 99.1 1952 448 1 4.787 96.2 1953 732 776 5.751 I 127.3 195.0 1954 6,945 111.7 1,395 3,668 380.3 Source: Health and Welfare Section, Dominion Bureau of Statistics, Ottawa. Final stages of construction of new Mental Health Centre and Child Guidance Clinic, Burnaby. BUILDING PROGRAMME I am pleased to report that our building programme is progressing rapidly. The North Lawn Building was let to contract on May 5th, 1953, and completed on February 7th, 1955. This building will be officially opened on May 4th, following which it will be occupied. The building will house 230 patients and will be devoted to the care and treatment of those patients suffering from pulmonary tuberculosis. In HEADQUARTERS M 25 addition, the bottom floor will be reserved as small treatment units for the early isolation of patients suffering from other infectious diseases. Tenders were called for the construction of a new large unit at The Woodlands School in October, 1954, and the contract was let to Dawson & Hall Company at a cost of $1,529,758.00. Excavation was started on December 20th, 1954. The construction is progressing according to schedule. This unit will house in excess of 300 patients, and has been specially designed for the treatment of infants and young children in the mentally defective group, together with those who are sick and infirm. The Woodlands School is at the present time operating to full capacity in overcrowded conditions. It has been necessary to admit on a selective basis as space becomes available. By the time the building is ready for occupancy, the accumulated waiting-list of prospective patients will exceed the capacity of the building. With the opening of the new unit a better distribution and more suitable segregation of patients will be possible. Tenders were called for a post-office and tuck-shop building at Essondale. In addition, this building will provide a coffee-shop, Credit Union office, and a centre for the use of the volunteers. It will also provide shelter for people while waiting for bus service. Tenders were called for the construction of the new Child Guidance Clinic and Mental Health Centre in Burnaby on June 19th, 1954. Construction was started on August 18th, 1954. This unit is specially designed to provide adequate space for the Child Guidance Clinics presently operating in very restricted temporary quarters in Vancouver and at the same time to provide space to initiate a new service on a day- hospital basis. Preliminary plans are under way with reference to the planning of a new hospital- site on Vancouver Island. Several prospective locations have been examined, but no definite site has as yet been selected. Plans are under way for the construction of a 300-bed unit addition to the Port Coquitlam Home for the Aged. These plans are well advanced, and it is hoped that this construction will go to tender early in the new fiscal year. The Public Works Department has had a very busy year in carrying out many major changes and alterations as well as maintaining the present plant. Details of the work may be found in the report of the Business Manager. GENERAL COMMENTS The twenty-third graduation ceremony of the School of Psychiatric Nursing was held in the auditorium of the New Westminster Junior High School on May 13th. The exercises were very colourful, and a capacity audience was in attendance. Mr. R. A. Pennington acted in the capacity of chairman, and Mrs. G. S. Selman, the vice-president of the British Columbia Division of the Canadian Mental Health Association, addressed the graduating class. The activities of graduation week were expanded this year to include a church service on the Sunday preceding graduation. There was also a graduation tea, which was held in the Nurses' Home. The annual observance of Mental Health Week was held from May 2nd to May 8th. Complete arrangements for the week were in the hands of the Canadian Mental Health Association, British Columbia Division. It was felt that the whole week was a success, and that much was accomplished in the way of general education. Members of our staff participated in many of the events. Dr. F. E. McNair opened the week with a radio interview. Five regional mental-health forums were held in Vancouver school auditoriums and proved to be very popular. Open house was held at the Crease Clinic on Friday, May 7th. The Clinic was open to the public during the afternoon and evening. All departments were open for inspection, and many fine exhibits were demonstrated. M 26 MENTAL HEALTH SERVICES REPORT, 1954-55 The Seventh Annual Sports Day was held at Essondale on Friday, August 27th. We were fortunate in having fine weather for the occasion. As usual, the Vancouver Firemen's Band provided music on the lawns. One thousand five hundred patients participated in the activities. Hot-dogs, cold drinks, ice-cream, and cookies were served from a large booth erected under the trees. The day's festivities were concluded with a dance in the evening. The arrangements established with the medical faculty of the University of British Columbia have continued through the present academic year. The entire graduating class has spent approximately two weeks in residence for practical experience. The students attend in small groups of six or eight. Honorary appointments to the Faculty of Medicine have been given to our senior staff members who are engaged in the teaching programme. We were able during the year to make a start in introducing television to some of our wards. Funds for the installation of sets have been allocated from the Patients' Comfort Fund. It is hoped that as funds are available we will be able to install sets on all wards. Our experience to date is very favourable. This added feature has been very well received and greatly appreciated by the patients. Priority is being given to those wards where the patient-groups are not able to participate in other recreational and diversional activities. I am pleased to record the establishment of a personnel department during the current year. A representative from the Civil Service Commission and a representative from the Provincial Secretary's Department have been appointed. It is hoped that the development of this new function will improve our general over-all organization. It is anticipated that the North Lawn Building will be ready for occupancy early in the next fiscal year. This building will provide, for the first time, adequate isolation and treatment of those patients suffering from tuberculosis and other infectious diseases. It is with a great deal of satisfaction that I report the organization of a volunteer programme involving the Crease Clinic, the Mental Hospital, and the Port Coquitlam branch of the Home for the Aged. The group has been developed under the £egis of the British Columbia Division of the Canadian Mental Health Association. Applicants are carefully screened and receive a course of six lectures before being attached to the visiting groups. The Volunteer Service Committee is headed by Mrs. Rex Eaton, and the chairman of volunteers is Mrs. R. B. Kerr. The programme is closely supervised under the direction of Dr. F. E. McNair. Mr. Blair Wood, from the psychiatric nursing staff, is acting as staff co-ordinator of volunteers. Actual visiting was commenced on July 2nd, 1954. The group now has fifty active members, derived from Vancouver, Burnaby, and New Westminster. The main group is well organized and is divided into teams, each team being headed by a captain. A team visits on Tuesdays, Wednesdays, Thursdays, and Fridays. These visits are for a full day. In addition, one team visits Friday evening. The response which the citizens have made has greatly exceeded both the expectations of the association and our own. The volunteers are scattered throughout the Crease Clinic, in both men's and women's wards and the three Lawn Buildings. Coverage is also given to Pennington Hall, where one member spends time in assisting in the bowling-alleys and one assists in the Audio-Visual Department. The most recent development has been the placing of volunteers in the Home for the Aged at Port Coquitlam, where they visit, write letters for patients, and generally assist in more personal ways. The volunteers have been able to secure members of a good many different nationalities, thus providing visitors to those of foreign extraction. Great credit goes to the British Columbia Division of the Canadian Mental Health Association in developing and organizing this new aspect of our treatment programme. It is felt that the organization of a volunteer service serves a wide purpose, meeting a great variety of needs. It assists the hospital directly in the matter of personal service, but, more important, it brings personal contact and assistance to the patient in a closer relationship than HEADQUARTERS M 27 can be accomplished by staff and patient relationships. It does much to increase the public's understanding of mental illness and the particular needs surrounding the treatment of the mentally ill. It brings great satisfaction to the individual volunteer who is giving service in a very personal way. There has been a remarkable increase in community interest with reference to The Woodlands School. Many groups of patient pupils have been invited out by various organizations and individuals to be entertained in their homes or in public halls. In addition, a great many gifts have been received. The British Columbia Society for Handicapped Children has been of great assistance in developing community interest with reference to the physically and mentally handicapped child. Several successful meetings have been held throughout the year in connection with the development of the Association for Retarded Children of British Columbia. These meetings have been chaired by Dr. Donald Paterson of the Crippled Children's Registry. Twenty-six representatives from the different organizations in the Province dealing with mentally retarded children have been brought together with an advisory panel. The Provincial Departments of Health and Welfare, Mental Health, and Education have been represented, as well as the Vancouver School Board and the Vancouver Departments of Health and Mental Hygiene. As a result of these meetings, a British Columbia association has been organized and registered. The development of this community activity for the retarded child is worthy of every support. Several meetings have been held with a select committee of the Vancouver School Board for the purpose of developing an in-service course for selected school counsellors. This training experience will be designed to acquaint the teacher-counsellors with the mental hygiene implications for child development of community and family living, and of the educational process. The various Provincial University and Vancouver Mental Health facilities will take part in the training programme. It is hoped that the Federal Mental Health Grants will assist financially. Although we have no formally organized public relations programme, we welcome every opportunity to interpret the function and scope of the Mental Health Services to the public. This year we were asked to prepare a display to be permanently housed in the British Columbia Building at the Pacific National Exhibition in Vancouver. The display takes as its theme the fact that mental illness is an illness, and as such is amenable to treatment. By means of photographs, charts, and brief statements the viewer is shown the various units of the Mental Health Services and informed of the special function of each. Emphasis is placed upon the mental hospital as a therapeutic community, and the display attempts to show how the various needs of the hospital resident are met by several departments of the institution. This display was seen by large numbers during the exhibition and continues to be on view, as the British Columbia Building is open the year round. Thus many school-children have the opportunity of learning something of the Mental Health Services, and this, we feel, should be helpful in recruitment of staff. We also prepared a display which was placed in the rotunda of the Parliament Buildings during the spring session of the Legislature. This display proved very popular and on request was moved to one of the department stores in Victoria for an additional two weeks. The display depicted the use of occupational and industrial therapy in the treatment of the mentally ill. It was generously illustrated with examples of work done by the patients in the occupational- and industrial-therapy shops. Both displays were greatly enhanced by the excellent photographs prepared in our own Audio-Visual Department. Strenuous efforts are being continued to increase the intensity of the treatment programme in the admitting and particularly the continued-treatment wards of the Mental Hospital. There is no doubt that if an adequate treatment programme could be carried out in these areas, there would be considerable improvement in our discharge rate. The statistical tables show the beneficial results of the increased treatment programme. M 28 MENTAL HEALTH SERVICES REPORT, 1954-55 Mental Health Services display, Parliament Buildings, Victoria, February, 1955. During the year we were able to establish a small post-lobotomy ward as a retraining centre for male patients following psychosurgery. In addition, we were able to improve the nursing care in the West Lawn Building by establishing proper nursing stations on each ward. A small coma insulin ward was established for both men and women in the Centre Lawn Building. A new schoolroom was constructed in the East Lawn Building. These added facilities will do much to enhance our treatment in these buildings. Arrangements are under way to initiate a full-scale treatment programme for our tubercular patients. This will become effective with the opening of the North Lawn Building. A specialist in the diseases of the chest has been seconded to our staff from the Division of Tuberculosis Control. There continues to be a good deal of interest shown in the work of the Crease Clinic. During the year the Clinic has been host to many organizations. The Honourable the Provincial Secretary visited various branches of the service on numerous occasions. We were pleased also to be visited by the Honourable the Minister of Health and Welfare. Several members of the Legislature have visited on occasion. During the year we have had visitors from all parts of the world, including Mr. Nathaniel Dreskin, Department of National Health and Welfare, Ottawa; Dr. H. R. Ohri, Punjab, India; Dr. C. A. Roberts, Principal Medical Officer, Division of Mental Health, Department of National Health and Welfare, Ottawa; Dr. I. L. Clancey, Clinical Director, Saskatchewan Hospital, Weyburn, Sask.; Dr. MacMillan, Medical Superintendent, Mental Defective Colony, Walsale, Kent, England; Dr. Phon Sang Sing Keo, Director of Mental Health, Thailand; Dr. Syuzo Naka, Professor of Psychiatry and Director of the Neuropsychiatry Clinic, Imperial University, Kyushu, Japan; Dr. Reva Gerstein, National Director of Program Planning, Canadian Mental Health Association, Toronto, Ont.; Dr. J. D. N. Griffin, Medical Director, Canadian Mental Health Association, Toronto, Ont.; Miss Alison Player, Melbourne, Australia; Dr. R. O. Jones, Professor of Psychiatry, Dalhousie University, Halifax, N.S.; Mrs. L. C. Smith, Executive Consultant, Canadian Association of Occupational Therapy, Toronto, Ont. HEADQUARTERS M 29 MENTAL HEALTH GRANT The Government of Canada for the seventh year made a Mental Health Grant available to this Province. The grant is administered by the Department of National Health and Welfare, and, as in previous years, a happy and cordial relationship has prevailed in our associations with the officials of the Federal Department. The organization for the administration of the grant is now well established. The use of the grant in 1954-55 follows closely the pattern developed in the past few years. In 1954-55 the total expenditure was $552,359.14, an increase of $82,625.64 over the 1953-54 total. The following paragraphs make reference to the major areas of expenditure this year. Professional Training Bursaries for postgraduate training of key members of the psychiatric treatment team were given a number of staff members, as follows:— Dr. C. E. Derkson completed one year of postgraduate study in psychiatry at McGill University in August, 1954. Dr. A. P. (Gould) Hughes completed one year of postgraduate study in psychiatry at the University of Toronto in August, 1954. Mr. M. Sutherland completed a year of postgraduate study in social work at the University of British Columbia, May lst, 1954. Miss Ryllys Cutler completed a one-year course of study in administration in schools of nursing at McGill University, June, 1954. Mr. J. W. Borthwick continued his three-year course of study in clinical psychology at the University of Washington. Dr. F. E. McNair, Clinical Director, attended the Pacific Northwest Laboratory in Group Development at Friday Harbor, Wash., August, 1954. Dr. A. E. Davidson, Mr. F. A. Matheson, and Mr. C. B. Watson attended the Sixth Annual Mental Hospitals Institute of the American Psychiatric Association held at Minneapolis in October. Dr. Ian Kenning commenced a one-year postgraduate course in psychiatry at McGill University in September, 1954. Dr. G. A. Nicolson commenced a one-year postgraduate course in pathology at the University of Toronto in July, 1954. Mrs. G. Ripley commenced a one-year course in supervision in psychiatric nursing at the University of British Columbia in September, 1954. Mr. D. Ricketts commenced a one-year postgraduate course at the New York School of Social Work in September, 1954. Eight bursaries were granted to enable social workers to enroll in the M.S.W. course at the University of British Columbia for the academic year 1954-55. Equipment and Supplies The complete X-ray equipment for the new North Lawn Building was approved for purchase from Mental Health Grant funds. The purchase of a mobile X-ray unit for The Woodlands School was also authorized. The establishment of a fully equipped radiological darkroom in conjunction with the Crease Clinic operating theatre was made possible by equipment purchased with Mental Health Grant moneys. Several major items of clinical laboratory equipment have been secured this year with Mental Health Grant funds. A chromatocab and a chromatography drying-oven have been installed in the Crease Clinic laboratory. This equipment has made possible the introduction of paper chromatography, a new analytical technique now used in several routine chemical analytical procedures and for research projects. M 30 MENTAL HEALTH SERVICES REPORT, 1954-55 Serological water baths (de Khotinsky) were provided for the laboratories of the Provincial Mental Hospital and The Woodlands School. This latter unit was also provided with a clinical electrophotometer. A major attachment for the flame spectrophotometer provided for the Crease Clinic laboratory in 1948-49 was authorized this year. The facilities of the Crease Clinic operating-room have been again increased by instruments and equipment authorized for purchase with Mental Health Grant funds. Of special importance in this connection is the provision of a full range of instruments for the use of the consultant orthopaedic surgeon. Two specially constructed stainless-steel instrument-cabinets were provided for the storage of the instruments, and a special operating-room table for orthopaedic surgery was authorized. A 16-mm. movie projector and screen were authorized for the recreation-room of the North Lawn Building of the Provincial Mental Hospital. This unit was also equipped with all the instruments and equipment to set up six minor surgeries and six nurses' stations. In addition, wheelchairs and several items of equipment for physiotherapy were made available, together with equipment for the administration of oxygen therapy. The large steam sterilizer (autoclave) with recording thermometer, smaller instrument sterilizers, and a water-still were provided to permit the establishment of a central surgical supply room in the Provincial Mental Hospital. A large utensil sterilizer, bedpan sterilizer, and mobile dressing-carts were authorized for Ward H2 in the Provincial Mental Hospital to permit an improvement in the quality of the infirmary care provided there. The instruments and equipment to set up seven combined ward surgeries and nurses' stations in the West Lawn Building of the Provincial Mental Hospital were provided. In addition, an extensive range of power equipment and hand-tools was made available in order than an occupational-therapy shop could be established in the West Lawn Building in connection with the reactivation programme. To increase the range of equipment in the print-shop of the Industrial Therapy Department, the purchase of a hand-operated printing-press was authorized. The provision of a special chair for chiropody treatments made it possible to improve the quality of foot care accorded the patients of the Provincial Mental Hospital. At The Woodlands School the instruments and equipment to establish a proper admitting suite were provided. The commencement of a specialized physiotherapy programme for the physically handicapped mentally defective children of The Woodlands School was made possible by the provision of a full range of specialized equipment for the new physiotherapy department. To assist in the work of the visiting speech therapist at this unit, audio recording and transcription equipment was made available. The teaching of the children in The Woodlands School educational department will be enhanced by the provision of a large supply of children's books suited to various ages and mental abilities. Community Mental-health Programmes The programme of the Mental Hygiene Division of the Metropolitan Health Committee of Greater Vancouver received support as in former years. Psychiatric Services in General Hospitals The psychiatric services of the Vancouver General Hospital continued to receive assistance. This year support was given to the salaries required for a medical social worker and a medical stenographer. In addition, a second electroencephalograph was provided from funds made available by the Laboratory and Radiological Services Grant. The Royal Jubilee Hospital was provided with a grant to pay the salary of a part- time occupational therapist employed in the psychiatric ward. . headquarters m 31 Staff Increases The stipends for our consultants in general surgery, neurosurgery, and orthopaedic surgery are provided by the Mental Health Grant. The ready availability of these surgical specialists has made a very significant improvement in the quality of the surgical care provided for the mentally ill. The Rehabilitation Department was again supported by a salary and travel allowance for the Rehabilitation Officer. The full details of the valuable work of this service will be found in the report of the Rehabilitation Officer, printed elsewhere in this Annual Report. Again we have expanded our active-treatment programme, and the success of this type of treatment is closely allied with the provision of a trained staff of psychiatrists, psychologists, laboratory technicians, psychiatric nurses, and other specialized groups on the therapeutic team, some of whose salaries are provided by the Mental Health Grant. The continued high discharge rates of our active-treatment institutions is evidence to show that active treatment and " total push " do produce results. COUNCIL OF PSYCHIATRIC NURSES The Council met twice this year. The annual meeting was held on April 21st, 1954, and an ordinary meeting was held February 8th, 1955. Both meetings took place in the medical conference room of the Crease Clinic. The Council was established in 1951. It is composed of eleven members, two of whom are ex officio members and nine of whom are appointed for a three-year period. There was some change in the Council membership, inasmuch as several new persons were appointed for a three-year term to replace members whose terms had expired. The present composition of the Council is as follows: Mr. R. A. Pennington, Deputy Provincial Secretary, designated a member ex officio by the Act; Dr. A. M. Gee, Director of Mental Health Services, designated Chairman ex officio by the Act; Dr. L. E. Ranta, Assistant Superintendent (Medical), Vancouver General Hospital, appointed by the Hospital Council; Dr. B. F. Bryson, Medical Superintendent, Provincial Home for the Aged, Port Coquitlam, appointed by the Hospital Council; Mrs. E. H. Duke, Matron, Hollywood Sanatorium, New Westminster, appointed by the Hospital Council; Miss E. M. Pullan, Director of Nursing Services, Provincial Mental Health Services, Essondale, appointed by the Hospital Council; Mr. C. B. Watson, Administrative Assistant, Provincial Mental Health Services, Essondale, appointed by the Hospital Council; Miss A. V. Romeo, Charge Nurse, Provincial Mental Hospital, Essondale, appointed by the British Columbia Psychiatric Nurses' Association; Mr. R. Butcher, Charge Nurse, The Woodlands School, New Westminster, appointed by the British Columbia Psychiatric Nurses' Association; Mr. G. W. Kenwood, Instructor, School of Psychiatric Nursing, Essondale, appointed by the British Columbia Psychiatric Nurses' Association; and Mr. R. H. Strong, Chief Psychiatric Male Nurse, Provincial Mental Hospital, Essondale, appointed by the British Columbia Psychiatric Nurses' Association. At the annual meeting the representatives of the British Columbia Psychiatric Nurses' Association requested that their representation on the Council be increased. This request was favourably received by the Council, and a resolution was passed and forwarded to the Honourable the Minister recommending that it be given consideration by the Government. At the ordinary meeting in February the Deputy Provincial Secretary was able to inform the Council that the Government had introduced a Bill into the Legislature to amend the " Psychiatric Nurses Act" by providing an additional member of the Council to be appointed by the British Columbia Psychiatric Nurses' Association. At the April meeting the Council accepted a recommendation of the British Columbia Psychiatric Nurses' Association to the effect that the certificate in mental M 32 MENTAL HEALTH SERVICES REPORT, 1954-55 nursing of the General Nursing Councils of Scotland meets the requirements for licensing as a psychiatric nurse in British Columbia. The Council requested the British Columbia Psychiatric Nurses' Association to conduct evaluation studies of the course in mental nursing prescribed by the General Nursing Council of England and Wales to determine whether it can be accepted as meeting the requirements for licensing in the Province. At the annual meeting the registrar reported that the Council had licensed 936 psychiatric nurses for the calendar year ended December 31st, 1954. This is an increase of eighty-eight over 1953 and reflects the large graduating classes in our School of Psychiatric Nursing for the past few years. STAFF CHANGES Our most serious staff problem has been the maintenance of a sufficient number of physicians having specialist qualifications in psychiatry. It is essential that we have an adequate specialist staff if we are to continue to provide a high level of treatment and medical supervision. Our resident medical staff has presented no problem. We continue to participate in the postgraduate training programme, and residents are accepted for twelve-month periods and in some instances twenty-four-month periods. This constant turnover of junior medical staff imposes heavy responsibilities on the senior supervising staff. We have for some years endeavoured to obtain sufficient psychiatrists to act as assistant clinical directors in small areas but have not as yet been able to achieve this goal. At the present time we have only fifteen certified specialists in the whole of the Provincial Mental Health Services. The majority of these are engaged full time in administrative duties. Only three are engaged full time in the actual treatment of patients. I am sorry to report the resignation of Dr. R. D. S. Herrick from the staff of The Woodlands School. Dr. Herrick was a certified specialist in psychiatry and had many years of experience. We have not been able to find a replacement with his degree of training. Dr. L. E. Sauriol, Medical Superintendent of The Woodlands School, was retired on superannuation due to ill health on December 31st, 1954. Dr. Sauriol terminated a period of thirty-four years in the service and will be greatly missed. Dr. C. E. Ben- well, who for many years has been Deputy Medical Superintendent, was promoted to the position vacated by Dr. Sauriol. We have as yet been unable to fill the vacancy thus created. Dr. Sauriol was entertained prior to his leaving by the entire staff of the School, and a suitable presentation was made to honour the occasion. Mr. Walter Creber terminated a lifetime's service by superannuation. Mr. Creber completed thirty-nine years of service. He headed the Male Nursing Division during a considerable period of time. Mr. and Mrs. Creber were entertained at a farewell tea, at which they were presented with gifts and tendered the thanks of the staff for Mr. Creber's long faithful service. I am sorry to have to report the tragic death by accident of Mr. J. T. Gawthrop, Deputy Business Manager of the Provincial Mental Home, Colquitz. The following staff members terminated service by superannuation: Mr. G. R., Symons, psychiatric male nurse; Mr. J. F. Moore, Deputy Charge Nurse, The Woodlands School; Mr. R. J. Hunter, driver, Colony Farm; Mr. W. Marshall, stockman, Colony Farm; Mr. F. E. Pollard, night chief; Mr. T. McFadyen, psychiatric aide; Mr. J. Hutchinson, building service worker; Mr. W. S. Aspee, psychiatric male nurse; Mr. S. Wimpenny, cemetery caretaker; Mr. F. Stoker, Deputy Charge Nurse; Mr. F. C. Hunt, psychiatric male nurse; Mr. H. W. Armitage, driver, Colquitz; Mr. W. G. Noon, Charge Nurse; and Mr. G. Gustafson, psychiatric male nurse. It is with regret that I advise you of the following deaths which occurred among staff members: Mr. F. T. Brown, psychiatric male nurse; Mr. D. M. Waters, psychi- HEADQUARTERS M 33 atric aide; Mr. S. G. Walker, kitchen helper; Mrs. M. L. Rock, psychiatric aide; Mr. R. Amos, psychiatric male nurse; Mr. T. E. Rippington, student psychiatric nurse; and Mr. B. H. Joyce, psychiatric male nurse. ACKNOWLEDGMENTS As our programme increases its ramifications into the community, it becomes more and more closely integrated with other services and community organizations. Our debt of gratitude is so widespread that individual acknowledgments are not possible. Our only hope is that where we have incurred indebtedness we may have rendered some service. We are greatly appreciative of our growing responsibility, and we will continue, to the best of our ability, to meet the obligations placed upon our service. I should like to express my gratitude for the fine degree of co-operation that exists between the officials of this department and other departments of government. Our relationships with the various departmental heads within the service have been congenial, and we are indebted to these people for more than the service which they render. I am appreciative of the fine relationships that exist between departmental heads and personnel, all of whom ultimately administer to the treatment and welfare of our patient population, whom we all serve. May I, through you, Mr. Pennington, express my appreciation to our Minister, the Honourable Wesley D. Black, who has had the difficult task of interpreting our needs to the Legislature. Our continued thanks go to you, Sir, for your continued splendid leadership. I have the honour to be, Sir, Your obedient servant, A. M. Gee, M.D., CM., Director oj Mental Health Services. M 34 MENTAL HEALTH SERVICES REPORT, 1954-55 CO W U i—i > Ph" m 00 X H H-l < m X '< H << ir. fc2 un HH |-H P CO l-H H < P Ph o Ph O H Z > o cn »■ o o cn cn oo C\\ "* CN CN r- ^t 00 H CN Mental i Servic itutions ■nbined CS i-f cn l> cs "^ •<* cn CO oc Os tn rt "n cn 00 + cn vo CN CN 00 CN CN NO Os rt «n <3\\ tn O r- ca r- r- no cn On CO SO y-t 00 ■^- oc cn 0\\ t- ON ! NO 0C Tl- NO 'd- r- 00 CN ft ■* "~t. 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N >*n r- 7-1 ■"• >n 1-1 c- : r» ON r- i : r- r- + 1-1 uO © i 00 ft r- cn t— NO CN s ~ •* •n NO tn | tn *n + TJ E o . rt a to ^ r , j t ■ ! -^ rt Cfl m c 0 3 Cfl .5 S -H •a o _ ■a c rt o &.* rt rt », H ° 2 _ — to 0 1 i«l a " a 1 cfl w UT5 •- E EC « la « 5 s « c _ 0 rt : "fi ^ Cfl 1 5 S 1 « rt c fl « 13 •a fl rt | 3 «3 n H H 1 c 1 X I OJ s e 2 « rt L tn CT So 60 i B ■32 a §| & H M W_ .2 3 73- — U Cfl 5 M c ON rt rt .5 u c D. — 1) « cu rt "O T) ■afl o « S'? S c H |-9 tl Ih to to t-. I, flo> o O < H H z z ir. a X 1 "ci fl to 0 2 3 o oi cfl 51 rt -~ O h ■n rt 3 *-> D. s as "Si w m "11 M M u s o£ £ 2 D fe w a«.a U U crt .S10 ■- co* J "•-■2 -* a — 3 w Si!'? -. o c 3 C w rt 0 CJ to 3 Cfl o •a c 3 a tl 0 0 ._ | n H 0 CU fcS HEADQUARTERS M 35 BUSINESS MANAGER'S REPORT A. M. Gee, Esq., M.D., CM., Director oj Mental Health Services, Essondale, B.C. Sir,—I beg to submit herewith for your consideration my report on the business operations together with financial tables and statements covering the various units of the Mental Health Services for the fiscal year ended March 31st, 1955. As will be seen from Table A, the average number in residence during the year was 6,301.19, an increase of 148.26 over the year 1953-54. Maintenance expenditure increased from $8,765,016 to $9,221,893, and the daily per capita cost from $3.90 to $4.01 or 2.74 per cent. The heaviest increase in costs comes under Public Works Department expenditures covering the maintenance of buildings, grounds, and plant. Dairy produce, meats, fruits, and vegetables to a value in excess of $463,000 were purchased from Colony Farm during the year. Aid received under Federal health grants for equipment, personnel, and staff training, under projects approved by the Federal authorities for the Province of British Columbia, amounted to $552,359.14. Particulars of this expenditure are given in a statement included in this report. During the year The Woodlands School stores department was closed and the staff transferred to Essondale. The new store at Essondale is now supplying The Woodlands School with all its requirements. The central butcher-shop in the Essondale store was opened and is now supplying all the kitchens at Essondale and The Woodlands School with meat. The Federal Government Meat Inspectors are continuing to make periodic inspection of our meat deliveries, and their co-operation in this regard is very much appreciated. All stationery was transferred from the stenographic staff to the stores department, and this department is now ordering and issuing all stationery supplies. New regulations regarding staff uniforms were drawn up this year. The main change made in this regard was that members of the male nursing staff are now required to turn in their old uniforms after the second year before a new uniform suit is issued. The old uniforms, if suitable, are dry cleaned and dyed and then issued to patients. This change has meant a considerable saving in the purchase of patients' suits. The Agricultural Prices Support Board is now paying us a subsidy in the amount of 21 cents per pound on our butter purchases. This subsidy means a saving of over $700 per week for all our institutions. On January 17th, 1955, the Public Works Department and all departments of the Mental Health Services not requiring extra staff started to work a five-day forty-hour week. A Civil Service Commission survey team started a survey of all departments of the Mental Health Services in March, 1955. An order has been placed for eight more television sets, to be purchased out of the Patients' Comfort Fund. In addition, a relative of one of our patients donated a television set for the use of the Colony Farm cottage patients. A second bus, to be used for the transportation of patients at Essondale, was ordered and received. I am pleased to be able again to report that during this fiscal year a large number of major improvements and additions to our plants and equipment were made. Some of the main items of interest in this regard are as follows:— Crease Clinic and Provincial Mental Hospital, Essondale The dayrooms of Wards F 2, East Lawn Building, and Wards E 3 and E 4, Centre Lawn Building, were completely refurnished. The old laundry building was converted into Public Works shops and office building. M 36 MENTAL HEALTH SERVICES REPORT, 1954-55 Complete new dish-washing facilities were installed in the East Lawn Building. A new morgue was installed in the East Lawn Building. A new garbage-room was constructed in the East Lawn kitchen. A fire-escape causeway was constructed between classrooms in the East Lawn Building. The boiler-house was painted inside and out. Work has started on converting the former store section in the East Lawn Building to a dispensary. A new heating and ventilating system was installed in the laboratory, lecture-room, shower-rooms, and diet kitchen in the Crease Clinic. A ventilating system was installed in the press area of the laundry. Additional parking facilities were provided in front of the Centre Lawn Building and the East Lawn Building. A new lobotomy ward in the West Lawn Building was completed and furnished. The contract was let in the amount of $129,381.95 for the installation only of pipe for the new sewage-disposal system. Work started on this contract in January, 1955. The Government will furnish the necessary pipe for this project. A contract was let in the amount of $25,790.50 for excavating a reservoir to provide an emergency water-supply for Essondale area. Plans were completed for the installation of two incinerators in the Crease Clinic. The 230-bed North Lawn Building for care of tubercular patients was completed in February, 1955. The official opening of this building will be held on May 4th, 1955. The new car and truck garage was completed. The East Lawn Building, the West Lawn Building, the Colony Farm cottage, and the boiler-house were completely rewired. A new dining-room was installed in the East Lawn Building for Ward H 1 patients. A new schoolroom was installed in the East Lawn Building for the use of patients. Plans were completed for the complete renovation of the West Lawn kitchen. A contract was let in the amount of $61,388 for a new tuck-shop and Credit Union building. The Boys' Industrial School was transferred to its new quarters at Brannen Lake, and the old Boys' Industrial School buildings were turned over to us. The Woodlands School, New Westminster The bakery in the administration building was remodelled to provide dayroom space for ground-privilege patients. The laundry building was demolished. The stores building was renovated to provide new facilities for the shoe-shop, manual arts department, and furniture repair department. The radio installations in Cedar, Willow, Beach, and Birch Cottages were completed. A new airing-court was installed between Cedar and Pine Cottages. A contract in the amount of $1,529,758 for a 300-bed unit was let. The contractor started work on this building in December, 1954. Provincial Mental Home, Colquitz Both main parking-lots were hard-surfaced. The dayrooms of Top East Ward, Lower East Ward, and Lower West Ward were completely refurnished. Work was started on converting old coal-bunkers into a storage building. Home for the Aged, Vernon A new laundry building was completed and put into operation. The interior of hospital building was redecorated. A new greenhouse was built. HEADQUARTERS Home for the Aged, Terrace M 37 A considerable amount of major repair work was carried out on the understructure of nearly all the institution buildings. A pump-house was constructed and a pump installed in the new well. A contract was let for the construction of a 100,000-gallon water-storage tank. Property was purchased for a sewage-disposal bed, and contract was let for the installation of the sewage-disposal system. Miscellaneous A contract was let for the new Child Guidance Clinic and Day Hospital to be built in Burnaby. Work started on this new building August 18th, 1954. A new roof was installed on the Child Guidance Clinic Building in Victoria. The outside of the Vista Building, Vancouver, was painted. In spite of the increase in Public Works expenditure and the number of major additions and improvements made or under way this year, I regret to advise that the ordinary maintenance is not keeping pace with our demands. This is particularly true in so far as painting and decorating is concerned, and a great many of our wards are now very badly in need of redecorating. A separate report has been prepared to cover the operation of Colony Farm. In closing I would like to express my appreciation of the many courtesies shown and the close co-operation that has been maintained between the various departments of the Government and the Provincial Mental Health Services at all times. All of which is respectfully submitted. F. A. Matheson, Business Manager. M 38 MENTAL HEALTH SERVICES REPORT, 1954-55 FINANCIAL TABLES Table A.—Showing the Average Number of Patients in Residence Each Year, the Total Amounts Spent for Maintenance, and the Gross Yearly and Daily per Capita Cost, 1945-46 to 1954-55. Institution Average Number in Residence Maintenance Expenditure Yearly per Capita Cost Daily per Capita Cost 1945-46 Provincial Mental Hospital, New Westminster Provincial Mental Hospital, Essondale 610.36 3,163.61 283.67 137.10 $433,041.89 1,769,363.15 210,798.32 114,337.96 $709.49 559.29 743.11 833.87 $1.94 1.53 2.04 2.28 Totals for the year.. 4,194.74 $2,527,541.32 $602.55 $1.65 1946-47 Provincial Mental Hospital, New Westminster 626.29 3,217.03 286.48 202.44 $497,945.37 2,117,563.62 231,894.65 138,802.91 $795.07 658.24 809.46 685.65 $2.18 1.80 2.22 1.88 4,332.24 $2,986,206.55 $689.30 $1.89 1947-48 Provincial Mental Hospital, New Westminster Provincial Mental Hospital, Essondale 628.00 3,275.41 290.31 326.75 $662,357.80 2,622,349.15 298,773.55 243,861.27 $1,054.70 800.62 1,029.15 746.33 $2.88 2.19 2.81 Home for the Aged, Port Coquitlam 2.04 Totals for the year 4,520.47 $3,827,341.77 $846.67 $2.31 1948^.9 Provincial Mental Hospital, New Westminster Provincial Mental Hospital, Essondale 631.75 3,394.08 287.76 372.03 119.68 $800,776.92 3,162,819.02 356,110.21 339,606.91 150,706.50 $1,267.55 931.86 1,237.52 912.85 1,259.24 $3.47 2.55 3.39 Home for the Aged, Port Coquitlam Home for the Aged, Vernon _ 2.50 3.45 Totals for the year _ 4,805.30 $4,810,019.56 $1,000.98 $2.74 1949-50 Provincial Mental Hospital, New Westminster 650.83 3,556.78 287.02 380.15 202.57 $891,944.27 3,500,902.41 384,874.24 374,093.25 215,009.96 $1,370.55 984.29 1,340.93 984.07 1,061.41 $3.75 2.70 Provincial Mental Home, Colquitz. 3.67 2.70 2.91 Totals for the year 5,077.35 $5,366,824.13 $1,057.01 $2.90 1950-51 Provincial Mental Hospital, New Westminster Provincial Mental Hospital, Essondale Provincial Mental Home, Colquitz Home for the Aged, Port Coquitlam 763.81 3,425.98 286.82 384.74 231.42 74.07 192.52 $1,081,062.76 3,419,312.37 388,744.44 437,282.20 244,853.02 139,016.27 525,256.87 $1,415.35 998.05 1,355.36 1,136.56 1,058.05 1,876.82 2,728.32 $3.88 2.73 3.71 3.11 2.90 5.14 Crease Clinic 7.47 Totals for the year. 5,359.36 $6,235,527.93 $1,163.48 $3.19 1951-52 Provincial Mental Hospital, New Westminster Provincial Mental Hospital, Essondale Provincial Mental Home, Colquitz. Home for the Aged, Port Coquitlam 799.47 3,485.14 282.68 381.03 216.43 208.97 188.82 $1,284,649.25 4,021,001.69 407,123.16 504,668.17 309,649.05 265,697.50 689,466.11 $1,606.88 1,153.75 1,440.23 1,324.48 1,430.71 1,271.46 3,640.85 $4.39 3.15 3.94 3.62 3.91 3.47 Crease Clinic 9.95 Totals for the year 5,562.54 $7,482,254.93 $1,345.11 $3.68 1952-53 Provincial Mental Hospital, New Westminster Provincial Mental Hospital, Essondale Provincial Mental Home, Colquitz 949.24 3,440.34 284.79 442.94 224.18 292.07 230.77 $1,590,703.00 4,441,278.38 433,108.50 617,445.55 384,971.73 325,842.57 759,406.04 $1,675.76 1,290.94 1,520.80 1,393.97 1,717.24 1,115.63 3,290.75 $4.59 3.54 4.17 3.82 4.70 Home for the Aged, Terrace 3.06 9.02 5,864.33 $8,552,755.77 $1,458.44 $4.00 HEADQUARTERS M 39 Table A.—Showing the Average Number of Patients in Residence Each Year, the Total Amounts Spent for Maintenance, and the Gross Yearly and Daily per Capita Cost, 1945-46 to 1954-55—Continued. Institution Average Number in Residence Maintenance Expenditure Yearly per Capita Cost Daily per Capita Cost 1953-54 1,150.76 3,491.15 285.28 469.13 228.26 293.19 235.16 $1,768,922.31 4,393,682.65 421,622.61 683,511.48 378,006.20 330,968.40 788,302.36 $1,537.18 1,258.52 1,477.93 1,456.98 1,656.03 1,128.85 3,352.20 $4.21 Provincial Mental Hospital, Essondale Provincial Mental Home, Colquitz. 3.45 4.05 3.99 4.54 3.09 9.18 Totals for the year 6,152.93 $8,765,016.01 $1,424.53 $3.90 1954-55 1,204.60 3,517.75 285.74 527.33 230.72 296.42 238.63 $1,811,848.81 4,685,444.76 426,786.04 739,859.92 368,726.10 328,553.97 860,673.73 $1,504.11 1,331.94 1,493.62 1,403.03 1,598.15 1,108.41 3,606.73 $4.12 3.65 Provincial Mental Hospital, Colquitz 4.09 3.84 Home for the Aged, Vernon Home for the Aged, Terrace 4.38 3.04 9.88 Totals for the year 6,301.19 $9,221,893.33 $1,463.52 $4.01 Table B.—Summary Statement Showing the Gross and Net per Capita Cost of Patients in All Mental Health Services Institutions for the Year Ended March 31st, 1955. Gross operating costs— The Woodlands School, New Westminster $1,811,848.81 Provincial Mental Hospital, Essondale 4,685,444.76 Provincial Mental Home, Colquitz 426,786.04 Home for the Aged, Port Coquitlam 739,859.92 Home for the Aged, Vernon 368,726.10 Home for the Aged, Terrace 328,553.97 Crease Clinic 860,673.73 Gross cost for all institutions Less collections remitted to Treasury.. $9,221,893.33 1,343,848.02 Net cost for all institutions $7,878,045.31 Daily average population Gross per capita cost, one year. Gross per capita cost, one day- Net per capita cost, one year. Net per capita cost, one day 6,301.19 $1,463.52 $4.01 $1,250.25 $3.43 Revenue (Patients' Maintenance Collections) oj the Mental Health Services for the Past Ten Years 1945-46 $388,312.23 1950-51 $763,884.12 1946-47 388,682.36 1951-52 928,398.83 1947-48 434,098.27 1952-53 1,147,831 65 1948-49 613,710.03 1953-54 1,300,056.89 1949-50 730,442.02 1954-55 1,343,848.02 M 40 MENTAL HEALTH SERVICES REPORT, 1954-55 co ffi H Z o w > ►J w H rt o h pf W H co Z H 05 W | "O O co M r-H O CO Cfl CO Q Z 5S e « w S3 H & O H Z w s w < H CO a CO Z w Oh X w o w hj ca < « VI VO tn (^ ^r O0 ** o ■t. o inOcocccocooNOcooD rH o6o6c~-tno6os'cAas<~}tn ^f CA SO rt 00 tn CA rt rt CA o V^ 00 CA rt in o, &e- !*-! 0 h^MmifiOO't'tO o.2 tnt>ootnoootncACAOs oo ^inTfr^^oVcovDiN CO osooasrtt~~Otntnotn 5f ^S tnosSDOscAOtn<0>rttn CO ■a *-. rtftOftC}SOtnasCAy-t cd cj tn oo ca rt ir- tn tn rt tn 3 a W On t-i 00 SO < fe^- VI o p v> Tt co 5 r- CO d tt CN c S cn cc ON u 1 .5, ^ G T-T M rtco (3 ro 00 0\\ CN (N m •o < >> co co © ro (S ^ 0 c co tn rt ft rt tn so CA ro* «3 u ft OS rf rt Q O > |>1 _,rH no co © co 00 CN e a*o - in t> as rt ro t^ K rtco V5- tN >n W1 M 5 S CO CO £ SO B o M ro' CO CO CO r, rt «3 VO W C to ta id a £ 0) V) 00- <»§• ■go tn O ! 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M. Gee, Esq., M.D., CM., Director oj Mental Health Services, Essondale, B.C. Sir,—On March 17th, 1954, at a meeting attended by the Deputy Provincial Secretary, the Chairman of the Civil Service Commission, the Director of Mental Health Services, and senior departmental officials, it was decided to establish a departmental personnel office. Effect was given to this decision by the appointment on August lst, 1954, of an Administrative Assistant (Personnel) to the Director, Provincial Mental Health Services. Unfortunately the development of this new function was impeded by the resignation of the new Personnel Officer, effective November 17th, 1954. A successor was appointed, effective January 17th, 1955, and minor changes in the duties and responsibilities were made, notably the consolidation of the personnel and pay functions under the Personnel Officer. Between August lst, 1954, and the close of the fiscal year, studies were made on a variety of subjects, including the following:— (1) Staff organization of the Essondale laundry. (2) Staff organization of the Essondale meat-cutting section. (3) Female nursing division—policy and methods re duty rosters and scheduling of vacation periods and regular days off. (4) Methods used in preparation of payrolls and the development of procedures for conversion of the Provincial Mental Health Services payroll to mechanical methods centralized in the Department of the Comptroller- General, Victoria. The figures shown on Table A appended to this report indicate recruitment and separation activity during the fiscal year. Casual appointees are included in the totals recorded. Total separations from the department amounted to 774, for a turnover of 34.5 per cent. Table B provides a staff comparison by division for the fiscal years 1953-54 and 1954-55. The monthly average of staff throughout the fiscal year was 2,240, compared with a monthly average of 2,154 in the preceding fiscal year. Table C indicates the ratio of psychiatric nurses to psychiatric aides. An acceptable standard is one aide to two psychiatric nurses, and the figures provided indicate a most unfavourable trend, particularly in the female nursing division. Following is a comparison of the numbers of psychiatric student-nurses enrolled in the School of Psychiatric Nursing under the two-year course:— Enrolled as of Mar. 31, 1954 Male students 49 Female students 148 Enrolled as of Mar. 31, 1955 Male students 50 Female students 142 Total 197 Total 192 It is apparent that the nurses' training programme will have to be expanded to cope with the present high rate of resignations and the expanding bed capacity of the Mental Health Services. A study of this problem has been initiated and will be completed during the next fiscal year. M 46 MENTAL HEALTH SERVICES REPORT, 1954-55 Table A The following figures indicate staff recruitment and separation activity during the fiscal year. The figures shown were taken from available records and are approximate. Casual appointees are included in the totals. Recruited Physicians 17 Medical interns 9 Registered nurses 25 Female psychiatric nurses 81 Male psychiatric nurses 26 Female student-nurses 117 Male student-nurses 44 Female psychiatric aides 307 Male psychiatric aides 129 Teachers 5 Occupational therapists 10 Recreational therapists 2 Industrial therapists Psychologists 6 Technicians 3 Dieticians 2 Cooks 4 Kitchen-helpers 22 Clerks 15 Stenographers 23 Trades 2 Laundry-workers 8 Miscellaneous professional 2 Miscellaneous technical 6 Miscellaneous 27 Farm help 25 Totals 917 Separated 17 9 18 133 30 66 22 249 88 5 13 1 2 5 1 1 7 16 10 24 2 4 3 7 23 18 774 Table B.—Staff Comparison by Division, 1953-54 and 1954-55 Vote Positions Provided in Estimates, 1953-54 Number on Staff as of Mar. 31.1954 Positions Provided in Estimates, 1954-55 Number on Staff as of Mar. 31, 1955 Patient Poulation as of Mar. 31.1954 Patient Poulation as of Mar. 31, 1955 Colony Farm (272 (a)) Colquitz Farm (272 (6)) 55 7 52 7 60 53 7 62 59 67 60 28 32 27 29 31 34 29 28 270 959 517 78 1 245 964 480 79 280 1,044 559 81 265 1,059 490 76 242 3,481 1,189 287 267 3,524 The Woodlands School 1,208 288 Colquitz U.B.C.-Crease Clinic 1,825 1,768 1,964 1,890 5,199 5,287 188 73 63 166 69 54 192 77 63 182 75 55 508 238 298 535 Home for the Aged, Vernon 224 285 324 289 332 312 1,044 1,044 2,271 2,172 2,428 2,319 6,243 6,331 HEADQUARTERS M 47 Table C.—Showing Ratio of Psychiatric Graduates to Psychiatric Aides (Male and Female) in Crease Clinic, Provincial Mental Hospital, Essondale, and The Woodlands School, as of March 31st, 1955. Classification Male— Charges Assistant charges _ Psychiatric nurses Female— Charges Assistant charges . Psychiatric nurses Respectfully submitted. Psychiatric Nurses 35 59 215 309 (61%) 30 44 138 212 (37.5%) Psychiatric Aides 197 197 (39%) 353 353 (62.5%) J. Dowling, Personnel Officer. M 48 MENTAL HEALTH SERVICES REPORT, 1954-55 PART II.—CREASE CLINIC OF PSYCHOLOGICAL MEDICINE AND PROVINCIAL MENTAL HOSPITAL REPORT OF THE CREASE CLINIC OF PSYCHOLOGICAL MEDICINE A. M. Gee, Esq., M.D., CM., Director oj Mental Health Services, Essondale, B.C Sir,—I herewith submit the annual report of activities for the Crease Clinic of Psychological Medicine for the fiscal year April lst, 1954, to March 31st, 1955. The following table gives a summary of the movement of population for the past fiscal year:— Men Women Total Total in residence, April lst, 1954__ Admissions during the year Discharges during the year Deaths during the year 110 573 557 5 132 791 775 2 242 1,364 1,332 7 Total separations- 562 777 1,339 In residence, March 31st, 1955.. 146 267 The Crease Clinic has been extremely busy this past year, as partially indicated by the heavy admission rate. This year we have had 1,364 new admissions to the Clinic, as compared to the total of 1,256 admitted during the fiscal year 1953-54. This is an increase of 107 patients and represents the largest number of admissions we have had to the Crease Clinic since the beginning of operations in 1950. The rate of voluntary admissions during this past year has again remained very high. Some 630 patients were admitted to the Crease Clinic this past year on a voluntary basis, consisting of 253 men and 377 women. Our separation rate has, of necessity, kept pace with our admission rate. During this past year 1,339 patients were separated from the Clinic, and of these only 93 patients were transferred for committal to the Provincial Mental Hospital. This means that the vast majority of patients admitted to the Clinic are returned to the community on completion of treatment. It is interesting to consider the great amount of work involved in caring for this number of patients. The examination and investigation of 1,364 psychiatric patients requires much time and effort. The active-treatment procedures, including physical therapies, psychotherapy, occupational therapy, recreational therapy, nursing care, physiotherapy, etc., again require a great deal of effort on the part of the various members of our staff. Also the work involved in developing rehabilitation and discharge plans for 1,339 patients is considerable. These facts are only mentioned to focus attention on the extremely heavy patient load and on the amount of work involved in caring for them. The work in each of the various departments in the Crease Clinic has expanded this past year because of the increase in the rate of admissions. This trend can be noted in the separate reports submitted by the heads of the various departments. The work in the operating-room area has increased particularly. Our operating- room serves all units of the Mental Health Services, including Crease Clinic, Provincial Mental Hospital, The Woodlands School, and Home for the Aged. Most of the surgery for these units has been performed at the Crease Clinic during the past year. The surgical consultants include Dr. F. Turnbull, neurosurgeon; Dr. George Wilson and Dr. James CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 49 Wilson, general surgeons; Dr. R. E. Outerbridge, orthopaedic surgeon; and Dr. J. R. Ireland, urologist. Anaesthetics are given under the direction of Dr. J. J. Carroll. There has been a total of 406 operative procedures carried out in the operating-room during the year. The following summary gives the details: 40 major operations, 104 minor operations, 73 orthopaedic operations, 133 applications of plaster, 47 neurosurgical operations, 5 genito-urinary operations, and 4 otolaryngological operations. These cases have all been cared for in our small post-operative suite, which at present has only accommodation for eight patients. We are certainly in need of additional space for this purpose, and, at present, plans are being formulated for enlarging this area to accommodate an additional 20 patients. These additional 20 beds should make the operation of this department much more efficient. Our educational programme has continued much as it has during the past few years. We have continued to offer a postgraduate programme of study to our medical staff. Also during this past year, members of the final year in the Medical School at the University of British Columbia have attended the Crease Clinic and the Mental Hospital for a two-week period. During this period the medical students have been assigned cases and have been supervised by various senior members of the staff. In addition to these activities, various public lay groups have visited the hospital from time to time for the purpose of being oriented in regard to the type of work carried on in our clinic. During the year Dr. M. Kennard, of the University of British Columbia Research Department, and Dr. W. Fister have been interested in a research programme in regard to studying the relationship of certain personality disorders to changes found in the electroencephalogram. This study is still proceeding. Open house was held at the Crease Clinic on May 7th, 1954, at the end of Mental Health Week. We did not have nearly as many visitors this year as we have had in previous years. The displays set up by the various departments were extremely well thought out, and those visitors who did come were able to gain a fairly useful idea of the functions and work of the Crease Clinic. Respectfully submitted. A. E. Davidson, M.D., Deputy Director oj Mental Health Services. M 50 MENTAL HEALTH SERVICES REPORT, 1954-55 REPORTS OF THE PROVINCIAL MENTAL HOSPITAL, ESSONDALE REPORT OF THE MEDICAL SUPERINTENDENT A. M. Gee, Esq., M.D., CM., Director oj Mental Health Services, Essondale, B.C. Sir,—I submit herewith the annual report of the Provincial Mental Hospital at Essondale for the fiscal year April lst, 1954, to March 31st, 1955. In residence on April lst, 1954, there were 1,832 men patients and 1,649 women patients, 123 patients were on probation, and 5 patients were carried on escape, thus making a total of 3,481 patients on our books. During the year 1,139 patients were admitted, making a total under treatment at the Mental Hospital at Essondale for the year of 4,748 patients. Of the number admitted, 824 patients were by ordinary committal, 27 were by urgency committal, 260 patients (198 men and 62 women) were voluntary admissions (that is, 22.8 per cent of the total admissions), 11 were admissions from the Yukon, 1 admission was by warrant, and 20 admissions were by Order in Council. No patients were transferred from The Woodlands School or from the Provincial Mental Home, Colquitz. The total admissions were thus 664 men and 475 women, making a grand total of 1,139 patients during the fiscal year. The rate of separations during this year has been kept at a very satisfactory level. There were 699 men patients and 525 women patients separated from the Mental Hospital at Essondale during this period, making a grand total of 1,224 patients. In residence on March 31st, 1955, there were 1,852 men and 1,672 women, making a total of 3,524 patients in residence at the end of the fiscal year. This is an increase of 43 patients in residence at the same date as compared to the previous year. During the fiscal year our Federal charges remained fairly constant in number as compared to the previous year. The number of Indians under care for the Department of Indian Affairs fluctuates slightly from month to month. The Indians we have in residence are from eighteen different tribes in British Columbia and the Yukon. At the end of the fiscal year we had 75 Indian patients in residence. The number of veterans under care, for whom the Department of Veterans' Affairs is financially responsible, vary by 10 or 15 patients per month but average 270 patients per month for the year. We have received 7 patients from the British Columbia Penitentiary, New Westminster. We are now caring for 31 patients from the Yukon. We are still maintaining 25 beds for male alcoholics. These beds are usually occupied, and from time to time there may be a short waiting-list. However, by arranging admissions through the Alcoholic Foundation, the admission flow is kept running smoothly, so little delay in admissions occurs in suitable cases being admitted. During the year there were 43 men patients and 50 women patients, making a total of 93 patients, admitted to the Mental Hospital at Essondale from the Crease Clinic. These patients did not recover sufficiently during their four months' residence in the Crease Clinic to be discharged to the community, and they were therefore committed to the Provincial Mental Hospital for continued treatment. During this same period 6 men patients were discharged from the Mental Hospital at Essondale to the Crease Clinic, since they were short-term cases and could be more suitably dealt with in that area. The intake of new patients each month shows that the majority are received directly from the community, with 5 to 10 patients from the Crease Clinic and the occasional patient from the Geriatrics Division, British Columbia Penitentiary, Oakalla Prison Farm, or Federal services. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 51 The separation of patients from the Mental Hospital at Essondale each month shows considerable fluctuation. The majority of patients are discharged to the community, directly to their relatives or friends. During the fiscal year a total of 200 patients were discharged in full from the Mental Hospital at Essondale to the Geriatrics Division. During the same period we were able to transfer 14 patients to the Provincial Mental Home at Colquitz. The annual report for the fiscal year April lst, 1953, to March 31st, 1954, reported 1,169 patients were admitted to the Mental Hospital at Essondale, whereas in the fiscal year April lst, 1954, to March 31st, 1955, there were 1,139 patients admitted, showing a decrease of 30 patients from the preceding year. This would appear to indicate a trend which we hope will become more marked in succeeding years. This year it will be observed there were more patients admitted to the Crease Clinic than to the Mental Hospital at Essondale. This would point out the advantage of early discovery and treatment of mental illness, enabling patients to respond to treatment with greater rapidity and making their periods of hospitalization progressively shorter. The percentage of patients recovered or improved, as compared to admissions, was 53.64 per cent. The percentage of deaths to the number under treatment was 2.95 per cent; the percentage of discharges to admissions (exclusive of deaths) was 95.17 per cent. The daily average population was 3,517.75. There has been a notable reduction of short-term and acute psychotic cases from the British Columbia Penitentiary since they have installed a resident psychiatrist at the Penitentiary. I feel this service in the Penitentiary is very worth while. The psychiatrist there has been able to treat many cases within the Penitentiary and screen the cases that are drawn to his attention. The majority of cases we now receive from the Penitentiary are psychotic, and actively psychotic patients, though criminals and though serving long terms, can be more readily hospitalized here and are much less disturbing to the hospital routine than many patients who were not psychotic or who were psychopaths and who had been admitted to this Hospital in past years. I think this is an important point, since the trend in mental-health care is to increase our patients' liberties, recreations, occupations, and activities generally within the Hospital whenever possible, and so bring the Hospital environment more in line with the environment of the community and home. This trend is desirable but is difficult of operation to provide at the same time the degree of security which is necessary in treating psychopaths and various criminals whose mental difficulties were not predominately a treatable mental illness. I would recommend that all Penitentiary and Oakalla cases go directly to the Provincial Mental Home at Colquitz or other suitable location where they could be provided with the type of treatment, care, and security they require for their several needs. This has been an extremely active year. The volume of work and services provided by the various departments can only briefly indicate the continuing and increasing activities of a hospital of this magnitude. It has been necessary for all departments to work to capacity. This has been difficult of attainment in many departments due to either shortage or changes in staff personnel. I wish at this time to express my appreciation of the splendid type of service being provided for our patients by all departments. It is noticeable that their activities are increasing rapidly as treatment activities are being increased and as changes in hospital trends take place. This, I feel, is an indication of the vastly increasing confidence our patients and the public generally have in the Provincial Mental Health Services. All our treatment centres have been active and functioning efficiently under the Clinical Director, the medical staff, the nursing staff, all therapy departments, and all those members who make up the complete treatment team. The Clinical Director's comprehensive report will give full details in this regard. Coma insulin treatment was renewed in the Centre Lawn Building of the Mental Hospital in April, 1954, in addition to insulin services being continued in the Crease Clinic. M 52 MENTAL HEALTH SERVICES REPORT, 1954-55 Dr. G. A. Nicolson, Director of our Pathology Department, has been away for postgraduate studies at Toronto. He commenced the course on July lst, 1954, and will complete it on July lst, 1955. During his absence this department has been functioning very well under the direction of Dr. Harry Wilson and Miss Alice Hagen, Senior Laboratory Technician, and her staff. There have been many changes and activities occurring in the Mental Hospital at Essondale, British Columbia's twelfth city. It is not possible or desirable in a report such as this to go into great detail, though examination of the score or more reports of the chief departments in which more details of their activities are enumerated will give some idea of the tremendous volume of work which is being carried out in this Hospital, and on comparing it with previous reports, some idea will be gleaned of the vast expansion which is taking place in most of these departments. Changes within the Hospital services are constantly occurring as they are required. Many of these refer to small items, such as the use of locked safety razors; others are more far reaching in their effect upon the functioning of the whole Hospital, such as the reactivation of our Hospital Council, whereby all departmental heads meet at regular intervals to present problems related to their services or the Hospital as a whole or to discuss new methods or techniques. Considerable credit reflects on Mr. C. B. Watson, Administrative Assistant, Administration, on his completion of the Handbook for the Guidance of Employees of the Provincial Mental Health Services. This is an informative and valuable reference, especially for our new personnel. We are finding Mr. J. Dowling, Administrative Assistant, Personnel, a valuable addition to our Hospital staff, and also Mr. G. Tomalty, of the Civil Service Commission, who now makes his headquarters here. The presence of these two men greatly assists us in all matters relating to personnel. We now have seven open wards where patients may leave the ward at will during the day. We have found a remarkable improvement in our patients where this type of care has been possible. Medical staff, nursing staff, and patients are all enthusiastic with the improvements so far attained in this type of ward. We now permit relatives to visit certain of our wards in the evening hours. This has worked out very satisfactorily, and both the patients and visitors have commented favourably regarding this privilege. This evening visiting, which was started one night per week, is in addition to our regular practice of permitting relatives and friends to visit our patients any day of the week, including Sunday, between the hours of 2 and 4 p.m. Another change made this year in many areas in the Hospital was the further extension of the five-day work-week for the staff. This necessitated considerable change, since the Hospital functions fully on a six-day week basis. During the course of this year we are pleased to make note of the fact that Dr. G. H. Stephenson and Dr. R. Halliday received their specialty in psychiatry from the Royal College of Physicians and Surgeons of Canada. Another valuable addition to the Hospital was the starting this year of hospital volunteer workers, a group of men and women selected, approved, and supervised by the Director of the Canadian Mental Health Association, British Columbia Division. This group has been extremely enthusiastic and active. These volunteer workers are being most helpful in many areas of the Hospital Services, and we greatly appreciate their devoting this time to the Hospital Services. A change in the method of handling our Order in Council cases was made this year. All those Order in Council cases whose sentences expire, and where further liberties are required for treatment or other reasons, now have their Order in Council rescinded in order that they may be dealt with as though committed pursuant to section 9 of the " Mental Hospitals Act." This change has greatly facilitated our treatment of J CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 53. this group of patients generally, and we feel it has increased their recovery rate by enabling them to take fuller part in patients' occupational and recreational activities. With the moving of our stores department in the East Lawn Building to the new stores building, the space vacated is being remodelled for the pharmacy department. This work is proceeding satisfactorily and will be of great assistance in providing more area for the staff of the pharmacy to prepare and distribute their supplies. The new morgue in the East Lawn Building is functioning satisfactorily but requires enlarging, and recommendations have been forwarded in this regard. The old laundry building, remodelled now for the various trades shops, is a great improvement and is more efficient, being centrally located, more spacious, and better constructed than the former shops. In August the move was made to our new garage, maintenance, and repair building. This well-equipped garage will greatly assist that department in its services. A new lobotomy ward for male patients has been developed in the West Lawn Building. This has made more specialized treatment and care possible for this group of patients following surgery. One of the most valuable alterations made during this fiscal year was on Ward H 5 in the East Lawn Building, where new offices and patients' facilities have been installed. Many changes are constantly taking place about the hospital grounds. New roads were built to the North Lawn Building and new parking areas were completed in front of the Centre and East Lawn Buildings by means of road-widening. Recommendations have been forwarded for further new parking areas to be developed. Much painting and general maintenance work have been done. Alterations and additions to the Crease Clinic ventilation and air-conditioning systems were made, and a start has been made on new garbage-disposal incinerators for the Crease Clinic. We have had, in addition to our hospital volunteer workers, many visitors to the Hospital this year. The Army, Navy and Air Force Veterans in Canada and the Canadian Legion, British Empire Service League, have regular groups visiting our veterans. The ladies' auxiliaries and councils of these organizations also visit periodically and provide many additional comforts for our veteran group of patients, such as reading material, fruit, sweets, and smokes, and, in addition, the pleasure they afford our veterans by their company. Many outings and band concerts are arranged in addition to those arranged by our Recreational Therapy Department. Television sets have been donated, and also a splendid Nadeau hand skill loom. This is a very valuable piece of equipment for our Occupational Therapy Department in that patterns can be pre-set automatically in order that deteriorated patients may operate this eight-harness machine. The religious needs of our Protestant patients are being well taken care of by our resident chaplain, Rev. John F. O'Neil, and the religious needs of our Roman Catholic patients by Rev. Father J. P. Kane. Religious services are held regularly for all those patients wishing to attend. Examination of the following report will show a great activity in this department. Services are held on many wards in addition to those services held in Pennington Hall and over the radio public address system. The Hospital Civil Defence organization remains quite active, with various members attending instruction at Civil Defence schools. This information is passed on to the whole group, and there are members from all departments of the Hospital service interested and active in this most valuable organization. There have been many staff changes. I would mention at this time, however, the retirement of Mr. Walter Creber, Chief Male Psychiatric Nurse, on March 31st, 1955, after completing thirty-nine years' service. Mr. Creber has always been a most valuable member of our staff and will be greatly missed by all his friends. The North Lawn Building for infectious diseases is rapidly nearing completion and will be opened early in the next fiscal year. This building will be a valuable addition M 54 MENTAL HEALTH SERVICES REPORT, 1954-55 to our present services and will likely improve conditions in the East and West Lawn Buildings by the removal of all the tubercular and other infectious cases. However, we still have a very urgent problem in the great overcrowding of our patients in many areas of this Hospital, and we will require much further new accommodation to handle those patients we now have in Hospital. A matter of greatest importance is the shortage and large turnover of our trained nursing and medical staffs. In the medical staff this is especially pronounced in July and August, when many of our members leave to go to other and better appointments for the monetary reward or to continue their education in the specialty of psychiatry toward obtaining their certification. These constant changes greatly accentuate treatment and administrative problems. We have a great need here for more well-trained senior medical staff who would remain and who would assume senior medical-staff responsibilities. I believe senior medical-staff salaries must be increased to attract this desirable type of medical personnel and, in fact, must be provided in order to hold those suitably trained senior medical personnel we now have at this Hospital. I wish to express my appreciation of the close co-operation which I have received from the staffs of all departments of the Provincial Mental Health Services and Government. Respectfully submitted. T. G. Caunt, M.D., Medical Superintendent. TREATMENT SERVICES T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—The following is the report of the Treatment Services in the Mental Health Services, Essondale. Significant progress has been made this year toward bringing the psychiatric hospital and the community in closer relationship. Despite the highest patient admission rate yet recorded in the Province, the separation rate has nearly approximated it, a product of efforts bent toward rehabilitation. The first great advance in the care of the mentally ill was the building of institutions which would provide humanitarian care. Originally places of refuge and safety for the patient, they often became vaults to lock away and forget a rejected group of the population. In these places called asylums, custodial care was emphasized and overcrowding and understating became permissible. The patients need space to live in, not just dormitory space, but living-room, dining, work, and hobby space; room for storing personal effects and room for personal cleanliness and grooming. When the space is not provided for indoors, it must be found out of doors. We have been rethinking this heritage of humanitarian care and have been introducing changes to make the patients' life a happier one. The second great advance has been a scientific approach to treatment. In the modern mental hospital and psychiatric clinic all the hospital facilities needed in a good general hospital are required. Furthermore, we draw on those branches of human knowledge which endeavour to cast light on the workings of the individual personality and also how people work together—psychology, sociology, anthropology, religion. This knowledge cannot be bought by the crate, carload, or pound—it can only be accumulated and applied by the building-up of a trained enthusiastic and dedicated staff. Tremendous steps have been made in the fashioning of a staff which has an organic unity, is competent and flexible. Yet we cannot expect to attract or hold pro- CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 55 fessional staff of top calibre unless financial returns for work done is in keeping with the going wage elsewhere in the community. The most dramatic of the medical treatments, the so-called shock treatments which we prefer to call somatotherapies, have been reinforced by the new drugs chlorpromazine and reserpine. At best they reduce the length and severity of symptoms which cut the patient off from society; they must be accompanied by the social treatments, occupational and recreational therapies, and the more personal treatments, social casework and psychotherapy. Without the enabling qualities of insulin and electric treatments, lobotomy, chlorpromazine, or largactil, our efforts would be seriously handicapped. The results of these treatments are tabulated below. The third advance is the drawing together of the hospital and the community. Rehabilitation is a responsibility of everyone at the hospital from the day the patient arrives. It is the special function of the Rehabilitation Officer, the Vista, the social service, and the medical staff. However, if rehabilitation is to succeed, community ties must be preserved during the patient's hospital stay or, if broken from long hospitalization, must be renewed. We endeavour to establish high standards of morale on hospital wards, and to create special atmospheres and attitudes around patients who present special problems that cannot be assisted by broad general principles of ward management. Group methods of treatment continue to grow in number and importance, and thirteen psychotherapy groups now meet each week. Problem relationships with other people lend themselves to change in a group setting where full expression of opinion is encouraged. Two large wards in the Mental Hospital have been made open wards, so that patients are free to come and go without waiting to be let in and out. For the most part, the patients who enjoy this freedom are making contributions to the hospital by working in one of the industrial areas. The removal of these traditional restrictions makes for a more relaxed atmosphere and so encourages the patient to find in himself a renewal of personal dignity. Club and interest groups have formed in these areas. The problem of preserving personal identity in a large hospital can be met only in part by this development. The advent of the volunteer worker from the community, sponsored by the Canadian Mental Health Association, holds out a real prospect that feelings of hope and personal worth can be rekindled in patients long sick and isolated from the community both by their mental illness and their hospitalization. The volunteer soon finds that the patient responds to his freely offered interest, and this is his reward for his weekly visit. We have found the visiting a vehicle for a better integration of the work of the Hospital to the community. M 56 MENTAL HEALTH SERVICES REPORT, 1954-55 Medical treatment team administering electro-convulsive treatment. Nursing care for patient undergoing coma insulin treatment. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 57 Table 1.—Cases Treated by Coma Insulin, by Sex, Diagnosis, Result, and Disposal, Crease Clinic oj Psychological Medicine (fl) FEMALES 1 V 0. >H O u OJ § a Z Result Disposal Diagnosis •o V > o o V > o Q, E 1—( 73 > O Ih a. E 5 D o cu.- ll a .a Eo «.9 to rt _. u 5 rt O _ti *- a a. -h a > c! ca o o tH "H H0-c2 c oS ■d rt to to 'X f* Oh Affective Disorders 1 1 1 1 1 1 Totals 2 2 - 1 2 | — Schizophrenia 21 8 12 50 19 36 9 1 2 6 3 6 14 6 8 37 14 29 8 6 2 2 7 2 1 1 17 5 11 44 18 35 9 4 3 1 6 1 1 Schizo-affective psychosis Unspecified schizophrenia Totals 155 18 116 21 139 j ...... 16 1 1 1 1 1 1 Mental deficiency with psychosis. Totals ... 2 1 - 1 2 - | . 2 159 20 116 23 141 18 (6) MALES Schizophrenia 19 3 5 61 42 9 3 2 1 10 12 1 1 10 2 5 39 26 8 2 2 8 1 12 4 14 2 5 53 40 9 3 2 5 1 8 2 Totals 144 25 94 25 128 | _. | ..... 16 5 1 1 1 2 1 4 1 1 3 1 1 1 1 2 1 3 1 1 2 1 4 1 1 1 1 2 1 4 1 1 1 Epilepsy with psychosis _ Psychotic depressive reaction Chronic brain syndrome Immature personality—aggressiveness Totals. 18 15 3 17 | __.. 1 162 25 109 28 145 17 M 58 MENTAL HEALTH SERVICES REPORT, 1954-55 Table 2.—Cases Treated by Electro-convulsive Therapy, by Sex, Diagnosis, Result, and Disposal, Provincial Mental Hospital (a) FEMALES ■d Result Disposal ■o ft Diagnosis rt to o£ S32 .£- C ll ■o u k. CU > O u CU P. to O Ih P. | to 3 £ > o he | to > O a a E i TJ to DC rt Xl o tft a ■d u Ml H m — Ih cj _> ■j- CS CU Secondary to Treatment by Psychopharma cology 2£ rt to ■ge.s O rt*3 to to £ to it c o •o Kb m B c o 2S 0 •d 81 OJ . _S"S 09 IS '3 2 l| Ih u rt hJ ■g s Affective Disorders Manic 19 i 15 3 3 1 1 14 Depressive 4 4 1 __ 3 Involutional 11 2 8 1 5 6 Totals 34 .... 3 27 4 8 2 1 -. .... 23 Schizophrenia Simple. 26 2 21 3 5 1 20 8 6 2 8 Catatonic 17 2 11 4 1 3 13 Paranoid 60 4 44 12 9 8 1 42 Acute undifferentiated _ 4 4 1 1 2 Chronic undifferentiated 4 4 4 Schizo-affective psycho sis—_ 11 1 8 2 2 1 8 Unspecified 14 13 1 1 1 12 — 144 .... 9 111 24 19 14 1 1 - | .... | 109 Pathological personality- 4 .... 3 1 4 Epilepsy with psychosis- 3 .... 3 3 3 3 1 2 4 3 1 3 1 Chronic brain syndrome- 6 .... 5 1 6 Mental deficiency with psychosis 1 .... 1 .... 1 4 .... 4 1 1 _ 2 Totals 25 .... 19 6 5 1 .... ..__ | .... [ 19 Grand totals 203 — 12 157 34 32 17 2 1 .... [ 151 1 (b) MALES Affective Disorders Manic. Depressive Involutional Totals.. Schizophrenia Simple Hebephrenic. _ Catatonic — Paranoid. Acute undifferentiated — Chronic undifferentiated Schizo-affective psychosis— Unspecified _ Totals Paranoid state. Pathological personality. Alcoholic psychosis Neurotic depressive reaction Anxiety reaction Obsessive compulsive neurosis Chronic brain syndrome Mental deficiency with psychosis Totals Grand totals.. 17 5 1 I 15 | 5 I 1 I 23 | 1 I 21 22 4 35 55 4 17 1 19 3 24 39 1 6 4 3 1 13 2 1 11 16 1 149 | 3 | 111 35 3 2 12 3 2 1 3 1 3 2 11 1 2 1 1 1 2 31 | 2 | 1 | 22 | 203 I 3 I 154 42 I 1 I 5 1 I 1 ~- 1 1 2 | 7 | 1 10 1 13 3 1 1 5 26 12 45 I 11 3 I 14 5 I | 112 1 I 1 | 138 19 4 33 39 4 1 1 1 11 _.. 1 1 1 1 2 1 _ 5 12 | CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 59 Table 3.—Cases Treated by Electro-convulsive Therapy, by Sex, Diagnosis, Result and Disposal, Crease Clinic oj Psychological Medicine (a) FEMALES Result Disposal Diagnosis T3 O ed — -. OH S2 XI c §1 Ztt. V CU > o u 1> Si X) O a | 3 s o a | T3 > 0 § S D •O o 00 rt _= e/i s T3 0J OX) CS .-_ IH '.. CU .2 "3 'jh cd Qj rt u . tH 2 £■0. o iii 2.£? 1J.S cu,'- c3 o •o u CH lH ^ . ■an HW rt 0.-S ♦* a 0) o KP3 O to to > 0 1 to 3 a TJ to > O ft 1 TJ > o tH 1 a S3 tj U be «H rt ,0 o 3 cS rl TJ U 00 Ih cS ■d u 3 o __ oo res ■Sfe a O H H w E a o &S.S rt iu-h "o § S CCS o eija CJ a. o> >. >> B_Hi o TD fi B go .C'B, 00 o .Sffi G-H a a B c 1 i i 20 1 14 5 9 11 Miscellaneous - 1 -- i i 1 22 2 1 15 5 11 - 11 (b) CREASE CLINIC OF PSYCHOLOGICAL MEDICINE 9 | 1 [ ___ 1 8 55 j 3 | 2 | 43 8 1 .... j — | 7 7 1 8 48 8 — .... 1 7 Miscellaneous— Totals 72 | 4 | 2 | 58 8 64 — .... — 8 1 1 1 Table 5.—Cases Treated by Lobotomy, by Diagnosis, Result, and Disposal TJ to rt to OH to Sa Xi R E-B Zeu Result Disposal Diagnosis Tt CD i- to > O to to ft TJ to > O Ih ft J to I TJ >- o Ih ft B TJ to > O p, I 2 D TJ QJ OC Ih rt ja o s rt .S'S CO o fa hh •S<3 E e .» si TJ1^ aj u *h'_£ '3 rt s?s ffl o 05-0 21 9 1 1 4 1 12 4 4 ] 4 2 2 19 7 7 Totals — 30 2 4 16 8 4 26 9 Respectfully submitted. F. E. McNair, B.A., M.D., CM., Clinical Director. DEPARTMENT OF OCCUPATIONAL THERAPY Women's Division T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,-—The report of the Women's Occupational Therapy Department for the past fiscal year is submitted herewith. In Canada there is a shortage of qualified occupational therapists, and twice the number now employed are required to fill vacant positions. Consequently the most difficult problem of this Department during the last year has been the unavailability of professionally trained staff and the fact that positions remain vacant for months. Most CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 61 of our new staff came from England, and it is to be hoped this policy of recruiting staff will be continued. As a result of lack of staff, our services have been curtailed and ward programmes have been temporarily discontinued. According to the American Psychiatric Association standards a hospital this size requires a staff of seventy-five in order to offer a complete occupational-therapy programme. This Department serves women patients only, but based on the above figures the present staff would seem to be inadequate. The staff consists of thirteen occupational therapists and instructors of handicraft, one school-teacher, and nine industrial therapists and seamstresses. Average number of patients registered for treatment was 912. Number of patients admitted for treatment to this Department was 1,851. Number of patients discontinued, transferred, or discharged during the year was 2,063. Number of treatments given was 162,070. Total number of hours workshops available to patient was 11,733. Three University of Toronto second-year students received clinical training in the Department for a period of two months. Lectures were given to the psychiatric and affiliating nurses, and the latter spent one week observing in the Department. Occupational-therapy displays were held at the April meeting of the British Columbia Society of Occupational Therapy, at open house on May 7th, at the Coquitlam Women's Institute Flower Show on August 19th, at the Nursing Exposition on December 15th, and at the Parliament Buildings, Victoria, in February. Christmas activities included designing the Hospital card, assisting in judging ward decorations, parties for patients attending the workshops, and the annual sale which realized $2,422.95. This money is placed in the Patients' Comfort Fund. Volunteer workers have been assisting in our Department since June. Their visits are welcomed by our patient-groups. Mrs. L. C. Smith, executive consultant for the Canadian Association of Occupational Therapy, visited us in September. Her visit was much appreciated, and we hope it may become an annual event. The school-teacher gives elementary instruction to students and supervises correspondence courses. The industrial-therapy departments provide treatment for longer-term patients and supervise the making of articles used in the Hospital. The Uniform Department made 7,105 articles and repaired 1,013, the sewing-room made 105,869 articles, and the Mending Department repaired 50,862 articles. Nurses' uniforms were also sorted in the Department. Respectfully submitted. (Mrs.) Kathleen Feltham, Supervisor, Occupational Therapy Department ( Women's Division). M 62 MENTAL HEALTH SERVICES REPORT, 1954-55 Individual instruction in Crease Clinic shop. General view of art room, Crease Clinic shop. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 63 Manufacturing nurses' uniforms in East Lawn occupational-therapy shops. A corner of the mending-room, East Lawn occupational-therapy shops. M 64 MENTAL HEALTH SERVICES REPORT, 1954-55 MEN'S DIVISION T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Following is the annual report of the activities of this Department for the twelve months ended March 31st, 1955. (a) Industrial Shops The industrial-therapy records were destroyed in the recent fire, so figures are not available for this report. I would estimate the figures to show a general increase over the previous year. The demands on the industrial shops are becoming greater each year with the expansion of the Hospital. (b) Occupational-therapy Shops 1. Crease Clinic Shop.—During a twelve-month period the average monthly attendance was 102. During this period 363 patients were discharged. An average of 40 new patients started treatment each month, and 18 were transferred to the Provincial Mental Hospital; 3 patients were treated on wards. Patients received approximately 37,469 treatment-hours. 2. Centre Lawn Shop.—The daily average attendance is 30 patients. In the course of the year 45 patients were discharged to the community; the remainder were transferred to other treatment areas for a further period before discharge. This is a small shop and the present case load places a heavy strain on our limited space. 3. West Lawn Shop.—This is a new therapeutic section and will be ready to receive patients in approximately one month. Its purpose will be to serve patients unable to attend the industrial shops and act as a screening section for industrial patients. A treatment programme will be directed from this department to serve the West Lawn lobotomy ward. The location of this shop will be in the section known as Ward B 1. 4. Veterans' Building Shop.—A considerable amount of work was completed for other departments of the Hospital. One outstanding item was the making of 495 checker boards for the Recreational Therapy Department. In addition, orders were received for 360 Chinese checker boards, 94 crib-boards, and 76 shuffle-board disks. The floor loom produced a total of 335 yards of 30-inch curtain material that was used to make drapes for various wards. After weaving, the curtains were made up by the Women's Occupational Therapy. One hundred and twenty-five yards of 14-inch material for tote-bags were produced on small looms in addition to twenty-two sets of place-mats and 100 woollen scarves. The second year of operation of the Yule Log Division produced a total of 218 yule logs which also found a ready sale. In addition, they found a good use for salvage newspapers from the wards. The Woodworking Section produced twenty arm supports and thirty-five back rims for the Loyalist furniture, as these items were not available at the time from the factory. One hundred bird-houses from gallon cans salvaged from the kitchens and other waste materials were made and sold. Thirty-six maple bang-a-peg toys were made for the Child Guidance Clinic in Vancouver. Pull toys were made and distributed to the Canadian Legion in the amount of 1,064, and 341 were sent to the Occupational Therapy sale. Considerable work was done on the wood-turning lathe for the Department of Public Works. This consisted of 16 turned legs for tables, 244 plugs for bed legs, and 164 ring frames for observation ports in side-room doors. In addition, two special cash- CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 65 Ceramic-room, Crease Clinic shops. Hand-weaving, Crease Clinic shops. M 66 MENTAL HEALTH SERVICES REPORT, 1954-55 Metal-shop, men's occupational shops. Cabinetmaking, men's occupational shops. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 67 drawers with coin and bill compartments were completed for the Business Office. A large quantity of knobs were made for tea-urns and coffee-pots, etc. A very fine contribution was received from the Ladies' Auxiliary to the Canadian Legion in the form of one of the new Nadeau looms. This loom is all metal and incorporates some very fine features not found in any other loom. No accidents of any sort occurred. The average number of patients in the shop daily amounted to eighteen. A considerable number of other patients took advantage of the pressing facilities and the use of tools to repair personal property. Respectfully submitted. R. Herring, Supervisor, Industrial and Occupational Therapy (Men's Division). DEPARTMENT OF RECREATIONAL THERAPY T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—I beg to submit to you the following report indicating the various programmes and showing the attendance of the activities directed by the Department of Recreational Therapy from April lst, 1954, to March 31st, 1955. Patients' Recreation Number of Total Programmes Attendance Badminton 60 944 Bowling 401 6,792 Chess 25 297 Concerts (visiting groups) 8 5,576 Concerts (patient talent to shut-ins) 18 2,255 Conditioning classes (alcoholics) 56 670 Dances 76 17,071 Dance instruction 77 2,466 Games periods, outdoors (supervised) 7 108 Golf 94 1,205 Gymnasium classes 16 562 Gymnasium classes (Industrial School for Boys) 16 237 Picnics 14 418 Softball League 29 2,979 Sports day (seventh annual) 1 1,400 Swimming 32 1,401 Tennis (supervised periods) 21 164 Ward programmes 233 15,239 Totals 1,184 59,784 M 68 MENTAL HEALTH SERVICES REPORT, 1954-55 | Baseball game, annual field-day, August 27th, 1954. Bowling-alleys, Pennington Hall. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 69 Badminton Staff Recreation Number of Programmes 15 Total Attendance 152 Bowling 62 495 Dances _ _ 2 880 Dance instruction 7 198 Gymnasium classes Swimming 10 49 48 669 Totals .... 145 2.442 The following is a list of programmes which were newly formed and Departmental events, qualifying for special notice:— November lst, 1954: Gymnasium classes regularly scheduled three days a week for the boys of Bisco, including calisthenics, gymnastics, games, and swimming. Directed by Recreational Therapy staff and continued for six weeks. January 11th, 1955: Conditioning period for alcoholics, 9 to 9.30 a.m., Monday to Friday, in Pennington Hall. January 21st, 1955: Reactivation period on Ward H 4, held daily. Recreational facilities were presented to all wards in the East Lawn Building. January 25th, 1955: Mr. Don Cunnings of the Recreational Therapy Department went on loan to The Woodlands School three periods a week for ten weeks. January 26th, 1955: Reactivation periods on Wards A 3 and C 3 held daily. Recreational facilities were presented to all wards in West Lawn Building. January 31st, 1955: Mr. W. R. Brown resigned as Recreational Therapy Director. March 9th, 1955: Volunteer workers commenced helping in recreational programmes. March 10th, 1955: Mr. R. L. Ramsay commenced duties as Recreational Therapy Director. The following is a list of Hospital events held in Pennington Hall:— April lst, 1954: Blood donor clinic. April 8th, 1954: Alumna? fashion show. April 23rd, 1954: Staff Drama Club presentation to staff. November 3rd, 1954: Blood donor clinic. December 10th, 1954: Staff Drama Club presentation to staff. December 11th, 1954: B.C.G.E.A. children's Christmas party. December 17th, 1954: Student-body dance. December 22nd, 1954: Bisco concert. March 18th, 1955: Credit Union annual meeting. March 31st, 1955: Alumnaj fashion show. Musical-therapy activities were as follows: — Church choir: 44 periods, 953 patients. Glee Club: 42 periods, 744 patients. Music appreciation: 176 periods, 8,576 patients. Music variety: 66 periods, 3,505 patients. Therapeutic music: 44 periods, 3,040 patients. Individual music: 15 periods. Staff choir: 9 periods, 305 patients. Although I have been on the Recreational Therapy staff for only a short time, it is quite evident to me that the success of the programme is a direct reflection of the keen M 70 MENTAL HEALTH SERVICES REPORT, 1954-55 interest the staff has in each patient and the assistance and co-operation received by the staff from the other departments. In closing this report I would like to express my great delight in being identified with the Provincial Mental Hospital as Recreational Therapy Director, and also I would like to express my sincere thanks and appreciation to all those who help to make our work enjoyable and successful. Respectfully submitted. R. L. Ramsay, Director oj Recreational Therapy. AUDIO-VISUAL DEPARTMENT T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Plans are under way for a new theatre building at The Woodlands School. The stage will be of sufficient width to incorporate a wide screen. A recommendation will soon be submitted to the Business Manager to install a wide screen in Pennington Hall. It is becoming increasingly difficult to obtain the " flat" type of productions suitable for Pennington Hall, since all of the more desirable films now require some form of wide screen. The educational film library has had heavy demands upon it during the past year, and with new films being added, the total number of films now in the library amounts to 206, with a value of approximately $14,000. New films bring up the problem of catalogues, which are in constant demand, and while they have been assembled from mimeographed sheets, the job is becoming too cumbersome to handle along with the routine work of the Department, and it would appear that catalogues could be made up by some other means. A great deal of credit is due to Miss L. Archibald, stenographer, who has given detailed assistance to borrowers by mail or telephone. Referring to the enclosed table, it will be noted that for the first time an educational record library is included. These seventy-six disks are the result of many years of planning. The original idea was to have audio and visual records, wherever possible, of various types of psychiatric disorders, for reproduction for analysis and educational purposes. Subsequent to the purchase of a number of small portable record-players for use by staff, volunteers, and patients, the recreational record library was used more than ever before. The records are also used in conjunction with the wired music system. Our work assists many departments throughout the Mental Health Services. A full- time photographer would be a great asset to utilize all equipment fully and complete the many assignments in this field. I wish to thank all of the staff who have assisted and co-operated with this department in the past year. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 71 Recreational Motion Pictures Number Total of Shows Attendance 35-mm. films at Pennington Hall 148 54,212 35-mm. films at The Woodlands School 147 25,306 16-mm. films at Provincial Mental Hospital, Essondale; Home for the Aged, Port Coquitlam; and Colony Farm 419 35,338 Total attendance 114,856 16-mm. recreational films shipped to other institutions— Mental Home, Colquitz 95 The Woodlands School, New Westminster 90 Home for the Aged, Vernon 46 Provincial Home, Kamloops 46 Girls' Industrial School 46 Boys' Industrial School 46 Allco Infirmary, Haney 46 Total 417 The 16-mm. projection equipment was loaned out 218 times. Educational 16-mm. Film Library Number of registered borrowers, 116. Films loaned, 489; attendance, 14,107. Films projected at Essondale, 228; attendance, 6,415. Photography 4x5 negatives exposed, monochrome 372 35-mm. negatives exposed, colour 71 8 x 10 prints produced 408 5x7 prints produced 47 7>Va x 4 transparencies produced, colour 44 3V4 x 4 transparencies produced, monochrome 13 Miscellaneous prints produced 22 2x2 transparencies produced, colour 71 16-mm. motion - picture film exposed, monochrome and colour 300 ft. Record Library Popular records loaned 2,083 Recorded music played on wired music system 891 hr. Miscellaneous disks recorded for Recreational Therapy and Audio-Visual 372 min. Educational Record Library Clinical tape recordings 633 min. Clinical disk recordings 670 min. Miscellaneous tape recordings 320 min. Records in library (transcriptions, 78's, long plays) 76 Respectfully submitted. G. H. Walker, Director of Audio Visual Department. M 72 MENTAL HEALTH SERVICES REPORT, 1954-55 LIBRARY REPORT T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Herewith is the report of the medical and patients' libraries in the Crease Clinic for the fiscal year ended March 31st, 1955. Compared to trie previous year, there was an increase of 3,782 in circulation in the patients' library and a decrease of 27 in medical library circulation. The latter is more than offset, however, by the receipt of 86 interlibrary loans requested by doctors, compared to 32 the previous year. Considerable bibliographic work was undertaken, especially in connection with the training programme for medical staff. In June the library undertook the editing and publication of the Leader, a Hospital bulletin which had formerly been put out by the Recreational Therapy Department. The stencilling and distribution is done by the Men's Occupational Therapy in the Crease Clinic, and regular contributions are received from the Audio-Visual Department, Recreational Therapy, Music Therapy, and the Chaplains' Services. In July the library began to use the services of volunteers, who personally take the books to the Homes for the Aged. Their visits soon became a bright spot in the week for the patients, and it is planned to extend their services to other wards. Books from the patients' library needing rebinding were sent to the Young Offenders' Unit at Oakalla. Many donations of magazines were received during the year, and they were distributed to all the wards in the Hospital. The George Derby Health and Occupational Centre were particularly generous. The Crease Clinic library provided service to all the wards of the Provincial Mental Hospital at Essondale, the Homes for the Aged in Coquitlam and Vernon, and the Vista in Vancouver. A portion of the Federal Mental Health Grant was again made available to the medical library for the purchase of basic works in medicine and psychiatry. Patients' Library Book collection 4,845 New books added 310 Donations 132 Total 5,287 Less— Losses 130 Discards 161 291 Total 4,996 Current magazine subscriptions 15 Number of books circulated 16,966 CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 73 Medical Library Book collection 1,924 New books added 148 To nurses' library 36 To laboratory r~ 23 207 Total 2,131 Journals, medical and psychiatric 85 Journals currently bound 21 Number of books received on interlibrary loan 86 Number of books circulated 928 Number of pamphlets 603 Respectfully submitted. (Miss) H. Walsh, Librarian. DEPARTMENT OF PHYSICAL MEDICINE T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Following is a report of the treatments given in the Physiotherapy Department of the Crease Clinic of Psychological Medicine from April lst, 1954, to March 31st, 1955: Male Female Total Bran and oatmeal baths 72 72 Cervical suspension 18 4 22 Delormes exercises 19 19 Foam baths 130 1,330 1,460 Galvano and faradic stimulation 100 49 149 Infra-red 450 342 792 Massage and remedial exercises 1,431 1,931 3,362 Needle sprays .__ 454 1,375 1,829 Progressive relaxation 8 539 547 Scotch douche 43 43 Sedative baths 870 788 1,658 Short-wave diathermy 928 401 1,329 Sitz baths 27 41 68 Starch baths 8 8 Steam baths 42 32 74 Ultra-violet lights 526 95 621 Wax baths 138 131 269 Whirlpool baths 29 66 95 Total number of treatments 5,250 7,167 12,417 Total number of patients treated 868 942 1,810 M 74 MENTAL HEALTH SERVICES REPORT, 1954-55 Chiropody Total number of patients treated 801 Total treatments 1,175 Respectfully submitted. F. E. McNair, B.A., M.D., CM., Clinical Director. DENTAL DEPARTMENT T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—The past year has been a busy one for the Dental Department. The ever- increasing demand by the medical staff for dental work for their patients has made it necessary for all members of the staff to work hard, and this they have all done. During the year a new system of ordering supplies has been put into effect, eliminating all emergency ordering and confining our general ordering to once per month. This was made possible by having the Occupational Therapy Department construct a large cabinet and then putting in a basic stock of supplies, from which we now also supply the needs of The Woodlands School Dental Clinic. Far too many instances occur where perfectly good anterior teeth are loosened and thus lost during convulsive therapy. This is due to the unsatisfactory mouth props at present being used. Dr. McNair has asked me to examine several new types used in other mental hospitals. One of these I consider ideal and would most strongly advocate its adoption by this Hospital. I believe the cost would be more than offset by the preservation of healthy teeth, and could save the Hospital from some nasty damage suits which a patient or his or her relatives, in my opinion, would be bound to win were it proven that this Hospital is employing inferior methods for the protection of its patients' teeth during convulsive therapy. Much time is at present spent by the laboratory technician on repairing broken dentures. This is due to the many old vulcanite dentures still in use. Whenever opportunity presents, these dentures are replaced with new ones made of the much stronger plastic. Summary of Work Examinations 1,992 Extractions 1,293 Fillings 1,366 Treatments 246 Prophylaxis 581 X-rays 628 Dentures made 247 Dentures repaired 256 Dentures relined 38 Bridge repairs 9 Gold inlays 2 General anaesthesia 7 Plastic crowns 3 Respectfully submitted. H. O. Johnsen, D.D.S. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL OPTICAL REPORT M 75 T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—The following is the report of the optical work done at the Provincial Mental Hospital and the Crease Clinic for the fiscal year April lst, 1954, to March 31st, 1955:— Refractions 429 Major repairs 281 Minor repairs and adjustments 120 Respectfully submitted. R H WooDBRIDGE; Optometrist. Beauty-parlour, Crease Clinic. BEAUTY-PARLOUR REPORT T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—I hereby submit the Beauty-parlour report for the fiscal year April lst, 1954, to March 31st, 1955:— Location of Unit Shampoos Sets Perma- nents Oil Treatments Haircuts Manicures Shaves Scalp Treatments Marcels Home for the Aged1 1,722 1,570 576 4,268 1,546 1,254 1,721 3,564 116 315 190 702 729 642 350 1,225 914 835 668 6,190 22 101 96 754 661 16 77 1,343 71 253 East Lawn Building2 52 Totals 8.136 1 8.085 1 1.323 1 2.946 8.607 1 973 2.097 1 394 52 Plus 192 make-ups. 2 Plus 4 dyes. Respectfully submitted. (Mrs.) M. Townsend. M 76 MENTAL HEALTH SERVICES REPORT, 1954-55 DEPARTMENT OF DIETETICS T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—A major change in the Dietary Department during this past year has been the completion of a centralized meat-cutting shop. Partial operation from this unit began in May, with services gradually increasing until centralization was completed in September. To accomplish this, it was necessary to effect a standardization of menus for all kitchens so that the daily work orders would be consistent. A rotation menu plan was set up, consisting of four one-week phases. The menu for approximately one-quarter of the population is on each phase, and as they rotate through the pattern they receive a well- balanced and varied diet. Prior to this system, each kitchen had operated as a completely separate unit; now all have basically the same meals, which may, of course, be adapted to the special requirements of the patients in the area. Dietician checking special-diet trays. Installation of a new dish-washing machine in the East Lawn Building was an important factor in raising the standard of service there. The fact that the dish-washing section has been relocated has helped to relieve the congestion in the kitchen. A total of four night cooks have been employed for staff meal service. As the number of meals served in three areas seldom reached a total of fifty, night meal service was concentrated into one building. The two cooks released from night duty were utilized in the areas serving large numbers of patients. Although some work was done in the East Lawn diet kitchen, this unit was not completed. The number of therapeutic diets has increased from 100 to over 200 in the past three years. During the year the Department assisted with plans for kitchens in two new units to be built at The Woodlands School and the Home for the Aged. Equipment orders CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 77 were placed for the North Lawn unit, and preliminary organization plans made. It was also necessary to plan new staff schedules so that the forty-hour week could be implemented in April. Considerable progress has been made during this year, but the shortage of dieticians on staff is a major problem. Complete supervision of the food services of the Provincial Mental Hospital, Crease Clinic, and Home for the Aged is impossible with a staff of only four. Respectfully submitted. (Miss) Catherine L. Neighbor, Chief Dietician. DEPARTMENT OF NEUROLOGY T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—I beg to submit the annual report of the Department of Neurology covering the period of April lst, 1954, to March 31st, 1955. Both the clinical and laboratory studies of patients showed an increase over the previous fiscal year. The number of electroencephalograms carried out was 1,331, compared with 1,079 the year before. A total of 328 pneumoencephalograms were performed, 91 more than in 1953. Thirty-nine cases were dealt with in collaboration with the neurosurgical service; fourteen of these required neurosurgical intervention of various kinds, and the remainder were handled with conservative therapies. For the first time practically all neurosurgery was done at the Crease Clinic, avoiding the costly transfer to the Vancouver General Hospital. Corticoencephalography was employed in the surgical eradication of epileptogenic lesions with gratifying results. Survey studies on a research project of the electroencephalographic relationship to mental illness were jointly continued with Dr. M. Kennard. Lectures on neurological and related matters were given to medical and nursing staff. Clinical demonstrations were given to first- and third-year medical students, as well as to students of applied psychology. Patients Referred to Neurosu rgery and Dispos it ion, April 1st, 1954, to March 31st 7955 Number of Cases Post-operative Disposition Diagnosis Rehabilitation Discharge Pending Return to Mental Hospital In General Hospital Died Total 5 2 .... 3 1 .... 5 2 1 1 2 1 1 1 2 2 1 1 2 3 | 3 1 | .... .... | .... 1 I 3 1 Totals 15 1 10 1 1 4 15 Respectfully submitted. W. P. Fister, M.D., F.R.C.P.(C), Director of Neurology. M 78 MENTAL HEALTH SERVICES REPORT, 1954-55 LABORATORY REPORT T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Total laboratory tests carried out at the Mental Hospital and Crease Clinic during the fiscal year April lst, 1954, to March 31st, 1955, were 51,486. This represents 5,460 more laboratory examinations than were performed in the previous year; this also represents a greater rate of increase than that of the previous fiscal year over 1952-53. In reviewing the detailed figures of the tests carried out and comparing them with the record of the previous year, several points are of some interest. In serological tests there is a further decrease in the percentage of positive Kahn tests, with an over-all increase in the total tests carried out. Laboratory technician in Crease Clinic laboratory. In the field of hematology the most outstanding variation from the previous year is in the blood-bank area, where grouping and cross-matching total 436, as opposed to 268. There is as well a very appreciable increase in bleeding and clotting times, with the more routine blood tests showing only a slight increase. Biochemical tests, particularly in the field of liver-function tests, show very pronounced rise. This is ascribable to two factors: first, an outbreak of infectious hepatitis among both patients and staff, and the increased use of largactil as a therapeutic measure. A further factor entering into the over-all increase in total laboratory tests has been the opening of the new North Lawn Building. The Mantoux testing programme is continuing. It is of further interest to note that a number of the more time-consuming procedures, particularly tests for 17-ketosteroids, show an increase of well over 100 per cent. Surgical and biopsy speciments are at approximately the same level as last year, and autopsies show a slight decrease. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 79 A very real rise has been present in the medico-legal biochemical tests for Coroner's Courts tand for the Royal Canadian Mounted Police. For the most part, these are blood alcohol estimations and blood, gastric contents, and tissue estimations for barbiturates. Electrocardiograms and basal metabolic rates are approximately the same level as last year. Enumerated below is the report of laboratory tests carried out from April lst, 1954, to March 31st, 1955:— Blood tests— Kahn, negative. Kahn, positive... Kahn, quantitative 3,111 40 27 1,393 Red-blood cells and haemoglobin Haemoglobin 3,352 Hematocrit 10 Mean corpuscular haemoglobin 2 Mean corpuscular volume 2 Mean corpuscular haemoglobin concentration 2 White-blood cells and differential 4,151 Eosinophile count Thorn test Examination for L-E cells .... Sedimentation rate Grouping Cross-matching Indirect Coombs test Sternal marrow Bleeding time . Coagulation time Prothrombin activity Platelet count Reticulocyte count Red-cell fragility Culture Widal Agglutination for B. abortus. Paul Bunnell test Glucose Glucose tolerance Amylase 142 1 1 1,914 145 .... 291 3 2 220 233 111 33 40 1 26 1 1 4 518 24 13 Non-protein nitrogen 221 Urea nitrogen Urea clearance Uric acid Creatinine Carbon monoxide Carbon dioxide combining power Cholesterol Barbiturate Bromide Chloride Sodium Potassium Iron 13 1 6 11 1 37 104 6 14 22 31 30 5 M 80 MENTAL HEALTH SERVICES REPORT, 1954-55 Copper 3 Calcium 26 Phosphorus 15 Alkaline phosphatase 68 Acid phosphatase 11 Icterus index 101 Van den Bergh 235 Total protein __. 70 Albumin globulin ratio 78 Fibrinogen 2 Hanger flocculation 904 Thymol turbidity 8 8 Bromsulphalein excretion 1 Alcohol 9 Salicylate 1 Ascorbic acid 2 Cerebrospinal-fluid tests— Kahn, negative 332 Kahn, positive 15 Kahn, quantitative .. 9 Colloidal gold 310 Cell count _._.___ 656 Total protein 869 Glucose 4 Chloride 1 M. tuberculosis 1 Ultra-violet absorption spectrum 214 Urine tests— Routine general 10,358 Acetone 2,004 Quantitative sugar 409 Benzidene test 561 Bromide 2,511 Quantitative albumin 273 Bence-Jones protein 2 Two-hourly 3 Concentration-dilution test 1 Diuresis test 1 Urea concentration test 1 Friedman —. 61 Bile 1,509 Urobilinogen 152 Uroporphyrin 1 Porphobilinogen 1 Phenylpyruvic acid 2 Diastase 2 Phenolsulphonphthalein excretion 3 Barbiturates 3 Salicylates 2 Total nitrogen 2 17-ketosteroids 27 Tuberculosis (24-hour specimen) 7 CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 81 Copper Cystoscopic specimens..... Smears— Miscellaneous Gonococcus Trichomonas vaginalis Fungus M. tuberculosis Vincent's organisms Malaria Sputum for tuberculosis Cultures— Miscellaneous Antibiotic sensitivity test. Diphtheria 121 4 1,116 95 77 6 50 3 1 181 383 211 1 Typhoid.. 1,376 Dysentery 1,339 Salmonella M. tuberculosis Candida albicans.. Gonococcus Water ... Gastric contents— Chemical analysis. Occult blood M. tuberculosis Barbiturates Alcohol Heavy metals Faeces— Parasites Occult blood M. tuberculosis Injections— Typhoid vaccine ... Diphtheria toxoid Skin tests— 5 127 14 2 8 67 3 3 3 63 68 1 563 54 Tuberculin 2,050 Pollen sensitivity Schick test Casoni test Smallpox vaccinations ... Basal metabolism tests... Electrocardiograms Surgical specimens Cytological examination- Autopsies Animal autopsies 1 197 1 148 204 401 89 6 125 60 Sections, paraffin... 3,982 Sections, frozen 3 Rumpel-Leeds test 1 Pleural-fluid routine 1 M 82 MENTAL HEALTH SERVICES REPORT, 1954-55 Hydrocele-fluid routine 1 Milk for preservatives 1 Tissue for barbiturates 4 Tissue for alcohol 9 Tissue for phenol 1 Tissue for salicylates 1 Tissue for chloral hydrate 1 Tissue and food for cyanide 2 Soap analysis 1 Total 51,486 Respectfully submitted. H. E. Wilson, M.D., Pathologist. DEPARTMENT OF RADIOLOGY T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—The following is a report of the work performed in the Department of Radiology from April lst, 1954, to March 31st, 1955:— Crease Clinic of Psychological Medicine Number of films taken 4,902 Number of patients X-rayed 1,979 Films Patients Chests 1,509 1,484 Extremities 202 65 Spines 377 114 Skulls 75 31 Pneumoencephalograms 1,920 160 Barium enemas 172 17 Barium meals 336 26 Pyelograms 84 12 Ribs 19 10 Pelvis 12 6 Abdomens 40 19 Jaws 31 9 Mastoids 28 7 Sinuses 34 9 Nose 3 1 Gall-bladders 25 4 Barium swallows 7 2 Ventriculargrams 16 2 Angiogram 12 1 4,902 1,979 CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 83 Provincial Mental Hospital Number of films taken Number of patients X-rayed Films Chests 8,996 Extremities 2,540 Spines 547 Skulls 276 Pneumoencephalograms 1,872 Barium enemas 567 Barium meals 813 Intravenous pyelograms 236 Ribs 54 Pelvis 38 Abdomens 174 Jaws 142 Gall-bladders 86 Sinuses 46 Noses 96 Barium swallows 79 Mastoids 16 Cholangiogram 4 Ventriculargram 6 Orbit 2 16,590 Respectfully submitted. 16,590 10,560 Patients 8,906 834 149 101 156 64 65 37 28 22 76 38 17 13 32 15 4 1 1 1 10,560 J. M. Jackson, M.D., Director of Radiology. DEPARTMENT OF PSYCHOLOGY T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Following is a report on the activities of the Psychology Department from April lst, 1954, to March 31st, 1955. During the past year two psychological interns were carried by the Department, with an effort being made to give these people a wider programme of supervised experience. A plan was formed whereby an intern should obtain some experience with mentally retarded patients in The Woodlands School. It was felt that a broader use of the facilities available in the training period would add to the scope of the psychologist who spends up to one year gaining experience that will make him an adequate member of the psychiatric team. Mr. A. Clarke, who completed his internship in October, 1954, remained on staff as a Psychologist II. The reorganization of psychologist positions was completed this year. There still remains an unfavourable ratio of staff to patients, and new positions are persistently sought in order to keep up with the work demands made on this small department. Of some assistance has been the work of the psychologist of the University research team, who has covered some cases that would normally be assigned to the psychologists here. M 84 MENTAL HEALTH SERVICES REPORT, 1954-55 There has been an increase in the amount of time spent in interdepartmental staff meetings this year. A psychologist attends all ward-round meetings, a total of six weekly. Here the referral system shows some improvement when a psychologist is present to review the possibilities of the individual case before the referral is accepted. The psychologist also has the opportunity to assess his findings in the light of the investigations completed by other departments. The programme of the psychology lectures for psychiatric nursing continues. Forty- five hours of lectures were given to approximately 100 second-year students. An effort has been made to rotate classroom activities amongst the members of the Department so that more psychologists become experienced in the presentation of psychological lecture material. Clinical psychologist examining a patient. The Psychology Department still contributes to the group therapy programme, with 108 sessions being attended. Psychologists are active in groups in the Provincial Mental Hospital as well as the Crease Clinic. A new system of recording of material obtained from group therapy has been instituted. This requires a pre-therapy note on the treatment goals for each individual, progress notes during therapy, and a concluding summary when group therapy is completed. This recording is in addition to the regular reports still kept on individual meetings. A contribution was made to the research programme carried on in conjunction with the medical staff. Psychological tests have proved a useful means of measurement when pre- and post-treatment comparisons are to be made. Twelve patients were seen and a total of fifty-six tests were given in a group therapy study with patients in the Mental Hospital. Another research design was set up for a study on the effects of a new treatment drug. It is planned to proceed with two testing periods with each individual, after which statistical comparisons will be drawn. The main function of the Psychology Department remains the clinical assessment of individual patients by means of psychological tests. Many tests are employed to meet CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 85 a variety of needs, but the most pressing need is for information most readily obtainable through the use of projective techniques. A thorough assessment of the patient's assets and liabilities is of utmost importance early in his hospitalization. However, there is an ever-increasing interest in re-evaluation of patients* who have been in hospital for a prolonged period, and again material brought forth on both projective and standardized psychological tests is of utmost importance in assessing the individual's degree of function. A total of 478 patients were seen for clinical assessment in one or more interviews. The following table lists the specific tests utilized:— Referrals completed 478 Referrals seen by research 102 Ward rounds 210 Group therapy t 108 Lectures to medical students 8 Hospital tour for University students 1 Student-nurse interviews 2 Psychiatric nursing lectures 45 Psychiatric nursing examinations 100 Abstracts of psychological examinations 2 Orientation lectures 5 Research project 1 Tests Administered Bender-Gestalt 124 Benjamin Proverbs 5 Blacky Pictures 1 Draw-a-Person 190 Goldstein Scheerer 9 Kuder Preference Record 5 Incomplete Sentences 8 McQuarrie Test of Mechanical Ability 1 Make-a-Picture Stories 1 Minnesota Multiphasic Personality Inventory 2 Occupational Interest Inventory _.... 6 Porteus Maze 7 Progressive Matrices 3 Rorschach 373 Rosenweig Picture Frustration 1 Stanford-Binet 10 Symonds Picture Story , ... 9 Shipley-Hartford 104 Szondi 52 Thematic Apperception Test 53 Wechsler-Bellevue 338 Wechsler Memory 15 Wechsler Intelligence Scale for Children 6 Word Association 1 Wide Range Achievement 3 Total 1,327 Respectfully submitted. Alice J. Elart, Senior Psychologist. M 86 MENTAL HEALTH SERVICES REPORT, 1954-55 SOCIAL SERVICE DEPARTMENTS, PROVINCIAL MENTAL HOSPITAL AND CREASE CLINIC OF PSYCHOLOGICAL MEDICINE T. G. Caunt, Esq., M.D., , Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—I beg to present the annual report of the Social Service Department of the Provincial Mental Hospital. During the years 1954 and 1955 the Department has moved toward greater consolidation, both in organization and administration. Social Service functions have been critically studied and defined, and a statement of policy relevant to these changes has been formulated. Withal social services in general to patients have continued to expand through the increasing use of diagnostic and brief services, as well as in the area of group work services. ■:■■ "' fl •: :H;:::,":' :.:i.s|l||||f N ■'.'...■ r UST" fc *WL a ^, EH . . ■ . : .-■ ■ ; Social-case worker interviewing relatives of a patient. Staff Changes, Provincial Mental Hospital During the year 1954-55, the Social Service Department of the Provincial Mental Hospital, with a basic establishment of eight social workers, has undergone several changes. Three resignations necessitated replacement by one experienced social worker and two who were newly graduated from the School of Social Work. In addition, two members of the staff were granted educational leave, and in the interim were replaced by one trained social worker, employed, however, on a part-time basis only. Another staff member was promoted to a supervisory position which had become vacant on the transfer of the encumbent to the Social Service staff of the Crease Clinic. In all, the Department carried on its responsibilities throughout the year with the assistance of five and one-half social workers on staff. Despite these changes in personnel, with their ensuing decrease and dislocation of services, over-all gains have accrued in the quality of services, in improvements in CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 87 Departmental organization, and in an expansion of those services provided on a short- term basis. This has been due primarily to the skill of the casework supervisor, and to the interest and sense of responsibility on the part of the entire staff. Changes in the Locale of Social Services in the Provincial Mental Hospital The Departmental structure instituted three years ago continues to prove adequate as a base for the effective use of a less than minimal staff in rendering service to the percentage of patients selected for coverage. This structure comprises two sections— Admission and Brief Services and Continuing Casework Services. Social Services in the Admission and Brief Services Section are located in the Centre Lawn Building and are now concerned almost entirely with direct service to the patient-group there in residence, whereas formerly this service was extended to all units of the Hospital, with the result that a percentage of the patients in Centre Lawn were selected for brief social services. Because of the demands from other units of the Hospital, it was not possible to concentrate on the total group of patients in the Centre Lawn Building, the admission unit to the Provincial Mental Hospital. During the year 1,163 patients were admitted to Centre Lawn; of this patient-group, 1,109 were referred to the Admission and Brief Services Section. For the past three years this Section has been staffed by one social worker. Increasing demands from Centre Lawn for service this year necessitated assistance from two social workers from the Continuing Casework Services Section and from three student social workers. This assistance was given at the expense of the programme in the latter Section. The benefits to the Centre Lawn programme were encouraging. The social worker, with assistance, was able to assess the social situation and social service needs of the 1,109 patients referred for social diagnostic study, and to screen out from these referrals 429 patients (38.68 per cent) for social services. These, of necessity, had to be of a very brief nature, which is understandable when the numbers needing this help and the staff available to give it are taken into consideration. It was not possible to extend help to the patients in Centre Lawn during the pre-convalescent and convalescent period. This is a very regrettable situation, since the percentage of patients being discharged from Centre Lawn admission unit has increased over the past two years from 44 to 65 per cent of all patients admitted. A preliminary review of staff needs in the establishment of a social service department in Centre Lawn admission unit would indicate the appointment of four workers on intake and brief services to cover the needs of newly admitted patients and four on continuing casework services to cover the needs of patients during treatment, pre- convalescence, and convalescence. The intake workers would greatly facilitate the diagnostic study by the team at the time of the patient's first staffing. The appointment of four workers to continuing casework services would make a marked contribution to the rehabilitation of the patient and, on his return to community, help him to hold his gains in treatment and to adjust to community life. Patients at this time need the security that lies in the concrete help, support, and understanding of a social worker from the Hospital. It is this service which often prevents a readmission. The Continuing Casework Section is located in East Lawn; although having an establishment for seven workers, the work-time of only four and one-half workers was available this year. The workers in this Section have tended to focus their efforts on the patients in the long-term treatment units in East Lawn, West Lawn, Homes for the Aged, and the Colony Farm. These units have increased their referrals of patients to such an extent that the Section had to close intake from time to time. However, 118 patients were referred for help from Centre Lawn while in treatment, and 217 were referred from East Lawn, West Lawn, and the Colony Farm. In addition, 413 patients M 88 MENTAL HEALTH SERVICES REPORT, 1954-55 were referred from the same sources for assessment of readiness for rehabilitation and for planning rehabilitation. The Section's greatest social-work activity has centred on East Lawn, with its patient population of 1,433 women. Case-load Details in the Social Service Department, Provincial Mental Hospital Tables 1 and 2 show the continued increase in the numbers of patients given direct service (42.4 per cent) over the previous fiscal year. The quality of service on interview count has improved some 60.27 per cent over that of the previous fiscal year. The activity of the Admission and Brief Services Section may be further estimated by the increased number of case summaries (713) prepared for the diagnostic study and the formulation of the initial treatment plan during the patient's first staffing. This Section covered 90.77 per cent of all patients admitted to Centre Lawn; 38.68 per cent were given brief casework services, ranging from three to six interviews. The remainder were studied for diagnostic purposes. In the previous year 31.15 per cent of all patients admitted to Centre Lawn were screened for brief casework services and no diagnostic study service was given. Tables 3 and 4 indicate a slight decrease in the number of patients given service in the Continuing Casework Services Section of the Social Service Department of the Provincial Mental Hospital. This is undoubtedly due to staff shortages and the fact that resignations were replaced mostly by beginning workers who must be oriented at first to the specifics of the psychiatric-hospital setting. Some 809 patients were given service in this Section, and some 5,577 helping interviews were undertaken in the integrated approach to patient treatment shared by social work with medicine, nursing, psychology, and other services in the hospital. Social Service Department, Crease Clinic of Psychological Medicine The year 1954-55 has been a year of consolidation and expansion of the work in the Social Service Department of the Crease Clinic of Psychological Medicine. Demands for in-patient services have increased, as well as those for continuing family casework services for patients discharged in full. This latter service is very necessary if patients are to retain whatever gains in treatment they make in the Crease Clinic with its accelerated period of treatment, ranging from eight weeks to four months. Emotional illnesses are long in the making; treatment to rehabilitation is only possible through intensive and extensive services over a long period. These must extend into the patient's home, his family, and often his relatives, friends, and the community. The patient's increasing need for family services on discharge are thus seen as a real necessity if an adjustment is to be made and maintained. Of the 1,385 patients entering the Crease Clinic during the fiscal year, it is estimated that approximately 1,108 come from their homes in the Greater Vancouver area. From a study in the Social Service Department, approximately 750 patients on discharge are in need of continuing family services. The service capacity of existing health, welfare, and employment agencies in the Greater Vancouver area is already seriously overtaxed. Therefore, the Crease Clinic and its Social Service Department must provide a follow-up family service for those patients whom existing community agencies cannot serve. The development of the day-hospital and out-patient unit is eagerly looked forward to in an effort to meet these patients' needs. Meanwhile a very large responsibility for this service rests with the Crease Clinic Social Service Department. It has received the help and support of the medical and nursing departments in this work, and grateful acknowledgment is hereby extended to them. Staff Changes, Crease Clinic During the fiscal year there have been three changes in senior staff. One casework supervisor transferred to another division of the Social Welfare Branch. This position CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 89 was filled from senior casework staff in Crease Clinic. Another senior caseworker transferred to a casework supervisory position in the Child Guidance Clinic. These vacancies in the caseworker ranks have remained unfilled to date. The present establishment for caseworkers in the Crease Clinic is set at seven. For much of the fiscal year the Social Service Department has operated with five social workers. Their in-patient social service responsibility covers 1,385 patients admitted during the fiscal year and 750 patients needing continuing family services on discharge. Department Structure This remains as instituted three years ago. The reasons for the structure were to attain better coverage of patients' social service needs through a functional utilization and structuring of a less than minimal staff. It still proves relatively adequate to these ends. This structure embodies the sectionalization of staff into Admission and Brief Services and Continuing Casework Services. In the Admission and Brief Services Section, 1,385 patients were reviewed and screened for referral to social services. Of these, 410 patients were referred to the Continuing Casework Services Section, and 734 patients were carried in the Admissions and Brief Services Section on a brief service level. The number of patients to whom no in-patient service could be given was 241. Despite the fact that 52.9 per cent of patients were carried in Admission and Brief Services Section reflects in no way any kind of adequate service to the patients concerned. Intake studies of the patient's situation, single interviews with relatives, single interviews with patients, and single interviews with psychiatrists account for a large proportion of the 52.9-per-cent coverage. In many of these instances the Admission and Brief Services workers' assessment revealed that a further service, either of a brief or continuing nature, would have been most helpful to the patient or his family. It was not possible to give such a service, even during that portion of the year when there were three social workers in this Section (April lst, 1954, to August 31st, 1954). In reviewing the records of the patients' first staffings, an over-all average of fifteen women patients and twelve men patients were presented weekly at each staffing (ward rounds). Each patient to be presented was reviewed by the social workers and casework supervisor in this Section prior to ward rounds, and a tentative decision made regarding referral. It has been concluded from this review that where fifteen women patients have been presented at the staffing in any one week, an average of three have been assigned to Continuing Services, and two to Brief Services, involving more than the very brief contact, as indicated above. Despite the fact that 33Vz per cent of the patients presented were assigned on any specific basis, the Section supervisor has always been aware that an additional 33VS per cent of the patients had problems, indicated in the initial social service review, as requiring casework services. The Continuing Casework Services Section started the fiscal year with four caseworkers on staff. In December, 1954, this was reduced to three workers. During the fiscal year 410 patients were referred to this Section. In such instances intensive casework services were provided to these patients and to their families for periods of time varying from two months to one year and involving interviews ranging from three or four a week to once every two weeks or a month. The latter applies to patients who have been discharged, whereas in some instances in-patients have been seen on a daily basis for several weeks of their hospitalization. Follow-up services to discharged patients have had to be provided at a minimal level. Case-load Details in the Sections Concerned with Admission and Brief Services and Continuing Casework Services, Crease Clinic Tables 5 and 6 show a continued increase in the numbers of patients given direct services at the time of admission (80 per cent increase over the previous fiscal year). M 90 MENTAL HEALTH SERVICES REPORT, 1954-55 On interview count the quality and activity in direct help has improved some 72.46 per cent over that of the previous fiscal year. This Section's activity in the diagnostic and treatment formulation staffings may be ascertained from the fact that 231 summaries were prepared by this Section for the patients' first staffings. Some 734 patients (52.9 per cent of all patients) were carried at a very brief service level. Tables 7 and 8 indicate that 33% per cent of all patients entering Crease Clinic were carried on an intensive continued-casework services level. Due to depletion in staff, this Section was able to carry only one-third of the patients it carried in the previous fiscal year in a sustained and continued casework helping relationship. These tables also indicate progress made in integrative therapy. There has been over 100 per cent increase in inter-conferencing of cases with other disciplines, that of nursing being most significant. Report on Social Group Work Services, Provincial Mental Hospital and Crease Clinic, April 1st, 1954, to March 31st, 1955 During the fiscal year the social group work service to patients (inaugurated in February, 1954) has expanded into three major areas of collaboration with medicine and nursing. These include development of social group activities for adolescent patients, an experimental " open ward" programme, and participation in nursing education. While development of the total service is still in its early stages, with only one worker, the social group work method appears to have stimulated widespread interest and gained considerable acceptance as a therapeutic medium. The following is a brief summary of services given:— Adolescent Treatment Group.—Demonstration programme in collaborative use of social group work method and group psychotherapy in treatment of teen-age patients who form a small but clear-cut minority within Hospital and Clinic. This is a mixed group of approximately ten adolescents referred by their own doctors for a socializing experience and especially for help in working through dependency needs and channelling awakening hetero-sexual drives. The group meets three times weekly (two social and one psychotherapy session—one session taken by social group worker, one by doctor, and one jointly led). It is composed of teen-agers from all parts of Hospital and Clinic living on adult wards. They have widely varying diagnoses (from schizophrenic to behaviour problems) and diverge markedly in previous socialization and background. A balance is kept between boys and girls, and aggressive and passive reaction patterns, as well as between Clinic and Hospital patients. It is a small, constantly changing group (turnover of 60 to 70 per cent in nine months) but with relatively stable nucleus. During the year this group has met ninety-six times (exclusive of psychotherapy sessions), extending group membership to a total of thirty-five patients with an average treatment period of six weeks each. Two-thirds of the total of twenty-four discharges have been Clinic patients, while five patients have been suspended or transferred to other treatment services. While attendance at meetings is voluntary, group attendance for the year has been 86 per cent, while a further 12 per cent is accountable to conflicting appointments, physical sickness, etc., leaving only 2 per cent as voluntary absence. This high attendance record in itself gives some indication of the need being filled. Group Goals.—1. To promote warmer, more meaningful interpersonal relationships and feeling of belonging to society. 2. To provide both outlets and controls for the aggressive and greater security and freedom of expression to the withdrawn. 3. To assist the total group acquire greater ability to make and carry out its own plans in an increasingly mature fashion. 4. To help all members gain increasing independence of parental patterns while developing social standards and values in keeping with those of the wider community. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 91 Through this service the group worker provides a different treatment focus in which, through the worker's concentration on the needs of the whole group and of the individual only as seen in and through the group, all members gain ability to adjust their own needs to those of their contemporaries and of society. The social programme, aimed toward improvement in relationships and behaviour, is basically that of a teen-age club, in which members are encouraged to develop ability in planning their own programme, making decisions, and assuming responsibility for follow through. It has been extremely permissive but within definite limits of hospital setting with additional controls as necessary in the light of individual and group needs. The group itself has become well established during the past year, slowly developing through the usual testing phases until it now has quite well-defined group mores and codes, many of which are now internalized by members. Despite slip-backs, there is marked general improvement in members' behaviour both in the group and on their wards. Group unity has also permitted increasing freedom in choice and setting of programme, enabling leaders to take members out of doors and occasionally off the grounds. Programme media used as tools in channelling hostility, increasing independence, and assisting in development of hetero-sexual interests have included simple active games, hikes and picnics, sing-songs, square and ballroom dancing, and listening to records. Painting and plasticine work (chosen by members in preference to clay) were important in freeing the group in initial stages. Food and its preparation has been a major interest (as might be expected), as have periodic group parties and informal discussion of social experience. In good weather the group has also made extensive use of a log cabin on the grounds, which has permitted a further range of programme activities. Group Movement.—During the year significant changes in group behaviour have occurred. These include broadening of programme and interests, development of group codes of behaviour enforced by the members, increased ability to make and carry through appropriate decisions and plans, along with a greater sense of freedom, unity, and belonging both for the individual members and for the group as a whole. While individual treatment goals vary widely, within the general goals according to the nature of each member's particular problems, it is safe to estimate that 50 per cent have made significant improvement in behaviour and general adaptation, while a further 25 per cent have benefited considerably in specific areas (these are, by and large, the youngsters with the more deep-rooted forms of disturbance). Of the remaining 25 per cent who have benefited only slightly or not at all, approximately half were new members beginning treatment at the year-end, while the remainder were those whose personalities were too damaged to gain anything from this form of treatment (and who were therefore suspended from membership) or those whose escape terminated treatment in its initial stages (one member). Major achievements, in addition to improved behaviour already noted, have come in several areas. Most important is the impetus which group progress has given to medical plans for separate living facilities for these patients in an adolescent treatment centre. While many refinements in selection and screening criteria, group methods and programmes, casework group work integration, and research techniques are still required, it is safe to state that the social group work method as demonstrated in and through this group has gained high acceptance in this setting as a valuable therapeutic tool in the treatment of adolescents. As a further step in sharpening group work skills, a major evaluation of all aspects of the programme is to be undertaken during the summer of 1955 as a guide to future planning. " Open Ward " Project.—As a second demonstration of use of social group work method, an on-ward programme has been initiated in relation to a hospital ward of 156 patients which was " opened " in February. This is basically a long-term treatment M 92 MENTAL HEALTH SERVICES REPORT, 1954-55 ward for patients working in various parts of the Hospital who have proved themselves capable of using parole privileges effectively. The social group work programme has been designed to assist the nursing staff in organizing and conducting an extensive social-recreation programme for the patients, developing interest and discussion groups to improve ward life. In this the worker has given direct leadership in initiating and planning activities, functioned as resource person to the charge nurse and her staff in carrying continuing programme and as liaison person between the various disciplines involved in the team, participating in a total of eighty major conferences. One of the major aims has been to institute group controls to replace the staff controls automatically relaxed with the opening of the ward, and to make a transition toward more socialized " community " living. Toward this end, small groups of patients have been planned around verbalized and inferred interests such as charm and personal appearance, cooking, talents (music, dancing, choral singing, drama), active games, etc., in addition to discussion groups around ward life and management. Patients are already showing marked response to the suggestion of more autonomous club-type activity, and repercussions begin to show in administrative circles toward efforts to provide necessary equipment and facilities, and to strengthen and solidify the staff team conducting the experiment. With the project yet in its initial phase, many difficulties remain to be overcome, but the approach is generally most positive and forward looking. Already much has been accomplished toward clearance of interdepartmental communication channels, provision of equipment, and stabilization of nursing personnel (who normally move from ward to ward as well as from shift to shift). To date two new social activity groups have been formed on the basis of patient interest involving roughly one-third of the total ward population. Entertainment Committee.—This group began in December, 1954, around planning of ward Christmas activities, including a concert party (with talent drawn from the ward) which was organized and conducted mainly by the patients themselves. As of March 31st, it had held a total of ten meetings and grown in both size (from six to twenty) and in scope of activities, planning and carrying out entertainment, decorating, refreshment and serving responsibilities for monthly ward parties, and initiating the request for joint parties with patients in the equivalent male open ward. This group has chosen its own mistress of ceremonies for each event, produced two short skits (written and acted by patients), and proposed formation of its own "kitchen " orchestra (subsequently organized). Initially led by the social group worker with a nurse as observer, this group has " graduated " to regular leadership by a member of the nursing staff. Volunteers now being oriented to the project are expected to be able to contribute their skills to this development at a later date. Beauty Counselling.—Started on March 14th, this group had met only three times to March 31st, but already thirty-eight patients were attending and a new interest in personal appearance had begun to show as patients discussed posture and figure, skin care, make-up, clothing, etc. Increased patient self-respect and mutual awareness continued between meetings and carried over to the ward as a whole. In addition to its direct value to the patients involved, this programme immediately focused attention on general ward needs for basic toilet articles, clothing, and cosmetics which had previously been overlooked. While this group has been led since inception by a member of the nursing staff, the group worker has assisted both the leader and supervising charge nurse in its organization and initial programme planning. Plans.—Patients have also indicated strong interest in cooking, games, book club, talent club, music, painting, and newspaper, a number of which will be developed in the autumn of 1955 after summer assessment of the initial programmes, while special efforts will be made to cover a wide variety of summer outdoor interest groups for ward patients in co-operation with Recreational and Occupational Therapy Departments. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 93 Social Group Work Orientation in the Nurses' Education Programme From September to March, 1955, the social worker has given a total of nineteen teaching clinics to orientate student and graduate nurses, student social workers, and medical staff in the use of group methods in a clinical setting. These have included discussion of theory and experience with existing groups plus suggestions for practical application of group methods toward life, and have aroused considerable interest in each of the lecture groups. Summary of General Activities of the Social Service Departments, Provincial Mental Hospital and Crease Clinic, April 1st, 1954, to March 31st, 1955 1. Supervision of Junior Staff.—The programme of individual and group supervision of junior staff has shown marked advancement during the fiscal year. Its value is apparent in the Departments' coverage of patients referred and in the quality of services rendered. The junior workers have received individually one and one-half hours of supervision weekly, senior workers an hour weekly. The advanced worker has consultation available from his casework supervisor as he needs it. Group supervision brings together senior and junior staff for group thinking and action in the over-all study and assessment of social service demands, as well as planning for better social services to patients and their families. The three casework supervisors on the Departments' staffs spent on an average of forty-five hours monthly in the supervision of casework staff—approximately 539 hours during the fiscal year. 2. Committees drawn from staff have been studying recording in an effort to focus it on the service requested, the patient to be served, and his movement to health and rehabilitation in the casework relationship. Conciseness as to diagnostic study, service plan, patient's response to services, as well as ways of integrating social treatment with all other treatment services have been considered. As a result, concise, focused recording outlines have been devised for use in treatment, pre-convalescent, and convalescent recording on patients. A committee drawn to evaluate the present statistical system in the Social Service Department has presented suggestions which will result in more relative accuracy and simplicity in the system. 3. Educational Activity to Allied Professions.—During the fiscal year the Social Service Departments have been active in the educational programme for fourth-year medical students, public health nurses, postgraduate nurses, affiliate nurses, and psychiatric nurses. Conferences with the Director of Education, School of Nursing, University of British Columbia, have resulted in a more purposeful participation of social work. Some thirty-six hours were spent in nursing education and eight in medical education. 4. Social-work Education.—Seven students from the School of Social Work had field placement in the Provincial Mental Hospital and the Crease Clinic, supervised by staff members of the Social Service Departments. During the years a valuable contribution has been made by the School and the students to the development and growth of social services in the psychiatric setting. Four groups of in-service trained social workers from the Social Welfare Branch were oriented to social services in the setting of psychiatric hospital and clinic. The Departments consider this a very important function and of value in the working relationships existing between the Social Service Departments in Hospital and Clinic and the field services of the Social Welfare Branch. This has been further strengthened by the Social Service Departments' participation in the educational programme in the annual staff meetings of the Social Welfare Branch regions. 5. Each year brings interesting visitors to the Mental Health Services. This year, visitors from Australia, the Philippines, Japan, and England were oriented to social services in the Mental Health Services. 6. The Goal.—The goal continues to be primarily concerned with increasing the time spent individually with patients at every level of their treatment and to integrate in M 94 MENTAL HEALTH SERVICES REPORT, 1954-55 a total push, therapeutic approach the contribution of social work. Mental Health Grants are making possible an increase in social workers available for appointments to staff in line with this goal of individual service to more and more patients. Last year eight bursaries were extended to social workers in training and contracted to work for a two-year period in the Mental Health Services. A recommendation for the structuring of a social service department in Centre Lawn has received consideration from administration. This will greatly assist in the attainment of the goal before us. The Social Service Departments gratefully acknowledge the support of administration, all departments of Hospital and Clinic, and the community health and welfare agencies—together they make a therapeutic community in the treatment and prevention of mental illness. Summary Table 1.—Summary of Cases Given Services in the Admission and Brief Services Section, Social Service Department, Provincial Mental Hospital, April 1st, 1954, to March 31st, 1955. 1954-551 1953-542 Cases brought forward from previous fiscal year 28 27 New cases 999 422 Cases reopened during fiscal year 110 58 Total intake into Admission and Brief Services Section case load 1,109 482 Total cases given service in Admission and Brief Services Section case load 1,137 509 Cases closed or referred 1,101 471 Cases carried over to next fiscal year in Admission and Brief Services Section 36 28 Number of cases given brief service casework services 429 509 1 Work of one worker stationed on admission unit assisted by two workers and three students from time to time. - Work of one worker only. Table 2.—Summary of Casework Activity on All Cases Referred to Admission and Brief Services Section, Social Service Department, Provincial Mental Hospital, April 1st, 1954, to March 31st, 1955. 1954-55 Total casework interviews with and regarding patients 593 Total casework interviews with patients 443 Total casework interviews with relatives 150 Total number of conferences and consultations concerning patients 482 Team conferences 88 Consultations with other disciplines 296 Consultations with other welfare agencies 98 Periods of casework supervision (hours) 480 Case summaries and case preparation 823 CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 95 Table 3.—Summary of Cases Given Services in the Continuing Casework Services Section, Social Service Department, Provincial Mental Hospital, April 1st, 1954, to March 31st, 1955. During Period of Pre-conva- lescence and Convalescence During Period of Hospitalization Cases brought forward from previous fiscal year 72 New cases 207 117 413 Total intake into case load 279 Cases closed or referred 233 530 390 Cases carried over 46 Total cases given service (treatment and convalescence ) 809 140 Table 4.—Summary oj Casework Activity on All Cases Rejerred to Continuing Casework Services Section, Social Service Department, Provincial Mental Hospital, April 1st, 1954, to March 31st, 1955. During Period of Hospitalization (Treatment) Total casework interviews with and regarding patients 1,088 Total casework interviews with patients 832 Total casework interviews with relatives 256 Total number of conferences and consultations concerning patients 971 Team conferences, social workers attending... 19 Consultations with other disciplines 760 Consultations with other welfare agencies and employment resources 192 Contacts with patients in Vista Rehabilitation Centre 2 During Pre- convalescence and Convalescence 1,801 1,407 394 1,717 66 1,202 401 48 Table 5.—Summary oj Cases Given Services by the Admission and Brief Services Section, Social Service Department, Crease Clinic, April 1st, 1954, to March 31st, 1955. 1954-55 1953-54 Cases brought forward from previous fiscal year 19 25 New cases 731 610 Cases reopened during fiscal year 149 116 Cases reopened from previous fiscal year 8 7 Total intake into Admission and Brief Services Section case load 907 733 Total cases given service in Admission and Brief Services Section 926 Cases closed or referred 910 758 739 Cases carried over in Admission and Brief Services Section 16 19 M 96 MENTAL HEALTH SERVICES REPORT, 1954-55 Total number of conferences and consultations concerning patients 2,617 Consultations with other disciplines 1,616 Team conferences (ward rounds) 113 Consultations with other welfare and employment agencies 888 Table 6.—Summary oj Casework Activity on Cases Carried by Admission and Brief Services Section, Social Service Department, Crease Clinic, April 1st, 1954, to March 31st, 1955. 1954_55 1953_54 Total casework interviews with and regarding patients 1,093 792 Total casework interviews with patients 635 331 Total casework interviews with relatives 458 461 1,469 914 102 453 Table 7.—Summary oj Cases Given Service by the Continuing Casework Services Section, Social Service Department, Crease Clinic, April 1st, 1954, to March 31st, 1955. During Period During Period of Pre-conva- of Hospital.- lescence and zation Convalescence Cases brought forward from previous fiscal year 60 101 New cases 80 169 Total intake into case load 140 270 Cases closed or referred 124 222 Cases carried over 16 48 Total cases given service (treatment and convalescence), 410. Table 8.—Summary oj Casework Activity, Continuing Casework Services Section, Social Service Department, Crease Clinic, April 1st, 1954, to March 31st, 1955 During Period During Period of Pre-conva- of Hospitali- lescence and zation Convalescence Total casework interviews with and regarding patients 2,262 1,581 Total casework interviews with patient 1,659 1,100 Total casework interviews with family 603 481 Total number of conferences and consultations concerning patients 2,574 1,680 Team conferences 113 Consultations with other disciplines 2,147 1,097 Consultations with Supervisor, Vista Rehabilitation Centre 9 114 Consultations with other welfare agencies 295 429 Consultations with employment agencies 10 40 Respectfully submitted. (Miss) Alice K. Carroll, B.A., M.S.W., Provincial Supervisor, Psychiatric Social Work. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 97 CHAPLAIN'S REPORT T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—The following report is submitted for the year April lst, 1954, to March 31st, 1955. It deals with the work of the Resident Chaplain in the Crease Clinic; the Provincial Mental Hospital, Essondale; and the Home for the Aged, Port Coquitlam, since, in the Chaplain's work as at present constituted, they cannot be separated; further, it does not cover the efforts of Rev. Father J. P. Kane as he is still on part-time duty. In accordance with the standards for chaplaincy work in a mental hospital as set up by the Association of Mental Hospital Chaplains (A.M.H.C), an affiliate of the American Psychiatric Association, and also by the Group for Advancement of Psychiatry (G.A.P.), this report covers five major areas of work. Since it is the second year in which there has been a full-time resident chaplain with the Mental Health Services, it has been a year of selection and concentration on those aspects of the work that can be covered by one man working a sixty-five-hour week and of discarding or only slightly touching other areas. (1) Worship In this area of work there has been adequate coverage for a large section of the patient population; namely, those who were not prevented from leaving the wards because they were either too disturbed or were physically or legally incapable. The only expansion in this area would be for more services on the wards themselves, which would require a real increase in man-power. The statistics at the end of the report will show the public services of worship at which there were ten or more patients gathered together voluntarily for a regularly scheduled service, but takes no account of the smaller or private services. (2) New Patients Although both the A.M.H.C. and also the G.A.P. require that all patients be seen by the chaplain upon or shortly after their admission to hospital, because there has not been the man-power available, this area of work has had to be completely disregarded even though it affects the field of public relations of the Mental Health Services as a whole, besides its aid and beneficial effects to the patient. (3) Counselling and (4) Visiting the III, Especially Those Critically III Both of these areas have been recognized and met to the degree that time permitted, even if not fully. (5) Public Relations This area has been slowly but steadily expanded during the year with regards to relationships with relatives of patients, with other clergy, and with the general public. It is a field that still requires great growth. During the year there were several successful special events. On Easter Day a service of worship was held during visiting hours in the afternoon, and the visitors were invited to come along with the patients whom they were visiting. A fairly good number accepted the invitation and afterwards were very grateful for the opportunity, and expressed a need for something similar more often. On Remembrance Day the hour of the memorial service was set to correspond with the 11 a.m. silence, and all recreational accompaniment removed to the evening. This change has been a great help to the patients. When the Archbishop of Canterbury was visiting the Province, arrangements were made both with the Diocese of New Westminster and within the Hospital itself so that a number of the patients were able to be taken to the mass service in the arena. This was 4 M 98 MENTAL HEALTH SERVICES REPORT, 1954-55 a real help to the patients, and the only drawback was that we were unable to accommodate more patients. During the year the Resident Chaplain went to the University of British Columbia and gave a series of lectures to the senior students at the Anglican Theological College on the role of the parish priest with regards to the mentally ill. Also active participation was taken in a three-day institute on marriage and problems related thereto. This was also conducted at the Anglican Theological College. During the year, consideration was given and recommendations submitted (1) for an addition to Pennington Hall to provide a chapel, since a real lack in the Hospital is that there is no place where a patient can go whenever he needs to for a few minutes of quiet and meditation; (2) for a chapel at the Home for the Aged so that its religious needs can be more adequately met; and (3) as to what would be required for more effective work at The Woodlands School. The periods spent each week in the use of the public address system of the Hospital have continued to be greatly appreciated and to prove their worth, even though they are sadly handicapped by the fact that the system reaches to such a small proportion of the patient population. The following statistics cover only the services conducted by the Resident Chaplain where at least ten patients were voluntarily gathered together, and does not cover the twenty-five celebrations of mass for the Roman Catholics conducted by Rev. Father J. P. Kane. Number of services conducted 212 Number of broadcasts of public address system 161 Total 373 Total attendance at the services only (the broadcasts reach one-sixteenth of the patient population) 24,312 Number of services held in Pennington Hall 68 Total attendance in Pennington Hall 20,731 Number of services held on the wards (128 in the Home for for the Aged and 16 in the Veterans' Block) 144 Total attendance on the wards 3,581 Number of communion services 20 Total attendance at communion services 1,215 Total number who communicated (most of these services are on a Monday morning) 713 Special mid-week services in Pennington Hall 4 Total attendance at special mid-week services 1,405 Average attendance— Pennington Hall, morning 432 Pennington Hall, evening : 317 Pennington Hall communions 61 On the wards 25 At four special services 351 Average number of communicants (Monday morning) 36 Average weekly congregation 468 Average weekly services and broadcasts 7 Respectfully submitted. John F. O'Neil, E.D., B.A., L.Th., Resident Chaplain. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 99 DEPARTMENT OF NURSING SERVICE Women's Division T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Presented herewith is the report of the Department of Nursing Service (Women's Division) for the fiscal year ended March 31st, 1955. This year there have been additions made to the areas of nursing service. A section of Ward E 3 in the Centre Lawn Building was set apart as an insulin treatment area for seven male and seven female patients. This area had been used for this type of treatment prior to the opening of the Crease Clinic. Because of the lack of nursing personnel, we were unable to open this as an insulin treatment area until April 5th, 1954. After much preparation on the part of the nursing staff, Ward F2 in the East Lawn Building was made into an "open ward." Much credit is due to the staff of this ward for its ability in meeting this type of nursing situation, for it has not been an easy task. With the change of philosophy toward the management of patients in an " open ward " situation, there was need to discuss methods of nursing care. Regular meetings have been held for this purpose which have proved very valuable to the ward teaching and administrative staff. The organization of meetings of the heads of staff of the departments offering treatment to patients under the leadership of the Clinical Director have proved very valuable in coordinating the efforts of each department, as well as providing an opportunity to discuss related problems, and regular meetings of the Hospital Council have done much to solve interdepartmental problems. This year a planned in-service educational programme was arranged for supervisors and charge nurses of the men's and women's division of the units at Essondale and The Woodlands School. The programme included discussions and demonstrations on various phases of nursing. Guest speakers from the Royal Columbian Hospital and the Victorian Order of Nurses were among the lecturers. As part of the programme an excellent display was set up in the School of Psychiatric Nursing. It included the newer treatments and the methods and care of patients. All areas of the Nursing Department have extended a much broader service to patients. The nursing staff are to be praised for enthusiasm and understanding in the development of the newer types of treatment programme. The change in methods of the management of patients has been encouraging but has brought heavier demands on the nursing staff. The demands made on the staff in the care of physical conditions has increased with the increase in surgical operations. Four hundred and twenty-seven patients have been given care on our surgical ward in the past year, as compared with 200 patients during the previous year. The School of Psychiatric Nursing has had a very busy year, with 173 students graduating from the psychiatric nursing course. The graduation exercises were held in the auditorium of the New Westminster Junior High School. Greater liaison between nursing administration and the students has been provided through regular meetings with the students' council. These have been probem-solving sessions and have resulted in a better understanding between administration and the student group. The purpose of these meetings is to prepare the students' council to manage its own affairs more completely, and this would include the general discipline of the student group. Minor illness has been very prevalent among the staff, some of which has been treated in the Nurses' Infirmary. We were fortunate indeed to have the services of Dr. Dobreva and Dr. Just, who have given so generously of their time and skill to the members of the nursing staff. The programme of immunization for tuberculosis through the use of B.C.G. vaccination has continued, and it would appear to be successful. There has been one case only of tuberculosis or pleurisy with effusion among our staff during the past year. M 100 MENTAL HEALTH SERVICES REPORT, 1954-55 The staffing of the Nursing Department has been difficult, particularly with respect to the maintenance of sufficiently well-prepared staff. The demands of nursing service have increased and the numbers of prepared personnel have decreased. The fiscal year ended on March 31st, 1955, with the following personnel: — Registered nurses 47 Graduate psychiatric nurses 192 Student psychiatric nurses .> 150 Psychiatric aides 297 Home housekeepers 26 Nursing counsellor 1 Total 713 Plus 15 at The Woodlands School. The personnel changes during the year are summarized as follows:— Total number of staff, year ended March 31st, 1954 655 Total number of staff, year ended March 31st, 1955 713 Resignations 311 Transfers 6 New appointments 331 The attrition rate continued to be high. The reasons for resignations are as follows:— Household duties 52 111 health 43 Change of residence 42 Marriage 39 To further education (music, course) 29 Change position 26 Unsuited to work 15 Services terminated 11 Training at General Hospital 10 Training at Provincial Mental Hospital 9 Failed lectures 8 Unable to get a housekeeper 5 Illness in family 4 Transportation difficulties 4 Completion of psychiatric graduate course 3 Personal reasons 2 Transferred to another position within unit 2 Temporarily employed 2 Attend Bible School 2 To travel 2 Work did not give satisfaction 1 Total 311 There were some changes in our senior nursing staff. Miss Edith Johnstone was granted leave of absence to visit mental hospitals in Britain and Europe. Miss R. Cutler returned from McGill University following completion of the course in administration in schools of nursing and was assigned to the supervision of the Centre Lawn Building following the resignation of Mrs. E. Boe. Miss S. Highman was appointed to night supervisor, replacing Mrs. H. Samuel, who was assigned to day relief supervisor. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 101 Our Department would function much more satisfactorily if there were greater stabilization of staff, and if there were staff who were more adequately prepared to take supervisor positions. There is also much need for personnel who are prepared in teaching in the School of Psychiatric Nursing. (Miss) Edith M. Pullan, R.N., Director oj Nursing. Men's Division T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Presented herewith is the report of Department of Nursing Service (Men's Division) for the fiscal year April lst, 1954, to March 31st, 1955. During the past year there has been greater fluctuation of male staff than for many years, and though our total staff count is higher, we have not been able to replace the number of male nurses lost to us with the same category of personnel and have had to supplement them to some extent with psychiatric aides. The following tables show the categories of staff appointed and lost during the past year in this Department:— New Appointments Psychiatric nurses 7 Psychiatric aides 59 Student psychiatric nurses 44 Total . 110 Separations Psychiatric nurses— Deceased 4 Superannuated 6 Resigned 18 Transferred 9 Terminated 2 — 39 Psychiatric aides— Resigned 34 Terminated 2 — 36 Student psychiatric nurses— Resigned 5 Terminated 1 — 6 Total 81 Total number of staff as of March 31st, 1954 412 Total number of staff as of March 31st, 1955 441 Of the thirty-four psychiatric aides shown as resigning, nine did so to enrol in the School of Psychiatric Nursing. On the evening of April 21st, 1955, twenty-two male psychiatric nursing students will receive their diplomas, thus bringing our ratio of psychiatric nurses to aides up slightly but still below that of last year. M 102 MENTAL HEALTH SERVICES REPORT, 1954-55 Following is the placement of staff as of March 31st, 1955:— Psychiatric Nurses Aides Students Total Provincial Mental Hospital 166 48 29 1 12 10 80 4 18 9 3 22 12 6 6 15 268 64 53 1 Holiday relief The Woodlands School 21 6 Ill _ 13 15 Totals 266 114 61 441 The recreational programmes have been stepped up for patients in continued- treatment areas, and it is with keen interest that staff note the benefits derived by the patients, both mentally and physically, from recently inaugurated reactivation programmes on deteriorated wards. The event of another male ward becoming an "open ward " on February lst, 1955, is another important milestone in steady advance of mental-health programmes and gives great encouragement to all concerned. I should like to take this opportunity to express appreciation to all nurses, physicians, and heads of departments who have helped and co-operated with the nursing staff at all times. Respectfully submitted. R. H. Strong, Chiej Male Psychiatric Nurse. DEPARTMENT OF NURSING EDUCATION T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—Following is the annual report of the School of Psychiatric Nursing for the fiscal year ended March 31st, 1955. The number of students applying for the course in psychiatric nursing has remained approximately the same as the two years previous. During the year 1953-54 an effort was made to increase the enrolment by admitting three classes a year instead of two. This plan was not successful. Enrolment of students in January reduced the number enrolled in May. Reverting then to the two-class-a-year plan, fifty-five women and fifteen men students were accepted in August, 1954, and thirty-five women and fifteen men students were accepted in March, 1955. A total of 248 women and eighty-eight men students received instruction in the basic psychiatric nursing course during the year. Approximately twenty women and six men students are assigned to The Woodlands School for three months of experience. Two instructors visit The Woodlands School one day each week to assist with their clinical instruction. Due to the co-operation of the physicians and supervisors, an excellent orientation programme has been instituted, and students are given extensive assistance with nursing-care studies. Because of the shortage of instructors, it has been necessary for Mr. G. Kenwood to teach combined classes for men and women in psychiatric nursing. The students have benefited from these classes, but women students have lacked the subsequent instruction on the wards that is so necessary to make their classes meaningful. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 103 During the year 114 affiliate students have received instruction, as follows: Vancouver General Hospital, 52; Royal Columbian Hospital, 26; Royal Jubilee Hospital, 8; Royal Inland Hospital, 8; St. Paul's Hospital, 12; and University of British Columbia (degree course), 8. The postgraduate course in psychiatric nursing was discontinued, and registered nurses are offered an alternative. They are permitted to take the two-month student affiliation course in psychiatric nursing, followed by four months of added experience on wards selected to provide a balanced experience. Ten registered nurses enrolled for the two-month course. The School of Psychiatric Nursing played an active part in in-service education and, besides contributing to the programme throughout the year, organized a nursing exposition which was well attended. The year has ended with the consciousness that in spite of maximum effort on the part of the instructors to meet the changing and increasing demands resulting from advances in psychiatry, further changes are necessary to prepare student-nurses to take their place on the psychiatric team. Respectfully submitted. Orma J. Smith, B.A., R.N., Senior Instructor. DEPARTMENT OF REHABILITATION Women's Division T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—The rate of discharge from Vista has been comparable to last year's figure, although there has been an increased discharge rate generally from the Crease Clinic and Mental Hospital in keeping with the increased admission rate. There has also been a greater incidence of unemployment in the community at large. We welcome the Federal Government's decision to make funds available to discharged psychiatric patients to make an adequate living allowance while vocational training goes forward. However, we have not yet taken advantage of this resource. As a by-product of the Canadian Mental Health Association's volunteer programme, a women's club has donated a sum of money to augment the patient's funds at the time of discharge when there is need. In recent months, out-patient service has been extended to patients discharged via Vista so that they are permitted to make appointments to see the visiting physician during his regular weekly call. Four or five patients seek this service each week. The Clinical Director has continued to direct supervision of this Department, although case referral is now made through the Assistant Clinical Directors. The social workers visit regularly to see their clients. At Vista the full co-operation is enjoyed from the Supervisor and her assistant, who work faithfully both to keep the patient's stay there a happy and fruitful one and also to maintain and improve the premises. The resignation of Miss Green, the housekeeper, was received with regret during the year. On one occasion during the year the Supervisor was at home to a small group of selected visitors from the hospital area whose work is intimately bound in with the discharge of patients, and who are accorded this opportunity to become familiar with the facilities of Vista. M 104 MENTAL HEALTH SERVICES REPORT, 1954-55 Intake Remaining in residence, March 31st, 1954 3 Total number admitted to The Vista from the Crease Clinic 42 Total number admitted to The Vista from the Provincial Mental Hospital 17 — 62 Separations Number returned to the Crease Clinic 4 Number returned to the Provincial Mental Hospital 1 — 5 Rehabilitated to the community 10 Rehabilitated to own home 10 Rehabilitated to job and lodging 32 Total rehabilitated 52 Remaining in residence, March 31st, 1955 5 Respectfully submitted. F. E. McNair, B.A., M.D., CM., Clinical Director. Men's Division T. G. Caunt, Esq., M.D., Medical Superintendent, Provincial Mental Hospital, Essondale, B.C. Sir,—The following report comprises the fifth annual report of the Men's Division of the Rehabilitation Department. Looking back over the year, it has been a difficult but successful one. The weather during 1954 was unusually wet and definitely affected the employment picture in general. Even during the peak months of employment, statistics show that there was a higher percentage of unemployment than in former years. This was evident in the concern shown by unions, social agencies, municipalities, etc., in referring this matter to higher governmental authorities for consideration. However, it is with pleasure that this Department can report a better than average percentage of sound placements throughout the year. The Crease Clinic of Psychological Medicine has done much to educate the general public to an awareness of mental illness and to show the hopefulness rather than the hopelessness of hospitalized patients. When one considers the number of patients treated in the Crease Clinic, it is evident that a great many families in British Columbia have had direct, or at least indirect, contact with the purpose and treatment possibilities of the institution. This is very noticeable in interviewing people in industry. Because of their awareness, there is less evidence of the so-called " stigma " of mental illness and a more accepting attitude in regard to employment. In November, 1954, an important meeting was held to discuss the possibility of using Schedule R for the training of rehabilitable mental patients. The meeting, chaired by Mr. H. A. Jones, Director of Technical and Vocational Education, Provincial Department of Education, included Col. J. Naish, Regional Supervisor of Special Placements, National Employment Service; Mr. C. E. Bradbury, Rehabilitation Co-ordinator, Department of Health and Welfare; Dr. A. M. Gee, Director of Provincial Mental Health Services; Miss A. K. Carroll, Provincial Supervisor of Psychiatric Social Work; and Mr. J. D. Addison, Rehabilitation Officer, Provincial Mental Health Services. The CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 105 details of referral were cleared and the way opened for training under Schedule R. Confirmation of this has been obtained from Mr. Ian Campbell, National Co-ordinator of Rehabilitation, and will prove to be a valuable resource in the rehabilitation of mental patients, provided extreme care is always exercised in choosing patients who will benefit by training. There are still many " tools " lacking to do a complete job in this specialized rehabilitation field—adequate funds and increased staff. There appears to be some prospect of obtaining an in-town rehabilitation centre, which is sorely needed. Further progress and details are unavailable at the moment. The need for rehabilitation services has been clearly shown in many fields. This need appears to be branching into further specialized avenues, such as treatment and rehabilitation services for alcoholics, a possible treatment and rehabilitation centre for drug addiction, as well as the already well-established agencies for rehabilitating the many forms of physical handicaps. All are a combination of services—medical, physical training, vocational training, and placement in a gainful occupation. In all fields, as in this Department, the aim is to return the patient to the community as a normal citizen. In dollars and cents, the cost of rehabilitation is small compared to the economic returns from well-established wage-earning ex-patients. Respectfully submitted. Summary of Referrals, April 1st, 1954, to March 31st, 1955 1-4 < tn Os & s o c 3 V. "3 ON s < a CO o o > o Z tn Os to to D a & V. o\\ ._- Ph in ih D_ o H 6 1 5 1 1 1 15 2 3 2 1 1. 1 7 4 3 1 5 3 2 1 1 1 1 2 7 2 1 1 3 10 5 1 2 1 1 3 1 3 3 1 2 1 1 1 1 1 5 2 1 2 1 1 1 1 3 1 1 2 2 3 6 1 1 2 1 6 2 1 8 3 1 1 3 1 1 1 10 l l 2 1 1 1 1 85 Psychoneurosis- 27 17 7. Epilepsy without psychosis. 7 10 70 in Situational maladjustment. l 3 7 Pre-senile psychosis. • 4 12 1 Immature personality—passive dependency Obsessive compulsive 1 1 3 Totals Closed - , 15 1 25 1 15 16 1 14 24 2 14 14 12 20 1 19 18 2 206 9 Total active rehabilitation cases... 14 24 14 15 14 22 [ 14 14 12 19 19 16 197 10 4 162 14 10 190 9 5 158 11 4 165 10 4 90 16 1 8 8 6 122 5 7 79 9 10 132 10 9 156 11 159 121 Cases assisted by referral and casework Total interviews _ _. 6 131 6 127 76 1,671 J. D. Addison, Rehabilitation Officer. M 106 MENTAL HEALTH SERVICES REPORT, 1954-55 STATISTICAL TABLES CREASE CLINIC Table 1.—Movement of Population, Crease Clinic, April 1st, 1954, to March 31st, 1955 Male Female Total In residence, March 3 lst, 1954 _ Admissions— 110 495 78 132 631 160 242 1,126 238 573 791 1,364 683 923 1,606 Separations— Discharged in full _ _ _ Died 557 775 5 2 1,332 7 562 777 1,339 11 14 25 In residence, March 31st, 1955 _ _ 121 146 267 Table 2.—Showing in Summary Form the Operation of the Crease Clinic since Its Inception c 5 'to I < Discharges rt u Q u 2 u & fi Z rt o o BQ tS to to a to tft at to u to to a h O _-> § 3 *■* U ii O rt JS u ^ u Percentage of Patients Recovered and Improved to Admissions Percentage of Discharges to Admissions (Deaths Excluded) Year ■o O M V > o a C ft •o > o 0, s > o a J 5 D Cfl St Percentage of Deaths to Whole Numbet under Treatme January, February, and March, 1951 1951-52 1952-53. 1953-54 ... _ . 264 963 1,221 1,256 1,364 26 158 96 85 147 38 496 727 814 901 23 155 201 213 284 7 97 148 131 C1) 12 21 14 7 170 215 243 242 267 45 28 25 i 264 1,133 1,436 1,499 1,606 24.24 67.91 67.39 71.58 76.09 35.61 94.19 94.35 98.96 97.65 1.06 1.46 0.93 1QS4-J5 0.44 1 "Without Psychosis" included in three columns of "Discharges" shown. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 107 Table 3.—First Admissions to Crease Clinic by Health Unit and School District of Residence and Sex, April 1st, 1954, to March 31st, 1955 Health Unit Male Female Total Health Unit Male Female Total East Kootenay, Cranbrook— School District No. 1 „ 2 4 2 1 1 4 3 2 3 8 4 3 1 9 2 1 3 1 6 7 2 1 1 2 6 1 11 3 3 19 2 5 192 2 5 1 1 1 10 2 12 1 3 5 1 13 3 3 4 6 2 9 1 2 1 2 2 5 4 11 10 3 35 1 17 234 6 7 1 1 2 1 14 3 2 5 20 1 7 8 1 1 22 5 4 7 1 12 2 16 1 4 2 1 4 2 11 5 22 13 6 54 3 22 426 Metropolitan Heal Vancouver—C School District In th Committee, ontinued o. 41 21 15 4 15 7 6 4 1 5 1 3 10 2 1 2 1 16 6 1 3 5 5 1 8 4 12 3 3 3 2 7 42 22 6 23 12 9 5 3 8 3 4 3 4 1 18 6 3 2 1 1 1 3 4 5 14 1 4 2 2 1 1 1 4 63 „ 3 44 37 „ 4 „ 5 , 45 10 18 School District Is North Fraser Valle o. 40 - 38 , 43 19 School District No. 6 „ 7 y, Mission— n 42 15 „ 8 75 9 „ 10 Upper Island, Coui School District > Skeena, Prince Rup School District > Peace River, Daws School District IN , 76 West Kootenay, Trail— School District No. 9 tenay— o. 47 4 „ 11 , 71 , 72 13 „ „ 12 4 13 South Okanagan, Kelowna— ert— o. 50 3 , 51 „ 15 „ 16 , 52 , 53 14 5 17.— 23 77 - - , 54 jn Creek— o. 59 1 6 North Okanagan, Vernon— School District No. 19 , 60 2 „ 20 of Health- School District No. 61 (part1)... Saanich and South Vancouver Island— School District No. 61 (part2)- 62 „ 21 34 „ 22 „ 78 South Central, Kamloops— School District No. 24 12 4 „ 25 Central Vancouver Nanaimo— School District Is , 63 3 „ 26 , 64 4 29 , 30 31 Island, o. 65 6 , 66 6 »» >» , 67 „ 28 , 68. , 69 , 70. , 79 55 „ 56 9 26 - „ „ 57... 3 „ 58 School districts not health units— School District IN » »» »» t* covered by Upper Fraser Valley, Chilliwack— „ 33 , 48 , 49... , 61 (part3) , 73 5 ,. .. 34 Boundary, Cloverdale— School District No. 35 3 3 „ 36 „ „ „ 37 , 74 , 80 1 4 Metropolitan Health Committee, 3 Vancouver— 11 School District No. 38 » 39 Totals 495 631 1,126 1 Includes Victoria and Esquimalt only. 2 Excludes Victoria, Esquimalt, and Oak Bay. s Includes Oak Bay only. M 108 MENTAL HEALTH SERVICES REPORT, 1954-55 Ph S3 CI cC U w 0 < Z o l/l 1/1 § Q < ft 0 n n u-i a in UJ -—1 5 H (/I lx <—i cq CO u X / u « I-I -J" u 5 w 0 <1 H H « *tf u lO CT\\ o 1—1 H (/! 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CS 1 CA tn cfl "S3 1 rt s I •2 © & Ah .£ 'T. V M <- c ■E tt 'c 4 b X c c s c {/ c t J f a i A i .2 c X t c £ 4 E — B k| ! C t ! c 3 c c 8 i 1 I f I C X c/ 1 > ^ c g -3: | i 0 c? c I. 4, (-. V _C *u 4. t . i - 1 > I | C/ C c xc -, t < > 0. c .£ t 4. X s k c c E 4. •t 1 -,= 1. c 1 t, 1 1 q 1 > i a i c - J c B E 2 R a" E.2 o E ™ o rt « B* 0 o CA t» B o.2 B B O S « E B C E 3 1 s .2 'Il |s to — t- rt IS E X « C Ir c e t rt i c- c £ c C B a i- > c7 1 E i > V 4, I 1 t u > L C^ ' ft, 1 t. C 3 to z fl o « •3 rt o ca cn Is O a ft | C v *E o 2 11 o C s o x: a 2 c M .21. .S « Ih /- 3 C 8-1 y S 5? c 3 .2 rt N "5 E o Cfl Cfl E $ E P. J E | PH > a g B £ S.S » -a 1Q at Z B to &,* 0 I « S.2 II X a & •- fl o rt rt E 5 CA CO i o ft £| » * a O > '■3 "" rt t- 3 cU o-S (fl o •fi 2 E| 4> .cfl (t Cfl B 0 Ih /— 3 C ss SI |i CA TJ cu (fl *o CU ft Cfl C P •a c rt •o fl> X "6 to X o ca" Ih CU ■o Cfl O Ih 3 CU P Ph 8} 01 3 cr to ft .3. ■a c rt .2 IE ft >. GO tfl 'cfl 0 X to >. wi ft 1 "rt .0 H &5 0 CJ 3 5 ! Q a V 0 "el (, "o c c X « > fl 3 C t to c CU C £ rt E 1 E a c X c I < 3 C t t ■3 rt ca 3 TJ 4. X 0 B 4 •a t- c 0 TJ 1- 3 C "? rt i ■a c | X u t rt c -3 t> 0- > « X to -o Ih (U CJ « Ih rt x: CJ ■a u s , & cc ft 3 3"H PS 1! •fl u 5 E '5 ft ■o c .3 'o o Bl CD O c E to >. ca ca 3 O > u to fl rt C fl a> u O.S .__ c 31 cfl X. « y 4> > Cfl <£_ !S y .B 5 IS U >. ft rt u TJ to E to X Ih a Ih Q TJ OJ fi C 3 O X '$ u .2 S rt ,- £.<_ « J _o ° o W5 B O •3 ■3 E O ■o u c c X 1 fl c h 1 ll Cfl rt o TJ c rt u 0 J CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 115 Table 8.—Readmissions to Crease Clinic by Marital Status, Mental Diagnosis, and Sex, April 1st, 1954, to March 31st, 1955 Marital Status Total Mental Diagnosis Single Married Widowed Divorced Separated Grand Total M. F. M. F. M. F. M. F. M. F. M. F. With Psychosis 18 1 1 1 1 1 3 1 15 6 1 2 2 13 3 1 2 1 7 1 2 1 45 20 2 1 1 1 12 6 19 1 1 1 3 4 1 1 2 2 1 5 1 1 1 1 36 4 3 2 1 1 2 10 1 3 1 65 31 2 1 1 2 2 16 7 23 1 1 1 101 35 5 1 Psychosis with cerebral arteriosclerosis 2 2 Psychosis of other demonstrable etiology Other and unspecified psychoses Anxiety reaction without mention of 3 4 26 Hysterical reaction without mention of 7 1 26 Psychoneurosis with somatic symptoms (somatization reaction) affecting di- 2 Psychoneurotic disorders, other, mixed, 1 Syphilis and its sequela. 1 Total with psychosis 27 | 26 31 110 1 11 1 -- 3 6 | 3 | 64 153 217 Without Psychosis 2 1 3 2 2 1 3 1 4 1 1 7 1 1 3 2 6 1 13 Immature personality _ Primary childhood behaviour disorders.. Epilepsy Other diseases of central nervous system not associated with psychosis 1 1 4 2 Total without psychosis 8 | 3 4 4 1 1 - 1 - 1 - 1 t - 14 7 21 35 29 35 114 1 11 3 7 3 78 160 238 Table 9.—First Admissions to Crease Clinic by Years of Schooling, Mental Diagnosis, and Sex, April 1st, 1954, to March 3 1st, 1955 Table 10.—Readmissions to Crease Clinic by Years of Schooling, Mental Diagnosis, and Sex, April 1st, 1954, to March 31st, 1955 Table 11.—First Admissions to Crease Clinic by Citizenship, Age-group, and Sex, April 1st, 1954, to March 31st, 1955 Table 12.—First Admissions to Crease Clinic by Religion and Sex, April 1st, 1954, to March 31st, 1955 Table 13.—First Admissions to Crease Clinic by Previous Occupation and Sex, April 1st, 1954, to March 31st, 1955 Detailed information for the above tables may be obtained on request. M 116 MENTAL HEALTH SERVICES REPORT, 1954-55 Table 14.—Live Discharges from Crease Clinic by Condition on Discharge, Disposition to, and Sex, April 1st, 1954, to March 31st, 1955 Condition Home Clinic Agency General Hospital Welfare Institution Other Mental Hospital Other Total Grand Total M. F. M. F. M. F. M. F. M. F. M. F. M. F. 72 37 261 73 67 38 470 100 2 1 2 3 2 1 1 1 1 1 6 40 . 8 43 7 5 37 10 1 30 12 79 44 308 126 68 39 510 158 - 147 83 818 Unimproved 284 Totals .■ 443 675 2 3 5 1 1 1 2 | 2 46 51 59 43 557 775 1,332 Table 15.—Live Discharges from Crease Clinic by Mental Diagnosis, Condition on Discharge, and Sex, April 1st, 1954, to March 31st, 1955 Condition on Discharge Total Mental Diagnosis Recovered Much Improved Improved Unimproved Grand Total M. F. M. F. M. F. M. F. M. F. With Psychosis 28 14 2 14 3 4 1 1 6 1 17 22 5 1 2 2 2 1 6 9 1 23 3 2 12 5 2 112 12 3 12 4 1 10 5 4 36 5 1 4 31 1 2 10 1 207 46 17 1 2 1 5 6 79 18 1 1 51 1 1 5 9 40 2 1 6 1 2 3 3 1 2 3 2 2 3 2 1 55 6 1 3 2 1 10 22 1 5 3 2 203 31 6 20 1 6 4 24 12 5 47 12 2 5 43 4 5 12 2 291 79 25 5 4 1 2 8 20 107 30 1 2 70 2 1 6 14 2 494 110 31 25 Psychosis with cerebral arteriosclerosis 1 5 3 _____ 4 2 5 1 5 1 1 1 5 26 Psychosis of other demonstrable etiology 20 Anxiety reaction without mention of somatic symp- 154 Hysterical reaction without mention of somatic 42 3 7 113 Psychoneurosis with somatic symptoms (somatization reaction) affecting circulatory system Psychoneurosis with somatic symptoms (somatization reaction) affecting digestive system— Psychoneurosis with somatic symptoms (somatization reaction) affecting other systems.. Psychoneurotic disorders, other, mixed, and un- 2 5 11 26 4 Total with psychosis , 74 68 42 | 35 254 451 74 116 444 670 1,114 Without Psychosis 4 1 1 1 2 1 1 17 9 9 4 2 8 3 2 21 17 5 1 3 8 4 26 7 4 2 2 1 5 3 2 14 11 2 3 1 5 2 1 3 44 16 14 6 2 7 14 6 2 2 37 29 7 4 4 14 6 1 3 45 21 Primary childhood behaviour disorders 10 Other and unspecified character, behaviour, and intelligence disorders 11 28 Other diseases of the central nervous system not Observation without need for further medical (psychiatric) care— - Other, unknown, and unspecified conditions 3 5 5 2 4 54 59 52 42 113 105 218 79 68 44 39 308 510 126 158 557 775 1,332 J CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 117 X w Cfl Q z < sT O o pi o I w o < o z e < ■ U m « < u S 7 u H CA tn . OO ft ; th THrHCScn ;cS^ icS vocot it]- ; th rs cs in cS cn vo cs icn icn coin CS ri | cn ! ■<* ft m th ; oo r-> r-i ! CS Os CS ON s-t y Os rt vOCSCS^J-Tl- IVO ICO Ov CC cn th cs rn cn l cn Os cn CS t- ■* CS Os CS i I r- cs cnrHi-Hr-OvrHcn ;vo hi rH | (S ,r- VOCS^fOOTt-rHVO iCS r— th th r- vo cs m oo cn cS cn cS rn \\ tn 00 TH rH vo Tf i cs I tH rH cs i cs CS I rH cs cs > w 1-3 CQ < ; 0> -g £> K N ;^ ^2 c 4j ' &JB8 S3 '_. tj ° s rt o j= '3 _?3 g 8.3 A _ u N o fl _C « S ■aw a fa o o N N ■9 81, i3 _i_ rt rt jf S | U US C^ ... E B.S, a) rt ! .5 TJ Hi ■3 !_*> s s s S. B » rt m 2 S. ^ a tj pj*3 o ° o ■a 8 3 §■§ ss 'S. £ E B.H-S »H-s.sa &£~ S-S oo r a* u.S. o B — h 1 £ Ph j O o 3 ■ O o » 0 >.Qi -_ « of M C O 3 rt tfl a tj -q son _s« >, rt >, , U J3 rt 0 ) OJ OJ rr- l 3 3 S3 ITJTJ § • Ih Ih J ■_>-.>.! 05 tf "O 9 *o { 9 °* 9 j O (H o to o to ( to to k tn cu G 5 c ; iiali S.Eh> . ,tj a *e o - CJ j _co cn c« <*. I cn w tft to • ■ OOO1-1 j3 x x >,.: >> >> >i 2 ■ ■ vi vi - H 03 ro u z X o -! aC ! ) <: a % < o H CrC u SOs ^H o ,, ft VO CO ►J < 3 «> t— cn cn v~> rt so IN r-t— inr-ooooom ■^•vo^-rH t-«oc ?! OH th' CN © (S i VO tJ- cs OV t~- cn tn CC rf r^ |cn OOOOCSrn r~Hi 3 0 a VO I *"" s vt cn : «n JS TJ 0 fl 5 I o 1 o a, § 0 0, E >> 0J >> CO | 0 < fl OJ u C 3 & a. 1 c c t a to t~ V > D B o U 4J > c c t to H CJ 'c? to tH fl to X to CO .a e 1| Is ?3 5 Cfl £ O o 3 oi to c C ± to 2 £ £2 O cc cn > co £ 4J '{ co a f i O t 3 01 4J C c x: rt E - § £ ■» J f f 3 oi If 8 tA o tfj _§ ® O TH co O" TH H TJ CO to tft 1 g C > co O Ih fl 4J C a g CO c Uh 0 > Ih c rt t- > Ih cy C "j3 Ih fl to to C4H 0 N a co O Jfl u >, tft a 1 rt O H Without ers of character, behavic ological personality— > CT C c 4J c t 0 c a > 1 c tr u to C > X c > c c u to fl 4J 1 o to X > *rt c c tft \\- \\ 1 c. > "cc c o tr •h i D a X 0 c c cc > X 15 3 4J Cfl to C tr C fl ■o c rt Hi 1 S ii Is Ih ■" £.1 3S 1 E EW > to C ■s s c 4J TJ to > c<* 4J X i tc 'C CL c c = T3 c ■ l- 1 1 CJ B ■0 V- E C '> cc X 1 X ■z c c X 1 >, 3 .2 u IB s TJ 3 ■a £ o c 4) DO « 4> c (/ cu tft X 0 o B 4> z; o a ■fl 4J ytt S?rt HH O cj _n 4j Ph o u -fl J P w HH O 3 •si Ph m to > 3 Hi c cu a 4J 0 *a x o o rt •S3 •*< Q rt ca s n o H g , i ■* u ON w ,—1 UI < H w Cfl oi .—I U -1 s OS o ft < ft oi w o oi < I u I/I Q a > OH ^t m cs cs ■ *tf vo rn cn - vo ^j- vo cs r-^t vo cs cs -^ cn ! "H- rH rH 1 cn y— i cs vo ft tn ft tn ■ ft tn \\ ' cs cS cn cn cnOOrHTj r-CJH. ■rHOvlTirH TH cs ft tn : cs m vo © th T ) co cn o cn i-h h cJ ft tn ft in ^t oo T. hJ o2 XI -1 rt o fi j: ™ Si E2 O 3, KE E>, s a SB fl Es a o fl fl fl N N N rt fl rt R fl H o o 9 ^ ^ '-' I E E B o E Q, a 0 E > 8 ' B o 3 ex > H S « >, " o « S S g"S 3 O O a o 3 4> ,0 >!tG , Ih o P 1 5 cj < O Ih I Cfl-JH X M S R PS - •- -1 g o g y Pj j-> .£ +j co ti rt ■— rt . ° Ew H i« o^ItS b MTJ « O^ 3 fl S fl 8 P t> * n TJ P ftp. i rt fl ' th rt rt cu n n ri >< n < ►Ll ft X to oz 2tS -fl rt fl C fl fl fl to O to o w fl *_2 C 3 C O cj O o o hC rt tC rt -fl o u o cu cj •JL fl •o c rt 3 O > to ■fl CU o cu ■a CJ rt o cs X to CS X TJ to U X Cfl o Idho cienc unsp ordei -t X cfl ^■x a to CJ fl -c ^ tf ° ft.t3 ^•o 53 *• o SB a _2 2o £~ a S 5 E So §5 9 « o 3 o fl ' .3 is"* J1 * s 3 s a a O, rt 3 _3 > - 00 CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 121 Table 18.—Deaths Occurring in Crease Clinic by Mental Diagnosis, Age- group, and Sex, April 1st, 1954, to March 31st, 1955 Age-group (Years) Total Mental Diagnosis 0-39 40-44 45-49 50-54 55-59 60-64 65-69 70 and Over o H M. F. M. F. 1 M. IF. 1 ! M. IF. M. F. M. F. M. F. M. F. 1 M. IF. 1 c fl O With Psychosis 1 1 1 1 1 1 1 11 1 2 Psychosis of other demonstrable etiology. 1 1- — -— — 11 l|__ 1 1 Neurotic-depressive reaction — 1 __ 1 Total with psychosis 1 2 1 1|- 1—-1 1 - 1- 1 4| 1| 5 Without Psychosis Other, unknown, and unspecified conditions... 1 1 1 1 1 1 1 1 1 1| 1| 2 Total without psychosis 1 1 II 1| - I—-1 1--I--I 1|--|— 1| 1| 2 2 ...... | 21...... I......I 1I......I. 1 11 1 1 5| 2 1 7 1 During the year seven patients in Crease Clinic died. Two patients had been hospitalized for a period between one and two months—one female with a mental diagnosis of manic-depressive reaction and the other, a male, diagnosed as neurotic-depressive reaction. The length of stay in hospital for the other five deaths was under one month. The female was diagnosed as an unknown condition without psychosis, and there was one male death in each of the four diagnoses mentioned in the above table under the With Psychosis section. Table 19.—Deaths Occurring in Crease Clinic by Cause of Death, Age-group, and Sex, April 1st, 1954, to March 31st, 1955 Age-group (Years) Total Cause of Death 0-39 40-44 45-49 50-54 55-59 60-64 65-69 70 and Over ■2 o H M. F. M. F. M. IF. 1 1 M.|F. M. F. M. F. 1 M. IF. 1 1 M. IF. 1 1 M.I F. 1 c rt Ih O Malignant neoplasms.. Vascular lesions affecting central nervous system - 1 1| 1 1 1 1 1 1 1 1 1 2 1 1 1| l| _ 1 1 i Pneumonia 1 1 Congenital malformations 1 1 Total, all causes. 2 — — 21 1 1 1 5| 2 1 7 The cause of deaths of two patients who were hospitalized for the period between one and two months was pneumonia for the female and arteriosclerotic heart-disease for the male. The four males who were hospitalized for a period under one month died from the following causes, one from each cause: A malignant neoplasm, arteriosclerotic heart-disease, bronchitis, and a congenital malformation. The female in this group died of a vascular lesion of the central nervous system. M 122 MENTAL HEALTH SERVICES REPORT, 1954-55 PROVINCIAL MENTAL HOSPITAL Table 1.—Movement of Population, Provincial Mental Hospital, at Essondale, April 1st, 1954, to March 31st, 1955 Male Female Total 1,832 50 5 1,649 73 3,481 On probation, carried forward from 1953-54 On escape, carried forward from 1953-54 123 5 Totals as at March 31st, 1954 _ 1,887 1,722 3,609 Admissions— 483 181 342 133 825 314 664 475 1,139 Total under care 2,551 2,197 4,748 Separations—■ 535 87 76 1 388 53 84 923 Died — 140 160 1 699 525 1,224 20 23 43 In residence, March 31st, 1955 1,852 1,672 3,524 CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 123 Table 2.—Showing in Summary Form the Operations of the Mental Hospitals since Inception Year Discharges Z* * ° a z« o B OH ° M c B-P<< -oSS C rt W.T3 o 3 Eti O.P to tn 3 c«—• rt |o« to O cd X u 2 « o fl 0 &H 3,301 121 4,067 3,487 186 4,255 3,612 125 4,471 3,710 98 4,713 3,836 126 4,781 3,902 66 4,843 3,925 23 4,919 3,960 35 4,965 4,019 59 4,960 4,110 91 5,014 4,151 41 5,174 4,269 118 5,447 4,355 86 5,758 4,602 247 — 5,999 to cn M seJ-215 C rt _.*o Qja q-DZh 1936-1937. 1937-1938. 1938-1939. 1939-1940 1940-1941. 1941-1942 1942-1943 1943-1944 1944-1945. 1945-1946 1946-1947. 1947-1948 1948-1949. 1949-1950 793 834 827 869 864 834 803 840 822 834 880 1,111 1,260 1,415 78s 74 72s 1117 107° 718 918 87 9610 117s 9710 124" 13712 195 300 330 345 455 410 400 443 423 377 352 496 560 748 787 268 207 208 230 254 255 260 309 300 240 238 240 209 202 9.96 8.87 8.71 11.39 12.38 8.51 11.32 10.36 10.46 14.02 11.02 11.34 10.87 13.78 63.60 67.30 78.72 88.50 79.97 56.46 66.50 61.66 58.39 57.43 68.18 63.64 76.59 69.40 6.59 4.86 4.65 4.88 5.31 6.54 5.31 6.02 6.04 5.84 4.59 4.40 3.63 3.37 Year Discharges 0° X) o .-_ i_ ^ Z5W to to to a *h£-o O cj to -1 to > cn |«g| M m. D.--5 ■£ S3 fl"cn S c e.a >-• f'ax to Cd C^ D-tO. rt< D +■» (. < £0 2 j r- r» 00 i i r— : j r- ■ in ; m cn 1 m vo PL, ; :cn ! CN I j 1 j ■t rn s rt rt tn \\ ft rf ; ON ! m i ^h m m ft t tn t r- i-h : «n ! : VO rn pq W < VO A 1 w ! **• ! 1 \\ CN s oo -h o\\ cn o m m j vo | i ON O Os m in m i-h ,' . : o ; , 9 >/-> Z to 1 tn PL, 1 *" \\ i i1_l i I '""' m Os , VO , i-h NT, tf i >n i ON O Os s 1 l-H i CN m 8- cn i rf r- | i.O i j O tn PL, j *"" i ! rt Ith i ! ^ tN H <» ' m i m cn i-« © HHt ! VO VO J hH »n S 1— *""' m vo ! 00 i-h | in rn ! O , ! cr-, 00 rt to b Ov PL. | r-t j ! l™t 1 - t— m E-i U J. c. i-h r- ft t «J m (N CN i-h p vo i-1 r- M- tJ- Tf S t—1 r-l r- hJ h < „ < cn -H r-> j ! m — VO Z u-. m PL, CN ! 1 "^ CN ^F JL oo CN as tn ; ri O W OS m s ft ft t-H | -H tn r- . s~ OO j t-i — O li ! f) r-t vo Provincial , April 1st T* as O tn oc i i-h CN tn s CN CN ! Vj ^ 1 CN oo VO . Q\\ TH vC OC Os CN ft i 'H CS Tf tn VO ^- ON CN rin r- CN 2 «-" CN ! *"' ^- VO ft,' CN | fr- CC C C C c > c c H > r f C c 0 > c o H o H H B u 1 fa t s 0 > a. c I- - 0 CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 127 X w cn Q Z < 0? 0 o o I ft) o < 03 O z o < H Z w OH \\OrnfN (S't^'^moo m i oo m i-h i-h o\\ m OscAtntnOftc~rt CS CN CN ft so t tn CA Os JH HO « 5C on W rt hJ "< hH 9 « Z rt O cn X u < o ir. as m H < hJ 5! H 03 o K *_ " r™ 03 Z rt W j J hH 3< o z > o OS Oh o H z o < H 03 Pi w « so it- i r. i ! M \\ cn so ft tn rt \\ Cr | [ cn CA I ft \\rt [ || j ,_! ; rH i-H (S CN «n '* i CN ! ! ! i i i ; m ! cm i-h m cn i-h "^rTm " I Tt- I rt T-l 1 •n i-h CN rt j ! CS rt CA rt i cA I rt i i r- i \\ tn tn cs i ! i I Ov rt ! rt rt ■rt-HVOt-l I rt ft y- ft ca r- cs : ft ft : ft so tn -ft ■3 O .5 u w 7 w •fl O. A If J] ■5.2 a < 0 gJB j n q v *c ig« ffi (. 03 ,_o III in 4J p. o 5f o .2 .8 -3 '« ^H O O 3 o >,K -_ B ™ « H, m j w S a. 03 a, (t, < pl, >,ihL a-S° J! o ■ ft u 3 , "313 E'3-. S o °. „fc & 3 rt rt '£ "3 3 3 o <3 » _ o u u u ft. 03 03 J E E2 o & il E & rt 3 a * F, cd 11 a 0 l_M M o *+H — si 8 e 3 __! S fl 51 a « 0 rt .2 g 0 I* h .♦_ ° ., o o ft rt J_ 3 XS _7h.t3 Ow " „T3 ^3c^>Dh,w. u «i rt 2 * > a O a fi c -2 1 « « B-ll ft. &I U 2 & ° H « C H 'j3 3 .2 .2 rt w o u ^ S^SH' . 2 H S ffl u u h >,^ (J U OJ U Wl l« ™ 03 03 £ ft, CL la s u w g , «CK OZ(£ M 128 MENTAL HEALTH SERVICES REPORT, 1954-55 X ft] tft Q Z < o pt a PL) o < tn o z o < ffl •S3 5s> ^ a C s* ca a -j 0 < ! Q ; Z uo o in 03 Os tn ,—i W - < 03 J CO < (3 Ch PS 03 <• s < o H H Z W 5 ON j H < o ,—I z J > « o ft, 0- < O H 03 z o 03 Ol § Q < H t/> as fe pa < fl rt OH >n rn VO •n tJ vo cn vc t]- m i-h ci ft in rt m vo */ .00 -H rH HI H H Os t- HHH a CN CC *rt o Ph' | CN ON CI fMtNrtrtmCN! irtrt ■^flrtln rt Cl rt ] f-J i CN rt rt rt CN j NO (-1 tn S m rt ND m m mcsincNcncsm i-h i-h i ,-h ,-« c* i— -^-vo irt ,-h ,-h r- ■ < ; — : : m oo rt to t D. 3 O 00 to 00 < T3 Ph en | | | | j j | Mi MM II II Ml M — cn ■ON DC S' 1 1 1 1 1 1 1 iii Mil M M III M rtg 52° ii CTN M M M 1 iii MM M II ill i i S NO j | ! j ! ! | I j ! CS 1 j j !! [ | j j 1 CS *■? 1 «n vo ft r- CN MIMM III 1 1 i 1 II II 1.1 1 II r-" 1- CN oT S ^ CN M 1 1 1 II 1 1 1 " M 1 i i i i III VD 2 VO ftl r^ 1 ! II II 1 III IMI M M Mi M r~ s" 1-1 i o CN Iii}!1! i i | mh i | ;| :: i i *-< ; : o o m ON m 1 m in ft.' NO 1 1 1 M I j | j | ^T 1 j 1 l| ! j Ill 1 ft in CN s NO 1 j j 1 ! | | I j ] ON j | | 1 ; i ! rt j ] o VO CN m b j |H j j I 1 | j | w 1 | | M 1 ! Ml i 1 CN t- S CS ! iiiiii i 111 s ii i r ii iii ii m 00 O Cl ON T Cl s NC | rt cl 1 . rt Cr 1 rt j rt . J | II 11 III 1 1 1 1 ! 1 i II M 1 1 M 1 .1 as m n i *"" t- H ii i ir iir ii ii ~m ~i o c~ S t"- ~ 11 P II Mi 1 i M N,H II ! r m Os CN~ NO CN m rt © a ~ [ i j j 1 j j III ; iH j i i ; | I j II S H I I 1 I I || 1 MM M M *"' M i i y 'ta O B OC tS 5 a 2 With Psychosis—Continued Syphilis and its sequela?— £ to ta X Cfl S o > Ih to fl 0 o 'i - p, >> ta c 0 u >, GO a ? rt o Without Psychosis Disorders of character, behaviour, and intelligence— Pathological personality— 1 p c cc 2 1 5 rt 0, > 0 c C C/l (- OJ C -i 5 a a rt C > c V i- 8 e c c < > c C S H H- C * C < c "fl ! u 0" -z a |C *t V C — c K (- a. X C 1 £ rt "J "II &| S c 1 E g pa > c -S "C c u 0 a. ■a V Cl 0- 0 I 1 a t- & a < i fl o tft .5 S3 C o c J3 i- 85 < — a, £ 'c a. C ( _C cu a * 0 B a ■c C X Ih = C > rt a c 1 J I u e 1 2- 1 O c to 'to > tp .fl to — "fl o — 5 rt ,__: 3 E to V— 3 C 0 2 _C •a c rt t-T 3 O '> rt ,fl cu -Q * I CJ £ rt w J3 " ■fl -c u ro •a r 1 S • J- B rt c a^ c go; 5 E2 rt 3;5 B Co rt pj c , © * 5 < O X to cc "t i c B = B ra « c 11 ii t a"- pa a E 5 c ■c 0. c= t d f E t c n i- (L c -fl u o ta in cS O c E 0) t/3 >. tft 3 0 Ih tD c S c 53 CJ "■g „ X » u C at 8 > o ~ .-_ s O V C C T C c c •c c < c » c *c c B c s p = a. X C L, 0 c X > c c X 1 C E- i *rt C -3 G rt u 0 J CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 129 X pq tft Q Z < e_T D O ci O ■ ft) o o z o < Q -j < H Z w LT; ON H 03 w hJ < f Z o X o o Oh O H 03 7 O oh so vovovoovmmr-^- vo vc cn rt cn •'t r- 1 rt. ,-h rt 1— in (N >n CN'd-'-HOCNCNCSm 00 cn CN C?v CS CN f CN Irt I CN I I ! m 1 1 cs : ; i-H I rt rt CA rt . i I ; If I CS m M- rt CA rt \\ i CA \\ CN CN CN i-h rt rn ! (N CN it i CN O < ft) PSi w ca < J E_ So- c = . p»oS 5n3 JS _> n Hi u 7. r_a 3 >>p_; t« 5 wCMPh' O U 0 cj J J cj b >» >. >. ' • qj 4) 09 00 M W ^ Pt Oh Oh O __ G w ' s ° s 2s_ 3 • J rt m _j ! .8 EL'S 3 DC C o _5-§.s S2.S §=3 6 o £ rt c P- SWH b >, o tn W 5 C/3 r^ ill ,_ Cl H E c 1 >-*°'£ v- rt S * C3 111 c *S.C < C ft * w CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 131 in O z 0 < Q hJ < H Z BJ 2 tn D h < H tft hJ > -— a ft] H -J < 0 Co CL cn O ,—1 X H J cn < H -J Z BS 2 ci ft, < -J x' BJ u r/i ^ Q > 7 o <1 ci 0- o H cn Z C D < fc ft hJ ca < 0* r~ovocNomoot^NOOv( i **■ vo en vo cn ON i— i- — — CN CN "* CN CN r~ tn m i-h i—- oo ci r— f. i-h m < on cn cS cn cn ■<* cn ■ vo tt cn oo i rttnr«>ntr)CAOsf*rtrfCA CA rt _ tft ».a S'S ft"! i I B i o E j ~ O rt « fl c U cn O to 5 ft '-P fl 3 O C t' .£ O p 5^ g .ass 1 'S3 s .a a d a g c^SS cfl U O ft, « Oh Oh < « rt s.a O W H ^ _! .2 .2 y 2 x "S. 5?B E > 0. 0 < ft IIs u is "-1 i~ rt oj aj i- a ■- « § 3 *5-a & 8 a B t-t -3 cj M ti U i rt H i *5 ■ 3 ■d ■ Cfl 3 fl u U O >> 13 2 a o cj a 5 hh S a rt2-2 S 03 .£ •- c . _, E _> -- t; ft j- O S 3 S >,-§. OZft. cn •q "O >> ____, rt oj £ ,_, rt ^ h £ -3 a" * i o > — 5?fl &i cu O ft O M 132 MENTAL HEALTH SERVICES REPORT, 1954-55 Table 8.—Readmissions to Provincial Mental Hospital at Essondale by Marital Status, Mental Diagnosis, and Sex, April 1st, 1954 to March 31st, 1955. Marital Status Mental Diagnosis Single Married Widowed Divorced Separated total Grand Total M. F. M. F. M. F. M. F. M. F. M. F. With Psychosis 40 1 2 2 2 1 2 17 4 1 1 1 2 1 1 12 4 2 2 1 1 31 6 5 1 1 2 I 2 2 2 1 1 7 1 1 4 1 1 1 3 1 3 1 3 8 58 11 2 2 3 4 1 2 1 4 66 11 2 9 2 2 4 2 2 3 1 1 124 1 .... 22 1 1 2 11 Presenile psychosis __ Psychosis with cerebral arteriosclerosis Alcoholic psychosis Psychosis of other demonstrable etiol- 2 4 7 6 Other and unspecified psychoses . Anxiety reaction without mention of 3 5 Hysterical reaction without mention of somatic symptoms Neurotic-depressive reaction 2 5 Total with psychosis , 50 ! 28 22 | 49 6 | 15 5 | 4 5 1 9 88 | 105 193 Without Psychosis 6 25 1 3 4 2 1 2 2 1 1 24 9 1 1 1 1 2 1 7 1 1 4 1 18 1 9 1 74 1 3 5 5 1 15 1 2 3 14 Immature personality 2 89 ..... .... 1 Primary chiidhood behaviour disorders - 2 5 Epilepsy _. 8 39 | 7 26 | 11 2 | 3 7 | 6 19 | 1 93 | 28 121 «■< 1 35 48 60 8 18 12 10 24 10 181 133 314 Table 9.—First Admissions to Provincial Mental Hospital at Essondale by Years of Schooling, Mental Diagnosis, and Sex, April 1st, 1954, to March 31st, 1955. Table 10.—Readmissions to Provincial Mental Hospital at Essondale by Years of Schooling, Mental Diagnosis, and Sex, April 1st, 1954, to March 31st, 1955. Table 11.—First Admissions to Provincial Mental Hospital at Essondale by Citizenship, Age-group, and Sex, April 1st, 1954, to March 31st, 1955 Table 12.—First Admissions to Provincial Mental Hospital at Essondale by Religion and Sex, April 1st, 1954, to March 31st, 1955 Table 13.—First Admissions to Provincial Mental Hospital at Essondale by Previous Occupation and Sex, April 1st, 1954, to March 31st, 1955 Detailed information for the above tables may be obtained on request. CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 133 Table 14.—Live Discharges from Provincial Mental Hospital at Essondale by Condition on Discharge, Disposition to, and Sex, April 1st, 1954, to March 31st, 1955. Home Clinic Agency General Hospital Other Mental Hospital Other Total Grand Total i M. | F. M. F. 1 M. | F. 1 M. I F. M. F. M. F. 8 2 1 :::: i:::: .... i i .... i... ... i... 8 | 2 90 | 129 15 9 194 21 ... 14 4 23 21 348 143 ... 2 3 214 169 25 12 145 32 3 197 36 24 562 Unimproved _ 312 Totals 197 238 1 ... | i 98 | 131 239 18 535 388 923 Table 15.—Live Discharges from Provincial Mental Hospital at Essondale by Mental Diagnosis, Condition on Discharge, and Sex, April 1st, 1954, to March 31st, 1955. Condition on Discharge Total Mental Diagnosis Recovered Much Improved Improved Unimproved Grand Total 1 M. | F. 1 M. F. M. F. M. F. M. F. With Psychosis 8 1 l 5 3 91 17 1 3 9 3 3 11 1 8 1 1 92 16 5 3 I 1 3 3 3 2 9 1 6 1 4 45 1 2 43 15 1 3 2 1 2 23 1 1 98 1 20 2 1 1 1 149 19 3 51 18 19 6 6 14 2 1 9 1 3 118 18 5 99 2 23 4 3 2 11 2 7 1 5 267 37 5 7 150 2 | - I ------ I 8 1 2 1 1 1 2 23 9 Other and unspecified psychoses — Anxiety reaction without mention of somatic symp- 8 25 Hysterical reaction without mention of somatic 4 1 16 Psychoneurosis with somatic symptoms (somatization reaction) affecting other systems Psychoneurotic disorders, other, mixed, and un- 1 6 3 Total with psychosis 21 | 2 8 | 3 | 157 150 115 149 301 304 605 Without Psychosis 1 1 | 1 12 1 19 163 1 4 1 3 7 1 38 4 7 2 5 12 7 8 1 4 "a 1 9 1 31 183 1 12 2 4 1 11 1 42 5 16 2 6 1 42 1 1 28 4 10 1 Other and unspecified character, behaviour, and intelligence disorders Other diseases of the central nervous system not associated with psychosis 2 | -._. | 13 | | 191 j 64 28 20 234 84 318 r* 1 ? 1 91 3 348 214 143 169 535 388 923 M 134 MENTAL HEALTH SERVICES REPORT, 1954-55 X - tft a z < o e. o I UJ G < o z o < -J < H z a UJ H < hJ O a hJ < H z w _* ft^ z > o OS cu o Pi 03 w o S-S < s u co HJ > W -1 pa tn rt as ca tn rj- r-> rt i ; ,_, _ ihhm it- rH ft SO \\ ri rt rt \\ Os CA j rH j s oocnOmoo-Hoovo »*n cn rH ;m^-i iooon cn i »-ics l th ,-< -<3- tj- Pk i : t—i t— : . r-i : i i i i | m I cn ] : i 1 t I iiiiiii : II °* l1-1 j s 1 l" I NO t I t 1 rt rt I 1 | VO t rt tH : ! ii; 1 ( 1 1 1 1 J : i i i | |t |h ON VO 1 in VO ft ! ! i ! ! ! i i 1 i 1 1 1 1 1 ! 1 ! ! s j i | oo i th j rn cs »-< i | : ri : vo ; j ; iii i i ! i i im I VO Ph M j 1* 1 :~ 1 1" ! |~ j jM | 1 Mill ■ s h i in i in ; tn i : | | ! ; i ;] 1 1 5ft i > i | 'i it c I c L 1 > 1 B R a c c c- 4. t- ft fl 4. £ C - c 1 w 4. < c 1 1 i £ "E C g c 4, . > X L 4. t C c N 1 4, -'I c I z 1 X c 1 a S ts. QJ ^_ " - > .t U r 6 c — c; S 3 < -1 c r c C e "i E ** c ( 1 1 n c x i i \\ - 1 j - i : a -■!7 C E C 1 ^ c 5 u ( V C g a C I c c X J 5 f -' 7 $ t i : r .2 | I 0 : f t i £2*a to o ■a o qX •ft Tj Tj" « 2 > o 'Js -° l> wi >> S x » is i -S a> > JJ o 1| 1-° 2-? Sc.5. *_. ca _, w c u c •a 'a 3 y u fl . s ,°2°c w — c _ J >.K [>_ 5&. s CJ >, tft tft 3 O > u c u -S t-H ■> o [fl to tft rt § TJ 2 to 1 Owe °c "h r cfl < TJ " C X > o C cj a u W 4 C a _c '> TJ P R c 4, c >$ i '■£ c > . T. C C '- < a < B s £ C c a. T C -. > 0 t: c c ) t . ) 0 > 1 i c Wl H o ■? •51 >. c ■ss ax ; ss - £0. O S "I c te .- - %| H C V C c -v > V P. fl £ [ i c c w ft CO fl E2 o a SE E & ».a rt E E g 9»-. M o 0 c 5 53 .2 a a 8 e ,1 S c Bit *- o " O g h S S s Mi Ell ■W Ur (/ . Jj U j x to t c >.x c .9 I 4. > '5 i i s 4, 2 fl o n ca N rt s 0 to ta s 0 G. E * CJ V ^ B rt " X t •a't i o n Hi ^ sl !■- r i - CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 135 ir-OmrHCOrH rt -rf rt tn rf C> CA ft ft rt tn ft OS rt ■rt 00 fi ft CA m Os CA ! rH rH , I CS th cn to fl cS O .'£ >. fft cS fl, T. c Cl 0 | H to ft to ■'fl * rfl Q *j , r" > 1 > > o CJ 4> 3 ftp i^ft P- CO . § § I I I I § 3 I E o s. I I i 3«tj Sig3 fl-3} \\ 111 -8II1 5 -3 te S. « £ 8 8 ; LO 0. tj h3 < < tn CJ I E1* rt ,u . rt -3 E E -.< ■SJ § & ■OSS rt 3 o >-, M •= ?. ■3 _: __ u a. —• p £ ^"o o s o "fl C—* cj P in h ca ed i g « «fl *G 5 .52 B cj cu A X 3 TJ TJ ; to to .3 ■5" i 2 2 5 FH CJ i tS to i fl ft ..sa rt 3 j a-o •_ u S rt | c 3 «_ «h 3? "2 iu&p ° -a p * r I SJ a.* H 0 0 £ * J_j o o M 136 MENTAL HEALTH SERVICES REPORT, 1954-55 o z G < < H Z w < H C/3 Ph o a H G Z w hJ to CQ ON PJ Q Z O to tn W d ° £ K Pi -yf tn m O Os a~ ►J h < tn Z hJ w g 2 Bh -j< a * y w 9 z 3 o w G < u tn OH rt > J10 ai c" till a e to O 3<= __»TH *H c S? OS. ■go 5S rH irnrH itSOl^rlH CN CS I CN CN th : th (N VOCn i-H(N \\ rt CA rt Jt-. r- m PJ CQ < _5 0 a? o o 5 o a 'g o o o O rt 53 -1 u 0 u i _. E |2 i &g i C c« ! >. o i w — I cj « iff ° s-s 3 IIS 2 o g E c r? *j o S 3 * o ■5 a o t> o w M aj 8.2 « S o E grt a ' C H w o ftp 'is* SJ 3 " (3taSf_eSjitHb9'-j6o*HH^j*Ji_* y_2£0.«.CHHH.j W U 2 J- >. 3 -- - ft o , B 3 5 I o §.2 : >> ft cfl >> ft. W Ih 0 ft TJ U CJ * u TJ rt c 0 TJ ca Ih c G O H2 tH O to X >. c X 0 cc *3 3 O u to to 0 rt X to c « >■ _ . _ 73 o o h 3 «_ c c X •a to cfl ccn and o o a ? o 2 g _. s -. S-S c ,E s ■f tp 3 rt b fl ' iS3 ) rt J2 3 E ° £ E 5- ».Sow oo CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 137 x w tft Q 7 < ft D O (A G i W G < O z G < -J < H Z w >H « w o> hh r—. Z H" Z tn O hH 52 cn tn < hJ < s cn O ffi ►J < H z w 2 d hJ •* g > o Oh G Z 5 3 D U G O cn E H < W Q 'HJ hJ PQ < TJ-H C rt OH ocncncsvomocscnvo tn m cn « o ON CN ^ "t lH TtrH H o Ti rt o H Ph NO CS rH rH Tf rH OO ! ri M |rH 1 CS rH CS ! V) en in s '*rHCq^H(NCSfS(NCNcnrHON rH CN CN oo rH CS j CN rH NO oo rt to a 3 o a) 00 < -a Z2 CO ft rH j j j CS | 1 I I j I ] cn Ml II cn s i |H i i i i ! *" iii : i ' i 1 Mi II 1-1 Is rt > go ft cnrHiiooiiiijIi || IIIIIII rN cs s tn ! i i no ! no : ft i |i-h ON CN 1-1 i rt o m ON VO tn VO Ph ojHHHm j <«t j Moo 1 tH H l|CM O its s tnHHHTl- j © 1 IrHrHcn r i ! tn CN j j i HH i 1 i CN CS T* VO 5 VO ft rHjJljicSIICSji « ii; it iii i i tn s CS j | jCSrHcn i j CS | th iii i I 1 ^ ! ! i I I iii i ! 1 - ON m 1 *n ft | i i i i *"1 i i i i i i rH iii i i rH s n j ; : j :h j | ih ■* 1 i m tn A tn ft' ~111 i r i r i in 111 -i rH >n s ~ r11r~ 11 iv i 1 1 1 1 1 i vo Os rf tn rf ft 11 n 111 iii it I : ! i i i 1-1 s" 1111111*" 111"1 CN Ml II i cs 2 ft i i i i i i ri i i j i | i s j | I j | *"* ! | j | { • | ^ ii! *"* 1 cs ON cn ! tn tn rf cn <± cn On tn CN ft CN j | i rH j i | : j ! i m cn s ! 1 i 1 I i i i I 1 I iii i i 1 ft ! ! ! ! 1 1 ! i 1 i i 1 ! iii 1 i ill 1 i : 1 ' > '< 1 1 i £ 111 ii i i r 111 rt ! rH 1 ! ! 1 ! i i 1 1 II rn |CN ft MINIMI!!-! \\ j rt rt II CS 1 cs s - i ! j i 1 | 1 i i i 1 1 1 1 II II 1 II 1 rt jfj i i Iii i i 1-1 2 CN pc; 1 M 1-1 -j 1-1 s 1 II II ! 1 I 1! II i ON 2 ft 1 i i i II II M II Ml i i i § 0 c DO rt 5 C 0) s 43 tj it s. 0 t- i •a c a •5 o C | X A c r- X c. Of c .£ i a a t- to > t- D to V o 'I rt "c X t c E "3 c C s 0 > c >— a « X c c 0 h- re c ■a c a .5 'c c rt u re 0- a c fl > fl * '5 i v: a a fl u > cr P C 1 t s u ft. 0 'a C _CL *o C T CL t re ! s u u S 0 •5 > '5 c j= u > tr P (. *C ■= c CJ < > c c t a s R U 17 P C E 4. •c u at c 0 tc 'ft 0 c > a ■ V a V C 1 - i CC t 1 1/ c t; l i- XI c a I C 0 E > t re E o t fl .£ c I 3 "• C 1 C .2 -1 c 1- "S .S u a: > fl w 3 o* to Oi tft TJ S re tn X a 'ft 0 X u >-. v. ft fl '1 3 o H •3 o u 5 3 O E a 0 X o c < > U c to 'u CC to X a s to 5 > IV C to c u. & TJ to S 'o o tft tft at 1 E CJ tft >s tft tft 3 O > Ih to fl rt H C CU o 0 s o ■a c o CJ •o OJ eg 'o 0> a Cfl c 3 C 0 a c 3 c w 0 ■fl CJ i ft ■w 3 O fl 1 o H tr "v C TJ c C5 1- c M 138 MENTAL HEALTH SERVICES REPORT, 1954-55 < H tft ft O X H G Z BJ hJ 03 o z G hJ < H z M >H U~l CO On PJ hJ HI" H Q z 0 —H CO tn to w X G < < hJ < o H ft Tt i/j lo 0 ON X 1—I -j H < CO H rt Z w d S BJ ft j < o Oh a 7 < 7. 0 z BS B- D G u O CO I H < PJ 0 w , ■fl — O cn m r NT m 0 cs cn NT O ON __, ■4 ■* rH ^ pp cs i : 1 th 1 : | | j | | m i" i i i - -1 w tH — PiH s ft j j | TJ- | TJ- ,_-, rt j j *"* Ci Mill tN M tn th-A T S "1 ft rH i rt , , rt , cn II II cn s tj- ^4- .__ ft r r i r m m i tn m 4 0 s i j ! j [HtN i j ! j ! cn m cn ft 1 j i jtN |H | |h j | ^t | | | | N- ?E « 0 s t-i ! \\ rt tn j C) ! j 1 [rH Os MM" - O ".a ft' r- t- ■Sr. -3^ s rH ,th ; \\0 ! CO i ! t-i ; "r^ tN On Cfl 0 fl 0 ft fl F ? TJ F CJ ■J C-5 . CU to .cn n cn 0 | ar. fl a, 1 rt 5 C 1 £ "5 c a 0 t/ c 0 00 O O CJ to tr X v tS C H x 'o fl O I 'io 0 fl CJ ES e. s S u a cj y 'tn O fl CJ c c a re ca er demons cified psyc on withou equelse fl ft rt 5 l-C 3 ft c 0 4. C 3 V it •° CJ" 1) .£ lH C^ 8 = •r* t/ *C cfl r; O C flf ft X > C T3 tJ cS 0 5 0 c L *C (1 X c c > cu % E CJ — 6 3 r 7 ! ? e 1 a y'a c > t- 1 2 > C y a, -fl- z chosis of oth er and unspe terical react hilis and its Total v. c to "u CC -S rt C fl a. er diseases o er, unknown Total v. t. e. S > R ft 5 4, > ft < > ft c > 0 < 1 2 I OO CREASE CLINIC AND PROVINCIAL MENTAL HOSPITAL M 139 x pj tft Q Z < bT O « G i PJ G < I H < w Q ft c < « in w in J On << —i Q ., Z H O tn CO CO W M O < H Z w < o z > o Oh G 7 5 e. G G o tn X H < Q o CM W < OH o_- go cntN^THc^MCXrHrhcnincnrHCSt--0'rtrHtNCStn'*rHTHCSl rH ii-tcn IrHfSr-tS lr.CN c-tN^tONtNcst— l m m tj- tT) i ft fn th rt CA iHlnMtNHH I CN tJ- I rH CS *H .t- jth itnen |m icn I Mi I I 'O I j M Tt ! th cS cn 2 £ H & u -i a I. 3 E ■sffl «s 22 S E c 3 3 .2 2 «. 2 S cj £s E cj tn s _,_, > - ? B *rt >. o o rt ■fl 3 ■-■■ a in .5 * -5 y fl fl . u * 3 ill's •h .fl -m rt cm 5 CJ ,„ OC3.2 r/- ° fi -A S cS "9 « fc _5 co fl fl £ ~ rt ca o « ti ■S3 O rt H i- -4-J c_i ■— r_r u- M -fl hfj tj Ileal i 2 Q H _> ?- | B, > 2 O g §§,|.J o tr-. Q Z Ch < z M CD z ci c* D G G o c/> X H < W PJ hJ CQ <: H OH t- to cs > 2 S Jh C o O rt rt = > tn r fl ! 3 cj 3 fl *-> 2 -o -fl o cj . 3 Cflfl -«, 3.2 "ii *S ° 2 O C C »s c

w ~ 0 ►* 3 1M rj O O I 3- cfl St a • 4) Tr cfl Cfl fl fl rt ca 0 ' £ § rt I-h Ih cS O ill i o « 3 3 HH w rt a. 3 S« >« a .0 e-«.5 E-2 5:s«s b,>2 ops t- >* K fl - S C g ;fl § s g s«^ ;.: '.-: -aSCQQCj<5o THE WOODLANDS SCHOOL M 141 PART III.—THE WOODLANDS SCHOOL, NEW WESTMINSTER REPORT OF THE MEDICAL SUPERINTENDENT A. M. Gee, Esq., M.D., CM., Director of Mental Health Services, Essondale, B.C. Sir,—I submit herewith the annual report of The Woodlands School for the fiscal year April lst, 1954, to March 31st, 1955, including reports of the various departments. On April lst, 1954, our population was 1,189, consisting of 692 males and 457 females. In addition, there were on probation 9 males and 8 females, making a total on our books of 1,206. On March 31st, 1955, we had 1,208 patients, consisting of 706 males and 502 females. In addition, there were 5 males on probation and 12 females on probation, making a total population of 1,225. Owing to lack of bed space our waiting-list has grown. There are 78 prospective patients under 6 years of age and 133 over 6 years now seeking admission. This necessitates accepting only the most urgent cases, resulting in a patient population of less promise for rehabilitation than formerly. This not only reduces the number of those who may be rehabilitated, but also adds materially to the already heavy nursing load. In view of the negligible results obtainable with so many of these new admissions, the interest shown and the care given to them by the nursing staff befits the traditions of their profession and deserves a special word of commendation. The health of our patients has been well maintained at a satisfactory level. The epidemic of dysentry sonnei that was so troublesome at the early part of the year gradually died out and has shown no recurrence. There has been the usual number of cases of measles and chicken-pox, but these diseases were well confined and at no time reached epidemic proportions. It is interesting to note that we had the first case of whooping-cough in October of this year. It occurred on one of the crowded wards. However, no other cases followed, due, no doubt, to the prophylactic immunization of all the smaller children in the school population. The death rate has been surprisingly low this year. This is the more noteworthy when one considers the number of weaklings among the individuals lately admitted, and also the various conditions from which they suffer, that under optimum treatment are incompatible with a long life-span. During the year we had two deaths, the autopsy findings of which indicated that death was due to anterior poliomyelitis. This is mentioned with the thought of the advisability of using the Salk vaccine for the residents of The Woodlands School when it becomes more plentiful. The various departments at the institution have been working smoothly. Manual Arts, Shoe Repairing, and Upholstery Departments are preparing to move into the new quarters provided for them by the renovation of the stores building. Here there will be more space, better lighting, and better arrangements of the power-machines, which should lead to more efficient operation. The Women's Uniform and Repair Department is also preparing to move to its new quarters on the second floor of the same building. The recreational and physical instruction of the pupils has followed its usual course, with weekly dances, picture shows twice weekly, and organized games. Special dances and parties in the Hallowe'en, Christmas, and Valentine seasons were successfully staged. The annual gymnastic display, to which visitors are invited, was better than usual. Many of the higher-grade pupils, upon whom its success in former years mostly depended, were out on probation. Nevertheless, the programme was well executed and was a credit to the members of the staff responsible for the necessary training. M 142 MENTAL HEALTH SERVICES REPORT, 1954-55 The Recreational Department is badly handicapped in its summer schedule by having no playground facilities. Organized outdoor games, such as softball, football, basketball, etc., are no longer possible. To decrease to some extent the number of boys and girls wandering about with nothing to do, work has been started on the construction of two outside checker-boards and a volleyball court and two horseshoe- pitching ranges. A playground of adequate size is badly needed. Picnics and entertainments outside the institution for our pupils have been organized as formerly. Gymkhanas, Pacific National Exhibition, the Shrine Circus, and May Day in New Westminster are a few of the events visited. A group of boys attend the softball games regularly. Picnics were held at White Rock, Second Beach in Vancouver, and other smaller ones at various places. Many small groups have been entertained at private homes in the community. The auxiliary to The Woodlands School, organized by the British Columbia Society for Handicapped Children, has been particularly active in this regard. In addition, they have recently established a clubroom in the city where our more dependable pupils may gather on week-ends and spend an enjoyable time under adequate supervision, or where parents who live at a distance from town may take our pupils during their visit. This has proven very popular and affords another opportunity for them to acquire socialization. The Social Service Department has been working at an increased tempo during the year. Our rehabilitation programme has been intensified, which leads to more interviews with employers and prospective employers. The functioning of the rehabilitation clinic, recently formed, has resulted in an increase in the number of social histories. There has also been an increase in the number of orientation courses at the School and educative talks in the community. In addition to this, group socialization is being experimented with among our younger pupils. Consequently the Social Service Department finds the present staff inadequate. The addition of another member is required in order that they may be able to cope with this increase in their work. The practice has been recently introduced of allowing some of the better male and female patients to go to jobs in the community during the day and returning to the School at night. This has worked out very well as a first step toward rehabilitation, and it promises, with further development, to be of more help in the future. To better co-ordinate our various training facilities to the needs of our pupils, a rehabilitation committee has been formed under the chairmanship of Dr. Hughes. Acting with her are the medical staff, heads of the various training departments, and representatives of the nursing staff. This committee has not been functioning long, but the results so far are gratifying. As well as performing the purpose for which it was intended, it makes the staff rehabilitation conscious and gives them a keener interest in their work. To discover the feasibility of organizing a day-school where pupils now resident could attend by day and return home at night, a survey was conducted by the Social Service Department of all parents of our pupils living in New Westminster and vicinity. Some of these parents had asked for such arrangements before their children were committed. The results of the survey proved disappointing. Even those parents who were so eager for such arrangements before the committal of the children were unwilling to accept them after committal had taken place. Transportation seemed the greatest difficulty as the parents live at considerable distance from the School and in different directions. The lectures and orientation tours for various outside groups were conducted by Dr. Herrick and later by Dr. Ellis, who has fitted in admirably to our teaching programme. Nurses from the various hospitals, Parent-Teacher Association groups, schoolteachers, School Inspectors, Normal School students, and student-nurses are some of the THE WOODLANDS SCHOOL M 143 groups who attended. Dr. Ellis also lectured to the final-year medical students and student psychiatric nurses from the School of Psychiatric Nursing, Essondale. It is anticipated that the lectures given to various student-bodies will be expanded further. With this end in view, Dr. H. G. Dunn, teacher of paediatrics at the University of British Columbia, is presently examining our patients and making a comprehensive card index of those conditions suitable for teaching purposes. In addition to facilitating teaching, the index will furnish us in accessible form with a fund of information that otherwise could be obtained only with considerable time-consuming effort. It will also be of decided advantage in any future research programme. With the exception of the construction of the new 300-bed unit, which is progressing satisfactorily, building changes have been of a minor nature this year. The stores building has been renovated and suitably wired, lighted, and partitioned to accommodate the various occupational departments. They have now well-lighted, airy quarters with sufficient area to properly set up their power-machinery to best advantage. This should lead to greater efficiency than was possible under the former conditions. The old laundry building was demolished, and the site cleared for the erection of a new auditorium, the plans of which are well advanced. Nurses' Home I has been vacated, preparatory to its renovation. The Public Works Department has kept the institution in a satisfactory state of repair. A new admission office has been set up on the third floor of the administration building and is now functioning. The staff has been fairly static this year. The various departments have reported most of the resignations. Those that might be mentioned in this report are Mrs. K. E. MacKinnon, Assistant Superintendent of Nurses, resigned on June 30th, 1954, as she was moving to California; Mr. C. Stapleton, head gardener, was superannuated, effective June 30th, 1954; Mr. J. Woodward, psychological clinical assistant, resigned, effective June 30th, 1954; Mrs. A. I. Rhodes, school principal, who entered service October lst, 1946, resigned September 30th, 1954; Dr. H. MacCrostie, dentist, resigned October 30th, 1954, due to ill health; Mr. G. Gustafson, psychiatric nurse, was superannuated, effective March 31st, 1955, owing to ill health; Dr. M. C. Muckart resigned July 22nd, 1954. We were unfortunate in losing the services of two members of the medical staff during the year. Dr. Herrick commenced duty on September 22nd, 1947. During his eight years with us he fitted in well with our training programme, especially in the masterly way he handled lectures and demonstrations to the various student-bodies attending the School. He resigned to join his family in England, his resignation becoming effective December 8th, 1954. Dr. Sauriol joined the staff of the Provincial Mental Hospital, Essondale, in June, 1921. He became head of The Woodlands School in 1930 and for a little over twenty- four years piloted its development with marked success. He was compelled to retire owing to ill health. Retirement was effective on December 31st, 1954. In addition to those mentioned in other reports, the following members have been taken on to our staff: Dr. Mildred C. Ellis, Physician—Grade 1, entered service July 2nd, 1954, to replace Dr. M. C. Muckart; Dr. T. Coulter, psychological clinical assistant, entered service July 16th to replace Mr. J. Woodward; Miss J. Ing, dietician, entered service September 23rd, 1954, replacing Mrs. G. Allan, who resigned in July; Dr. B. Tischler, Physician—Grade 2, entered service October lst, 1954; Mrs. H. Davy was appointed school principal, effective October lst, 1954, replacing Mrs. A. I. Rhodes; Dr. S. Gallagher, dentist, entered service December lst, 1954, replacing Dr. H. MacCrostie. Dr. T. Dobreva came to The Woodlands School from the Provincial Mental Hospital, Essondale, to assume relief duties during shortage in our medical staff. M 144 MENTAL HEALTH SERVICES REPORT, 1954-55 Dr. Gallinger assumed duties at the Provincial Mental Hospital, Essondale, from September to gain further experience in psychiatry. Mr. Stapleton, who is mentioned above, joined our staff on September lst, 1930. He put in many years of conscientious work as gardener, and during these years has been a decided asset to the Hospital staff. He reached his retiring age in 1954 and was superannuated. The following recommendations for the coming year should be mentioned:— A playing-field is still our most pressing need. The only suitable area available is at the north end of the grounds. This should be levelled and suitably treated to form a playing-field as soon as possible. We should not face another summer without these facilities. The office space in the School has now become quite inadequate. With the completion of the new wing there may be some relief. However, the reallocation of offices should be carefully examined. The present location of the dental office is unsatisfactory. Odours from the kitchen and scullery are always present, and when the weather is warm the heat in the dental office is oppressive. In addition, there is no place for the patients to wait. These factors have led to complaints of successive dentists. A new location is badly needed. At present we have no library in the School and no space available where one can be established. Reference books are in various parts, with no one knowing exactly where. A central place where books may be kept and read by the various branches of the staff is urgently required. In closing, I should like to express my gratitude to the members of the staff, particularly the heads of the departments, who have shown such splendid enthusiasm and co-operation in the past year. I would also like to thank you and the various governmental departments for their assistance and support. Respectfully submitted. C. E. Benweix, M.B., Medical Superintendent. EDUCATIONAL DEPARTMENT C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—I respectfully submit the annual report of the Educational Department for the fiscal year from April lst, 1954, to March 31st, 1955. Four teachers resigned from the school staff during the year. Miss Patterson resigned to be married in July. Miss Young resigned for the same reason in August. Mrs. Regehr resigned in August because her health was not equal to the strain of teaching twelve months a year. Mrs. Rhodes, school principal, resigned in September. Four teachers to replace these began their duties October lst. They were Mrs. Frost, Miss Oseki, Miss Anderson, and Mrs. Manning. Mrs. Frost is teaching a kindergarten class in the mornings and the senior handwork class in the afternoon. She is also in charge of the library and has started a school choir. At the present time there are thirty members, comprising junior boys and girls and senior girls. Miss Oseki is teaching a primary academic class in the mornings and a science class and two pre-school classes in the afternoon. Miss Anderson is teaching a pre-school class in the morning and a play class and a kindergarten group in the afternoon. THE WOODLANDS SCHOOL M 145 Mrs. Manning has a junior academic class in the morning and a remedial reading class and a primary academic class in the afternoon. Mrs. Davy became school principal on October lst, and also took over the opportunity class formerly taught by Mrs. Rhodes. Mrs. Siddall took over the senior academic class formerly taught by Mrs. Davy. Again this year, most of the school staff took pupils to May Day celebrations at Queens Park. About sixty pupils attended. Gardening classes were held under the direction of Mrs. Davy and Mr. Ewles, psychiatric aide attached to the School staff. About thirty boys and girls had plots. They derived much pleasure from these, and in many cases, besides eating the raw vegetables, they were allowed to cook vegetables on the wards for themselves. They also supplied the cooking class with produce for their Friday dinners. Classroom scene, The Woodlands School. Four picnics were held during the summer for the boys and girls who attend school. The junior and intermediate picnics were held on the school playground. The senior picnic was held in Queens Park, where baseball was thoroughly enjoyed by all. The senior academic class was taken on a trip to White Rock by Mrs. Davy and Mr. Ewles. Hallowe'en and St. Valentine's Day were both celebrated with parties and special dances. The annual Christmas concert was held in December. Parties and a dance at which refreshments were served were also held during the festive season. Piano tuition under Mrs. Brankley has now been increased to fifteen minutes per pupil twice a week instead of once a week. This may seem a small amount of time for such instruction, but only four pupils with special qualifications are being taught. Educational films, which are integrated with school lessons, were shown as usual during the year. M 146 MENTAL HEALTH SERVICES REPORT, 1954-55 Mrs. Middleton, teacher of retarded children in Kelowna, observed school classes from June 3rd to July 8th. Many groups of visitors, both large and small, were shown through the school during the year. Mrs. Davy was on leave of absence from March 8th to 31st and was replaced by Mrs. Scharf. The annual gymnasium display was held in March under the direction of Mr. Lynes, assisted by the school staff. I should like to take this opportunity to thank the various departments which have given us their co-operation during the past year. Respectfully submitted. (Mrs.) H. M. Davy, School Principal. DEPARTMENT OF OCCUPATIONAL THERAPY Girls' Division C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—I respectfully submit my annual report of the Department of Occupational Therapy for the fiscal year ended March 31st, 1955. The Occupational Therapy Department was reopened to women patients on Friday, June 28th, 1954, after having been closed for three months, following the departure of Mrs. E. Jones to take up a position at the Pearson Hospital. Twenty-five patients were entered on the register during the first week, and numbers increased steadily during the ensuing months. During October the total reached fifty, three patients receiving treatment on the wards. During March of this year the Wednesday morning session in the Occupational Therapy Department was suspended, and two ward classes, each of one hour's duration, were started for spastic and athetoid patients unable to attend the Department—one class on Ward K and one on Ward II. About eight patients attend each class, and even after so short a period of trial, with very limited equipment, it is apparent that these patients are benefiting from the brief sessions. Where practicable, those participating are being encouraged to continue on projects between weekly classes, but the majority require careful supervision and cannot be expected to work on their own. Sixty women are now receiving occupational therapy, but it is not possible for a single therapist to give sufficient individual attention to such large numbers or to maintain adequate treatment records. In addition to spastic patients, it appears that there are many boys who would benefit from occupational therapy. In December last Dr. Herrick requested that a group of eight boys be given occupational therapy, but although the Department could provide various crafts suitable for male patients—for example, basketry, rug-making, stool-seating, etc.—it was impossible to take on these patients under existing conditions. There is urgent need for further qualified staff, and it is hoped that assistance may be obtained shortly. While a nursing aide would relieve the therapist of much routine preparation and finishing of work, in addition to taking patients to and from wards, it will not be possible to expand the treatment programme much further until another qualified therapist is provided. In addition to the usual crafts, basketry has been introduced into the programme of occupational therapy, and the work done has been of a remarkably high standard, THE WOODLANDS SCHOOL M 147 taking into account the fact that many patients in the lower, as well as the higher, intelligence groups have attempted it. It has proved extremely popular. Another craft now gaining impetus is puppetry, and it is hoped eventually to start a puppet theatre. The large floor-loom is now in use, and some excellent work has been done on it. Blanket slippers are being made for some of the wards, and some half-dozen patients are assisting in this project. Particular emphasis is laid on the development of qualities important to eventual rehabilitation; for example, concentration, perseverance, initiative, a sense of responsibility, co-operation with others, and so forth. A party for the women and girls attending the Occupational Therapy and Mending Departments was held on February 18th. This consisted of an excellent tea provided by the catering department, followed by dancing, games, and competitions. Table decorations for the staff dining-room at Christmas time were again made in the Occupational Therapy Department. During the year a new portable two-way loom, which can be worked with one hand only, has been acquired, in addition to a number of basketry and other small tools. Several light bed-looms and an upright rug-loom for remedial work have been ordered from England. It is hoped in the near future to obtain ten special chairs for use by spastic patients who attend school and occupational-therapy classes on the wards. The chairs at present in use are unsatisfactory, as they do not give sufficient support to enable the patient to relax properly whilst working. A start has been made in co-operating with the Physiotherapy Department. One patient has been attending regularly for remedial occupational therapy, following up treatment received from the physiotherapist. Much valuable work might be done in the remedial field, however, if the two departments were in closer contact. Perhaps consideration could be given to the possibility of establishing an Occupational Therapy Department on the ground floor, closely linked with the Physiotherapy Department. Wheelchair patients could then be given treatment in the Occupational Therapy Department, where specific use could be made of available equipment. The present Occupational Therapy Department can accommodate a maximum of twenty-five patients. There is great need for a storeroom where tools and materials may be kept, as there is insufficient cupboard space in the Department. Many valuable materials are kept in cardboard boxes under tables and on tops of cupboards, and there is no provision made for the proper storing of tools so that they may be easily checked at any time. Much help and co-operation have been given by other departments during the past months. It is felt, however, that the Occupational Therapy Department could co-ordinate much better with other departments if the therapist could, from time to time, attend meeings with the medical and other professional staff, in regard not only to questions of rehabilitation, but also to matters connected with treatment of patients. Respectfully submitted. Frances M. Robertson, Occupational Therapist. Boys' Division C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—I hereby submit my report covering the Industrial Arts Department for the fiscal year April lst, 1954, to March 31st, 1955. M 148 MENTAL HEALTH SERVICES REPORT, 1954-55 The tools and equipment have been kept in excellent condition. Losses and breakages have been nil. No repairs were required. Supplies have been carefully maintained, and effective use made of all material. The boys' work is still improving. Projects completed were very good. Some larger jobs were accomplished, which reflected a good deal of credit on the boys. A sale was conducted prior to Christmas, and the proceeds sent to the Business Office. Individual instruction and supervision are still the keystones of our work. Mutual respect and consideration were very evident. Keen interest in the shop has been shown by our many visitors. Co-operation and consideration from doctors, nurses, and other departments left nothing to be desired. A new shop is slowly approaching completion. The floor-space is much greater, and facilities will be a tremendous improvement over the present shop. Cabinets, counters, tool-holders, etc., are being made in the present shop by the pupils for their use in the new set-up. Attention to the physical and mental welfare of the pupils still takes precedence. The year has shown steady improvement in results with satisfaction to all concerned. In conclusion I wish to express my appreciation of your continued help and thoughtfulness. Respectfully submitted. Harold Mercer, Industrial Arts Instructor. DEPARTMENT OF RECREATIONAL THERAPY C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—I respectfully submit my annual report from April lst, 1954, to March 31st, 1955. This Department has continually requested an additional instructor. Three years ago the need was recognized, and a position was created in our Department. Repeated requests to have the position filled were not granted. The classes have reached their maximum number for the size of our hall, and the classes are too large for one instructor. Our largest class has an average attendance of fifty-six. Assistance was given in January of this year when an instructor was on loan for three months on a part-time basis. The help was appreciated, and results were noticed in greater participation of the classes. Our annual displays have continually shown the high calibre of work that our pupils are capable of achieving. Not only have they gained in co-ordination and physical development, but their socialization has been a contributing factor in the rehabilitation programme. It invariably follows that our outstanding pupils in recreation have been our rehabilitees. Since our old playground was used for new buildings, we have been restricted to small playing areas that are very inadequate. The wards and cottages make use of any small area that is available, and because of this condition there are wards that can send only a limited number outdoors. We have reached a point in our building programme where an area is now available for a playing area and playground. The proposed area could be bulldozed and levelled out, and would relieve the present situation. Our future planning will include two or three small playgrounds beside the cottages to take care of the needs of the smaller children. With the use of portable play equipment, this plan is now operating on a limited scale. THE WOODLANDS SCHOOL M 149 Entertainment through television is filling a great need for leisure time on the wards. Sets are being installed, and it is found that supervision has become less of a problem. Through the medium of television a new field of entertainment and education has been created for our boys and girls. Last year our annual display was a marked success, with many visitors commenting on the high calibre of performance and the improvement of the boys and girls. Last summer a group of ninety-six boys and girls went to Second Beach in Vancouver for their annual day's outing. A second group of our " workers " spent a day at White Rock, and they thoroughly enjoyed themselves. For some it was the first time that they had been outside of The Woodlands School in years. Our New Year's party was another highlight of the year, with 200 attending. We had balloons, novelty hats, noise-makers, and streamers, and finished the evening's entertainment with the singing of "Auld Lang Syne." Respectfully submitted. J. A. Lynes, Chief Instructor. DEPARTMENT OF DENTISTRY C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—The Woodlands School had the services of a dentist on a full-time basis during the fiscal year 1954-55, except for the months of October and November. The operations completed by Dr. MacCrostie during the period from April to September were as follows:— Patients attended 1,114 Examinations 552 Prophylaxis and scaling 146 Fillings 801 Dentures 19 Denture repairs 20 Extractions 290 Miscellaneous treatments 150 I commenced my duties at this institution on December lst, 1954. During the month of December a superficial examination of the majority of ambulatory patients was undertaken. A thorough examination was not possible because of the lack of X-ray facilities. However, by seeing approximately 900 patients a comprehensive understanding of the patients' oral problems was determined. Rampant caries as seen in normal children was not evident. The greatest problem in this institution dentally is periodontal. The cause of this condition, I believe, is mainly lack of adequate oral hygiene. There are other modifying factors, such as a soft-food diet, mouth breathing, unusual chewing habits, possible endocrine imbalance. I would recommend that the routine now established on the wards be changed to include adequate oral-hygiene methods. The facilities of the local dental office were increased to enable us to do some laboratory procedures. This permits the Dental Department to accelerate the services rendered to the patients. The equipment installed included a large cabinet for storage of supplies with counter area and a reconditioned laboratory lathe. Respectfully submitted. _,T^ „ o .»._-»„ F J S. J. Gallagher, B.Sc, D.D.S., Dentist. M 150 MENTAL HEALTH SERVICES REPORT, 1954-55 DEPARTMENT OF DIETETICS C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—The following is a report of the Department of Dietetics covering the year April lst, 1954, to March 31st, 1955. Mrs. M. Allen resigned her position as dietician in July, 1954, and the cafeteria and food service were capably managed by Chief Dietician Miss C. Neighbor and Charge Cook A. Bowes. I joined the Dietary Department in late September, 1954. During the year two catering services of importance were rendered to the staff of The Woodlands School and to staff guests from the Provincial Mental Hospital, Essondale. The first was a tea held November 30th for Dr. Herrick, whom we were unfortunate to lose from our staff after a number of years. The second was a tea held February 17th for Dr. L. E. Sauriol on the occasion of his retirement as Medical Superintendent here. There were also a few notable changes which cannot be overlooked. These were the gradual change-over to delightful coloured crockery and the installation of a stainless- steel steam ventilation-hood over the serving area—both in the staff cafeteria. At the end of the fiscal year the kitchen staff were happily looking forward to the forty-hour week which they had obtained, effective April lst, 1955. An effort has been made to improve food service from the ward kitchens, and to improve variations in the food items, especially the meat dishes and fresh vegetables. The results, thus far, have been satisfactory, but we feel that it is a matter which can be further improved. Construction for the new unit is well under way, and we are looking forward to seeing it completed with its fully equipped kitchen and dietary office. Respectfully submitted. (Miss) Jean Ing, B.Sc.(H.Ec), Dietician. LABORATORY REPORT C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—The Woodlands School laboratory report for the fiscal year ended March 31st, 1955, is submitted herewith. One change in computing laboratory statistics has been made this year; namely, combining white-blood counts and differential counts, and combining red-blood counts and haemoglobins as two major groups of test recordings rather than four separate entities, as listed in the report of the previous year. Autopsies performed at The Woodlands School are included with the Provincial Mental Hospital statistics, but it is of interest to note that two of the autopsies performed consecutively on patients from a single ward showed gross and microscopic changes pathognomonic of anterior poliomyelitis. Neither clinically nor on other autopsy findings was there any evidence of expansion of this disease either within this specific ward or The Woodlands School as a whole. J THE WOODLANDS SCHOOL M 151 The laboratory work accomplished has been listed below. Hematology— White-blood count and differential 468 Red-blood count and haemoglobin 336 Haemoglobin 149 Sedimentation rate 200 Bleeding time 4 Clotting time 4 Reticulocyte count 8 Eosinophile count 10 R.B.C. fragility 2 Platelet count 1 Prothrombin activity 1 Chemistry— Blood sugar 110 Icterus index 189 Thymol turbidity 40 Van den Bergh 53 Cholesterol 2 Glucose tolerance 1 Serum bilirubin 1 Calcium 1 Phosphorus 1 Alkaline phosphatase 1 Serology—Paul Bunnell 17 Cerebrospinal fluid— Cell count 3 Globulin 3 Sugar 1 Bacteriology— Cultures— Miscellaneous 94 Tuberculosis 17 Diphtheria 2 Fungi 5 Faeces for typhoid and dysentery 930 Blood 1 Urine 18 Smears— Miscellaneous 237 Tuberculosis 30 Monilia 2 Vincent's angina 1 Gonorrhoea 2 Skin scrapings for scabies 1 Vaginal swabs for trichomonas 14 Antibiotic sensitivity 72 Cough plates for H. pertusis 3 Milk count 1 Faeces— Parasites 14 Occult blood 16 Bile 2 Fat 1 M 152 MENTAL HEALTH SERVICES REPORT, 1954-55 Urinalysis— Routine general 631 Bile 374 Urobilinogen 2 Quantitative sugar 5 Acetone 11 Quantitative albumin 3 Concentration-dilution test 2 P.S.P. renal function test 1 Urea clearance 1 Phenylpyruvic acid 75 Sulkowitch test for calcium 1 Total 4,175 Respectfully submitted. H. E. Wilson, M.D., Pathologist. DEPARTMENT OF RADIOLOGY C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—I respectfully submit the annual report of this Department for the fiscal year ended March 31st, 1955. The following work was accomplished:— Extremities . 180 Shoulders .. 7 Teeth 26 Pelvic 10 Nasal sinuses 5 Abdomen 15 Skulls 40 Spines . .... . 42 Noses . . ' 10 Hips 10 Ribs 5 Gall-bladders .. . 3 Total 4,275 Respectfully submitted. J. M. Jackson, M.D., Director of Radiology THE WOODLANDS SCHOOL M 153 BEAUTY-PARLOUR REPORT C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—I respectfully submit my report for the fiscal year April lst, 1954, to March 31st, 1955. Permanents 181 Finger-waves 1,238 Shampoos 1,419 Hair-cuts 2,545 Shaves 180 Selsun treatments 3 Respectfully submitted. (Mrs.) Jacqueline DeCoene, Hairdresser. DEPARTMENT OF NURSING SERVICE Women's Division C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—I respectfully submit the report of the Department of Nursing Service for the fiscal year April lst, 1954, to March 31st, 1955. The year ended with the following personnel: Registered nurses, 3; psychiatric nurses, 79; student psychiatric nurses, 15; psychiatric aides, 117; and home supervisors, 12. New appointments for the year were 135. Resignations numbered 122, with the following reasons: 111 health, household duties, general training, to be married, and unsuited for the work. There have been some changes within the senior staff of our departments. Mrs. K. MacKinnon, Assistant Superintendent of Nurses, resigned in June, 1954, to take up residence in the United States. Miss D. Curie, R.N., who held the position of head nurse in Pine Cottage, was appointed Assistant Superintendent of Nurses in July, 1954. Mrs. M. Sanford, R.N., transferred from the staff of the Provincial Mental Hospital, Essondale, in October, 1954, when appointed head nurse in Pine Cottage. Mrs. M. Mowat, R.N., head nurse in Cedar Cottage, resigned in January, 1955, to resume household duties. This position is now vacant. All members of our graduate staff have profited by the in-service educational programme carried out at the Provincial Mental Hospital, Essondale, for the last eight months of the year. Mrs. Sinclair, R.N., from the teaching staff of the Provincial Mental Hospital, has given us valuable assistance in helping to stimulate interest in the newer methods of treatment and care of psychiatric patients on her weekly visits to The Woodlands School. Our recreational activities have been carried out with great enthusiasm, as in former years. I would like to thank the various departments for their help and co-operation. Respectfully submitted. (Miss) V. M. Sanders, R.N., Superintendent of Nurses. m 154 mental health services report, 1954-55 Men's Division C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—I respectfully submit this annual report of the Department of Male Nursing for the fiscal year April lst, 1954, to March 31st, 1955. The male nursing staff shows a slight increase, as at this time we have 89 graduate psychiatric male nurses, 110 psychiatric male aides, 1 instructor of nursing, and 5 psychiatric nurses-in-training, a total of 205. Our population is gradually increasing, with a greater number of juveniles, spastics, and pupils of low mentality, who all require more nursing and daily care. This, with the increase in utility work, clinical reports, etc., has caused this slight increase in our staff requirements. This year we have become better acquainted with the pupils we received to populate our new cottages. Many have been reallotted in their housing, and all have been placed on fuller activities. The wards in these cottages are now operating on a well-established basis, and have been able to adjust to the installation of additional beds. Social activities, which are also educational with our type of pupils, have been maintained at a high functional level. This included picnics, dances, seasonal parties, concerts, picture shows, and numerous outings. The behaviour of our boys has been very good this past year; this, I think, we can attribute to the increased privileges and activities we have been able to establish. We now have over one-third of the boys on ground privileges. A number of the more-advanced boys are allowed to leave the grounds in small self-conducted groups and, when nearing rehabilitation, are granted individual privileges. The television sets we obtained for three of our wards have proven a great medium of entertainment and education; we hope it will not be too long before we have a set on every ward. Regular attendance at the weekly clinics and staff meetings has been enjoyed by our senior staff, and on several occasions groups have been taken to the Provincial Mental Hospital, Essondale, to attend in-service lectures. Considerable thought and discussion have been given the rehabilitation programme, and I feel we have made very good progress in this field. No doubt we will accomplish much more as we continue our studies and correct our faults. In closing, I wish to express my appreciation for all help and counsel received from you and other departments who have so ably assisted with our many problems. Respectfully submitted. J. N. Elliot, Chief Psychiatric Male Nurse. DEPARTMENT OF NURSING EDUCATION C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—The report of the Department of Nursing Education for the fiscal year ended March 31st, 1955, is herewith submitted. The psychiatric nurses-in-training of The Woodlands School joined the students at the Provincial Mental Hospital, Essondale, for lectures and demonstrations. One male student and ten female students graduated from the School of Psychiatric Nursing at ceremonies held at the New Westminster Junior High School on May 13th, 1955. This THE WOODLANDS SCHOOL M 155 was the last group of psychiatric nurses-in-training to graduate from the School. In future all students will be directly enrolled in the School of Psychiatric Nursing of the Provincial Mental Health Services, as established by Order in Council No. 2001/51. Respectfully submitted. (Miss) Edith M. Pullan, R.N., Director of Nursing. DEPARTMENT OF PHYSIOTHERAPY C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—During the past year the Physiotherapy Department completed 1,754 treatments. This represented a total of 854 males, 821 females, and 79 staff. The basic case load of spastic or permanently crippled children has been augmented by post-surgical orthopaedic corrections and classes in posture and foot deformities. We are now in receipt of all equipment ordered, with the exception of medium-size walkers. The new equipment is in almost daily use, either in the Department or on the wards. A vacancy for additional staff, preferably male, to handle the heavier patients now exists, and it is hoped that it may be filled in the near future. Respectfully submitted. (Mrs.) Janet M. Granberg, Physiotherapist. DEPARTMENT OF PSYCHOLOGY C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—Following is a report of work performed for the fiscal year ended March 31st, 1955, at The Woodlands School. There was no psychologist from April lst, 1954, until July 16th, 1954, when Thelma T. Coulter, Ph.D., joined the staff as clinical psychologist. The Department has been reorganized, with three main functions in mind: (1) Routine testing with regard to intelligence or developmental age of new patients two months after admission; (2) personality assessment of patients with behaviour disorders and recommendations concerning them; and (3) assessment of patients being considered for rehabilitation, this assessment to include intelligence, basic organization of personality structure, personal and social adjustment, interests, and aptitudes. Referrals for psychological testing are received from the medical staff, the social service, the nursing staff, and the school. Because intellectual level is only one aspect of the total personality, more emphasis is being placed on the personal and social adjustment of the patient so that deviations in personality can be adjusted before the patient is rehabilitated. For this reason, greater use is being made of a battery of projective techniques. Therapeutic interviews have been commenced with a selected number of patients who have the capacity to gain insight into their maladaptive unconscious motivations. It is hoped that eventually a full-time psychological intern will be added to the staff to M 156 MENTAL HEALTH SERVICES REPORT, 1954-55 do routine testing so that more patients can receive the benefit of this therapeutic relationship both individually and as a group. During the year 110 patients were examined and a total of 316 tests administered. Reports on these interviews were written for the clinical file of each patient. In addition, talks were given to each of twenty groups of students and outside organizations. Daily conferences were attended on 164 occasions. Weekly clinics were attended on twenty-four occasions, and full personality evaluations of the pupils under review were presented. Abstracts of twenty-eight psychological examinations performed at various Child Guidance Clinics were made. Following is a tabulation of tests used in psychological evaluations of patients in The Woodlands School:— Arthur Point Scale 2 Bender Gestalt 7 Cattell Infant Intelligence Scale 6 California Test of Personality 7 Children's Apperception Test 11 Crawford Small Parts Dexterity 4 Draw-a-Person 56 Ingraham-Clark Reading Test 1 Kuder Preference 3 Mental Health Analysis 11 Minnesota Clerical 1 Minnesota Personality Inventory 2 Modified Alpha 1 Otis Arithmetic 2 Porteus Mazes 41 Progressive Matrices 8 Rorschach Method of Personality Diagnosis 32 Stanford-Binet, Form L 18 Stanford-Binet, Form M 8 Thematic Apperception 17 Wechsler-Bellevue Intelligence Scale I 14 Wechsler-Bellevue Intelligence Scale II 35 Wechsler-Intelligence Scale for Children 29 Total 316 It is hoped that in the near future some experimental research can be carried out by the Psychology Department on the variability of mental defectives in the moron group in learning ability, taking into account the differences in etiology. Respectfully submitted. Thelma t CoulteR) ph D Clinical Psychologist. DEPARTMENT OF SOCIAL SERVICE C. E. Benwell, Esq., M.B., Medical Superintendent, The Woodlands School, New Westminster, B.C. Sir,—The year 1954-55 has been a year of consolidation and expansion of the work of the Social Service Department. In numbers of cases carried there has been continuous expansion. This is also evident in rehabilitation and in community education services. THE WOODLANDS SCHOOL M 157 Staff Changes The present establishment for social workers at The Woodlands School stands at three and one casework supervisor. During the year there were two resignations from the social-work staff, with the result that during most of the year the service was carried by two social workers and the casework supervisor. At one time the service was carried for three months by one social worker and the casework supervisor. A replacement was secured for one resignation; the other vacancy has yet to be filled. Department Structure The Department operates in two sections; the first focuses on admission, reception, and training casework services, and the second on pre-rehabilitation and rehabilitation casework services. When the establishment of our workers is maintained, two social workers give service in the first section and two in the second. In the first two years of operation the social workers were involved much more extensively in casework services before and during admission and during the reception of the pupil into the training- school. Another area of intensive services during this time was casework services to the pupil while resident in the training-school. Rehabilitation during this time was in its beginning phase. The pupils' rehabilitative potential had yet to be assessed, and the staff reoriented from custodial-care service to a service of vocational training and rehabilitation of those pupils able at some time to be relatively self-directing and self- supporting. During the first two years of the Social Service Department's operation, the social worker on rehabilitation had to initiate the rehabilitation assessment. Much time was spent in finding, interviewing, and assessing pupils for rehabilitation. Recently the training-school has set up a rehabilitation clinic and conference, whereby all the departments having knowledge of the pupils come together to study and assess the pupils' rehabilitation potential. The social worker's contribution to this clinic is the social study of the pupil, his family, and his situation before admission and while in residence at the School; besides this he gives likely leads as to job resources in the near-by community. The work emphasis in the Social Service Department is beginning to centre on rehabilitation, and no doubt this will increase as the years go by. Case-load Details Table 1 indicates a total pupil intake of 897 during the year, a 65.55-per-cent increase; of this total intake, 346 cases were concerned with pre-admission services. These involve the worker in giving information to inquiring parents and relatives, as well as orienting them to the school programme and buildings. Some sixty-five cases were concerned with services to the parent and the pupil at the point of the latter's reception into the School. Some 486 cases were concerned with casework services to pupils in residence, as well as pre-rehabilitation and rehabilitation services. In the latter area, 123 pupils were interviewed or assessed for rehabilitation. Table 2 shows increases in face-to-face helping interviews with pupils and parents during the time of the pupils' training and at the point of planning rehabilitation. A total of 3,302 interviews were directed to helping pupils and parents. Some 3,638 conferences and consultations were held by Social Service with other disciplines furthering integrative therapy, as well as multi-disciplined planning for the pupil in residence and the pupil about to be rehabilitated to either family convalescent or working convalescent care. Some 126 conferences and consultations were with employers prior to placement, and 210 consultations were with employers following work placement. Group Work Project The problem of constructively occupying the patients in their leisure time on the wards has long faced the nurses in carrying out their daily routine at The Woodlands M 158 MENTAL HEALTH SERVICES REPORT, 1954-55 School. With the increased emphasis on socializing the patients and preparing them for possible rehabilitation, it has become recognized that recreation on the wards can play an important part in developing the intellectual capacity, the emotional maturity, and the social habits of the patients. However, until recently, the staff time has not permitted a ward leisure-time programme to be developed on an organized basis. In February of this year an inroad was made toward meeting this problem when a pilot group work project was launched on one of the wards on the women's side. A group of nine youngsters, ranging in age from 9 to 16 years, were selected to participate in a leisure-time programme once a week under the direction of a trained group worker. These girls have a relatively high intellectual potential and were chosen with a view to forming a reasonably cohesive group. The programme drawn up included such activities as handicrafts, games, singing, dancing, stories, and listening to records, with the object of (a) providing a social experience for the children through which they could learn to work and play co-operatively, (b) developing the skills of the children and stimulating and broadening their interest, and (c) experimenting with a kind of programme media which can successfully be used on the wards with this kind of patient. In order to organize this programme and to co-ordinate it with the School routine, it was necessary to obtain the interest and assistance of the staff of almost all the departments of The Woodlands School. In January a staff group representing the Medical, Psychological, Nursing, Education, and Social Service Departments met to discuss the project and to assist in its planning. Through this interdepartmental co-operation the project became integrated with the total programme of the institution, and we are grateful to these and other departments, particularly the Occupational Therapy Department, whose continued support has enabled the development of the project. It is still very early to evaluate this programme, but the results to date have been most encouraging. The children in the group have responded with great enthusiasm to the activities—to the extent in one case where a child who had formerly been reluctant to come back to the school from home visits cut her Easter holidays short in order not to miss the weekly play session. It became apparent very soon that these children, who are on a ward with some fifty other patients, ranging from youngsters to those well on in middle age, needed to participate in their own personal group, through which they could exercise their own initiative. Although the social development of the children is limited in keeping with their retardation, it was interesting to note that the children quickly developed a feeling of belonging and the feeling of responsibility toward their group. When one member of the group was absent, it became the pattern of the group for one of the other members to make a craft article for them so the absentee would not miss out. The group was able to exercise some control in keeping out those who are not in the group, and, when the occasion arose, they were able to suggest who they wanted for a new member. Recently they have been able to work out a system of cleaning up, through which the responsibility will be shared equally by all members of the group. After several weeks of the leader determining the activities for the children, they gradually began to make their own suggestions about the programme, not only for games, but in regard to craft programme. Now each week the group members sit down together to plan their craft programme for the coming week. In making the articles, the children are encouraged to express their own ideas and to use their resourcefulness within the limits of their ability. In an institution where the children must constantly conform to routine and uniformity, the opportunity for them to express their individu- lity through the activities and through the opportunity for self-determination as a group takes on a particularly important meaning. It has been established that mental deficiency is often accompanied by emotional disturbances on the part of the defective because of inability of the family and community to meet the problem of the backward child. It is interesting to note that in this group of nine children, seven were rejected by their family and one of the remaining THE WOODLANDS SCHOOL M 159 girls had one parent who was treated for a psychosis. The results of these home environments were seen in the lack of emotional stability and socialization of many of these children. The group experience has contributed toward enriching the emotional life of these children, not only through their creative expression in the activities, but through their friendly relationship with the leader. This is strikingly demonstrated by the growth of one child, age 11, who first sought her attention in the group by annoying the others and by being loud and boisterous. This was an unattractive child who had been rejected at home and who undoubtedly felt she was not worthy of genuine affection. She gradually found her feeling of achievement and of self-worth in the group. She began to find she could get recognition from the leader and from the other girls through her constructive participation in the group activities. She gained such attention by saying " please " and " thank you " that she began to use these words almost to excess. When the girls in the group gave her a surprise birthday party, this child became assured of her acceptance by the group and the fact that she could be liked for herself. Although the child occasionally reverts to her former antics, her general behaviour has steadily improved, and her experience in the group has substantially contributed toward her personality growth. Through the co-operation of the nursing staff and their interest in seeing more recreation on the wards, a nurse's aide was assigned to assist with the programme with a view to carrying on similar activities on the ward at other times in the week. Through this method there has been an increased programme of play and leisure-time activities on the ward for the patients who can benefit from these activities. In carrying out this programme, it was necessary to face many problems which will have to be met if a group work programme is to become enlarged at The Woodlands School. At the present time there is no allocation of money for equipment and supplies to carry on this programme. An adequate budget will be necessary if more leisure-time activities are to be developed on the wards. The dayrooms and playrooms will have to be improved by the provision of more cupboard space and facilities for recreation. The lack of segregation on the ward creates another difficulty in that it is difficult to organize activities or even to provide equipment which will be appropriate for patients with such varying levels of mental and physical ability. Even with this specially selected group of patients, it has been difficult to conduct a programme to meet the diverse range of capacities of the group members. It would be helpful to the staff and to the patients for the patients to be grouped so that they could work and play more harmoniously together. Lastly, it will be necessary to increase the social-work staff if this programme is to be expanded. At present, with the heavy load of casework, the staff is not able to carry on more than the one experimental group work programme. General Activities of the Social Service Department (a) Social-work Education.—The Social Service Department participated in the educational programme for the in-service trained social worker co-operating with the Division of Training of the Social Welfare Branch. Four sessions were conducted, during which the functions and services of social workers in the training-school setting were outlined, together with case presentations which were illustrative of services at every level of the pupils' training, education, and socialization. (b) Education to Allied Professions.—Four groups of affiliate and postgraduate nurses were oriented to the contribution of social service in this specific setting, as were groups of teachers in training and psychologists in training. (c) Public Interpretation.—Nine community organizations, among whom were the Parent-Teacher Associations, the public health nurses, the registered nurses' association, women's service clubs, church groups, and various membership groups of the British Columbia Association for the Advancement of the Mentally Retarded, have been M 160 MENTAL HEALTH SERVICES REPORT, 1954-55 introduced through clinical team presentations or individual talks to the institutional programme for the care, education, training, socialization, and vocational rehabilitation of the mentally retarded child and adult. There is a vast and ever-increasing interest on the part of community in this service. A willingness to co-operate in programme is increasingly evident on the part of many community groups. Some groups have expressed an interest in developing community co-operative and ancillary services to the institutional programme. (d) Community Co-operation.—Out of the activity of the School and the Social Service Department in public interpretation, with its emphasis on the need to share in the development of an over-all programme for the mentally retarded, the New Westminster Association for the Advancement of the Mentally Retarded has provided a club- room in the community for the use of pupils in residence having visiting privileges. The Vancouver Association has fostered a child in the School, providing a spending allowance. (e) Liaison between the School and the Auxiliary.—The Woodlands School now has a very active auxiliary, formed by parents residing in the New Westminster area, most of whom have children in residence at the School. They have offered their homes for hospitality to parents from out-of-town areas who are visiting children in The Woodlands School. Hospitality has been extended to pupils in working convalescent care on their days off work. Homes have been offered to the same group of pupils on a short- stay basis between jobs or before going out to a job. The value of this service in socialization is inestimable. The auxiliary is considering ways of helping in the provision of certain equipment for the use of the pupils in the School. The supervisor of the Social Service Department has officiated most ably as liaison person between the auxiliary and the School staff committee. She has had the responsibility of interpreting the institutional programme and ways through which the Auxiliary might co-operate in its development. Staff Development An opportunity was afforded a staff member to study the administration organization of training programmes in schools in Eastern Canada and United States, and the services and functions of social work in the training-school. Many valuable ideas were obtained both from the Ontario programme and that of the Southbury training-school in the United States. Staff committees have been busy throughout the year in a study of social-work activity at the different job levels, as well as studying the statistical system, recording, and group work method. The Social Service Department hereby acknowledges with grateful thanks the assistance received from administration and all departments of the School. The movement to an integrated programme has been outstanding and augurs well for future developments. THE WOODLANDS SCHOOL M 161 Summary Table 1.—Summary of Cases Given Services by the Social Service Department, The Woodlands School, April lst, 1954, to March 31st, 1955 1954-55 1953-54 Cases brought forward from previous fiscal year 97 98 New cases 800 512 Cases reopened during the fiscal year 65 56 Cases reopened from previous fiscal year 32 20 Total intake into the case load 897 588 Total number of cases given service 994 686 Cases closed or referred 864 589 Cases carried over 130 97 Table 2.—Summary of Social-work Activity in the Social Service Department, The Woodlands School, April 1st, 1954, to March 31st, 1955 Interviews with or Regarding Pupils and Patients Consultations Regarding Pupils and Patients With Pupils With Relatives Total With Other Disciplines With Other Agencies With Employers Total 1954-55 Pre-admission Reception Education and training.. 11 20 512 935 164 35 264 1.361 175 55 776 2,296 198 84 1,113 1,413 130 9 288 277 366 328 93 1,401 2,026 Totals | 3,302 . | 3,848 1953-54 Pre-admission 34 48 568 684 468 262 540 135 502 310 1,180 890 162 300 1,260 885 128 36 66 103 290 336 Education and training.... 1,272 1,183 2,811 [ 3,081 1 Respectfully submitted. (Miss) Alice K. Carroll, B.A., M.S.W., Provincial Supervisor, Psychiatric Social Work. M 162 MENTAL HEALTH SERVICES REPORT, 1954-55 STATISTICAL TABLES Table 1.—Movement of Population, The Woodlands School, April 1st, 1954, to March 31st, 1955 Male Female Total 692 9 497 8 1,189 On probation, carried forward from 1953-54 17 701 37 505 20 1,206 57 738 525 1,263 Separations— 11 16 5 4 6 13 15 Died 22 18 32 23 55 14 5 19 706 502 1,208 Table 2.—Showing in Summary Form the Operation of The Woodlands School since April 1st, 1954 __ Discharges a a a. i o o ;fl a o TJ X a to 0 to r"1 2j= tft to it « Ih O to to flj •fl to O fl, 1 •o to > o u I c D to to -i_> Qj5 c HCID *H C c O 3 C toZ rt S-fl hi £-2§ 1954-55 57 4 11 22 1,208 19 1,263 0.07 26.32 1.74 Table 3.—First Admissions to The Woodlands School by Health Unit and School District of Residence and Sex, April 1st, 1954, to March 31st, 1955 Health Unit Male Female Total Health Unit Male Female Total East Kootenay, Cranbrook— School District No. 1 „ 18 West Kootenay, Trail— School District No. 9 „ 11 South Okanagan, Kelowna— 1 2 1 1 1 1 1 11 2 5 1 1 1 1 1 2 1 7 1 1 1 2 1 1 1 1 1 1 1 1 3 1 1 18 2 6 1 Upper Island, Courtenay— School District No. 47 „ 71 Skeena, Prince Rupert— School District No. 52 Peace River, Dawson Creek— School District No. 60 Victoria-Esquimalt Union Board of Health- School District No. 61 (part1)-. Saanich and South Vancouver Island— School District No. 61 (part2)... Central Vancouver Island— School District No. 62 „ 65 1 2 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 North Okanagan, Vernon— School District No. 19 1 „ 20 „ 22 Upper Fraser Valley, Chilliwack— School District No. 33 Boundary, Cloverdale— School District No. 35 1 1 1 „ 36 „ „ „ 68 „ „ „ 37 „ 70 Metropolitan Health Committee, Vancouver— School District No. 38 School districts not covered by health units— School District No. 48 „ 39. „ 61 (part3).... „ 41 „ 44 North Fraser Valley, Mission— 37 20 57 School District No. 75 . 1 Includes Victoria and Esquimalt only. 2 Excludes Victoria, Esquimalt, and Oak Bay. 3 Includes Oak Bay only. THE WOODLANDS SCHOOL M 163 Table 4.—First Admissions to The Woodlands School by Mental Diagnosis, Age-group, and Sex, April 1st, 1954, to March 31st, 1955 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. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Mental deficiency— Idiocy Imbecility 2 2 1 1 4 4 3 2 1 1 1 2 1 1 1 1 '!-— ......j i 4 ll -i 2 1 2 2 1 1 2 1 1 1 1 2 1 1 1 5 7 12 3 6 5 8 1 3 10 15 12 1 4 Mongolism 1 1 9 Mental deficiency with epilepsy. Other and unspecified types ii_i::::: 4 2 1 6 1 Totals 2| 4| 111 4| 4| 2 61 1 2| 1| 5[ 1 4| 2 1| 4 2 1| 371 20| 57 The fifty-seven cases shown as first admissions to Woodlands were all by certification under the " Mental Defectives Act," and the marital status of these fifty-seven admissions was single. Table 5.—First Admissions to The Woodlands School by Years of Schooling, Mental Diagnosis, and Sex, April 1st, 1954, to March 31st, 1955 Table 6.—First Admissions to The Woodlands School by Citizenship, Age-group, and Sex, April 1st, 1954, to March 31st, 1955 Table 7.—First Admissions to The Woodlands School by Religion and Sex, April 1st, 1954, to March 31st, 1955 Table 8.—First Admissions to The Woodlands School by Previous Occupation and Sex, April 1st, 1954, to March 31st, 1955 Detailed information for the above tables may be obtained upon request. Table 9.—Live Discharges from The Woodlands School by Mental Diagnosis, Condition on Discharge, and Sex, April 1st, 1954, to March 31st, 1955 Condition on Discharge Total Mental Diagnosis Improved Unimproved Grand Total M. F. M. F. M. F. Mental deficiency— 2 1 1 2 3 1 2 - 1 1 1 2 3 2 1 1 2 1 2 1 2 1 Moron _ 5 2 Mongolism 2 1 2 Totals _ 3 1 8 3 11 4 15 Of the four improved patients, two males and one female were discharged to home, and the other male patient was placed elsewhere in the community. All eleven unimproved patients were returned to their homes. r M 164 MENTAL HEALTH SERVICES REPORT, 1954-55 0. O « O i w o < tn "in O Z o < hJ < H Z W >H m hJ o 2 ^ SC to tn a h z « < "H Q O 0 W I H 2* is 2 « £ d O s tn Ph Q c/5 ° 9 z z < < S o os tH CO w o Pn- < X o tn > pa hJ « So OH (N - ,» cs cs - CJ w-. - c cn cs VO Total ft rH (S ! rH ! j -t ! tn ft ', CA VO S CS OtSH f-N - ft C- CA CA rf VD rt to a 3 O 00 to Ml < 3° tn' -—^~ a ^ CN Ov m m li, "Mill - 1 i i i i ss Mill i On 2 rS ft "Ml! *■« § [Mill N Os *7 in ft' " I I i i - i iii: s 1 *"" 1 iw | CS 1 O ft i *" 1 | 1 -1 s II!:" - j -««* m cn ft I I I I I 1 I Ml s 1^ 1 1 1 1 - ■ ^ . ^ ; m v£> >4- ft II" II - I i^ i i ^ s CS "III cn ! ^ i jH cN cp ft MM!!! 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M ft i~ !""* 1 1 cl j MM s | | j-1 - 1 " i I i - !•_ D c fclj rt 5 "rt fl o C_ cu bo k a Cj co (5 =u "l >. to C CO 'u cfl -d > -H O rt c C TJ « v— 2 > a j C c V- C s to c c aj B "a .| c 1 pa 1 C Ci C i -a OJ i- 3 a u z to X CC a X s c s >, a *o *rt fl Q> ft rt O H to O > C a rt cu Ph « 1 tr ■to X %- c a X « - C c N c t 1 i to 'o Cfl CU •a > — u a c fl X to >— S > X 1 E "c 6 C c 5 ft QJ 'ft U O c o o CC •a 3 c h M 166 MENTAL HEALTH SERVICES REPORT, 1954-55 X - tft Q Z < o Pi o I w o < X H < n to ir. pj Os in D < H u c/i >H rn pq o U 0 ■f X o s t/5 0 i/j H 0 z Tf < in H-l r> CJ o o F- S d H rt §<: rt z 2 D O O O cn H H < W Q w H-l « ■a — C C3 Ifi OH - - en cs tn - CS - «H Tt cn cs N "rt O H ft' j : cs t-h | | | i rH NO S HHW (NHf)HHtnr( NO rt b a fl o Ih 00 to 00 < ft % | | | | |: i I CN ON m 1 o m ft s Os cs o cs ft s OS 7 tn ft s j j j [ 1 1 j j [ j 3 ft 1 1 1 1 1 ! 1 1 1" ^ 2 1 ! 1 (S | 1 ! ! j i-h cn as l c~ pp M I II 1 I if 1 § "" i i i" i i i i cn so 4 ft i i i i i i i i i" * s i" i i i i" i i i cs H. ft : 1 (N ft : ; 1 i r-t i ^ s u-s •a c D pp s 1 i 1 i 1" 1 I i i - u Q "o D 3 c- u i 1 a ij > c 5. *t a X _ 5 B to >. tr 3 E f> to tr C tr iz > 8^ o£ ™ r i tft <♦_ 3 = _£ v O K II £ - H=C a V a a 0 u I a. > c 4 C a s x T C c I « ( 1 < 0 ! 1 .5 1 0 B p7 w I 1 rt cu fl 0 c .2 c (U s 3 o £ " *.£ c t; .2 E ,81 £ . -3 s-i •- a tft o .___: c to 3 « u 'I C d s c THE WOODLANDS SCHOOL M 167 X a tr a 7 < < H tft ft O X H O 7 w hJ d < ft Q ft o w cn P < u >■ ca o o X u c/_ a z < ►J Q O O i IT) On rt z 5 Pi D o u O cn X H < ft Q w < ■a-H fl g HWmNmHNHHTf (f| cs 5 o CS OH 1 CS ft j I ! i-H (N NO _ ft rt 0 H £ i-h i-h rn cs *h rs rt i-h m i-h NO M l-H U rt > pj >% o c s m 1— rt n M ^ ^•O rt ft 11! Is fl as O3o s i I 1 _. 13 M Ph u S u H^«^ £ i ; cs ■* u . , rt "hj " ft' III ^ 3 8 u g « XJ s " Ith Mil rn rt in 13 IS ft 0 fl *- 3 ?. fl 00 C £ i 'rH j 1—1 -J tft rt fi ft 1 i 1 1 i ! <* fl =1 = i 2 ^ j -< , «-i * j l-H (A fl ft i i i i I** "fl 4§ £ £ 1 ! j '■ i ' ! ! 1 i i i . ,_, i i i i «5 fl ft II II rn *= l fl J. o S § CS M*=I p; £s s ....iii*"1. *H E to j u tft rt CU rt 1 >. fl M _- 3 E T HH 0 O 4 fl fl rt cu fl O fl rt — W i Oh "fl > CS C i-i Ih a 3 o a> « CM rt 5 c cS u =3 °o 6 il tS . »Ih , C +j re to 0 1) 5 CC 1 _ 2 I « « Z rt 35 o fl 0 * E °« rt -tt C C Cfl « fl rt u rt O H I < cc s E « CC c 1 C < < 1 to u X < to c C C 1 i c M 168 MENTAL HEALTH SERVICES REPORT, 1954-55 PART IV.—PROVINCIAL MENTAL HOME, COLQUITZ, VANCOUVER ISLAND REPORT OF THE MEDICAL SUPERINTENDENT A. M. Gee, Esq., M.D., CM., Director of Mental Health Services, Essondale, B.C. Sir,—I take pleasure in submitting herewith the annual report of the Provincial Mental Home, Colquitz, for the fiscal year April lst, 1954, to March 31st, 1955, with reports from the heads of the various departments. It is with regret that I report the loss on January 16th, 1955, of Mr. J. T. Gawthrop, our Deputy Business Manager, who was fatally injured in a motor-car collision when coming to work four days previously. In the short time he was with us he had proved himself a very capable and efficient organizer, and his absence will be felt in many ways. Severely injured in the same accident was Mrs. K. Stapleton, who was on her way out to start her first morning's work in this office. I am pleased to report she is making satisfactory recovery. Our patient population on April lst, 1954, was 283. This number fluctuated during the year, but on March 31st, 1955, the patient population was 287. During the year fourteen patients were transferred to this institution from the Provincial Mental Hospital, Essondale. Five patients were discharged in full, one being returned to the British Columbia Penitentiary, and one being transferred to the Nova Scotia Mental Hospital, Dartmouth, N.S. Three patients were discharged on probation, and are still on probation. There were five deaths among the patients during the year, the cause of death being circulatory in four and bronchopneumonia in the other case. Throughout the year the physical health of the patients has been remarkably good. We had a number of rather severe cases of influenza, but not of epidemic proportions. Otherwise there was no serious illness or accident to report. For the second year we were unable to have the mobile unit of the Division of Tuberculosis Control visit us, but as in previous years the Victoria Tuberculosis Clinic was most co-operative in checking the cases considered active when the mobile clinic visited us last. It is good to be able to report all of these cases are now classified as arrested, and the five patients reported last year as confined to bed because of pulmonary tuberculosis are now ambulatory and off specific medication. Dr. G. Hall and Dr. W. Dempsey continued to care for the physical and dental needs of the patients respectively. We continue to have about 60 per cent of our patients employed in some beneficial and useful occupation. During the year, in a number of wards, the old furniture was removed and replaced with new plastic-upholstered chairs and couches in varied bright colours. This has added much to the comfort and appearance of the wards and has been favourably commented on by patients, staff, and visitors. The recreational- and occupational-therapy facilities were used to the limit. We hope to extend our occupational-therapy facilities by utilizing the present stores space for occupational therapy after conversion of the old boiler-room into a storeroom. This large undertaking is well under way, much of the work being done by the patient help under the supervision of Mr. H. Helander and his assistants. The patients have not lacked recreation in various forms throughout the year. Weather permitting, they were in the recreation court both afternoons and evenings PROVINCIAL MENTAL HOME M 169 throughout the summer months and on many afternoons in the fall and winter. Different outdoor games were organized and played, softball proving the most popular. Indoors, television continues to be popular. The bi-weekly moving pictures continue to be shown, and in addition to our own entertainment programme we had fourteen concert parties sponsored by individuals, service clubs, etc., who visited and entertained the patients. A very much appreciated outing is the 21/i-hour tour of Greater Victoria on May 24th each year. We are able to take as many as thirty-one or thirty-two patients. The spiritual needs of the patients were taken care of by visiting clergy of various denominations, as in previous years. During the year ten members of the nursing staff left the service. Two of these, Mr. G. Moon and Mr. H. W. Armitage, had reached the age of retirement, and the others left for varied reasons. The ten vacancies resulting were all filled by psychiatric aides, making the psychiatric aides now 33 per cent of the total nursing staff. We have no training-school here at the present time, but during the year 160 hours were spent in giving postgraduate lectures to the psychiatric nurses and instruction to the psychiatric aides. On the whole the past year has been a satisfactory one, and we feel we have accomplished a number of things which have added to the comfort and well-being of the patients here. I wish to compliment the staff and personnel on their efficiency and co-operation during the year. In conclusion, I wish to express my appreciation to you for your understanding and support and to your staff members who visited during the year in a consulting capacity. Respectfully submitted. L. G. C. d'Easum, M.B., Medical Superintendent. DEPARTMENT OF OCCUPATIONAL THERAPY L. G. C d'Easum, Esq., M.B., Medical Superintendent, Provincial Mental Home, Colquitz, B.C. Sir,—The following is the report of the Occupational Therapy and Maintenance Department for the year ended March 31st, 1955. This has been another busy year for our Department. In the shop, art metal, leatherwork, rug-making, wood-carving, and woodwork have kept the patients occupied and happy. Some model aeroplanes were made in the shop, and the patient who made them will be given opportunities to fly them. We have had very encouraging results in wood-carving. Painting in oil and water colours has been encouraged on the wards, and patients there have been supplied with materials; an assortment of stretchers was made in the shop for pictures of various sizes. Quite a number and assortment of toys were made in the shop, and these toys were taken to a local radio station, before the Christmas season, to be distributed to needy families. The Occupational Therapy Shop is open to patients from 8 a.m. to 9 p.m. on week-days. We still keep it open on Saturdays, so the patients here have not been affected by the five-day week. A nice lot of tools and small machines were ordered and received during the year, these coming through the Federal grant. The new equipment will be used in the proposed Occupational Therapy Shop in the old storeroom. A considerable amount of maintenance and new building has been done by our Department during the year. Approximately 650 lineal feet of concrete steam-line duct M 170 MENTAL HEALTH SERVICES REPORT, 1954-55 was installed. This duct entailed a lot of work; it is underground, so there is excavating and back-filling to do, besides the formwork and pouring of concrete. A two-room addition was built to the greenhouse, also a three-room 30- by 50-foot storage room over the old coal-bunker, as well as a two-car garage on Roy Road farm. Approximately 400 feet of concrete curbing was poured at the back of the buildings. Our Department also installed about 500 feet of drain-tile, with proper catch-basins at the required places. Water that used to flow over the roads and into the buildings at the back of the main building is now diverted into the new drains. The old boiler-room has almost been completed for the new storeroom; a new and lower concrete floor was poured, a mezzanine floor constructed, and cupboards, counters, shelves, and platforms built to requirements. This new storeroom should prove a lot better than the old store, as it is compact, light, and contains the same floor area in one room as the previous one had divided into five rooms. The painters have painted new buildings as we have built them. They painted the new barn on Roy Road farm, plus the old barn, dairy, and silos. Considerable decoration of wards, dormitories, etc., was accomplished, also window-washing and general cleaning. The usual maintenance of furniture, bed repairs, building of furniture as needed, and repairs to buildings have been attended to during the year. Fire-fighting equipment is checked regularly, as are conditions throughout the institution and other buildings to ensure that there are no fire-hazards. My thanks to you for your counsel and help during the past year, also to the staff of this Department for their co-operation. Respectfully submitted. H. Helander, Instructor of Trades and Maintenance. DEPARTMENT OF RECREATIONAL THERAPY L. G. C d'Easum, Esq., M.B., Medical Superintendent, Provincial Mental Home, Colquitz, B.C. Sir,—Indoor activities were the main attraction during April, 1954, with outside action beginning in May and continuing through September. Softball, tennis, golf, volleyball, catch, lawn-bowls, and football provided most of the interest. Softball, with about thirty patients playing at various times throughout the summer, was the most popular game; kicking a soccer ball was next in popularity, though with fewer participants; tennis was not too well received, the best court being available only to parole patients. Volleyball is difficult to organize, and the facilities for lawn-bowling are not the best, but, generally speaking, the activity in the recreation court during the summer was good. At least two ball games each week (evening games) produced considerable interest and enjoyment. A large number of patients not interested in active sport were engaged in cards and chess and as spectators at the ball games. Starting in October and still in effect at the present time, there are two bingo games each month, at least one card party, and one evening of travel, industry, scenic, and other interesting movies, which, combined with the regular Sunday and Wednesday evening movies, provide three evenings of organized recreation each week. One hundred and twenty patients on an average attend the picture shows, sixty the bingo games, and thirty the card parties. PROVINCIAL MENTAL HOME M 171 In addition to the above, there is considerable card and chess playing on the wards throughout the day. Respectfully submitted. J. Lowndes, Recreation Instructor. DENTAL REPORT L. G. C d'Easum, Esq., M.B., Medical Superintendent, Provincial Mental Home, Colquitz, B.C. Sir,—I herewith submit a report on the dental services administered to patients at the Provincial Mental Home at Colquitz. During the period April lst, 1954, to March 31st, 1955, the following was done:— Examinations and consultations 130 Extractions 95 Restorations 65 Prophylaxes 10 Denture adjustments 17 Denture repairs 4 Denture refines 1 Impressions taken 13 Bites 13 Try-in of dentures 13 Intra-muscular penicillin 1,600,000 units Members of the staff, who were carefully selected to assist me, have, as before, proved themselves to be of invaluable help. I should like to thank them for their co-operation. Respectfully submitted. W. G. Dempsey, D.D.S. DEPARTMENT OF NURSING SERVICES L. G. C d'Easum, Esq., M.B., Medical Superintendent, Provincial Mental Home, Colquitz, B.C. Sir,—The following is a report of the Department of Nursing Services for the fiscal year April lst, 1954, to March 31st, 1955. During the year ten members of the nursing staff left the service for the following reasons: Superannuation, 2; health reasons, 2; resigned to accept other employment, 3; temporary help, 2; services terminated, 1. Psychiatric aides were employed to fill the vacancies in our establishment when psychiatric nurses left this field of endeavour. Besides regular ward duties, staff members escorted groups of patients to the Vancouver Island Chest Clinic at Victoria and others for eye examinations and emergency dental treatment to the respective doctors' offices in the city. Staff were detailed to special duty at St. Joseph's Hospital, Victoria, for a total of sixty-two eight-hour shifts. One psychiatric nurse and one aide escorted a patient to Nova Scotia. Members of the Nursing Services are to be commended for the manner in which they performed their duties. M 172 MENTAL HEALTH SERVICES REPORT, 1954-55 As the number of resident patients changes but little from year to year, those granted grounds privileges, employed in the various departments, and engaged in routine ward activities remain at a constant level. Weather permitting, the recreation courts were in use daily. The radio and television continued to provide enjoyable entertainment for the patients. On May 24th thirty-one patients were taken on a 2Vi -hour tour of Greater Victoria. Besides the bi-weekly and extra picture shows, fourteen concerts, sponsored by individuals, service clubs, and organizations, augmented the entertainment programme. The Travelling Library, Public Library Commission, Victoria, changed the books in our library twice during the year. Popular magazines were sent in by individuals and organizations. The Church of England minister, Rev. N. J. Godkin, held services on the second and fourth Sunday of each month. The Salvation Army held services on the first and third Sunday of each month. They were accompanied by their band on four occasions and by the songsters twice. Major and Mrs. Martin distributed Christmas parcels on December 22nd. Roman Catholic patients were visited, and mass was held each month by Rev. Father L. MacLellan. The Red Cross Society and the Britannia Branch of the Canadian Legion, with the Women's Auxiliary to the Britannia Branch, provided comforts for ex-service patients monthly. Other organizations supplied comforts at times. Chief Joseph Law, of The Corporation of the District of Saanich, visited and renewed our fire department certificate, in recognition of a high standard of fire safety and cleanliness in effect in the institution. Mr. M. C. McCallum, Audit Division of Narcotics Control, Department of National Health and Welfare, Ottawa, visited the institution on November 18th and checked out very limited supplies of narcotic drugs. The co-operation between the other departments and that of the Nursing Services was excellent and greatly appreciated. Respectfully submitted. P. T. McLeod, Chief Psychiatric Nurse. TRAINING-SCHOOL REPORT L. G. C d'Easum, Esq., M.B., Medical Superintendent, Provincial Mental Home, Colquitz, B.C. Sir,—April, 1954, saw the completion of a series of postgraduate lectures for all nursing staff, except the night shift and the last four psychiatric aides. Classes were resumed on October 16th, and since that date lectures have been held on a daily basis for all available staff. A total of 160 hours of lectures have been given for the forty staff members in attendance. Again, the only staff not attending the lectures have been the night shift and the last psychiatric aides. Interest remains good, with the psychiatric aides persistently reiterating their wish to be included here in a regular course leading to graduation and certification as psychiatric nurses. Respectfully submitted. J. Lowndes, Instructor. PROVINCIAL MENTAL HOME STATISTICAL TABLES Table 1.—Movement of Population, Provincial Mental Home, Colquitz, April 1st, 1954, to March 31st, 1955 Number1 In residence, March 31st, 1954 287 On probation, carried forward from 1953-54 1 On escape, carried forward from 1953-54 1 M 173 Total as at March 31st, 1954_ Admissions—Transfers ... 289 ... 14 Total under care 303 Separations— Discharged in full Died On probation and still out 4 Escaped but not discharged 1 Total separations Net increase In residence, March 31st, 1955 15 1 288 1 This institution cares tor male patients only. Table 2.—Transfers to Provincial Mental Home at Colquitz by Health Unit and School District of Residence, April 1st, 1954, to March 31st, 1955 Health Unit Number Health Unit Number East Kootenay, Cranbrook— Simon Fraser, New Westminster— School District No. 3 1 School District No. 40.. 1 North Okanagan, Vernon— 43. ... _ 1 School District No. 21 ..... 1 Victoria and Esquimalt Union Board of Health- South Central, Kamloops— School District No. 61 1 School District No. 24 3 Unknown— Cariboo, Prince George— School District No. 98 .... 1 School District No. 55 1 — „ 57 1 Totals. _ 14 Metropolitan Health Committee, Vancouver— School District No. 39 1 „ 41 2 Table 3.—Transfers to Provincial Mental Home at Colquitz by Mental Diagnosis and Age-group, April 1st, 1954, to March 31st, 1955 Age-group (Years) Total 0-24 25-29 30-34 35-39 40-44 I 45-49 50-54 55-59 60-64 65-69 70 and Over Schizophrenic disorders— .... 1 ~2 "t 2 1 1 2 1 1 1 .... "l 1 1 10 Paranoia and paranoid states Psychosis with cerebral arteriosclerosis Psychosis, other and unspecified- 1 1 1 Totals 1 2 1 2 | 1 3 2 1 1 14 M 174 MENTAL HEALTH SERVICES REPORT, 1954-55 Table 4.—Transfers to Provincial Mental Home at Colquitz by Mental Diagnosis and Marital Status, April 1st, 1954, to March 31st, 1955 Mental Diagnosis Marital Status Total Single Married Widowed 8 1 1 2 1 1 11 1 1 1 Totals — 10 3 1 14 Table 5.—Transfers to the Provincial Mental Home at Colquitz by Years of Schooling and Mental Diagnosis, April 1st, 1954, to March 31st, 1955 Table 6.—Transfers to the Provincial Mental Home at Colquitz by Citizenship and Age-group, April 1st, 1954, to March 31st, 1955 Table 7.—Transfers to the Provincial Mental Home at Colquitz by Religion, April 1st, 1954, to March 31st, 1955 Table 8.—Transfers to the Provincial Mental Home at Colquitz by Previous Occupation, April 1st, 1954, to March 31st, 1955 Detailed information for the above tables may be obtained upon request. Table 9.—Live Discharges from Provincial Mental Home at Colquitz by Mental Diagnosis and Condition on Discharge, April 1st, 1954, to March 31st, 1955. Mental Diagnosis Condition on Discharge Total Recovered Improved Unimproved 1 2 1 1 3 1 1 1 3 1 5 The three patients with improved condition were discharged to home, while the unimproved patient was discharged to another mental hospital. The recovered patient was placed elsewhere in the community. Table 10.—Live Discharges from and Deaths Occurring in the Provincial Mental Home at Colquitz by Mental Diagnosis and Age-group, April 1st, 1954, to March 31st, 1955. Age-group (Years) 0-24 25-34 35-44 45-54 55-64 65-69 70 and Over Live Discharges 1 1 3 3 Other and unspecified psychoses—Psychosis with psychopathic 1 Pathological personality—Other and unspecified 1 .... | 2 3 .... | .... | .... 5 Deaths Schizophrenic disorders—Paranoid type — 1 3 1 5 — 1 3 1 J PROVINCIAL mental home M 175 Table 11.—Live Discharges from and Deaths Occurring in the Provincial Mental Home at Colquitz by Mental Diagnosis and Length of Stay, April 1st, 1954, to March 31st, 1955. Length of Stay Mental Diagnosis 8-11 Months 1 Year 2 Years but under but under 2 Years 3 Years 3 Years but under 5 Years 5 Years but under 10 Years 10 Years and Over Total Live Discharges Schizophrenic disorders Other and unspecified psychoses 1 i i 2 .... [ .... .... | .... 1 1 3 1 1 Totals _,- 1 | 2 | .... J 1 1 | .... 5 Deaths Schizophrenic disorders. 1 1 .... | 5 5 .... 1 5 5 Table 12.—Deaths Occurring in Provincial Mental Home at Colquitz by Cause of Death and Age-group, April 1st, 1954, to March 31st, 1955 Cause of Death Age-group (Years) Total 0-34 35-44 45-54 55-64 65-69 70 and Over Arteriosclerotic and degenerative heart-disease 1 2 1 1 4 1 Totals 1 3 1 5 All five patients who died had a length of stay in the Home for a period longer than ten years. M 176 MENTAL HEALTH SERVICES REPORT, 1954-55 PART V.—GERIATRIC DIVISION REPORT OF THE MEDICAL SUPERINTENDENT A. M. Gee, Esq., M.D., CM., Director of Mental Health Services, Essondale, B.C. Sir,—I submit herewith the annual report of the Geriatric Division of the Provincial Mental Health Services for the fiscal year April lst, 1954, to March 31st, 1955. During the past year there has been no appreciable decrease in the demand for admissions of aged mentally ill persons to this Division, as there was a total of 333 applications received, compared to 337 applications for the previous year. This represents a continued average of twenty-eight applications per month from all parts of the Province. The ratio of requests for men compared to women remains equal, as there were 167 applications received for men and 166 for women. Of the 333 applications received, it was possible to accept only 219 patients for admission to the Division, leaving, therefore, 114 patients who were denied the care provided in our Homes for the Aged. The greatest demand for accommodation continues to be from the south-west corner of the Province, including Vancouver Island, the Greater Vancouver area, and the Fraser Valley. Of the total number of applications received, 291 were requests for admission to the Port Coquitlam unit. From the Okanagan area, 36 applications were received for admission to the Vernon unit, but it was possible to actually admit 43 patients from this area directly, thereby accommodating those few patients who were on the waiting-list at the end of the last fiscal year. At the end of this year there are no names on the waiting-list for either the Vernon or Terrace units, and all applications received from these areas have been accepted immediately. As in previous years, many requests for admission have been very urgent and, after careful evaluation, have been accepted on an emergency basis immediately or very shortly after receipt of the application, even though others had been waiting longer. In all such cases the patients were exhibiting behaviour of such a nature as to be dangerous to themselves or others in their community, and no other facilities existed for their proper care and management. A total of 82 such cases were accepted, which represents 24.6 per cent of the total number of requests received. As in past years, many hours were spent by the Medical Superintendent of the Division in dealing with numerous inquiries and requests for the care provided by this Division for aged persons in the Province. These inquiries are received by telephone, letter, and, more frequently now, by requests for office interviews with the families of prospective patients. The problem in the community appears to be twofold. Firstly, there is insufficient accommodation available to provide adequate care for the increasing number of aged individuals who, because of senile changes, become great problems in management. Secondly, although adequate care can be provided in many instances by nursing homes or private mental hospitals, the financial burden thus imposed on the family becomes insupportable. The total number of patients in residence at the beginning and end of this fiscal year remains unchanged. As will be noted in the accompanying tables, there were 543 men and 501 women, a total of 1,044 patients, in residence in the three units of the Geriatric Division as of April lst, 1954. As of March 31st, 1955, there were 523 men and 521 women, a total of 1,044 patients, in residence. There has been an increase of separations during the year, with 220 deaths and 15 discharges in full. An increase of 50 deaths over the number for the previous year of 170 reflects the fact that the GERIATRIC DIVISION M 177 patients who are the greatest problem in the community are the more debilitated and feeble, and an increasing number of admissions to the Division are in this category, so that the death rate is consequently increased. A total of 248 patients, 104 men and 144 women, were actually admitted to the three units of the Division during the past fiscal year. Of the 15 discharges from the Homes for the Aged, all but one were discharges back to the community, and in most instances were returned to their families. It is felt that a still greater number of patients could be rehabilitated to the community if the services of a social worker were available at the Port Coquitlam unit especially. With the limited medical staff and the lack of social workers at the present time, it is impossible to make an adequate investigation of the family situations and other resources that quite possibly could be made available to many of our patients who have shown improvement and who might very well be cared for at the community level or in a nursing-home situation. As the requests for direct admissions to the Terrace and Vernon units did not utilize the number of vacancies created by deaths and discharges, several patient transfers were arranged from the Mental Hospital and Port Coquitlam unit. On September 8th, 1954, twelve male patients were transferred to Terrace, nine being admitted from the Provincial Mental Hospital and three from the Port Coquitlam unit. On the return trip, one Terrace patient suffering from active pulmonary tuberculosis was brought to the Mental Hospital for active therapy for his infection. On December lst, 1954, four male patients were admitted to the Vernon unit from the Mental Hospital. On March 2nd, 1955, thirteen male patients (eight from the Mental Hospital and five from the Port Coquitlam unit) were taken to Vernon. In each instance the patients and escorting staff were transported via Canadian National Railway without difficulty, and with the best of co-operation from the railway personnel and the various departments in the Mental Hospital. Port Coquitlam The general health of the patients at the Port Coquitlam unit has been very satisfactory throughout the past year, although there is a large number of very feeble and debilitated patients who require complete and constant bed care. There are approximately 110 women and 50 men at all times who require this type of care. During the past year, Ward H.A. 9 has been developed as a secondary infirmary ward for women, with extra staff and equipment to care for the surplus of bed patients over those being cared for on Ward H.A. 7. Ward H.A. 6 continues to give infirmary care for our male patients. During the months of January, February, and March the number of upper respiratory infections and influenza reached epidemic proportions and created a marked problem in nursing care on all wards. The antibiotics proved a great boon in the treatment of these patients, but many of the more feeble and elderly men and women succumbed to secondary bronchopneumonia. In April, 1954, the use of the new tranquilizing drugs, largactil, and, later, ser- pasil, was initiated at this unit for the treatment of those patients who were great problems in management because of restless, agitated, or destructive behaviour. This therapy has been of great assistance, and in most instances the patients have responded very favourably, with a consequent reduction in nursing care required and an improvement in the general ward atmosphere. A number of patients were referred to surgery during the year, and in all cases the operative procedures were carried out at the Crease Clinic, with post-operative care being given on the West 2 Surgical Ward or in the infirmaries at the Mental Hospital. A total of thirteen patients were referred to the surgical consultants—three men and ten women. In addition, three men were referred to the urological specialist because of hematuria, and in one case transurethral prostatic resection was required. In October M 178 MENTAL HEALTH SERVICES REPORT, 1954-55 an elderly lady accidentally suffered tracheal obstruction by dislodgement of her partial denture. She was immediately transferred to the Royal Columbian Hospital, where the foreign body was removed, but she succumbed a few days later from a lung abscess. Throughout the year thirty-five patients were referred for orthopaedic care because of fractures. Of these, four men and sixteen women required surgical treatment for a fracture of the neck of the femur. In addition, eight women suffered fractures of the wrist, and the remainder a variety of minor bone injuries. In all cases the injuries were sustained by accidental falls on the ward. In many instances the falls were unwitnessed, as there is not a sufficient number of staff available on the ward to give the constant supervision required for the large number of feeble and confused patients who tend to wander and attempt activities beyond their physical capabilities. In all cases the orthopaedic service afforded these patients has been prompt and efficient. General medical ward care has been provided throughout the year by myself, with the assistance of part-time service from one of the physicians at the Provincial Mental Hospital. During the first part of the year Dr. McLeod attended to routine medical problems in the mornings as his other duties permitted. In January he was replaced by Dr. Sussman, who has continued in the same capacity, and the assistance of these two men has been invaluable. During the summer months Mr. K. Atkinson, a fourth-year medical student from the University of British Columbia, gave full-time assistance on the wards and is to be commended for his genuine interest and assistance in the medical care of our elderly patients. However, in order to provide adequate medical care to the patients, it is becoming increasingly evident that there is a need for a full-time physician at this unit in addition to the Medical Superintendent, whose administrative duties are gradually demanding a greater part of his time. The general nursing and ward services continue to function efficiently, and I wish to commend the sincere interest and devotion shown by the nursing staff in their care of our aged men and women. Many letters and words of appreciation have been received from relatives and friends of patients concerning the kindly and sympathetic care given to the patients by the nursing staff. I am pleased to report that general ward supervision has been greatly enhanced by the appointment of Mrs. Warrender as unit supervisor on April 12th, 1954. Mrs. Warrender has shown exceptional interest in the problems peculiar to the care of aged mentally ill patients, and has been able to improve considerably the general organization and efficiency of the female ward services and activities. However, there is still a great need for an additional supervisor to cover the night shifts and for week-ends. The many and varied duties of the clinical office have been carried on efficiently throughout the year under the supervision of Miss Marjorie Anhorn. In January Miss Beryl Tompkins was transferred to the East Lawn clinical office, and her duties have been carried on by Miss Beverley Snook, who entered the Mental Health Services the same month. Rev. J. F. O'Neil has continued to show a devoted interest in the religious needs of our patients and has conducted regular services on Wards H.A. 1, H.A. 4, and H.A. 8 throughout the year for those patients who are unable to attend regular services at Pennington Hall. The Audio-visual Department has also continued to show 16-mm. movies on the wards regularly, and this entertainment is appreciated by a large number of our patients. The beauty-parlour on Ward H.A. 4 also continues to be a very popular service for the elderly ladies, and one operator is employed full time in keeping pace with the demand for her services. Many patients are able to attend the various concerts and attractions at Pennington Hall, and throughout the year special occasions have been marked where possible by suitable ward parties or other entertainment to brighten the daily routine of our patients. Occupational therapy has also been encouraged, and all patients who are physically and mentally capable of being occupied with simple handicraft procedures have been assisted by the occupational therapist assigned to this area. GERIATRIC DIVISION M 179 A very welcome addition to the services afforded our patients appeared in October, 1954, when the first group of volunteer workers arrived on the wards of this unit. In March two additional workers were assigned to this area, so that at the end of the fiscal year six ladies have been active here in volunteer work. These workers have been wholeheartedly accepted by patients and staff alike, and they have shown a genuine interest in the welfare of our elderly patients. Their activities, such as friendly visiting, distribution of library books, organization of reading groups, and, more recently, assistance with occupational activities, have been eagerly looked forward to each week by our patients, men and women alike. I would like also to report two special events which added greatly to the entertainment of our patients. On August 26th seventy patients were again guests at the Pacific National Exhibition Shrine Circus through the courtesy of the Vancouver Shriners' organization, who provided transportation to the Forum at Exhibition Park and returned the patients to the hospital after a very enjoyable and interesting afternoon. All the patients who attended were very grateful for this generous evidence of community interest in their welfare. On September 14th a few of our elderly ladies attended the special service in New Westminster honouring the Archbishop of Canterbury. The dietary service has continued to be of a high standard throughout the year, both in respect to the quality of the general diet supplied to the wards daily and in the special dietary service provided for Wards H.A. 6, H.A. 7, and H.A. 4. The new kitchen equipment provided last year has functioned well, except for the steam-canopies, which still do not adequately remove the steam from the large urns. As a result, the painters have delayed the interior decoration, which is urgently needed in this area. The Public Works Department has carried out general maintenance throughout the year, and several new pieces of needed equipment have been provided on the wards. In April the radios were finally installed in Wards H.A. 8 and H.A. 9, and new flooring was provided for the clinical offices and several wards. During the summer months, exterior painting was completed for Cottage 6, and the H.A. 1 airing-court was enlarged and improved. An airing-court has also been provided at the north end of Cottage 8. In November more major changes were carried out in H.A.K. to provide a proper nurses' office on the main floor, and, with additional equipment, there are now much better facilities for the supervision and care of the patients domiciled in this building. During the year the nurses' offices in the newer buildings were provided with desk and charting units designed at this unit and built by the Public Works carpenters. They have proven very practical and acceptable by the nursing staff. However, there are still a number of projects that are urgently required, the most important of which include the provision of adequate garbage storage for all cottages, screening of the kitchen and dormitory areas in several cottages, additional fire exits from the dayrooms of Wards H.A. 1, H.A. 2, and H.A. 3, and interior decoration of the older buildings. During the year several distinguished visitors were welcomed at this unit and were conducted on a tour of the wards. Professor Marriage, of the research staff of the University of British Columbia, and Miss Carrol, Psychiatric Social Work Director, visited this area on April 14th. On August 20th Mr. Arnold Webster, Mr. Arthur Turner, and Mr. E. E. Winch, members of the Legislative Assembly, visited several wards, and expressed considerable interest in the care being given at this unit for the aged mentally ill patients of the Province. I regret to report that Dr. A. G. MacKinnon found it necessary to resign from his position as Medical Superintendent of the Vernon unit and left the service in September, 1954. As it was impossible to replace Dr. MacKinnon with a full- time physician in charge, it was necessary to change the medical and administrative policy at this unit and to introduce the same organizational structure as presently exists at the Terrace unit; that is, a non-medical administrative supervisor in charge of the unit, with medical care provided on contract by a local practising physician. Immediately following M 180 MENTAL HEALTH SERVICES REPORT, 1954-55 the departure of Dr. MacKinnon in September, Dr. J. R. Smith, a leading physician and surgeon in the City of Vernon, assumed responsibility for the medical and surgical care of the patients at the Vernon Home for the Aged. Dr. Smith has shown a keen interest and has given efficient and willing service and co-operation to this portion of his practice. On November lst, 1954, Mr. L. Fox was appointed supervisor of the unit and, over a period of several weeks, gradually released his duties in the pay office at the Crease Clinic and assumed full-time supervision of the Vernon unit. Mr. Fox has been carrying on very efficiently in this position since that time. The functions of the clinical office were seriously disrupted during the year, not only by the absence of an administrative head during the months of September and October, but by a change of clerical staff. In April last year Miss K. Lystang joined the office staff to fill the position previously vacated by Miss Lenz. Four months later Miss Inouye obtained a transfer to another department of the Provincial Civil Service, and Miss Lystang, relatively new to the Mental Health Services, had to carry the full duties of the clinical office. She is to be commended for her devotion to duty in the absence of senior administrative guidance. The general health of the patients at this unit has continued to be very satisfactory, and continuous preventive and therapeutic treatment for the patients in their care has been the guiding policy of the nursing and medical staff throughout the year. There have been no major medical problems, and only one major surgical operation, a herniorrhaphy on a male patient, was performed during the year. Five women and three men received fractured hips as a result of accidental falls. Where operation or fracture treatment has been necessary, the services of the local physcians and staff of the Vernon Jubilee Hospital has been found ready and competent. One male patient suffering from a skin cancer behind the left ear was transferred to the Port Coquitlam unit for treatment. Largactil therapy has been used for seven moderately disturbed patients, with a successful result in six cases. One male patient suffered a severe skin reaction to the drug, and treatment had to be discontinued. Intermittently since July, 1954, a strain of staphylococcal infection, resistant to antibiotics, has caused boils and carbuncles among patients and staff and has increased the nursing problem considerably. A minor epidemic of influenza became prevalent throughout the Home during March, 1955, increasing the patient bed count at one time to as high as sixty and reducing staff coverage to a minimum. The nursing staff are to be commended for their faithful and capable service, especially as the type of care required for aged mentally individuals is very demanding on our nurses' time, patience, and energies. During the year two additional psychiatric nurses have been added to the complement, with a resultant improvement in the quality of nursing care. The staff in general has remained stable throughout the year, with Miss M. R. Thiemann, as Superintendent of Nurses, and Mr. L. J. Hadden, as Chief Male Phychiatric Nurse, occupying the senior positions. One male psychiatric aide resigned and one replacement was obtained. A high turnover rate of female aides continues as previously, but as most resignations were due to prospective marriages, it is indicated that the personnel in most cases are satisfied with working conditions. This continuity of staff also ensures capable and experienced nursing care. Vaccination with B.C.G. was carried out in May, 1954, for all female aides with positive TB. tests. All staff were given T.A.B. injections when due and received TB. chest X-rays every six months. The dietary department has continued to provide good wholesome meals throughout the year, and this fact is reflected in the excellent physical health of the patients. Special meals have been prepared on various occasions, such as Easter, Victoria Day, Christmas Day, etc. Mr. Owens, Chief Cook, is very attentive to special salt-free and other diets required by several of our patients. GERIATRIC DIVISION M 181 Various items of maintenance in the kitchen have been completed, including the installation of steam exhaust fan. The swill contract was again awarded to Mr. A. P. Joste, but at a reduced figure due to the smaller amount of waste food. Other ward services have also continued to function smoothly, although the hope of developing an occupational programme at this unit received a set-back with the resignation in June of Miss Jean Carter. It is felt that the enthusiastic, fully trained therapist in a small unit suffers a feeling of frustration when trying to teach the finer arts and skills to aged persons, whose capabilities are naturally more limited and must consist mostly of knitting, crocheting, fancywork, and leathercraft. The nursing staff encourage and help those willing to try the simpler crafts, and it is recommended that this type of therapy should be promoted by seeking the services of a handicrafts instructress. Spiritual services have been held regularly throughout the year. Reverend Smith was replaced in January of this year by Reverend Reeves, who holds twice-monthly services and the occasional communion service. Reverend Faths Miles holds a Catholic service every week. These ministers of the gospel, as well as a local Seventh-day Adventist choral group, contribute in many ways throughout the year toward the welfare of the patients at this unit. Further community interest has been shown, especially during the Christmas season, by entertainment and small gifts from such groups as the Girl Guides, Teen Towners, and the Business and Professional Women's Club in Vernon. Throughout the year every occasion of special interest is celebrated by small parties or picnics for those patients able to participate, the arrangements being made voluntarily by the nursing staff. Two special occasions of entertainment during the year were the band concerts provided by the New Westminster Army Band on May 23rd, and the R.C.M.P. Band on July 16th. Both concerts were thoroughly enjoyed by the patients. Motion pictures are also shown weekly throughout the year. Visitors come regularly to visit with friends or relatives being cared for in this Home, the average number of visitors per day being approximately five. Special visitors during the year included the Honourable P. A. Gaglardi, Minister of Public Works; Mr. C. D. Campbell, now Deputy Minister of Public Works; and Dr. Jenkins, of the Department of National Health and Welfare. Fire Chief Little, of the Vernon Fire Department, conducted the annual fire drill and demonstration in June for the benefit and instruction of the staff. Chief Little has also been most willing whenever called upon for advice or instruction concerning fire- prevention measures at this unit. The laundry commenced operation in May, 1954, when Mr. J. Sowles, formerly at the Provincial Mental Hospital, was appointed laundry manager and reported for duty on May 17th. Since then an average of over 31,000 pounds of soiled linen has been processed monthly, effecting a considerable saving in laundry costs. Unfortunately Mr. Sowles became ill in September and was temporarily replaced by Mr. May, who has capably assumed charge since. The linen-mending room was moved to a larger space in the laundry building and a new commercial-type sewing machine installed. Permanent awnings have been installed over the windows on the south side of the laundry to help reduce the excessive heat which develops within the building during hot weather. Considerable maintenance work was performed by contract during the year, including painting of the male day ward, the female staff dining-room, visitors' room, and the dispensary. The interior of the nurses' homes and the Supervisor's house were also redecorated. In the annex a mixing-valve has been installed on the water-tank to prevent accidents caused by scalding, and two new water-closets and sinks provided in the washroom to accommodate the number of patients domiciled in this building. Mr. Hornell has conscientiously and efficiently attended to the many routine maintenance jobs which occurred during the year, and Mr. Legg, the gardener, has been most assiduous in his efforts to keep the lawns and gardens in excellent condition throughout L M 182 MENTAL HEALTH SERVICES REPORT, 1954-55 the year. In December a large greenhouse was completed, which has increased the gardener's scope and will provide fresh blooms for the wards during the winter months. In November Mr. B. A. Marshall, former Chief Engineer, left the unit on transfer to the new Boys' Industrial School at Brannen Lake. His place has been taken by Mr. A. M. Brown, who has carried on as Chief Engineer since that time. The shift engineers, men who, day in and day out, tend the boilers and maintain the steam for heating, cooking, laundering, etc., are worthy of commendation for their devotion to duty. Terrace The general health of the patients at the Terrace unit continues to be fairly good, although the increase in mortality rate during the past year reflects the increasing age of the patients at this unit, many of whom are becoming very feeble. There have been no major medical problems and no serious epidemics of infection, although there were a large number of patients ill with influenza during the winter months. Three patients required surgery during the year, and three patients suffered fractures of the humerus as a result of accidental falls. Two patients developed evidence of active pulmonary tuberculosis and were discharged to the Provincial Mental Hospital at Essondale for isolation and treatment. Dr. R. B. Hicks terminated his service to the unit on leaving Terrace at the end of October, but his place has been filled by Dr. J. B. Dukelow, who continues to supervise the medical care of the patients regularly and efficiently. General nursing and ward services have continued to function well, although at times it has been difficult to maintain adequate staff coverage on the wards, and the unit has operated throughout the year with only a minimum of ward help. There have been thirteen resignations during the year, which, with their small staff, represents a high turnover. Higher wages elsewhere in the locality appear to be the main factor influencing this difficult problem. With the advent of spring, several more resignations are anticipated. The radios and picture shows, as well as card games and reading, continue to be the best enjoyed forms of recreation by the patients generally. No organized occupational programme has been possible at this unit as the available staff are fully engaged with general ward routines and have no time for such activities, although they should be an important part of ward activity in a unit of this type. Regular church services are conducted by Reverend O'Connell and Reverend Father Turgeon, who replaced Father Donze shortly after the new year. These services are held on alternate Sundays, and are fairly well attended. The dietary department, directed by Mr. Piffer, Chief Cook, has operated satisfactorily, although the institution of the forty-hour week in January has created hardships in this department. Despite frequent requests for additional staff, authorization has not yet been obtained, so that the kitchen help is inadequate for proper functioning when present staff are absent through illness or other reasons. In addition, the patients who have heretofore carried on a large portion of the routine work in the kitchen are becoming feebler and consequently much less effective as kitchen help. Under Mr. Morgan's stewardship, the stores has operated efficiently. Supplies of all kinds have been kept at good levels, although, generally speaking, the merchandise has been of a more inferior quality than in the past. Surplus stocks of groceries have been maintained whenever necessary to provide against possible transportation breakdown. The laundry has operated satisfactorily throughout the year. Mr. Kenyon was recently transferred to the Provincial Mental Hospital laundry, and his place has been filled by Mr. A. Norton. A new tumbler dryer is on order and, when installed, will greatly improve the efficiency of this department. GERIATRIC DIVISION M 183 The engineering staff, under the able direction of Mr. McLachlin, Chief Engineer, have maintained the heating plant in satisfactory working order throughout the year. Extensive repairs were required for stokers and grates on the two low-pressure boilers, and it is hoped that the long-promised new stokers will be available for use before the winter months of 1955. Adequate heating of wards and dormitories is a prime requisite in the care of elderly individuals. During the past year extensive repairs were made to the footings, floor joists, and sub-flooring of the three apartment blocks, as well as the two-story building housing two apartments and the single men's quarters. In the hospital building, the floor joists and flooring were renewed in Dayroom No. 2 of the East Ward. New floor joists and footings were placed under the entire kitchen floor, as well as excavation work done to allow for adequate ventilation. At the end of the fiscal year, work had started on the new sewage-disposal bed and, when completed, will solve one of the major problems at this unit. Work is also progressing toward the provision of an independent water system for this Home. Following test pumping of the well, the water potential was found to be very adequate, and a permanent pump has now been installed. Concrete footings have been poured and some structural timbers have been delivered in preparation for the building of a water-storage tank. Interior redecorating of the hospital building is needed, as a large part of this structure has not had a coat of paint for five years, and this lack of ordinary maintenance is becoming increasingly noticeable. Although provision was made last year for the appointment of a staff painter, the position was later deleted for reasons unknown. A start was made last fall to paint the exterior of all institution buildings, but this project was delayed because of inclement weather and the lateness of the season. In concluding this annual report, I wish to commend to you the staff of all three units who have diligently and efficiently created a high standard of care for our aged patients. May I also extend to you my sincere appreciation for your guidance and advice throughout the year in the medical administration of the Geriatric Division. Appreciation is also extended to Dr. Caunt, who has readily and willingly taken over my duties when it has been necessary for me to be absent. Respectfully submitted. B. F. Bryson, M.D., Superintendent, Homes for the Aged. M 184 MENTAL HEALTH SERVICES REPORT, 1954-55 STATISTICAL TABLES HOME FOR THE AGED, PORT COQUITLAM Table 1.—Movement of Population, Home for the Aged at Port Coquitlam, April 1st, 1954, to March 31st, 1955 Male Female Total 136 51 372 130 508 181 187 502 689 Separations— 12 36 6 100 18 Died 136 48 106 154 3 24 27 139 396 535 Table 2.—First Admissions to Home for the Aged at Port Coquitlam by Health Unit and School District of Residence and Sex, April 1st, 1954, to March 31st, 1955. Health Unit Male Female Total Health Unit Male Female Total East Kootenay, Cranbrook— Simon Fraser, New Westminster— School District No. 1 1 1 School District No. 40 5 12 17 „ 2 1 1 43... 3 2 5 „ 5 1 1 North Fraser Valley, Mission— West Kootenay, Trail— School District No. 42 2 1 3 School District No. 11 1 1 „ 75..... 1 1 „ 12 1 1 Upper Island, Courtenay— South Okanagan, Kelowna— School District No. 47. 1 1 School District No. 15 1 1 Peace River, Dawson Creek— North Okanagan, Vernon— School District No. 60 1 1 School District No. 19 1 1 Saanich and South Vancouver „ 22 1 1 Island— 78 1 1 School District No. 61 (part1)... 3 11 14 South Central, Kamloops— , 62 1 1 School District No. 24 2 2 „ 63 1 1 2 Cariboo, Prince George— Central Vancouver Island, School District No. 28 ... 1 1 2 Nanaimo— „ „ „ 56 1 1 School District No. 65 1 1 Upper Fraser Valley, Chilliwack— „ 67....... 1 1 School District No. 33 2 2 „ 69 1 1 34 3 1 4 70 1 1 Boundary, Cloverdale— School districts not covered by School District No. 36 ... 3 4 7 health units— Metropolitan Health Committee, School District No. 49 1 1 „ „ 73 1 1 School District No. 39 18 58 76 Ex-Province 1 1 ,. 41 „ 44 1 3 14 4 15 7 Totals 52 129 181 „ „ „ 45 2 2 4 1 Excludes Victoria, Esquimalt, and Oak Bay. GERIATRIC DIVISION M 185 Table 3.—First Admissions to Home for the Aged at Port Coquitlam by Mental Diagnosis, Age-group, and Sex, April 1st, 1954, to March 31st, 1955 Age group (Years) Mental Diagnosis 60-69 70-79 80-89 90-99 Not Stated Grand Total M. F. M. F. M. F. M. F. M. F. M. F. Schizophrenic disorders— 2 1 4 7 25 2 1 1 1 8 1 62 7 17 4 27 5 5 1 43 6 1 1 1 10 2 98 19 10 2 141 Psychosis with cerebral arterioscler- 25 1 Other, unknown, and unspecified con- 1 Totals 14 29 79 21 1 32 1 5 t 1 51 130 181 All patients were admitted into Mental Health Services by certification. Table 4.—First Admissions to Home for the Aged at Port Coquitlam by Marital Status, Mental Diagnosis, and Sex, April 1st, 1954, to March 31st, 1955 Marital Status Mental Diagnosis Single Married Widowed Divorced Separated Not Stated lotal Grand Total M. F. 1 1 1 M. 1 F. 1 M. ] F. 1 1 1 M. F. M. 1 F. 1 M. I F. 1 1 M. ! F. 1 8 2 2 6 2 .... [ 5 16 | 20 5 1 | .... 12 3 1 5 69 10 1 1 1 .... 5 1 2 1 | 2 1 43 6 1 13 98 19 13 141 Psychosis with cerebral arteriosclerosis... 25 1 Other, unknown, and unspecified conditions I 1 | .... 1 Totals 10 10 17 | 30 16 84 1 1 2 6 | 4 1 1 1 51 1130 181 Table 5.—First Admissions to Home for the Aged at Port Coquitlam by Years of Schooling, Mental Diagnosis, and Sex, April 1st, 1954, to March 31st, 1955 Table 6.—First Admissions to Home for the Aged at Port Coquitlam by Citizenship, Age-group, and Sex, April 1st, 1954, to March 31st, 1955 Table 7.—First Admissions to Home for the Aged at Port Coquitlam by Religion and Sex, April 1st, 1954, to March 31st, 1955 Table 8.—First Admissions to Home for the Aged at Port Coquitlam by Previous Occupation and Sex, April 1st, 1954, to March 31st, 1955 Detailed information for the above tables may be obtained on request. M 186 MENTAL HEALTH SERVICES REPORT, 1954-55 Table 9.—Live Discharges from Home for the Aged at Port Coquitlam by Mental Diagnosis, Condition on Discharge, and Sex, April 1st, 1954, to March 31st, 1955. Condition Total Mental Diagnosis Improved Unimproved Grand Total M. F. M. F. M. F. Schizophrenic disorders .— 2 2 3 2 1 7 1 1 9 2 3 3 1 12 5 Totals 4 5 8 1 12 6 18 The disposition of the four males whose conditions were improved upon discharge was one to home and three to elsewhere in the community. The eight in an unimproved condition went to another mental hospital. For females, three with improved condition went home and two elsewhere in the community, while the one unimproved patient was discharged to another mental hospital. Table 10.—Live Discharges from and Deaths Occurring in Home for the Aged at Port Coquitlam by Mental Diagnosis, Age-group, and Sex, April 1st, 1954, to March 31st, 1955. Age-group (Years) Total Mental Diagnosis 60-69 70-79 80-89 90-99 Grand Total M. [ F. 1 M. F. M. F. M. F. M. F. Live Discharges Schizophrenic disorders 1 1 7 2 1 1 2 2 1 1 9 2 3 3 1 12 5 ...... | 1 | 10 | 2 2 | 3 | ...... 12 6 18 Deaths Schizophrenic disorders Senile psychosis . 15 2 47 9 12 2 1 1 32 7 4 3 1 31 4 1 1 82 17 1 113 1 Total deaths 17 56 15 40 4 4 36 100 136 geriatric division M 187 tn O z o < < H 7 w « < ►J H 3 On u O H H Q u 2 " PS O u s o 5 5 z < 3 x O O ca K H W 00 Q Oh ^ H O < X u tn > w M T3 — So __ CA »n 00 ___, m __ ,_, v> cn OH Ph 00 i-i ! © c3 O H s . s i ^ i __ j \\o w : oo w _ to tft ft i \\~ - *-< ON CN CN o — Wi 5= ! IN ft cn : co : i ro a —5 ft i i ,_l •"* : r- cn 1 v «> a i ■o ' w a •£ c u <" *c £g £ -3 o r 5-ts - 5 x to t_ u ►is « rt ^ a, c * oa X —i toX JC c >» * >. a O (L V K u. CA v 0- (Ai M 18 MENTAL HEALTH SERVICES REPORT, 1954-55 Table 12.—Deaths Occurring at Home for Aged at Port Coquitlam by Cause of Death, Age-group, and Sex, April 1st, 1954, to March 31st, 1955 Age-group (Years) Total Cause of Death 60-69 70-79 80-89 90-99 Grand Total M. F. M. F. M. F. M. F. M. F. 2 10 1 2 1 1 4 4 1 35 6 1 3 1 1 1 9 1 1 1 1 1 1 1 4 23 1 3 3 2 2 4 __ 3 1 2 23 1 2 3 1 1 2 5 2 8 1 61 1 9 4 5 1 1 2 1 5 2 Vascular lesions affecting central nervous system 10 1 Arteriosclerotic and degenerative heart-disease_ 84 1 10 6 8 1 1 Intestinal obstruction without mention of hernia 2 2 Accidents _— 2 Total, all causes ___ _ 17 56 15 40 4 4 36 100 136 GERIATRIC division M 189 X H < ft Q a, o W tn D < u, h r_? ft co ^ M U 3 o o Oh H < tn Q 2} o « X -J * 2 OS ^ ft w c/3 o X Q Z H < < > a < z H <*) 2 « ft 0 o u o O X H o CO z X ft H J < ft Q ft ca < o^ « > Si S3;* O So os£ 2^ 2^ HIClCJOrtTtHO^OMHi lOCNMrtrHrHtt^ln-H I rt 4 o B£ \\ CA \\ rf rt j ,-. rt , tn ! ft \\ rt ; y-t \\ CA rt SO j I ft CA C . u CD 00 tS ," *a Q>; g X c_ -e £ rt g " Y rt 003 ££ o s 3 a •■:; cn u C DO cu to _£ X hi rt _3 H S5 S3£|8.g§ n A c £ >, .a g >« P. £2 X 2S S 1 1 i I 1 i 1 1 < a Q -- a aj ft rt ft SO j | j rt | CJ\\ ft O 3© 2 | | tn CA CA | | j Os o i-i w ""a ft IIIIIII! ^ a. in |3 tO < OS osC; a i 1 **" tH : M i i o X) ftl _, to tn ft j I 1 1 ! ; m ^ ffl 03 __ T—1 u fl £ » a _5>< ' Z cn ° « cd a j M»n [ j j 1 j ir M < O O M C to 13 cd 6|S ft a I in ; ; ; j ! es 1 rt fi \\ rt ! | r-t SO Q H h iiiiiii * j? ^ ■^h Os "I £ i r i i i i i CA rH W .__ ft i *"• j 1 i 1 j i rt 1 H" 4o ■ O J a a 1 in j 1 1 1 1 CA fe 2 Xl ft iiiiiii! w 5j -IS a s ! i tn j j ; 1 | tn NG AT HO and Sex, ">hS .k a ft 1 1~ 1 1 1 i 1 « a 1 1^ 1 1 I 1 1 ^ 2 >H Ph < 5 ft o &o O o 2 W n h H O <, % w @ QJ a a. 1 in rt u » cd «_ 3S rH Q 3 i W o EL aj * ft | I a. o a £ ■c ME T c Cfl G t_Q tj D X a f •§ 1 •c S % 0 C c ions affe otic and n with h c f a E > « *cd cler nsic c n •— o _. O H « z c « ascula rterios yperte leer of iseasej cciden - 2 > 3 O u a rt Mainland Travelling Clinics Vancouver Island Clinics — .5 o ,0 M o 3 > o O o X) c q o to u ti o to » eg c ,_. G —. t/1 u c rt D. O O E rt n o u c •a c o tr. « 13 cs to t) c o u o O ii a. 3 u "a. _) -_: o T3 > a < c o 6 rt n o c to rl tft B s 1 rt o U ,_- c n c 0 S rt rt _. "rt > < u U u U u a. X U U J Z 0 a. a. a. a a w H ^ * 3 U L> f- Number of clinics held 250 4 7 6 2 2 4 1 2 4 4 1 6 2 4 4 3 3 2 1 10 5 2 124 11 3 1 5| 5 477 516 16 IS ]t) 5 5 11 i 8 13 in 4 16 5 13 13 8 8 8 4 ->q 17 5 210 39 17 15118 1,059 275)14 18 11 3 4 7 1 7 m 3 17 4 5 8 1 4 5 241 81 2 117 8 3 11 5 555 Playroom observations 1651 9 18 11 3 3 9 8 9 4 15 5 4 12 8 10 5 2124 15 . 155 29 6 7)14 550 Psychiatric interviews 1,442(43 62 59 13 12 29 5 20 25 29 8 37 10 37 33 17 19 13 10 75 40 9 409 76 33 31136 2,632 Agency case conferences — 454|16 26 23 6 511 2 8 14 11 4 16 5 16 14 8 9 8 4 29 18 5 42 39 17 16 18 844 Consulting case confer 1 ences 3751 1 1 -| 2 1 2 2 5 1 1 1 3 ... 5 3 1 4 4 1 1 414 Private case conferences._ 122| — 169 291 Pre-clinic conferences 2441 -. 1 - - ~ - - 1 244 M 202 MENTAL HEALTH SERVICES REPORT, 1954-55 Table 2.—Number, Sex, and Status of All Cases Examined at the Child Guidance Clinics, April 1st, 1954, to March 31st, 1955 Mainland Travelling Clinics Vancouver Island Clinics -^ o > 3 O CJ C ■a o ca o M M * to "a — V > c M 0 o X a a 0 CA § x: c 55 c 0, 0 0 E a o cj d a o tft C rt c 0 o 0 V a u u q a OS u o a to M O < B 0 S a o c rt ca E rt CCJ O '3 rt c u 3 a rt 0 B 0 E cd C3 ca "rt Pt M rt s t) ^ > < U U u u q u- I M « hI 7 6 a. 3. s- a « tn h > > < U '- /- H New Cases Males— 1 Adults 41 1 1 10 1 12 2 3 4 3 5 6 4 4 1 8 4 2 6 9 6 • i 5| 3 3 1 10 2 7 1 11 102 1 10 1 9 2 6 4 24 75 Children— 217| 9 488 Females— Adults.— 38j 1 1 1 1 1 ...J _ 2 1 -| 1 1 9 1 1 2 61 Children 119| 5 9 5 1 2 2 2 7 4 2| 3| 1 4 2 2 •1 2 10 6 1 48 4 2 4 4 252 Totals _ 415|16 21|18| 5 5|10| 2| 8|12| 9 4[11| 5|14 12| 8 7| 6| 3|22jl5| 3 170|15|13|13|34 876 Repeat Cases 1 I Males— 1 | Adults. ' 18 72 — 1 2 2 3 1 1 2 2 4 2 2 1 __ •1 5 2 30 i L 1 2 2 2 27 Children 2 2 137 Females— ! Adults 9- -! l 2 1 13 Children 391— 2 1 1 1 2 -| l 1 9 1| 2 i 63 Totals 138| | 5| 6| 1 •1-1 •! 2| 2 -1 5|_| 2| 2|- 2| 2| 1| 7| 3| 2 43| 3| 4| 3| 5 240 Total cases ' 553|16 1 26|24| 6 1 1 5 11| 2 I 9 14 11 4|16| 5]16 1 1 1 14 8 9| 81 4 29 18 1 1 5 213|18|17|16|39 1,116 1 1 1 1 CHILD GUIDANCE CLINICS Table 3.—Sources of All Cases Referred to Child Guidance Clinics, April lst, 1954, to March 31st, 1955 M 203 Agency or Source Number of Cases Total Percentage of Distribution 1. Social agencies— 2 16 121 6 29 16 1 201 11 18 37 43 26 4 21 1 1 4 16 8 36 1 2 7 6 4 12 30 10 17 3 62 56 31 14 34 1 11 1 64 129 1 1 393 318 163 47 64 129 2 35.21 28.49 14.65 4.21 5.74 11.56 .18 2. Medical and health agencies— Health Centre for Children Metropolitan Health Committee — ___ , North Fraser Valley Health Unit __ _____ __ North Okanagan Health Unit ___ _ Peace River Health Unit Public health nurses ..._. Selkirk Health Unit South Central Health Unit_ South Okanagan Health Unit Upper Fraser Valley Health Unit.. _ Western Society for Rehabilitation _ 3. Schools- Public Other- Boys' Industrial School Girls' Industrial School Jericho Hill School (School for the Deaf and the Blind) 4. Juvenile Court Adult Probation. Provincial Probation Officer Police 6. Parents, relatives, self, friends „. 7. Other- Speech therapist Royal Canadian Air Force _ Totals _ 1,116 1,116 100.00 r M 204 MENTAL HEALTH SERVICES REPORT, 1954-55 Table 4.—Problems and Disorders Presented by the New Cases Given Full Examination by Child Guidance Clinics, April 1st, 1954, to March 31st, 1955 Children Adults Total M. F. M. F. 1. Primary behaviour disorders— (a) Habit disorders— Thumb-sucking . . 1 22 2 12 5 1 7 5 7 3 6 1 27 3 3 4 3 5 4 9 1 5 9 6 29 4 1 14 2 12 2 5 1 13 1 5 1 1 2 23 3 21 2 11 1 4 2 3 7 4 5 2 2 1 1 3 7 5 3 3 8 2 2 3 2 6 1 2 4 1 2 7 3 1 1 2 1 1 1 2 1 15 2 6 2 1 3 3 1 1 1 1 26 1 3 1 8 2 2 3 2 1 2 2 1 1 3 2 3 1 7 1 12 2 1 3 1 1 1 2 1 32 6 Tantrums - . — Soiling Other .. . 17 7 1 (£») Personality disorders— 14 8 7 1 Sensitiveness Aggressiveness.- Phantasy . Feelings of inadequacy— - Negativism Other 4 9 1 35 8 3 (c) Neurotic disorders—' Tics and habit spasms . _ ... Stammering... _ — 4 3 8 Nightmares _ 7 19 Fears 3 11 (rf) Conduct disorders— Truancy Fighting and quarrelling Stealing 15 8 64 6 Use of alcohol _ Cruelty _ 10 1 Disobedience - 19 3 Untruthfulness 14 24 2 10 Staying out late. 5 21 3 Other _ 4 2. Psychotic and prepsychotic— 7 Other 1 3. Psychoneurosis and neurosis— Hysterical type 2 Anxiety type. 2 1 4 5. Psychopathic personality— — — 6. Educational disability— (a) Associated with dull-normal or border-line intelligence (b) Special mental disability— 1 41 3 Reading - — Other 24 2 (c) Social adjustment — - 7. Behaviour disorder associated with somatic disorder— 21 1 7 2 4 CHILD GUIDANCE CLINICS M 205 Table 4.—Problems and Disorders Presented by the New Cases Given Full Examination by Child Guidance Clinics, April 1st, 1954, to March 31st, 1955—Continued Mental deficiencies— (a) Familial (b) Mongolism- (c) With developmental cranial anomalies.. (d) With congenital spastics _ _ (e) Post-infectional— (/) With epilepsy (g) With endocrine disorders. (h) Other forms (0 Undifferentiated Mental retardation No ascertained mental deviation— (a) Problem of physical health and development. (b) Spastics- (c) Speech problems— (rf) Sight problems (e) School problems.— (/) Hearing problems.. (g) Social problems— (1) Placement (2) Adoption (3) Other (/.) Unascertained- (/) Normal personality- Vocational guidance Totals .. Children M. 11 9 1 12 1 2 1 2 29 5 9 23 2 10 10 12 32 1 488 10 7 2 4 21 2 17 7 1 1 6 13 32 1 2 2 1 252 Adults M. 75 61 Total 22 20 3 17 2 2 1 1 2 53 9 28 31 5 13 18 25 64 3 2 4 10 876 Table 5.—Chart Comparing Ages with Intelligence Quotients of All New Cases Seen at Child Guidance Clinics, April 1st, 1954, to March 31st, 1955 FEMALES Respectfully submitted. U. P Byrne, M.D., D.P.H., D.I.H., Director, Child Guidance Clinics. 0- 19 6 5 7 11 16 13 12 3 1 3 19 16 15 13 16 13 2 1 16 11 15 13 15 9 1 1 4 6 5 19 11 12 1 1 1 | 20- 49 50- 69 70- 79 80- 89 90- 99 61 55 46 7 1 100 109 110-129 -. 130 139 140+ Totals 74 97 81 59 1 1 | 313 MALES Intelligence Quotient Age-group (Years) Total 1-4 5-9 10-14 15-19 20-24 1 1 25-29 | 30-34 1 35-39 40+ 0- 19 20- 49 2 4 11 14 11 12 17 11 1 1 14 24 25 34 40 44 35 2 2 13 20 38 42 39 26 5 1 5 5 6 16 14 13 14 1 1 3 23 50- 69 53 70 79 80- 89 99 90- 99 109 100-109 114 110-129 86 130-139 g 140+ _ 3 Totals 83 221 184 73 1 1 M 206 MENTAL HEALTH SERVICES REPORT, 1954-55 SOCIAL SERVICE DEPARTMENT U. P. Byrne, Esq., M.D., D.P.H., D.I.H., Director, Child Guidance Clinics, 455 West Thirteenth Avenue, Vancouver 10, B.C. Sir,—The year 1954-55 has been a year of consolidation and expansion of the work of the Social Service Departments. In numbers of cases carried, the Victoria Clinic Department has continued to expand, while the Vancouver Clinic Department case load has decreased slightly due to space and staffing limitations, as noted below. However, in the preventive aspects of child guidance as well as in more efficient structuring of services, the Vancouver Social Service Department has expanded significantly. Staff Changes During the year there were four resignations—two staff members leaving for family reasons and two leaving for salary reasons, one going to a social casework teaching position and one going to a research position. Replacements were secured for three of these resignations, and the fourth replacement will be secured in April, 1955. In addition, two staff members were on educational leave—Mr. D. B. Ricketts undertook a third year of postgraduate study at Columbia University and Mrs. P. Coyle a second year of postgraduate study at the University of British Columbia. Both will be returning to the Clinic in June, 1955. Because of these staff changes, the Vancouver Clinic had to function with fourteen of the usual establishment of sixteen social workers. A change in the student-training project this year meant that only four students took their field-work training with the Clinic, whereas last year there were ten. Of this year's group, one has since come on staff at the Vancouver Clinic, one is applying for employment with the Mental Health Services, and one has accepted employment with the Tuberculosis and Venereal Disease Divisions of the Social Welfare Branch. The Victoria Clinic retained the same three staff members during the year. Changes in Department Structure in Vancouver Clinic During the year the Admission and Brief Services Section (intake section) was further structured to include a casework supervisor to be responsible for the administration of that Section and to be responsible for casework supervision of three social workers assigned to the Section. In the Continued Services Section the casework supervisor assumed similar administrative responsibilities plus supervision of six social workers. Preliminary review of this structuring indicates that a better ratio would be five intake workers to six continued-service workers. This would greatly facilitate a rapid intake study which, in turn, will facilitate more rapid diagnostic study by the complete team assigned to each case. In addition, it is hoped that more cases could be carried beyond the diagnostic study period for a limited number of interviews by the intake worker. At present the intake worker can only see the family for one or two interviews in addition to the diagnostic study period. This has meant that almost all cases requiring interviews, beyond the initial period, have had to go on a waiting-list for continued treatment. In these cases the intake worker retains responsibility for emergency services but does not initiate contact with the client during the waiting time. Of seventy-nine cases on the waiting-list and assigned during the fiscal year, eighteen closed at the point of assignment to Continued Services Section. This amounts to approximately 23 per cent, which is a somewhat lower figure than that of other clinics who have studied the effect of waiting-lists. The percentage is significant enough to speculate as to whether a planned brief service was indicated in these cases or as to whether a " spontaneous remission " was predictable following the diagnostic study. CHILD GUIDANCE CLINICS M 207 Increasing staff in the intake section would not only permit intake workers to carry brief-service cases, but also would tend to decrease the waiting time for initial interview. As of March 31st, 1955, there were twenty-six cases waiting assignment to intake workers for initial interviews. At the same time nineteen cases were waiting assignment to continued-service workers. Without additional space and staff, a waiting period will be necessary. But with present establishment, the most feasible plan appears to be that of avoiding a lengthy waiting period prior to initial interviews. Case-load Changes, Vancouver and Victoria Table 1 shows the continued increase in direct-service cases carried by the Victoria Clinic. The Vancouver Clinic direct-service cases appear to be decreasing. It should be noted that this is an artificial levelling-off because of the following reasons:— (a) Intake on direct-service cases was limited as much as possible to the Vancouver City area during the past year. Parents from Burnaby, Richmond, New Westminster, North Vancouver, and West Vancouver were referred, whenever possible, to their district Social Welfare Branch office or the social service department of their municipality. (b) Staff changes during the year meant a decrease in the case-carrying staff of the Social Service Department from eleven to nine. (c) The severe limitations of office interviewing space, coupled with the staff decrease, made it impossible to handle more cases, although the demands for service have not greatly diminished. All staff are eagerly awaiting the opening of the new building. Table 2 illustrates the increased casework activity on cases carried. For Victoria the increases shown are a result of the increase in direct-service cases carried. For Vancouver there are substantial increases shown in the number of conferences and consultations held to review plans and progress regarding direct-service cases. In addition, the number of periods of supervision per worker has shown a slight increase. These figures are a reflection of the increased activity of the casework supervisors who have been released to a great extent from their former case-carrying responsibilities. Changes in General Activities, Vancouver and Victoria Table 3 illustrates the further development of the total aspects of the professional social worker's job. In addition to case-carrying responsibilities, the Social Service Department has continued to increase its activities in other aspects of responsibility, such as consultative, programme and staff development, community education, community organization, and research. Much of this work has been handled through committees, some of which met out of office hours. Projects under way include revisions to recording methods to facilitate both operational research and research into effectiveness of services. With the new building, it is anticipated that more lectures, orientations, talks, etc., can be given by staff. It is hoped that more staff time can be devoted also to general community education to promote mental-health principles. Further time and effort could be devoted to the interpretive and preventive functions plus further time devoted to assisting in community planning for additional resources if additional staff were available. It seems apparent that the number of children requiring direct treatment will continue to increase beyond available facilities unless more personnel can be obtained to carry out preventive work before problems become acute. M 208 MENTAL HEALTH SERVICES REPORT, 1954-55 Indications for the Future The following recommendations are submitted for consideration:— (1) Establishment of a position of research-worker to carry out such projects as:— (a) Evaluation of services. As noted above, preliminary steps have been taken toward uniformity of recording. In addition, follow-up reports are being gathered on travelling clinic cases. (b) Evaluation of community resources needed by children examined by clinics. (c) Evaluation of lacks in parental relationships contributing to behaviour disorders, delinquency, mental illness, etc. (d) Evaluation of the needs for decentralized stationary clinics or further travelling clinics. (2) Establishment of a position of group worker to assist in a programme of group work and group therapy for those children and their parents who would benefit from group treatment. (3) Continuation of interagency meetings to discuss policy and referral procedures similar to the discussions held during the past six months with the family service agency of Vancouver. (4) Provision of more adequate salary ranges and opportunities for furthering programme and staff development through participation at professional conferences. As an adjunct to furthering the preventive aspects of clinic work, it is hoped that case loads in district offices, municipal welfare departments, and children's aid societies will gradually be reduced. Often a prompt, intensive service by the local agency can prevent development of more serious problems. Occasionally such cases are still referred to the Child Guidance Clinic solely on the basis of lack of worker or supervisory time on the part of the referring agency. In conclusion, may I express appreciation for your assistance during the past months. Statistical Tables Table 1.—Summary of Cases Given Services by Social Service Department, April 1st, 1954, to March 31st, 1955 1954-55 195: -54 Vancouver Victoria Vancouver Victoria Direct-service Cases Cases brought forward from previous fiscal year — 211 85 195 58 225 23 39 181 17 34 293 46 38 165 12 22 Total intake into case loads 287 232 377 199 Total cases carried in case loads1 4752 293 300 207 526 315 245 160 182 93 211 85 Indirect-service Cases 427 356 6 91 635 231 47 56 Total cases given service _ 1,258 397 1,392 348 1 Corrected for cases reopened during the year (minus 23 Vancouver, minus 17 Victoria). 2 Does not include cases waiting assignment to intake workers. CHILD GUIDANCE CLINICS M 209 Table 2- -Summary of Casework A ctivity on Cases Carried in Social Service Department, April 1st, 1954, to March 31st, 1955 1954-55 1953 -54 Vancouver Victoria Vancouver Victoria 6,306 75% 25% 980 51 163 73 495 704 2,514 59% 41% 183 1 46 31 196 74 7,473 69% 3t'. o ) 839 y ) 162 384 751 2,020 With adults 56% 44% Team conferences attended on direct-service cases—■ 151 Casework conferences— Internal 33 83 Periods of supervision 70 Table 3.—Summary of General Activities of Social Service Department, April 1st, 1954, to March 31st, 1955 Activity Totals Vancouver Victoria Average per Worker Vancouver Victoria Total cases carried— Direct-service cases Other agency cases _ Periods of supervision received3 — Programme and staff development committee meetings Meeting attendance per worker Orientations to clinic of outside professional personnel Talks, lectures, etc., to outside groups Community committee meetings regarding development of community resources _ 475 783 704 168 300 97 74 43 125 48 481 781 39 67 9 3 1002 33 2 25 43 2 2 1 Based on ten of fourteen workers actually carrying cases. - Based on three workers carrying cases. 3 For Vancouver, includes supervision periods of four students. Respectfully submitted. Robert W. Macdonald, B.A., B.S.W., Acting Supervisor. PSYCHOLOGY DEPARTMENT U. P. Byrne, Esq., M.D., D.P.H., D.I.H., Director, Child Guidance Clinic, 455 West Thirteenth Avenue, Vancouver 10, B.C. Sir,—The following is a report of the work of the Psychology Department of the Provincial Child Guidance Clinics from April lst, 1954, to March 31st, 1955. The appended table provides a summary of the quantitative aspects of our work which will serve as a basis of comparison with preceding years. Perhaps the most significant feature of this year's table is that it does not show any outstanding changes in the diagnostic aspects of our work. The optimistic interpretation that we have reached a point of stability within our present limits may justifiably be presented. This indication of stability reflects not only trends within our own setting, but within the field of psychological testing as a whole. For a time, each year saw an increasing number of tests M 210 MENTAL HEALTH SERVICES REPORT, 1954-55 available and a shifting from one to another in the clinicians' attempts to find the best possible instruments. Now we have reached a point where we are making more intensive and productive use of those tests which have proved valuable to us. One major factor in the changes from year to year has been the increasing use of projective techniques. During the past year there has been little change in the relative number of projective tests given, but this does not mean that we are making the best possible use of them. Rather, it reflects the fact that the number of tests given is limited both by the time-limits of our present diagnostic procedure, which allows tests like Rorschach and T.A.T. to be used with relatively few children, and by the lack of staff with the necessary high level of training. As anticipated in our last report, the table shows a marked increase in the total number of play interviews during this year. There has also been an increase in the number of children seen for treatment by this Department. Whereas, formerly, we considered our participation in the treatment programme mainly as a learning experience for staff, we now feel that we are also making a significant contribution in this area. During this year we have seen seventeen children on a weekly basis for play interviews. Seven of these cases were closed during the year, one was transferred to another department, and there were nine continuing at March 30th, 1955. The total number of interviews was over three times that of the preceding year. In addition to the use of play interviews in the treatment programme, there is an increase in their use as a part of the diagnostic procedure. Staff changes during the year include the resignation of Mrs. Robin Brown and Mrs. Marion Fitzpatrick and the appointments of Miss Ann Cameron, Mr. Herman Heil- bron, and Mrs. Beatrice Lipinski as psychological interns. Mrs. Dorothy Reeves, who was with this Department for over five years, has recently resigned and has left a vacancy at a senior level which has not been filled as applicants of sufficient training and experience are not available. There have been no staff changes in the Victoria Clinic. The development of the Department is apparent in spite of the ever-recurring changes in staff. Gains often appear to be lost through these changes, and although this is recognized as inevitable, a greater degree of permanence, particularly at the supervisory level, is imperative for the further growth of this Department. Our participation in the orientation programme continued, with an increase in the number of persons and groups seen. Four groups of medical students were given a brief survey of the work of this Department. Four lectures were given to groups of nurses at Essondale and one to the nursing class at the University of British Columbia. These lectures were followed by visits of small groups to the Vancouver Clinic, at which time they observed at least one psychological examination and its relation to the whole diagnostic process. Various members of the Psychology Department also contributed to case presentations to members of the education class at the University of British Columbia and to the graduate students in the School of Social Work. They also participated in educational programmes arranged by communities visited by the travelling clinic teams. This year five graduate students from the class in clinical psychology at the University of British Columbia each spent two half-days at the Vancouver Clinic, where a general orientation programme was planned for them, as well as an opportunity to observe clinical psychologists in action. In summary, the work of the past year shows some development in our contribution to the treatment programme and steady, although quantitatively unapparent, gains in our diagnostic work. Further growth will depend to a large extent on being able to secure staff at a high level of professional development with a greater possibility of permanence. 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GEO-: Ph- G n c u 9 c o 3 w ■^ to to & 3 nj H © 3! 3 *3 so = 81- c of. &o , 5 p c i US.S.' — o "* is J 0-3 g '-3 20^ „Sgl"S up_, « ■ .5 ti o ,a OJ to o 5p_ o r-> < T3 JO 3 o D a, tn I M 212 MENTAL HEALTH SERVICES REPORT, 1954-55 PART VII.—COLONY FARM REPORT OF BUSINESS MANAGER A. M. Gee, Esq., M.D., CM., Director of Mental Health Services, Essondale, B.C. Sir,—Submitted herewith please find profit and loss and other financial statements and reports covering the operation of Colony Farm for the fiscal year ended March 31st, 1955. Profit for the year, after providing for all operating costs, amounted to $110,481.99, as against $86,952.85 during 1953-54. This increase was due, in most part, to the greatly increased potato yield. The fruit and vegetable cannery also showed a sharp increase in profit while the orchard and truck-gardens and hog department reflected reduced profits due to lower prices. Plans were completed and tenders called for the construction of a new equipment- shed required for the storage of farm equipment. The outside of nearly all the Colony Farm buildings was painted during the year. The Colony Farm purchased a flock of Dorset sheep from the Dominion Experimental Farm, Agassiz. This flock of sheep will be used as a means of controlling the growth on the dykes and will also provide the institution with a certain amount of lamb and mutton. I am pleased to again report that the Colony Farm exhibit of cattle and sheep at the Pacific National Exhibition in Vancouver made a very creditable showing considering the keen competition. The cattle won six first prizes, five second prizes, six third prizes, and many other lesser prizes. In addition, they also won both the junior and reserve junior championships for females. In the sheep section the Colony Farm Dorsets won two first prizes, three second prizes, one third prize, and four fourth prizes. In addition, they also won the prize for the best aged flock and the reserve champion ram prize. FINANCIAL REPORT PROFIT AND LOSS ACCOUNT FOR THE YEAR ENDED MARCH 31st, 1955 Department Debits Credits Loss Gain $163,961.45 19,667.72 4,393.83 63,391.70 33,328.57 89,938.22 4,450.05 73,569.19 25,420.08 $231,187.68 20,906.50 4,570.00 102,338.66 48,667.77 108,413.58 4,855.34 156.20 67,507.07 $67,226.23 1,238.78 176.17 38,946 96 15,339.20 Hogs 18,475.36 405.29 73,412.99 Field Crops and Pasturage 42,086.99 $478,120.81 $588,602.80 $73,412.99 $183,894.98 73,412.99 $110,481 99 COLONY FARM DAIRY AND HERDS DEPARTMENT Profit and Loss Account, March 31st, 1955 Receipts By sales— Live animals . . . . $13,305.64 8,804.94 . 208,174.60 3,350.00 98,815.00 M 213 $332,450.18 265,223.95 Beef supplied to institutions _ . . Dairy produce and pasteurizing .... Expenses Salaries and upkeep $76,032.30 87,246.65 827.50 1,700.00 99,417.50 Trucking __ _ Tractor work _. . . . Inventory, March 31st, 1954 . Profit .. $67,226.23 $20,530.00 376.50 TRACTORS Profit and Loss Account, March 31st, 1955 10,265 hours'work at $2 . $20,906.50 19,667.72 \\25lA hours' work at $3 Expenses Salaries and upkeep . $18,436.27 1,231.45 Gasoline and oil .. . . Profit $1,238.78 TRUCKS Profit and Loss Account, March 3 1st, 1955 1,828 hours' work at $2.50 $4,570.00 4,393.83 Expenses Salaries and upkeep $3,992.83 401.00 Gasoline and oil Profit $176.17 M 214 MENTAL HEALTH SERVICES REPORT, 1954-55 Supplies to Government institutions . Salaries Repairs CANNERY Profit and Loss Account, March 31st, 1955 Receipts Fruit Sugar and spice Crates and cans Truck work Tractor work _... Fuel Water Light and power Sundry expense __ Expenses $102,338.66 $4,644.50 358.19 33,783.28 8,665.03 12,419.01 557.50 50.00 1,300.00 400.00 1,200.00 14.19 Profit 63,391.70 $38,946.96 Produce supplied to— Mental Hospital, Essondale Crease Clinic Boys' Industrial School ORCHARD AND TRUCK-GARDEN Profit and Loss Account, March 31st, 1955 Receipts Home for Aged, Port Coquitlam . Colony Farm Cannery Inventory, March 31st, 1955 Salaries, seeds, etc. Expenses $37,209.27 63.00 373.11 21.00 1,450.39 $39,116.77 9,551.00 $18,658.27 Tractor work 3,000.00 Fuel 50.00 Manure 1,500.00 Inventory, March 31st, 1954. Profit $23,208.27 10,120.30 $48,667.77 33,328.57 $15,339.20 COLONY FARM M 215 HOG DEPARTMENT Profit and Loss Account, March 31st, Receipts By sales— 1955 $3,528.05 75,554.53 $79,082.58 650.00 By credit for manure __ __ _ Inventory, March 31st, 1954 ... ... . . 28,681.00 $15,356.76 365.00 826.00 _ 44,282.46 200.00 200.00 800.00 Expenses Salaries and upkeep $108,413.58 Truck Tractor — - - Feed Fuel .... Water .... Light and power . . Inventory, March 31st, 1954 $62,030.22 27,908.00 89,938.22 Profit $18,475.36 SHEEP DEPARTMENT Profit and Loss Account, March 3 1st, 1955 Receipts By sales—- Live sheep $450.50 Mutton to Essondale Hospital 817.84 Inventory, March 31st, 1954 3,587.00 Expenses $4,855.34 Salaries and upkeep _ $1,470.05 Truck 45.00 Pasturage and feed .... 373.00 $1,888.05 .... 2,562.00 4,450.05 Profit .. $405.29 GENERAL EXPENSES OF MAINTENANCE AND ADMINISTRATION Profit and Loss Account, March 31st, 1955 Salaries and miscellaneous expenses Farm drainage Truck work Tractor work Gasoline and oil Sundries Loss on inventory of equipment Proportion, Headquarters expense Repairs through Public Works Department $28,511.67 2,310.91 945.00 2,104.00 144.40 206.00 2,929.66 $2,100.00 34,161.35 $37,151.64 36,261.35 $73,412.99 M 216 MENTAL HEALTH SERVICES REPORT, 1954-55 FIELD CROPS AND PASTURAGE Profit and Loss Account, March 31st, 1955 Crop Acreage Yield (Tons) Acre Value Potatoes 65.5 968.40 14.80 $48,398.18 Turnips 4,0 74.60 18.65 3,886.54 Hay 38.0 82.00 2.16 1,968.00 Ensilage . 171.0 1,580.70 9.24 7,903.50 Pasturage .... 267.0 2,670.00 Onions 3.0 24.74 8.25 2,523.85 Mangels 4.0 15.70 3.92 157.00 $67,507.07 Expenses Supervision $1,890.00 Tractor work 13,098.00 Truck work — 1,830.00 Seeds and sets 4,188.08 Fertilizer and spray 1,733.80 Manure 2,500.00 Sundries 180.20 25,420.08 Profit $42,086.99 MISCELLANEOUS STATEMENTS, INVENTORIES, ETC. Produce and Services Supplied by Colony Farm for Year Ended March 31st, 1955 Mental Hospital, Essondale Dairy produce— Milk, 61,9871/4 gal. $46,490.33 Cream, 164*6 qt 176.80 Table cream, 2,960*/2 gal. 9,177.14 Skim milk, 909*4 qt 127.33 Pasteurizing of purchased milk 25,663.00 Meats— Beef and veal, 41,245 lb $12,895.41 Hearts, livers, etc., 1,250*4 lb. 410.23 Fresh pork, 229,911 lb. 74,837.20 Pork plucks, 3,725*4 lb 717.33 Mutton and lamb, 2,374 lb 806.16 Mutton plucks, 64% lb 11.68 $81,634.60 89,678.01 Fruits and vegetables— Fresh $87,511.46 Canned 94,850.73 182,362.19 $353,674.80 The Woodlands School Dairy produce— Milk, 33,400 gal. $25,050.00 Cream, 101 qt. 108.57 Table cream, 738*4 gal. 5,389.33 Skim-milk, 3,120 gal. 1,248.00 Pasteurizing of purchased milk 13,758.00 $45,553.90 COLONY FARM Crease Clinic Dairy produce—■ Milk, 30,346 gal. Cream, 299 qt. Table cream, 1,890*4 gal. Skim-milk, 94*4 qt. M 217 $22,759.50 321.41 5,860.55 13.23 $28,954.69 Home for the Aged, Port Coquitlam Dairy produce— Milk, 39,325 gal. $29,493.75 Cream, 64*4 qt. Table cream, 980% gal. Dairy produce— Milk, 11,435 gal. Cream, 60 qt. Table cream, 87% gal. Boys' Industrial School Fruit and vegetables Tractor work Fruits and vegetables— Fresh Canned Mental Home, Colquitz Accounts Receivable, March 31st, 1955 Sundry amounts due from live stock, etc., sold 69.31 3,040.71 $32,603.77 $8,576.25 64.48 272.00 $8,912.73 1,053.78 73.50 $10,040.01 $262.50 6,351.13 $6,613.63 $773.04 Remittances to Treasury Sundry remittances to Treasury during year 1954-55 in payment of live stock and produce $490,477.78 Equipment in dairy .. Equipment in cannery __ Cattle-barns and piggery Farm implements Summary of Equipment Inventories, March 31st, 1955 Pumping-stations and land-clearing Carpenter-shop Blacksmith-shop Tools and implements, The Woodlands School $24,416.55 8,758.97 1,959.50 27,600.90 2,302.00 1,090.97 694.25 3,420.00 $70,243.14 M 218 MENTAL HEALTH SERVICES REPORT, 1954-55 Orchard and Truck-garden Plum-trees $1,148.00 Prune-trees 1,600.00 Pear-trees . 973.00 Apple-trees 343.00 Cherry-trees 294.00 Rhubarb-clumps 750.00 Garden tools and equipment 4,443.00 $9,551.00 Respectfully submitted. F. A. Matheson, Business Manager. VICTORIA, B.C. Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty 1955 520-1155-7759 """@en ; edm:hasType "Legislative proceedings"@en ; dcterms:identifier "J110.L5 S7"@en, "1956_V02_07_M1_M218"@en ; edm:isShownAt "10.14288/1.0348913"@en ; dcterms:language "English"@en ; edm:provider "Vancouver : University of British Columbia Library"@en ; dcterms:publisher "Victoria, BC : Government Printer"@en ; dcterms:rights "Images provided for research and reference use only. For permission to publish, copy or otherwise distribute these images please contact the Legislative Library of British Columbia"@en ; dcterms:source "Original Format: Legislative Assembly of British Columbia. Library. Sessional Papers of the Province of British Columbia"@en ; dcterms:title "Mental Health Services PROVINCE OF BRITISH COLUMBIA ANNUAL REPORT FOR TWELVE MONTHS ENDED MARCH 31ST 1955"@en ; dcterms:type "Text"@en ; dcterms:description ""@en .