Riverview Hospital (Coquitlam) - Riverview Hospital

Riverview Hospital was a Canadian mental health facility located in Coquitlam, British Columbia. It operated under the governance of BC Mental Health & Addiction Services when it closed in July 2012. In December 2015, the provincial government announced plans to begin construction in 2017 to replace the obsolete buildings with new mental health facilities scheduled to open in about 2019.

At one time Riverview Hospital was known as Essondale Hospital, for Dr. Henry Esson Young (1862-1939) who played an important role in establishing the facility. The neighbourhood where the hospital is located also became known as the Essondale neighbourhood.

History

In 1876, Royal Hospital in Victoria was converted to British Columbia's first facility to house mentally ill patients. Due to overcrowding, Royal Hospital was closed and the patients moved to the new Provincial Asylum for the Insane in 1878. Again facing problems of overcrowding at the turn of the century, in 1904 the provincial government purchased 1,000 acres (400 ha) in then-rural Coquitlam for the construction of Riverview Hospital and the adjacent Colony Farm lands.

Patients were originally housed in temporary buildings, and in 1913 the building that would eventually be called West Lawn began treating the 300 most seriously ill male patients. The building was originally constructed to hold 480 patients. By the end of the year it housed 919. By this time, Colony Farm was producing over 700 tons of crops and 20,000 gallons of milk in a year, using mostly patient labour. British Columbia's first Provincial Botanist, John Davidson, established an arboretum, nursery and a botanical garden on the hospital lands, often with the assistance of patients as there was a belief in the therapeutic value. The botanical garden was moved to the new University of British Columbia in 1916, but the arboretum and nursery remained.

In 1924, the Acute Psychopathic Unit, later called Centre Lawn, opened. Then in 1930, the 675-bed Female Chronic Unit (later called East Lawn) opened due to overcrowding. The first phase of what would eventually be called the Crease Clinic, the Veteran's Unit opened in 1934, with the second phase opened in 1949, giving Riverview its most iconic building. Finally in 1955, the Tuberculosis Unit (now called North Lawn) opened, marking the peak of patient residence.

By 1956 the hospital had reached 4,306 patients up from 450 in 1913. In 1959 the charge of mental health services was transferred from the Provincial Secretary to the newly formed Department of Health Services. The transfer was followed by a transition from custodial care to the more active psychiatric care of patients. In 1967 Dr. Davidson resigned as Deputy Minister and was replaced by Dr F.G. Tucker, a resident physician of Essondale (Riverview) from 1953 who, in 1959, became the Clinical Director of the Crease Clinic.

A steady decline in beds and facilities started in the 1960s and continued up to 2004 at which point there were only 800 beds. It is said that the reason for the decreasing number was initially due to the introduction of anti-psychotic medications and the development of psychiatric units in acute care hospitals as well as a move toward outpatient care. As early as 1967 a decision had been made to downsize Riverview Hospital. The decision was first brought up officially on paper three years after the publication of the Mental Health Act of 1964 that intended to have mental health care be as readily available to the population as that of physical health. The two acts worked in conjunction so that by 1970 there were 17 Mental Health Centres in British Columbia, 12 of which had opened within the previous 4 years.

Decreases continued. In 1969 the Provincial Government appointed a committee to review the role of the Mental Health Branch of social services in British Columbia. The committee decided to further downsize Riverview in a stated plan to implement other community care centres. As further closures were being planned, legislation was also passed in 1969 that deemed Riverview an “open hospital” allowing private practitioners to send their patients to Riverview. A shift away from directors trained in psychiatry to administrative ones was marked. As services and beds at Riverview continuously decreased, while opening access of it through private practice, another official plan to entirely close Riverview Hospital was written in 1987: A Draft Plan to Replace Riverview Hospital.

Regional clinics began drawing patients from Riverview, and both advances in treatment and eventual cutbacks in funding resulted in fewer people receiving mental health care province-wide. In 1983, West Lawn closed and farming operations at Colony Farm were discontinued. In 1984, the provincial government sold 57 hectares (141 acres) of Riverview lands to Molnar Developments. Shortly afterward, this land was subdivided and became Riverview Heights, with about 250 single family homes. In 1985 an acute geriatric unit was opened at Riverview Hospital.

In 1988 management of the hospital was officially transferred from the directors to a board of provincially appointed trustees. The shift was an anticipated one, as the Report of the Mental Health Planning Survey of 1979 states: “What began as the sensible idea of using non-medical, trained administers for administrative tasks, has subtly become the use of untrained non-medical administrators, and a simultaneous denial of the psychiatrist's role in clinical leadership." The shift had been happening from the early 1960s and has been argued to be one of the reasons for the 1969 committee's decision to downsize Riverview and decrease funding. The board, as far less experienced in psychiatry than the original managers who held doctorates and who were trained psychiatrists, were again replaced in 1992 by another board without trustees that was said to give a broader representation of concerns including those of consumers [patients], businesses, and union and community agencies.

By 1990 the decision had officially been made to reduce Riverview to a 358 bed facility with the supposed intention of opening regional care facilities throughout the province as stated in the Mental Health Initiative.

In 1992 Listening: A Review of Riverview Report was published as an attempt to resolve the complaints of patients and their family members that had gone ignored for years. The report “emphasizes that a full assessment of patients' decision-making abilities and personal support network is necessary, and that a patient be notified and given an opportunity to object before an incapability certificate is completed”. The new rights of patients was implemented less than a decade before the hospital was entirely shut down. Also in 1992, the Crease Clinic closed.

By the year 2002 there were 800 beds in all of Riverview. In 2004 it was stated that by 2007, 400 new beds would open in other areas of British Columbia for mental health services but places and dates were never mentioned. Neither did the report state how many beds would be removed from Riverview. In 2005 the East Lawn building closed, in 2007 the North Lawn building was closed, and in 2012 the last patients were moved from Centre Lawn, and Riverview Hospital closed. Evidently the number of beds taken away and the number of beds stated to be implemented, and the smaller amount that were actually implemented do not even out to the amount of beds that were closed at Riverview.

Other buildings on Riverview Hospital grounds continued as mental health facilities. In 2005, the city's task force on the hospital lands rejected the idea of further housing on the lands and declared that the lands and buildings should be protected and remain as a mental health facility. In 2009, Riverview Hospital was added to the Canadian Register of Historic Places.

Other mental health facilities have been constructed on the Riverview grounds, the first being Connolly Lodge, which opened 1 March 2002; Cottonwood Lodge opened a few years later, and Cypress Lodge on 23 April 2010. Together these three lodges have beds for 64 patients. In addition, 12 Cottages are still in use for residential Patient care by the Forensic Hospital.

Implemented Units of Riverview Before Closure

Industrial Therapy Building

The Industrial Therapy Building was implemented in 1963 with a total cost of $505,000. Patients were assigned for instruction and training in a selected shop. The shops included: Cabinet, upholstery, furniture finishing, metal, printing, electronics, machine, mattresses, tailor, and shoemaking. It was said that the program was of use to the patients as they would need vocations when they were to resume life in the community. The shops were supposed to give them skills to work once discharged from the hospital.

Acute Geriatric Psychiatric Division

The Geriatric Psychiatry Division of Riverview Hospital was opened in 1985. A 26-bed Acute (temporary) Admissions Unit was opened. The division was intended to be the first stage of a larger implementation of geriatric services in psychiatry across British Columbia. The program focuses on social interaction and fast movement into the community and social situations.

Publications

Riverview Reminisces

Riverview Reminisces is a collection of stories and anecdotes from the staff of Riverview Hospital. The stories collected span from the first years of Riverview's existence to the last years prior to its closure. It was published in 1992. The following are example of the stories found in the book held at the Central Branch of the Vancouver Public Library.

"In 1872 the superintendent Mr. Sharpe “was accused of stealing the patients socks and drawers. He denied this, but when faced with proof he pleaded guilty to wearing their socks, but denied wearing their drawers. He still kept his job” (1).

“At one time there were 5000 patients, just in Riverview â€" not counting Valleyview or Forensic. There were 50 patients on each North Lawn ward. Ward North 3 had two beds in the washroom. There were 150 beds on F3. The beds were so tightly packed together that you had to push a bed out in order to make it, then push it back into line and move the next one” (9).

“When there were 125 patients to a ward the pills came up in ice cream pails [...] you'd take the plants out of the pot and underneath you'd find all these anti-convulsant pills the patients had hidden there. Funny thing, there didn't seem to be an increase in seizures either.” (ibid).

“We had a meeting with a patient and the Patient Advocate and the patient was told that she had the right to refuse medication. When we got back to the surgery we found the patient was due to have her two week, long-acting medication. She said, “I have the right to refuse.” I said, “We have the right to give you the injection.” She said “I have the right to refuse.” I could see this could go on like this for some time so I said, “We have the right to give the injection. Which cheek do you want it in, the left or the right?” She said the right cheek, so we did that.” (17').

“Requisition from Marg Wagner (East Lawn-Ward F3B) to David Davies, (then Admin. Assistant â€" Crease Unity.)

Service Required: Please paint the entire ward. It is presently badly chipped and marked and looks very dingy.

Reply from D Davies:

You are living in a fantasy world. Do you think that paint grows on trees? Have you priced a can of pain recently? Do you know the hourly rate for a journeyman painter nowadays? For goodness sake woman, be realistic! Have you seen my office lately? If any more paint or plaster peels off, I will be able to walk out without opening the door. If I can't get a paint job, what makes you think you can? I suppose you will be wanting wall-to-wall carpeting next. Where do you think this is, the Harrison Hotel? For your information, repainting is carried out according to a cyclical schedule. I believe F3B is due in about ten years. If you will settle in the meantime with a minor touch-up job, I believe you could get one at your local supervisors office. Don't phone me, I am busy in Hawaii for the next few weeks. Jan 16/86” (ibid).

“When I was on C3 we decided to try group therapy â€" this was before it was commonly done here. We chose the group and started discussions. They got some really good, free-flowing discussions going and there was this one little short stubby guy there who hadn't spoken for ten or twelve years. It wasn't that he couldn't speak, he just didn't. One day in the group he spoke. He just said a few words in a little squeaky voice, but he was making the attempt to talk. We were so pleased we brought this up at a ward rounds and it got the ward doctor all excited. He decided the patient would talk more and better if he had sodium amytal to relax him. They laid the patient on the bed, strapped him down and came at him with these needles and the poor guy was obviously scared out of his wits. As soon as the patient was sedated he began to fall asleep and I'll always remember the doctor slapping his face, yelling “Come on. Wake up. Talk!” He never did talk again” (49).

Mental Health Consultation Report: A Draft Plan to Replace Riverview

A Draft plan to Replace Riverview Hospital is a 1987 report that demonstrates the reasoning for closing Riverview Hospital, the intended community implementations of psychiatric services and the necessary transitional procedures (the majority of which were never seen).

The report states: “Implementation will involve redeveloping and reallocating existing resources applied at Riverview Hospital” (21). Riverview was to be reduced to a 550 medium/long term patient capacity from its then 1,306 with the resources being reallocated “elsewhere in the community” (ibid).

The process was said to constitute the following: 218 staff FTEs for case management/outpatient treatment duties, resulting in 4,360 additional units of care being available to the mental health system; 1,090 additional patient places for Community Support Programs (i.e., social/recreational and life skills/vocational); 310 additional residential care beds for mental health care divided between intermediate and special adult residential treatment facilities; 60 psychiatric acute care beds to be added to the general hospital system (ibid).

Implementation was suggested to be a two-stage process. The first stage was to include the development of community residential, day program, and case management/outpatient treatment resources around the province to reduce Riverview patient population to 550 over 3 years. Additional beds in general hospitals and testing of medium/long term inpatient units in urban areas were suggested to fall under the first stage. Further implementation of the medium/longer term care units was to take place following the three years so as to conjoin with the anticipated closure of Riverview five years from that date (ibid).

An orderly transitional period was deemed necessary for patients to be relocated to appropriate community settings with “sufficient mental health staff and programs to monitor, follow-up, and promote their readjustment outside the institution” (22).

The report emphasizes that implementation of the plan should be gradual and orderly with continuous monitoring to assure the system meets the needs of the mentally ill. It also repeats that there should be careful assessment and supervision of patients being transferred from Riverview Hospitalâ€"that any transfers should be based on clinical assessment and that proper discussion with family members must take place. (ibid).

Home and family care were strongly recommended in the report for geriatric patients.

In the sections titled “Summary of Recommendations” the first two recommendations enforce the role of the families to take care of the patients. The third emphasizes the role of volunteer programs to help the mentally ill. The role of a physician, i.e., G.P. was also suggested to become the primary person to treat mental illness. Suggestion 14 states that general community services should play an important role in aiding those with mental illness. Recommendation 25 also enforces the role of general practitioners and community psychiatrists (30).

As can be seen by the stated recommendations, extra finances were hoped to be avoided in the change. As well, the overall amount of finances given by the provincial government to psychiatric care was expected to decrease which is apparent in the report. Be that as it may, recommendations still distinctly states that “The current level of financial resources at Riverview Hospital should be available for treatment, rehabilitation, and support of the mentally ill people transferred to community-based facilities and programs” (22).

Despite financial cuts, many of the recommendations still enforce sufficient beds for the acutely mentally ill, proper assessment and supervision and sufficient education for the new careers to be offered as psychiatric care changes. Even more importantly recommendations 63 and 64 state that all programs must be in place prior to any reductions or adjustments to Riverview and that bridge funding between the psychiatric hospital and community programs must be available (32). The report, although subtly recommending a decrease in governmental financial aid for psychiatric services, repeatedly states that sufficient funding and proper care in transfers including previously implemented community resources and supervision by Riverview before and after discharge are crucial.

Aftermath of Riverview Closure: Problems and Reports on Solutions and Further Implementation of Community Resources

Information from Newspaper Articles: Printed and Online

In 1992 about 8,000 of the yearly emergency admissions to Vancouver's mental health facilities were people with both drug addictions and mental illnesses. The reason is stated that “Port Coquitlam's Riverview Hospital is being emptied, and the sick are being thrown to the coyotes”.

Joseph Noone, the clinical director psychiatrist-in-chief at Riverview in 1992 claimed that A Draft Plan to Replace Riverview Hospital had “magical faith that the Social Credit government would follow through on its promises to expand services in the community once they had downsized this hospital”. Noone claims that he was suspicious of the report since its publication. Noone also stated that 1,000 patients were brought in and shipped out of Riverview annually.

The 1990 “Mental Health Initiative” stated that the provincial government would invest $26 million in additional funding over the following 10 years. But only the first payment was initiated and in 1992, the second payment was 18 months overdue.

The Greater Vancouver Mental Health Services had only 115 full-time workers with over 4,000 patients in the same year. Ex-patients of Riverview were often left without help or financial aid which caused them to flock toward the Downtown Eastside of Vancouver.

Mark Smith, director of Triage, a shelter in Vancouver stated that “there is zero available housing for these people â€" not even flop houses”. He also says that much of the time, Riverview would try to discharge their patients right into the overnight shelter. He claims that the mass discharges were turning the Downtown Eastside of Vancouver into a mental health ghetto. He also mentioned that many of his clients that had recently been discharged from Riverview (mostly schizophrenics) would commit suicide shortly after discharge due to failure to properly medicate from lack of professional supervision.

Andrew Wan, a Kitsilano mental health worker stated that in 1992, the conditions of privately run boarding homes are often no better than others. The places are run-for-profit so they skim over expenses.

In 2013 the mayor of Maple Ridge stated he was concerned with the number of people with mental illness who were living on the street in the Lower Mainland. His council is pushing to re-open Riverview Hospital to help solve the problem.

On September 20, 2013, the BC Government rejected the recommendation of the Union of BC Mayors to re-instate Riverview Hospital. The reason the Governor gave was that re-institutionalization is not the solution to homelessness or drug addiction. Instead there is "a new set of problems we need to deal with" (September 27, 2013 qtd by Bev Gutray and Marina Morrow). Gaps in the community health care system are what need to be addressed (September 27, 2013 Gutray and Morrow).

Information from Official Documents: Reports and Press Releases

In 1994-95 expenditures on mental health services in BC were up by 34% over 1990-91. The BC government had invested the overdue money in the health care system.

In April, 1996 the Vancouver Management Resource Group stated that the Vancouver Health Board was in the process of developing a budget based on the assumption that decreases in Federal transfer payments would mean a status quo or reduced budget overall for 1996/1997”. The increased funding was very short-lived.

Optimistically, the same 1996 report stated that due to numerous media reports about the crisis in the current system that suggested the downsizing of Riverview was leading to unacceptable pressure on the rest of the system, the Riverview Board recommended, and the Ministry supported to stop further downsizing of Riverview inpatient beds until the system stabilized.

The press releases by the Provincial Health Services Authority indicated that conditions had improved seven years later. In 2003, three new mental health facilities had opened in Prince George, Kamloops and Victoria. Along with the new buildings 80 patients from Riverview were discharged. They did not indicate whether beds had been implemented for the patients who had already been discharged prior to the construction of the three new buildings that were immediately filled with then-Riverview patients.

In 2002 there were 800 beds at Riverview. The stakeholders meeting stated that by 2007 there would be 920 specialized mental health beds located in smaller hospitals throughout British Columbia but neither dates, places, nor names were given. No mention of sites opening in the city of Vancouver were mentioned either.

At the 2004 Stakeholders meeting, it was stated that there were 84 new beds in mental health housing facilities in British Columbia. From 2003 to 2004, 4 beds were officially written to have been added. At the same meeting it was stated that by 2007, over 400 newly developed mental health beds will open in the Vancouver Coastal and Fraser Health Authorities, a 520 bed decrease from what was stated the previous year. At the same meeting President of PHSA Mental Health Services Leslie Arnold stated “A comprehensive transition care plan, including input from family members, is developed from each RVH patient prior to transfer”.

References

External links

• Riverview Hospital clickable map and detailed building history
• Video: Riverview Past and Present