management’ which entreats people to direct their own care, but above all comply with their pharmaceutical routines. These two things together- the shrinking social welfare state and the neo-liberal discourses of self-management converge to undermine any theoretical intervention which might lead to a more truly progressive notion of recovery and liberation. Also, people’s experiences of institutionalization and their needs and desires post-institutionalization are rarely taken into account in these discussions.
1. De-institutionalization in the Context of Mental Health Reform
The transfer of people with serious mental illnesses from large psychiatric hospitals to various tertiary and supportive living arrangements in the community, continues to shape policy and care for people with the most serious and chronic forms of mental illness in the regional health authorities. While only a small population, people suffering from serious mental illness capture a substantial proportion of mental health care budgets. Thus, especially in times of restructuring, deinstitutionalization garners significant attention.
The 1998 BC Mental Health Plan called for regional self-sufficiency in mental health care through the devolution of tertiary resources from Riverview, BC’s only large provincial psychiatric hospital. The final phase of the Riverview redevelopment process began in 2000 and involves relocating approximately 800 of Riverview’s remaining occupants to cities and towns throughout BC. As of September 2007, 389 replacement beds have been established in BC to house former Riverview residents. At the end of the deinstitutionalization process there will be 400-500 replacement beds in the Lower Mainland and 380-415 in the rest of BC.
2. Madness and Citizenship in a ‘Post’ Institutional Age
The psychiatric deinstitutionalization movement of the 60’s was widely criticized for moving people with mental illness out of psychiatric institutions and into an unprepared ‘community’ which lacked the resources to provide support to these individuals. The deinstitutionalization movement coincided with the emergence of a ‘recovery’ paradigm in mental health that held that people with mental illness could integrate into the community and live fulfilling lives. The patronizing tenor of some of this discourse, notwithstanding, deinstitutionalization held out the promise of a new approach to mental illness – one that would ‘return’ individuals to citizenship and independent lives. Since this time, deinstitutionalization in the Canadian context has continued to unfold but with new resources and new models of care in place. Through the stories of individuals who have recently left Riverview Psychiatric Hospital in BC this presentation will explore the meaning of citizenship for people with mental illness in this ‘post’- institutional time.
3. Is it really PSR?
Custodial care models are being replaced with psycho-social rehabilitation models of care (PSR). These “new” models of care have been lauded by the government, policy makers and those overseeing and implementing the changes as ‘visionary’. Indeed, preliminary findings from a tracking study of patients suggest that individuals’ quality of life has generally improved in the new facilities. Our findings identified