Policy Module

Module Takeaways

• Relate policy formation and implementation to the lived experience of service users and practitioners.
• Understand how colonial policy as enacted through the Indian Act has impacted the current material circumstances and mental health and wellbeing of Indigenous peoples
• Formulate an opinion about the history of deinstitutionalization which takes into account its impacts, both intended and unintended

Module Components

• Three sets of masks created by racialized young women that depict both their own experience with mental health experience and how they believe others perceive children and youth with mental health differences.
• Art and poetry expressing an Indigenous perspective on mental health and a context text explaining the link between colonialism, the Indian Act, and the messages expressed in this work.
• Historical documents and insider audio commentaries mapping out the development and ethos of community mental health in Canada
• Audio testimony, documents and researcher reflections on the difficult history of Greenacres, Ontario’s first purpose-built dementia care facility 
• One woman’s story of recovery from mental health difficulties, a contemporary account of community mental health by one of our expert colleagues
  
• Three skits by project community experts that explore past, present, and desired future of our mental health system

Module Assessment

Have your students write a 250-word letter as a progressive policy-maker of today acknowledging 3 essential lessons that they have learnt from the component(s) which they examined and propose a way to ensure that policy is both responsive and proactive. Address your letter to one of the following people featured in this module:

• Ya’Ya Heit
• Jayne Whyte
• Lucy Costa
• Ralph Buckley
• A resident of Greenacres
• A staff-person at Greenacres
• Margo Robinson
• Branwen Willow
• Cat Omura

Module Learning Lens

As governments change and priorities shift, so too do state policies and programs. There have been major new Canadian policy initiatives over the last fifty years that have aimed to improve the lives of individuals experiencing mental health difficulties. One such policy is deinstitutionalization–the closing down of long-stay institutions that provided treatment for mental health patients. This module considers the policies of deinstitutionalization and the impact of these policies on the lives of people receiving psychiatric services. It also includes recent research on Ontario’s first purpose-built dementia facility, created during this transitional time and an illustration of trans-institutionalization, a pattern of patient redistribution that is an often-unacknowledged result of deinstitutionalization. Nevertheless, it must be acknowledged that this whole history of the re-evaluation and evolution of mental health in Canada took place without consideration of the ongoing and damaging material, spiritual, and emotional impacts of colonialism in its many manifestations on the wellbeing of Indigenous peoples.

In the 1950s, the shift of care from large long-stay mental hospitals to a range of community-based arrangements began. Former institutional residents were discharged to live independently or the care of their families, or they were placed in group or nursing homes. At first blush, this appears to be a vastly better idea.  Why not house people in facilities designed for a few people rather than several hundred? Or why not support them to live independently, finding work and friends, and living as part of the broader community? These were the policy arguments and humanitarian ideals behind the move toward community living, presented in this module through original historical documents from the deinstitutionalization era.

However, as our community partners and others whose lives intersected with this historical evolution make clear, the on-the-ground perspective breaks sharply with the values professed by the new community mental health programs. Contemporary commentators “spoke back” to the historical documents that we shared with them, noting the limitations of the new system and expressing frustrated  hopes for healing. Our community experts talked about their problems accessing good care and insufficient support in reintegrating into society. Their list of the “structural determinants” of life with chronic mental health difficulties includes social isolation, poverty, long term unemployment, and difficulty accessing good housing.

How could such a well-intentioned policy have such devastating impacts? Learning about the original plans for community mental health care in Canada gives students planning a career in the field new perspectives on this challenging question. Studies suggest that people have suffered as a result of deinstitutionalization not necessarily because the policy was a bad idea, but because it wasn’t carried out well or fully resourced. In addition, research has demonstrated that policy initiatives that focus on one aspect of recovery for individuals, while failing to provide broader supports, can lead to unintended negative consequences for people living with mental health concerns.