Components: Toronto – Self-Guided

Three green gears working togetherComponents: Toronto – Self-Guided

Timing: 45 Minutes
Mode: In-class; Online

The following texts and sets of audio commentaries and primary historical documents allow students to investigate the ideas and policies behind deinstitutionalization in Ontario, with a particular focus on Toronto. These self-guided resources are well suited for flipped classroom use with an in-class or online discussion or learning activity.  Working in class or online, instructors and learners can select resources that suit the time available and a geographical and topical focus that is of interest.

Ask students to use the following themes to guide their exploration of these components:

  • Shift from institutional to community mental health
  • Economic and social marginalization
  • Relevance and impact of cost-reduction policies
  • Underdeveloped community mental health supports
  • Paternalism, power inequalities, professional hierarchies
  • Psychiatric survivor movement
  • Community engagement and input
  • Policy developed by service user 

head and shoulders photograph of Lucy Costa
Lucy Costa. Toronto advocate, activist and former service user.

An advocate with the client Empowerment Council at Toronto’s CAMH and a graduate student at Osgoode Law School, Lucy Costa is a former service user and a long-time patient advocate and community activist. Costa’s careful reflections on the three documents that we gave her remind us that the paternalism and power inequalities inherent in the asylum have lingered in public policy, even as the walls of the institutions dissolved.

In Ontario, deinstitutionalization led to the closure of almost 80% of psychiatric hospitals beds in the 1950s and 60s.  The push for change is evident in the first policy document for you to download and read Dr. C.A. Roberts’ 1963 Report on Ontario Mental Health Services Lucy Costa locates similar language in recent mental health reports and sets the 1963 document alongside the emergence of pharmacology as the dominant therapeutic and mental health legislation of the period. 


Fifteen years later, on the eve of the closure of Western Toronto’s Lakeshore Psychiatric Hospital, bureaucrats at the Queen Street Mental Health Centre (now CAMH) created a second policy document for you to download and read – a Fact Sheet detailing the institutional restructuring.  Focusing primarily on the fiscal aspects of the closure and the fate of current patients and staff, only two paragraphs in the 4-page memo speak to the shape and scope of future community mental health services.  Picking up on a mood of energy in the document, Lucy Costa notes that fiscal imperatives are reframed as positive policy changes, and inserts the story of an emerging psychiatric survivor movement, located just off-stage in downtown Toronto.


Toronto psychologist Dr. Reva Gerstein’s 1983 Mayor’s “Action” Task Force Report on Discharged Psychiatric Patients is a very different kind of policy document. Download and review these pages from The Gerstein Report.  In fact, because she had been a mental health practitioner for 30 years, Gerstein’s text can be read as a professional report card on the policy initiatives set out in the earlier Ontario documents.  Writing of the failure of community mental health services to allow former patients a life of dignity, Gerstein acknowledges that, “neither my former colleagues nor I ever fully appreciated the need for a comprehensive range of aftercare support services.”  Listen to Lucy Costa argue that we are still walking through the same mental health landscape today.