Deinstitutionalization in the most literal sense involved the massive depopulation of psychiatric hospitals and institutions for intellectually disabled people, often called training schools, across the country. This maneuver had a rippling effect across many sectors of society, including the economy, workforce, public health and education, human rights and, most obviously, mental health care treatment facilities. Downsizing and eventually closing mental hospitals and training schools, formerly designed as asylums, psychiatric facilities and homes for the ‘feebleminded’, was not simply an activity that was confined to the mental health system, nor did it exclusively affect former patients and their families. The changes wrought by deinstitutionalization were far-reaching for their impact on the Canadian economy and on human rights discourses, particularly those that hinged upon ideals of ability, disability, health, and illness.
In Alberta, the majority of people who had been sterilized had also been institutionalized, meaning that deinstitutionalization affected large numbers of people who had long been segregated from mainstream society for eugenic reasons. Many of these people had lived most of their lives in institutions where they had little to no privacy and were constantly under surveillance by hospital staff. The move into the community represented a new degree of freedom, but it also introduced several new challenges. Moreover, moving out of one institution did not necessarily mean that people left institutions all together, as some people were relocated to nursing homes, jails, or quasi-institutional spaces, including boarding houses. Therefore, while the historical concept of deinstitutionalization usually pertains to the trend beginning in the 1960s to move people into the community from long-stay medical facilities, it does not necessarily mean that they were moved into independent living quarters.
The idea of caring for people in institutional settings emerged in the late 18th century, and was promoted chiefly by philanthropists, not medical authorities. They argued that people considered mad, lunatic, or disabled should be segregated from society for their own good, so that they could rest and be rehabilitated in private facilities far from the noise and chaos of urban spaces. The earliest institutions were modeled on spas, or retreats, and strategically located in rural regions where patrons could relax and be cared for by engaging in simple activities such as gardening, sewing, cleaning, and other gender-specific tasks. By the mid-19th century these retreats were largely being taken over by psychiatrists and lunacy and disability were increasingly medicalized ailments requiring treatment and intervention and not simply rest. Over time, these institutions also became more specialized and began dividing their populations according to categories of disease, disorder, or disability.
Over the course of the twentieth century, psychiatric institutions and training schools for people with developmental and intellectual disabilities began showing their age as residents grew increasingly accustomed to the rhythms of institutional life but showed few signs of progress towards rehabilitation or reintegration into mainstream society. Stories of overcrowded asylums repeated across the continent and mental hygiene surveys routinely reported on the unsavoury conditions faced by patients and staff alike in an under-funded and overcrowded system where these institutions appeared to warehouse the detritus of society.
The process of closing asylums was multi-faceted and had a combination of economic, political, cultural, and medical triggers. American historian Gerald Grob, one of the leading scholars on the history of mental health care policy in the United States, argued that there were several distinct factors that culminated in what became a transnational phenomenon called ‘deinstitutionalization’. He suggested that psychotropic medications and changes within the professional landscape of psychiatry, including a shift towards more private practice and an increased reliance on general practitioners; more federal funding for intensive research programs into mental disorders; a changing politico-economic climate that coincided with the dismantling of the welfare state; and the rise of human rights and humanitarian campaigns, including those leveling critiques at the plight of institutionalized individuals, were critical ingredients in the history of deinstitutionalization.
On the social horizon, for example, amid the momentum of civil rights, feminism and gay and lesbian rights movements, activists began campaigning for patients’ rights and their place in the human rights discourse. Disability rights activists engaged in aggressive campaigns for better access to services, while psychiatric patients and their families began lobbying for anti-stigma campaigns, alongside demands for adequate housing, basic health services, voting rights, and access to safe employment. Some of these campaigns were both fuelled by and gave inspiration to a set of intellectual critiques that questioned the way that mental disorders were understood and treated, many of which leveled their criticisms at the asylum itself. By this time, institutions were also under scrutiny for having been the sites of human experimentation, eugenics, and a series of abuses. Allegations and court challenges brought critical attention to these places as sites of unethical conduct.
Deinstitutionalization was not an event, but instead a process, which varied substantially in each province or state, and had considerably different results for the individuals concerned. Some studies concluded that the term deinstitutionalization was misleading; ‘transinstitutionalization’ better suited the reality faced by people who left long-stay hospitals only to later be admitted, albeit in shorter stints, to a variety of hospital-based facilities, including nursing homes, emergency rooms, and for some, penitentiaries. The institution, then, had not disappeared, but had transformed into a new era of service delivery that relied on a more individualized and client-oriented series of services. The onus had shifted from the state and medical authorities to consumers, patients, and families who needed to navigate the contours of a patchwork of services, supports, and gaps in a modern health system. All provinces in Canada engaged in the process of reducing long-stay residential populations, or deinstitutionalization. Some provinces, such as Saskatchewan, adopted the approach quickly and moved patients out of hospitals aggressively. Between 1975 and 1980, 62% of the closures associated with this strategy took place across Canada. Alberta, took a more gradual approach, but similarly engaged in the transnational trend towards moving individuals out of long-stay health facilities, which especially affected young and middle-aged patients. Elderly patients were also moved out of the long-stay mental health facilities, and many of these individuals were transferred to old age homes.
In Alberta, for example, the Michener Centre, formerly the Provincial Training School for Mental Defectives in Red Deer, Alberta, was home to 2,300 residents, but by 1977 the numbers had dropped to 1,800. Some of those numbers were explained by the establishment of new facilities, including the Deerhome institution for adult and elderly patients, which had been established in 1958. However, many former residents were released into the surrounding communities, including Red Deer. Michener had been one of the main sites for the provincial eugenics program.
One example of an individualized experience comes from Doreen Befus who had lived in institutions for over forty years; first in the Michener Centre and later in Deerhome. Doreen had been sterilized as a teenager living in Michener and had not been told about the operation. In 1976, at the age of 49, having lived in institutions for 42 years, Doreen was released into Red Deer, whose population was then just over 30,000. At first she lived semi-independently in a group home with the help of social services, which included regular contact with a social worker and a variety of public supports. Three months later, Doreen struck out on her own for the first time in her life, renting a one-bedroom basement apartment, supported through a combination of provincial and federal programs for adults with disabilities. She commemorated this moment in her diary with a tiny cutting of the classified ad that described her new accommodations: “1 bedroom suite, refrigerator, stove, includes heat, $290/month.”
Her move triggered a dramatic set of changes in Doreen’s life, not the least of which included living on her own, paying her own bills, becoming an active member in her church, securing appropriate employment, maintaining her social services appointments, cooking, cleaning, and assuming a host of responsibilities. She was familiar with some of these activities, having participated in cooking and cleaning at the provincial institutions as a trainee. Managing money, however, had only ever been an exercise within the protective walls of the institution, whereas taking public transit, making appointments with social workers, doctors, psychiatrists, and others had never been part of the closely monitored functions of the institution. On the outside, life was very different and people like Doreen who had spent their entire lives within a carefully structured and supervised environment carried many of their institutionalized habits into the community. In a cruel irony, she was gainfully employed as a nanny and a caregiver for children in the community, though she had been sterilized out of concern that she was unfit to be a parent. She worked hard in her community to draw attention to the rights of people with disabilities, including the right to become parents and to live independently, two critical features that were routinely restricted to people who had been confined to institutions.
Dyck, Erika. (2013). Facing eugenics: reproduction, sterilization, and the politics of choice. Toronto, ON: University of Toronto Press. Chapter 5.
Grob, Gerald. (1997). “Deinstitutionalization: the illusion of policy,” Journal of Policy History, 9(1), 48-73.
Grob, Gerald. (1991). From asylum to community: mental health policy in modern America. Princeton, NJ: Princeton University Press.
Simmons, Harvey. (1982). From asylum to welfare. National Institute on Mental Retardation.
Sealy, Patricia, Whitehead Paul. (2004). “Forty years of deinstitutionalization of psychiatric services in Canada: An Empirical Assessment.” Canadian Journal of Psychiatry, 49(4), 249-257.