Schizophrenia Society of Nova Scotia: 150 years of healing, serving

An article published in today's edition of The Chronicle Herald:

The Nova Scotia Hospital marks a century and a half of helping patients with mental illness

By John Gillis, Health Reporter

WHEN IT WAS OPENED, the vast Mount Hope Hospital stood on the Dartmouth waterfront off Asylum Road.

Today that route is called Pleasant Street and the Nova Scotia Hospital is a collection of smaller but still imposing buildings. The site will remain a centre of psychiatric care, but years from now a passerby might be hard-pressed to imagine its institutional past.

The first patient was admitted to what was then known as a lunatic asylum 150 years ago today, A.H. MacDonald notes in his Mount Hope Then and Now: A History of the Nova Scotia Hospital.

The evolution of the facility reflects the history of modern psychiatry, Dr. Nick Delva, chief of psychiatry for the Capital district health authority, said in the hospital’s health sciences library recently.

The original hospital, the first of its kind in Nova Scotia, was founded by former Halifax mayor Hugh Bell [pictured], whose push for such a facility was backed by American advocate Dorothea Dix.

It was mainly a place to hold people with mental illnesses, rather than treat them, Dr. Delva said. A stay of two years would have been considered a short one.

He said the approach to the care of patients would likely have been centred on the idea of healthy living.

The hospital was deliberately located away from busy Halifax. Patients would be given good food and treated humanely. The hospital operated a farm across the road, partly so that it would be self-sustaining and also to give able patients an occupation.

A minority of patients would fare well enough to be discharged.

"Through just the natural courses of the illnesses, people would recover," Dr. Delva said, noting people with depression and even acute psychoses may go through cycles or "burn themselves out."

An 1876 hospital record book notes reasons for admission, including intemperance, "change of life" for a 47-year-old woman, sunstroke and measles.

Other people who would clearly be recognized as having mental illnesses today might never have seen the hospital in those days, said Dr. Alistair Munro, who worked at the Nova Scotia Hospital from 1983 to 1999 and is a former chief of psychiatry.

"Insanity was a disgrace," he said. Many people would have been kept at home, despite their illnesses, to avoid shaming their families.

There would have been some drugs available to treat mental illnesses at that time, but the fact the brain is a collection of separate cells — fundamental to current therapies — was not known until the turn of the 20th century.

The hospital grew in size, eventually holding more than 700 people. In 1918, 270 people were admitted, bringing the number under care to 746.

A letter from that year describes a patient of Dr. Lewis Thomas:

"This is to certify that Miss Mary O went insane in 1918 and died at the Nova Scotia Hospital Nov. 18, 1918. I first began to treat her on Feb. 6 for nervousness. This nervousness gradually developed into insanity. I consider that the explosion of Dec. 6, 1917 [pictured], had a good deal to do in causing this mental condition to develop."

There were major advances in the 20th century in the drugs available to treat mental illnesses, helping to drive a major shift in the approach to care.

"The expectation is that most people will live in a non-institutional setting," Dr. Delva said.

Several smaller buildings were constructed on the hospital grounds and the large original Mount Hope building eventually came down.

Those newer buildings are also destined to come down. Simpson Hall, built in 1964 as a residence for students of the hospital’s long-running nurse training program, will be demolished in the coming year to make way for four 10-bedroom houses for people getting ready to live in the community.

Plans are for the 50-year-old red-brick Purdy building, itself a waterfront icon, to fall in time.

In mid-December, there were a total of 116 in-patients at Nova Scotia Hospital buildings.

Among the artifacts on display in the library is a 1950s-era electro-convulsive therapy machine. So-called "shock treatments" may be thought of as outmoded, thanks in part to our "cultural memory" of the therapy gleaned from sources like the Oscar-winning film One Flew Over the Cuckoo’s Nest, Dr. Munro said.

He called the 1975 film, based on a 1962 novel, "dishonest," depicting conditions and approaches that were already very dated by that time.

Electro-convulsive therapy is still a treatment given at the Nova Scotia Hospital, but it’s a far cry from the punitive and traumatic treatment many might imagine. Dr. Delva said all kinds of medical evidence supports its effectiveness in treating persistent depression. It’s given under anesthetic and patients receive muscle relaxants that eliminate violent seizures. Dr. Delva said a person can’t drive home afterward because of the anesthetic but otherwise should have no physical effects.

A majority of mental issues are now handled by family doctors in co-operation with a variety of other health practitioners.

Some psychiatric patients still spend long periods in hospital. Some are seniors with dementia, some have intellectual disabilities as well as psychiatric illnesses and there are rehabilitation services for people who need significant help getting ready to live in the community.

Between those people whose illnesses can be managed by family doctors and those who require long hospitalization are a group of patients who need a complex system of care, Dr. Delva said.

Many can still live in the community with supports and medications, though for people whose illnesses impair their understanding of how well or sick they are, contact from mental health care providers sometimes needs to be assertive.

"That means you’ve got to get out there, be their memory, be their support," Dr. Delva said. "Those are people that would have been in institutional settings for sure their whole life in the olden days."

Today, mental illness may not always be viewed as the social disgrace it once was, but a real stigma remains.

Dr. Munro attributes much of that to the terrible conditions and failure to help patients in underfunded and overcrowded psychiatric hospitals of the middle part of the 20th century.

Dr. Munro and Dr. Delva agreed funding for mental health care is still not where it needs to be. But Dr. Delva said he’s optimistic Nova Scotia is moving in the right direction.

"Good care, good facilities will remove the stigma," he said.