The Nova Scotia Hospital marks a century and a half of helping patients with mental illnessPhotograph of the Halifax Explosion from Wikipedia.
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.
From today's edition of The Chronicle Herald:By John Gillis, Health ReporterPhotograph of Cheryl Doiron courtesy of The Canadian Institute for Health Information.
Deputy minister makes rare appeal for public support
Nova Scotia’s deputy health minister called on mental health organizations and the public Friday to help her light a fire under politicians to do more to help people with mental illnesses.
In a passionate off-the-cuff speech at the opening of the Canadian Mental Health Association’s national conference in Dartmouth, Cheryl Doiron said her department has put more money into mental health services over the years, but spending has declined as a proportion of the overall health budget.
"It’s very hard to get it to be the primary issue, particularly for politicians who are making budget decisions . . . because they are not getting the same pressure about mental health as they get about cancer and coronary disease and diabetes," she said.
"We, working from the opportunity we have within government, organizations such as (the national association) and the Nova Scotia (association) and other groups, and all of us collectively need to be doing something much more significant to make this a burning bridge issue for decision makers."
Mental health spending accounts for just over 3.5 per cent of the $3.2-billion provincial health budget.
Ms. Doiron said the relatively small amount of funding for those services means the province is failing to provide "absolutely essential help" to children and others.
She gave the example of an adolescent mental health program at the IWK Health Centre. The in-patient treatment lasts 12 to 18 months. But the 13- to 19-year-olds who might benefit from the intensive program have to wait that long just to be admitted.
Ms. Doiron said she pleaded the case to cabinet and was able to secure extra funding of $1.5 million this year and about $2 million in subsequent years to expand to 18 beds from 12.
An enduring bias against people with mental illness means people are often reluctant to speak about their conditions, and society doesn’t know they should be treated just like people with physical ailments, Toronto psychiatrist David Goldbloom told the conference in his keynote address.
"I think one of the challenges around mental illness is that its unique properties include affecting our thinking, our moods and our behaviour: the very dimensions that define us as individuals," he said. "That makes it a lot tougher to separate the illness from the person."
And while growing numbers of people report in surveys that they have had direct experience with mental illness, either personally or through a friend or relative, the perception that people with mental illnesses are dangerous or violent has increased, Dr. Goldbloom said.
That attitude is exemplified by reporting on events such as the recent beheading of a passenger on a Greyhound bus and crime dramas like CSI and Law and Order, he said.
"The reality of mental illness, its mundane reality, is virtually never depicted," he said. "The same applies to the newspapers, because somebody recovering from mental illness or somebody simply making a great adaptation to mental illness is about as newsworthy as a plane landing safely at the airport."
Dr. Goldbloom said research shows that negative perceptions are formed very early, so young children should be a focus of efforts to erase stigmatization.
Workplaces should be another major target, he said.
Finding and keeping meaningful work goes a long way toward helping a person with mental illness develop a sense of self and social connections; mental illness is the leading cause of short-term disability keeping people out of the workforce, Dr. Goldbloom said.
The Mental Health Commission of Canada, of which he is vice-chairman, says mental illness drains $51 billion from the Canadian economy each year.
But there is hope that negative attitudes can be broken down, Dr. Goldbloom said.
He recalled that when he was an intern in the early 1980s, hospital staff were "terrified" of the gay men who appeared with symptoms of what was later identified as HIV/AIDS, only touching them with triple-gloved hands.
"Think of how far it has come in the ensuing 25 years," Dr. Goldbloom said. "It’s really an extraordinary social transformation. Mental illness has not come anywhere near as far as HIV."
But more public education still neededBy John Gillis, Health Reporter, and The Canadian Press
A new national survey shows Canadians’ attitudes toward mental illness are changing for the better, says the executive director of the Schizophrenia Society of Nova Scotia.
The report, released Monday by the Canadian Medical Association and based on an Ipsos Reid survey, shows 75 per cent of Canadians disagree with the idea that people with mental illnesses could "just snap out of it" if they really wanted to and an overwhelming majority believe mental illness requires treatment by a health professional, said Stephen Ayer.
"What this report says to me is . . . people are becoming educated," he said. "This is good news."
The results also indicate Canadians believe the diagnosis and treatment of mental illnesses is underfunded and should be on par with funds allotted to diseases like cancer and diabetes.
In 2006-07, Nova Scotia spent less than four per cent of its health budget on mental health.
Mr. Ayer said the report underlines the importance of educating young people about mental illnesses. He said half of people who develop a mental illness begin to have symptoms by age 14.
Medications that help people cope with and recover from mental illness began to appear in the 1960s.
"In the past, it’s always been that if you got a mental illness, you were basically doomed to an asylum," Mr. Ayer said. "But that’s no longer the case. People are starting to recognize that."
A release accompanying the Canadian Medical Association’s eighth annual National Report Card on Health Care focused on some of the more negative attitudes found in the survey, including that 46 per cent of Canadians think some people use the term mental illness as an excuse for bad behaviour.
Mr. Ayer called that question ambiguous, noting the responses were quite evenly spread across the scale used in the national survey.
Only half of those surveyed would tell friends or co-workers that they have a family member suffering from a mental illness. That compares to 72 per cent who would openly discuss a diagnosis of cancer in the family.
"This year’s report card shines a harsh, and frankly unflattering, light on the attitudes we Canadians have concerning mental health," said Dr. Brian Day, president of the Canadian Medical Association.
"In some ways, mental illness is the final frontier of socially acceptable discrimination.
"Can you imagine the public uproar if mental health was replaced with race, gender or religion?"
The survey also found troubling attitudes toward people with drug and alcohol addictions, with less than half of respondents believing addiction is a mental illness.
Only one in five would socialize with someone who has a drug or alcohol addiction and less than five per cent would hire someone who has a drug or alcohol addiction.
"These figures show clearly the insidious stigma still associated with mental health and mental illness," Dr. Day said in a statement released with the report card.
"These are the attitudes that have kept mental health on the outside for far too long."
The mental health results, from an Ipsos Reid online survey of 2,024 Canadian adults, are considered accurate within 2.2 percentage points.
The Canadian Mental Health Association’s national conference begins Friday in Dartmouth.
Dr. David Goldbloom, a Toronto psychiatrist and vice-chairman of the Mental Health Commission of Canada, will give the keynote address called Stigma and Mental Illness: Past, Present and Future.
