Commentary

 

Riverview Village aims to improve quality of life for mentally ill
Herschel Hardin, July 16, 2017.  This article first appeared in the Vancouver Sun.

Herschel Hardin is president of the Riverview Village Intentional Community Society.  

 

We fret about the future of the Riverview Lands as if they were an idyllic place fixed in time, where any change to the way we use the Lands, or any imaginative idea for them, is hard to countenance.

 

We should instead ask ourselves how the Lands can best be used to help those who suffer from serious mental illness - the historical legacy of Riverview - and take it from there. 

 

With that as our imperative, we're proposing, as the backbone of the Lands, an  "intentional community" in which those with serious mental illness, stabilized in acute and tertiary care, will live together with others without a mental illness in an integrated community purpose-built to help the seriously mentally ill flourish.

 

We've named the proposed community Riverview Village.  It's a new and innovative option for the future.

 

A little bit of clinical background will help to understand the rationale, because the introduction of anti-psychotics for those with schizophrenia has changed the paradigm from the days of the old Riverview Hospital. 

 

Before anti-psychotics, there was no satisfactory treatment for psychosis, with its delusions, hallucinations, often paranoia, and related symptoms like catatonia.   Anti-psychotics deal with these symptoms and in most cases stabilize people, after which they can be discharged from hospital.  It's why we no longer need a huge, institutional treatment complex on the Lands, with a correspondingly huge number of patients and staff.

 

What happens after discharge, though?  Anti-psychotics don't help reintegrate people into society or expand their horizons.  And, indeed, there's a whole other range of symptoms, ongoing chronic symptoms, that for many of those with schizophrenia pose great difficulty.  Profound loss of motivation often accompanies such illness ("avolition" it's called, in clinical language).  Poor social interactions are another difficulty, exacerbated for many by their having fallen ill in their late teens when social skills are usually developed.

 

Dampened feelings and responsiveness, trouble with rhythm and clarity of speech, slowed movement, and cognitive deficit can be other difficulties. 

 

These problems do not respond well to existing treatments.  Unlike anti-psychotics for psychotic symptoms, for example, there's currently no effective medication for them. Also, unlike acute-care treatment which is relatively brief, these challenges may last for the rest of people's lives.  Many people end up isolated and languish, with limited activities and seemingly bleak futures.  They are said to be "in the community," which sounds nice, but they're not "of the community." As long as they don't cause trouble, we may in fact not have any contact with them at all.

 

The intentional community we're proposing both recognizes and addresses this new paradigm, where anti-psychotics allow for deinstitutionalization but continuing chronic symptoms endure.

 

In the proposed community, those with a mental illness will establish real relationships with those without a mental illness, breaking their isolation. A community centre will anchor the village and a wide range of activities.  Meaningful work will be arranged for those who can manage it. An arts hub is proposed, with studios and retail shops, whereby the mentally ill can connect with artists and craftspeople, and where those with an aptitude become part of that artistic community and sell their work. Community facilitators will help bring people together and keep the community vibrant.

 

Most of all, the Village will give those with serious mental illness a true sense of belonging   It will bring the strength of community to bear, something already demonstrated in existing intentional communities with therapeutic objectives.

 

There will be critical clinical benefits as well from this community engagement and support.  Relapses - going through the "revolving door" in and out of acute care or the justice system - will be reduced, with economic savings as a bonus.  Acute and tertiary beds will be freed up, and also freed up by the increased access to housing. 

 

Keep in mind what the goal is here: to help those with serious and persistent mental illness contend with their residual chronic symptoms and achieve a better quality of life. 

 

Make no mistake, either, about how challenging those difficulties are and the degree of attention we should give to them.  Even if they're not dramatic and intrusive like psychosis, they're every bit as serious in their own way.   Dawn Velligan and Larry Alphs, two American specialists on the subject, remind us, in a clinical article in the Psychiatric Times, "it may be that the negative [chronic, enduring] symptoms of schizophrenia... contribute more to poor functional outcomes and quality of life for individuals with schizophrenia than do [psychotic] symptoms."

 

This is where the Riverview Lands offer a unique possibility - a community that those with a serious mental illness will be able to consider their own and where they will have the best chance to flourish.

 

 

Creating the common good in community

Michael Clague February 25, 2017.

Michael Clague is a former director of the Carnegie Community Centre, Vancouver and executive director of the Social Planning and Research Council of B.C., among many other things in a varied past. While at the Carnegie Centre he discovered the power of the arts for building community, and later went on to work with arts stakeholders in the Downtown Eastside, supporting residents' participation in the arts. His most recent book is called Staying True, Staying the Course: A Study of Ten Successful Community Service Organizations in British Columbia (1997-2008).

The redevelopment of the Riverview lands is a once-in-a-generation opportunity to make a significant statement about community and the values inherent in healthy communities. The proposal for a Riverview Village by the Riverview Village Intentional Community Society is an important example of these values: inclusion, respect, recognition, and contribution in a welcoming, supportive environment.

The Riverview Village idea is to create a community which recognizes and accepts that everyone of us faces challenges to our mental well-being over our life-time. Some much more so than others. In this proposal people living with mental illness and those not facing these conditions will live together as neighbours in active relationship with one another. People who are mentally well will move into Riverview knowing that they will be community-building with those with mental-health challenges. Undertaking neighbourhood projects together, looking out for one another, and the concomitant development in personal relations - these are what building a healthy community is all about.

Inclusion is not just about putting people of diverse backgrounds together in the same physical location. It is about setting up the conditions, expectations and incentives for people to positively engage with one another in mutual learning, in play, in mutual help and in contributing to community life. This is what good local citizenship is all about. As someone who has worked with and learned from people with mental illness, who has experienced family and friends so affected, I can attest to the value of this approach - creating the "common good" in community.

The common good is that which helps all to have a better life. Jean Vanier, 1998 Massey Lectures, Becoming Human.


A bold and valuable initiative that deserves all possible encouragement
Mike Jay, April 5, 2015.

Mike Jay is a UK writer and cultural historian, and author of a feature article on Geel, Belgium, "The Geel question," in aeon.co. His most recent book is This Way Madness Lies, Thames & Hudson, London and New York, 2016.

Therapeutic communities for those suffering from mental illness have a long and remarkable history. I have made a particular study of Geel, a town in Belgium which has taken the mentally unwell into the care of local families since medieval times. Its model was widely adopted across Europe in the nineteenth and twentieth centuries and remains a proud tradition today.

There is abundant evidence that being supported by a wider community is beneficial for many sufferers: in the old adage often quoted in Geel, 'care is cure'. The main problem, today more than ever, is finding those with the will, commitment and expertise to design and realise a community in which the mentally unwell can be accommodated.

Riverview Village proposes an 'intentional community' to which this goal would be integral. Such a community would offer great prospects to all involved. The seriously ill residents will be able to lead a life that would be impossible for them to sustain elsewhere, and which for many will be their best chance of fulfillment and happiness. Psychiatric and care services will be enriched with new therapeutic options, and the chance to develop groundbreaking models of care. The non-mentally ill residents will be residents and partners in a community brought together and bonded by its ethos of mutual support. This is a bold and valuable initiative that deserves all possible encouragement.