Herschel Hardin – June 18, 2001
One of the guiding principles of B.C.’s five-year plan for mental health, A Pathway to Hope, is innovation and a commitment to change. At least that’s what it says, page 31, over the signature of the minister of Mental Health and Addictions, Judy Darcy at the time.
But what lies behind successful social innovation, particularly when it comes to helping the seriously mentally ill?
In 2016, RVICS posted a study it did of seven different intentional communities, “Intentional communities with therapeutic or developmental objectives.” Two of them dealt with mental illness, two with those struggling with addiction, another two with developmental disabilities, and the seventh with Alzheimer’s. The communities covered were quite diverse – in time of origin, structure, size, kind of people being helped and hence purpose and modalities – but they also shared much in common.
One shared characteristic was innovation. That’s what struck me first, as we explored the communities’ origins: that in each case, when the communities were established, they were breaking new ground, arising directly from need, circumstance, empathy, and inspiration. “Nothing like them,” we wrote, “[had] existed anywhere else in the world.”
In all of the cases, it was a need not being met by existing institutions and services. The conventional wisdom of professionals wasn’t of much use, either. The skepticism of others, meanwhile, simply didn’t enter into it, because the innovation had its own compelling dynamic. One of the communities we looked at, Delancey Street in San Francisco, for those wrestling with addiction, took others’ skepticism as their badge of honour, recounting repeatedly, in their history, “They said it couldn’t be done.” Yet it was done.
“The fact there was no exact precedent for it elsewhere,” we commented, “only added to the founder’s and the group’s conviction that, in being innovative, they were doing something all the more valuable, which was indeed the case.”
I’ve been looking into the history of Assertive Community Treatment recently, and although ACT was a different kind of innovation altogether, the same kind of linkages were there: the concept arising directly from need, circumstances, empathy, and inspiration.
ACT was developed by a group working out of a state mental hospital in Madison, Wisconsin, way back in the early 1970’s. They had successfully treated patients and worked out discharge plans for them, only to see them returning through what was dubbed the “revolving door.” ACT was their creative response. A community mental-health team might have supposedly been assigned to follow the patients once discharged, but it was the hospital team that had them at their door once more, decompensating, and they knew the patients well. Given the team’s empathy and frustration, they couldn’t just go through the treatment, discharge, and revolving-door routine all over again.
Note that ACT was not a strictly clinical innovation. The nickname for ACT, a “hospital without walls,” provides a clue – still a hospital of sorts, where antipsychotic medication is a key, so no change there, and still largely the same kind of staff, but configured in a different way.
And this brings me to the RVICS proposal for an intentional community for the seriously mentally ill, on the səmiq̓ʷəʔelə/Riverview Lands (you knew I was going to get there eventually). The case for an intentional community is a compelling one, and so always seemed obvious to us at RVICS. It has now, also, been finally recognized, albeit in a tentative way, by B.C. Housing and the provincial government, at least to judge by one of B.C. Housing’s stated objectives for the Lands: “Wellness: Embrace the community as a resource to support wellness and set a new standard for mental health integration.”
Sure, that’s vague and awkward phrasing, but the reference to the community as having a specific purpose or intention (“to support wellness”) is ipso facto a commitment to intentional community. This simple step, acknowledging therapeutic intention of community, is something we’ve been trying to get the Province and B.C. Housing to move on for many years now.
The question arises: How did the RVICS group come up with their idea of an intentional community for the Lands?
Two kinds of experience and perception of need led to the RVICS proposal. One was front-line experience in the Downtown Eastside, by a minister at a church mission and a psychiatrist respectively, the latter also working with a community mental health team. The other, more at the proposal’s very origin, was the perception of need by family members, for their mentally ill relatives, as gathered by a family member himself who was involved, quite by historical accident, in family peer support and advocacy for a couple of decades.
Nor should we forget the trigger which ushered in the consideration of possibilities to begin with: the City of Coquitlam’s determination to have the Lands retained for public, mental-health purposes rather than being sold off. I like to refer to the City’s defence of the Lands and their historic legacy as “NIMBY spelled backwards.” Without that, RVICS wouldn’t exist today. We wouldn’t have bothered.
So…unique historical strands and a unique concatenation of circumstances.
I hope sometimes in the future, as a contributor to this blog, to provide more of this story – the historical roots of the RVICS proposal, roots which go back to the 1980’s.
Comments and expressions of interest in contributing to RVICS Commentaries should be sent to email@example.com.