From institution to community: an historical and evaluative study of services for mentally ill people in Ontario, Canada

This thesis progresses from a broad, historical review of the development of services for mentally ill people in Canada, to a detailed evaluation of one exemplar of contemporary community provision, the Homes for Special Care Programme in London, Ontario. The aim is to combine these traditionally separate types of research, historical and systematic evaluative, to produce a study with a focus which progresses from the national to the local level and from historical origins to present day achievements. The initial provisions of care for the mentally ill in each of Canada's provinces are reviewed, from Canada's earliest beginnings to the asylum building period of the nineteenth century. The roles and influences of the Federal Government of Canada and the Canadian Mental Health Association (CMHA) during contemporary times are illustrated and the corresponding arrangement of mental health services is depicted. The development of services up to the present day is then reviewed with reference to the province of Ontario's delivery of institutional and community services to the mentally ill, and the policy and practice dimensions of such care. The Homes for Special Care (HSC) Programme in Ontario, its history, rationale and the services it provides is portrayed as one example of community care programmes for the mentally disabled and the HSC Programme operating out of London, Ontario's London Psychiatric Hospital is then evaluated. The final chapter focuses on this need and advocates for such programmes from the foundation of a humanitarian, normative and need perspective. While this thesis can be characterized as a qualitative work, portraying and presenting mental health services as evolving incrementally in a positive direction, it also has quantitative features such as the London Activity Residential Scale (LARS) and the Residential Competency Scale (RCS). It draws upon work undertaken for the thesis but published separately as Pioneers of Mental Health and Social Change' and the "Residential Competency Scale". A survey of placement needs at London Psychiatric Hospital undertaken in 1986 is also presented in order to buttress arguments and to complement the qualitative and historical attributes of this work.