The Suitcase Project – Unpacking Riverview’s History and how it could impact the future of mental health treatment in B.C

Maria Vinca, Kaia Proctor, Mohak Sood- April 15, 2020

“You know, I think one of the very very difficult sides of all of this is – there’s always been this idea that people would have when they would drive by – they’d go, ‘oh my god. You know that’s the mental institution, that the insane asylum.’”- Anna Tremere, Riverview Historical Society

Riverview Hospital opened its doors in 1913, and has remained a monumental historical site in Coquitlam B.C ever since. 

Originally known as Hospital for the Mind, located at Mount Coquitlam, it was opened in an attempt to solve problems with overcrowding at the Provincial Asylum for the Insane, which had been the primary care facility for those with mental health problems in British Columbia for the previous thirty years.

Upon opening, it welcomed 340 of B.C’s most seriously affected male mental health patients into its original West lawn building. At this point it was renamed Essondale Hospital, and so began it’s controversial and revolutionary history. 

Anna Tremere is a recipient of an Award of merit for her work with the Riverview Historical Society.

(Coquitlam Heritage)

Anna Tremere, a former nurse who worked at Riverview for over 30 years, has spent her retirement trying to preserve and understand this history – which she says was very much affected by the media and public perceptions towards mental health care facilities throughout the over 100 years it was treating patients.

“[Popular media] showed a very, very negative picture of the psychiatric system. In Canada, we’ve had, you know, a history where you see these things. But was all of that true? No it wasn’t. But a lot of times people are more interested in that side of it, the more shock value sorts of things. And that’s been a challenge.”-Anna Tremere, President of The Riverview Historical Society

Tremere is the president of the Riverview Historical Society, and says the lives of the patients, doctors, and nurses who worked at Riverview deserve not just a second look, but a thorough examination to improve the treatment of mental health patients in BC in the future.

“A lot of people have this attitude where they say  ‘oh my god everybody that went out there, they were locked up.’  and you know you would drive by you see the bars on the windows. Everybody thought that was it. They were all locked up inside these dark places and they’d say “Oh, what could possibly be going on behind these doors and windows” Well actually when you went  inside. You really learned. People would drive into the grounds and one of the first things they would say is Oh my God, I never realized how peaceful it is.” – Anna Tremere, President of The Riverview Historical Society

Riverview was known for pioneering many new treatments for mental health patients. What began with treatments such as hydrotherapy, electric shock therapy, and insulin comas was transformed in 1954 with the introduction of the first effective psychiatric medication, Chlorpromazine. Following its introduction, Tremere says it opened up a transformative era in the treatment of psychiatric patients.

“When that first medication came into being, it was the start of such a change. After that more medications and different treatments started to come in. It just opened up everything so that’s when you started to see great changes. They were hiring different types of specialists. It was such a progressive time period from then on.” – Anna Tremere, President of The Riverview Historical Society

Riverview’s Center Lawn Building, originally known as the “Acute Psychopathic Wing”

The Shoe Shop at Riverview
(Coquitlam Archives)

One of the biggest changes following the introduction of medications was a complete overhaul in how much freedom patients were given. What was before a very controlled and closed off experience for patients, as per Tremere, became very communal, and patients were suddenly given opportunities far beyond what they had been previously allowed within an institutional environment. The starting point was when a ward was opened up allowing patients to roam around the grounds freely for the first time.

“The patients went outside and patients came back in. Nobody ran away. There were no problems on the grounds. And it was like okay, this worked” – Anna Tremere, President of The Riverview Historical Society

The success of opening up wards created a whole new form of recreational therapy at Riverview.

“Patients participated more in programs and activities. People were out on the grounds, more and more and the whole idea of being on the grounds, they were just like a community of care out there .” -Anna Tremere, President of The Riverview Historical Society

Riverview’s Botanical Garden was the first in Western Canada and features a diverse collection of native plant life.

With the establishment of Riverviews Botanical Gardens, patients began not just roaming but also working outside.

“They would go out with tools and they go and do work on the grounds. There was a farm they’d be farming at. Female patients were working in different offices. There were so many different programs that gave people a sense of purpose.” – Anna Tremere, President of The Riverview Historical Society

According to Tremer, this sense of purpose had a profound effect on many of the patients she worked with.

“They’d get up, go get their breakfast, get dressed and go out to work. Not every patient did, I’m not saying that, but many did. They participated in either a work program, or some kind or an occupational program, whatever. And then when they came back I could actually say to them “So what did you do today John?” And John could actually tell me about what he did during the day. Not everybody wanted to talk about anything or what they did. But the alternative was what? Just sit there in a ward and do what? Not much.” – Anna Tremere, President of The Riverview Historical Society

Marina Morrow – a former professor at SFU –  headed a study which followed patients who were removed from Riverview during its slow shut down in the 2000’s. Morrow says that this unique environment Riverview provided was actually what many of the former patients she interviewed spoke about missing most when talking about their transition to other institutions.

“Some of the people we talked to, spoke about a loss of community. It was most focused on doing odd jobs there. That came out in a number of interviews where people said ‘well you know I used to get extra money, working when I was at Riverview I can’t do that here.’”-  Dr. Marina Morrow, Professor at York University

Dr. Marina Morrow is a Professor at York University. She has a research focus in critical health policy that explores mental health reform in Canada.
(Photo Credit: Simon Fraser University)

However, despite this positive aspect of Riverview’s history, Morrow feels that any care center where patients are institutionalized is not the best option for mental health patients. 

“I generally don’t support institutionalized care because one of the things for people to be kind of cognizant of when learning about this stuff is that most of the people at Riverview were not there as voluntary patients. Most were there because they’d been involuntarily committed under the Mental Health Act in BC which is considered a highly problematic act that can fairly easily take away people’s liberties and freedoms.” -Dr. Marina Morrow, Professor at York University

Riverview had numerous lawsuits filed against them for reasons varying from malpractice to forced sterilization at different points throughout the time it was open. This is a part of Riverviews history Tremere has also worked hard to recognize through her work with the Riverview Historical Society. One of her greatest works being “The Suitcase project.”

“The Suitcase Project” aimed to recognize both patients and health care workers who’s stories and struggles had been forgotten. 

“I would never deny that there were turbulent periods in Riverviews history, or that we didn’t have some things that were problematic, certainly electrical convulsion therapy, different things like that when they first started out, but then moving forward you see, what a change.

When I started at Riverview at 18 I worked on a night shift. At that time the ward I was on had 150 or 165 patients, helped only by myself and one other female healthcare worker. 

We didn’t think it was unusual. It was, but that’s just the way things were.” – Anna Tremere, President of The Riverview Historical Society

However then over time you saw the counts as they were decreasing and decreasing staffing got  better, medications improved, there was so much. So it’s very complicated how things changed, you can’t just look at one particular facet of time to really understand the whole thing.”

The goal of the Suitcase project was to raise awareness for the 1 in 5 Canadians who suffer from a mental health issue. Pictured here in the suitcase of “Ruth Iona” a forgotten patient at Riverview.

Since Tremere witnessed such a drastic change throughout the time she worked at Riverview, she sees a huge benefit that reopening Riverviews facilities could potentially offer mental health patients in B.C. Particularly in relation to the mental health and addiction crisis in Vancouver’s Downtown Eastside.

“The alternative is what we’re seeing today, people in the downtown Eastside have no basis. They don’t have the support that they need, because it’s not available in a sufficient amount. There are access committees, there are wonderful outreach groups, they’re doing amazing things. But there aren’t enough to meet the needs of the population.” – Anna Tremere, President of The Riverview Historical Society

This image was captured in Oppenheimer Park, which has become a camp for homeless individuals in B.C. Many of whom struggle with addiction and mental health issues.

The crisis in Vancouver’s Downtown Eastside is easily one of B.C’s most complex issues, and Morrow says a solution may not be quite so simple as just reopening Riverviews facilities.

 “I think we need to really rethink what the institutional model has done historically, I think it’s one we just need to abandon and move on to newer, more progressive models.” -Dr. Marina Morrow, Professor at York University

Because Tremere witnessed such a drastic change throughout the time she worked at Riverview, she sees a huge benefit that reopening Riverviews facilities could potentially offer mental health patients in B.C. Particularly in relation to the mental health and addiction crisis in Vancouver’s Downtown Eastside. 

“The alternative is what we’re seeing today, people in the downtown Eastside have no basis. They don’t have the support that they need, because it’s not available in a sufficient amount. There are access committees, there are wonderful outreach groups, they’re doing amazing things. But there aren’t enough to meet the needs of the population.”

However abandoning an institutional model does not mean the facilities could not be reutilized into a more voluntary, and community based support system. 

The Gerstein Crisis Center in Toronto for example, is a mental wellness facility that Morrow says has done an amazing job of incorporating a resource based, supportive community environment into a completely voluntary and open space where people are free to come and go as they please.

“It’s like a beautiful home where somebody can come in to have their own bedroom, have their own locker, have home cooked meals and just get away from whatever is causing them that distress. Then they have some time to think, get some crisis support counseling, that kind of thing. So I think there are other models out there that are actually really good models that work really, really well and aren’t really based on this notion of being in an institution with the kinds of, rules and restrictions and historic abuses that we know have occurred in those environments.” -Dr. Marina Morrow, Professor at York University

While Riverviews former facilities have gone unused for the last eight years there are plans to open up a new 105 bed facility in 2021. According to B.C Mental Health and Substance Use Services this facility will treat people in B.C living with the “most severe, complex substance use and mental health issues.”

Approximately 80 buildings were eventually built at Riverview, which reached a peak population in 1955 of 4,726 patients and about 2,200 staff. Riverview was a small, self-sufficient town at this point.
(Coquitlam Archives)

An Artistic rendering of the new facilities on Riverview’s land set to open in 2021.

(BC Mental Health and Substance Use Services)

Lisa Kofod, a representative from the Burnaby Center for Mental Health and Addiction says the new center is bringing new hope for improving programs for mental health patients in B.C.

“I have had the opportunity to participate in some of the planning meetings associated with this new facility. I’ve seen first-hand how much effort, experience and compassion is going into each stage of its development”-Lisa Kofod, Burnaby Center for Mental Health and Addiction

The facility will not however reutilize any of Riverviews former buildings, which Tremere says is a bit of a shame considering how many people they could potentially house.

 

This has always been the thing when people talk about opening up Riverview. A lot of people say, ‘Oh god we don’t want to open up. That’s a mental place.’ But they’re not listening to what people are saying when they’re talking about reutilizing the facilities and opening up those areas, because what they’d be providing is progressive armored treatment facilities.” – Anna Tremere, President of The Riverview Historical Society

Regardless of how Riverviews facilities are used in the future, there’s no doubt in the wealth of information that can be gained through examining its history and treatment of patients. 

 

 A key takeaway when looking at what did work to patients benefit at Riverview, is the sense of purpose and community that was fostered by the many active programs and work opportunities offered during its later years.

 

Morrow stated through her work she’d found one key factor in improving mental health outcomes for people who are struggling.

“Mental health issues are often highly affected by the social environment that people are living in. So if you’ve got really good housing, if you’ve got income supports, if you’ve got places where people can socialize and be connected to other people. You’re going to have good mental health outcomes.” -Dr. Marina Morrow, Professor at York University

Looking back – despite it’s institutional nature, and the history of abuse that tainted it’s legacy – this is one aspect of Riverview that was undoubtedly done right.