Chapter 2 of 13 · ~1,314 words
2. From Asylum to a Modern Network: British Columbia's History
Victoria, New Westminster and Essondale
The first provincial asylum opened in Victoria on 12 October 1872 in a former hospital building. By that evening, seven people had been transferred there from the local jail. In 1878, care moved to a new institution in New Westminster, initially home to about 37 patients. [28, 29]
Further expansion brought the psychiatric hospital to Coquitlam. In 1904, the province set aside approximately 400 hectares; a new institution opened on 1 April 1913, later known as Essondale. The name honoured Henry Esson Young, a physician and provincial minister who supported its construction. By the end of 1913, the hospital had 453 patients. An entire working settlement developed around the wards: a farm, workshops, staff housing, roads and support services. [30]
The large buildings combined acute treatment, residence over many years, elder care and support for people with intellectual disabilities. These functions gradually separated into different institutions. The New Westminster facility became Woodlands; Essondale and Crease Clinic developed in Coquitlam, and their histories later came together under the name Riverview. [31]
| Year | Event on the future Riverview site |
|---|---|
| 1913 | Opening of the men's building, later named West Lawn |
| 1924 | Opening of the 300-bed acute care building, now Centre Lawn |
| 1930 | Transfer of 500 women from New Westminster to the new women's building |
| 1949 | Opening of a new Crease Clinic wing for the early stages of mental illness |
| 1950s | Essondale's population reached approximately 4,630 |
| 2012 | Transfer of the historic hospital's last patients |
Chronology source: BC Housing's public history of the site. [32]
Overcrowding transformed everyday life: privacy was scarce, and beds filled attics and basements. The farm supplied the hospital with milk, meat and vegetables; its operations depended heavily on unpaid, often compulsory patient labour. A person could spend years both as a hospital resident and as a worker in its agricultural enterprise. [32]
Changes in clinical work
Social services were introduced in 1932, followed by a staff psychologist in 1937. Alongside hydrotherapy, clinicians used insulin comas and metrazol-induced seizures; ECT became widespread in the 1940s, and the first nine lobotomies were performed in 1946. Chlorpromazine and reserpine entered treatment in the mid-1950s. [29]
Changes also affected ward routines and length of stay. During Crease Clinic's first year, 791 of 963 admitted patients returned to the community within the four months provided for by law. By March 1955, five open wards served 587 patients; in 1959/60, about 70% of Essondale's patients lived on open wards. Group psychotherapy, outpatient follow-up and vocational and daily-living rehabilitation developed. [29]
These changes required a different working day. A nurse observed behaviour and functioning, a social worker prepared for the person's return to the family, a physician reviewed treatment, and activities beyond the ward restored familiar actions. Life after hospital gradually moved to the centre of attention. Organizing that life would become the principal task of regional services.
Eugenic legislation and life after surgery
The sterilization law passed on 7 April 1933 took effect on 1 July. A three-person board comprising a judge, a psychiatrist and a social work professional reviewed applications from the institution's director. The premise was the presumed hereditary transmission of severe mental illness or intellectual disability. A unanimous board decision authorized the operation. [33]
The person was required to give written consent; when the board deemed the person incapable of making that decision, a spouse, parent or guardian could sign. If none of these people was present in the province, authority passed to the Provincial Secretary. The law also protected the surgeon from a civil claim for performing a properly authorized operation, while retaining liability for negligence in carrying it out. These provisions gave the institution decisive influence over a patient's reproductive life. The law was repealed on 18 April 1973. [33]
Legal scholarship estimates that approximately 200 to 400 people were sterilized in BC.2 In 2005, nine women who had undergone these operations at Riverview received a total of 450,000 CAD (approximately 134,000 CAD PPP) in settlement of their claims. The consequences of a hospital decision lasted for decades; legal recognition of the harm came after the law had been repealed. [34, 35]
From a single complex to regional services
In 1965, Essondale and Crease Clinic were amalgamated as Riverview Hospital. In 1973, the hospital graduated its last class of psychiatric nurses, with training moving to colleges. West Lawn closed in 1983, and Colony Farm ceased operating as a working farm. Some functions of the large hospital settlement gradually passed to educational, municipal and community institutions. [36]
A provincial initiative in 1990 proposed moving much of the care to smaller specialized regional facilities while retaining a specialist centre on the Riverview site. Crease Clinic closed in 1992. The subsequent development of local inpatient units and residences required new staffing arrangements, transfer of clinical records and support for people for whom the hospital had been home for decades. [36]
Transfers from Riverview: clinical and everyday outcomes
Regionalization unfolded over decades. Riverview's patient population fell while local services assumed acute treatment, long-term care and rehabilitation. Small residences opened on the site itself in 2001, 2006 and 2008: Connolly, Cottonwood and Cypress, each with roughly twenty places. Individual rooms and a more domestic environment replaced large shared wards. Riverview's last 40 patients moved to facilities in Surrey and Vancouver in 2012. [32, 30]
A prospective quasi-experimental study by Petersen and colleagues, published in 2013, followed 189 long-stay Riverview patients; 80% had schizophrenia-spectrum disorders. Some moved to specialized psychiatric residences, some to less structured community housing, and some remained in hospital. Most continued to receive care around the clock. [37]
Psychiatric symptoms remained broadly stable. Aggressive behaviour did not increase, although some socially inappropriate behaviours became more frequent. Neuropsychological impairments generally remained at their previous level, while some measures improved. Patients managed money, food preparation and storage, transport and work tasks more successfully; subjective quality of life improved significantly. During follow-up, one person spent time in a correctional institution, one in a forensic psychiatric facility, and one experienced a period of homelessness. These transfers combined continuing intensive care with greater opportunities in everyday life. [37]
Kwikwetlem land and new services
For the Kwikwetlem people, the slopes above the Coquitlam River offered refuge during floods and places for ceremony, hunting and gathering medicinal plants. Hospital construction changed the landscape and deprived the community of influence over the use of its traditional territory. In 2012, Kwikwetlem and BC Housing signed a protocol agreement for cooperation; in 2016, the Nation filed a land-title claim. [38]
On 10 March 2021, the province and Kwikwetlem announced a new name for the site, səmiq̓ʷəʔelə, meaning "place of the great blue heron," and the beginning of joint planning. The name was given as an act of restoring cultural presence and revitalizing language. Today, archaeological work, naming, art and site planning involve the Nation and its heritage protection requirements. [38]
On 12 October 2021, the 105-place Red Fish Healing Centre opened here, replacing the Burnaby Centre for Mental Health and Addiction. Provincial capital expenditure was 130 million CAD (approximately 38.8 million CAD PPP). The centre brought together treatment of severe mental illness and addiction, with individual rooms and space for rehabilitation, research, teaching and remote contact with families. Kwikwetlem participated in its design and treatment programs. The centre includes space for spiritual practices, and a carved pole by the Nation's artists stands near the entrance. [39]
Psychiatric care on this site evolved from a large institution with its own working estate to a combination of specialized treatment, small residences and connections with local services. Throughout that history, hospital routines, living space, human rights and the possibility of returning to everyday activities changed alongside treatment methods.