Community Mental Health Nursing in Alberta, Canada: An Oral History

Article excerpt

Abstract. Community mental health nurses had a central role in the construction of new rehabilitative practices and community mental health services in the 1960s and 1970s. The purpose of this article is, first, to explore how nurses understood and created their new role and identity in the turbulent context of deinstitutionalization. The development of after care services for patients discharged from Alberta Hospital in Ponoka (AH-Ponoka), a large mental institution in Calgary, in the Canadian province of Alberta, will be used as a case study. I specifically focus on the establishment of outpatient services in a new psychiatric department at Foothills General Hospital in Calgary. Second, I examine how deinstitutionalization itself shaped community mental health nurses' work. Oral history interviews with nurses and other mental health professionals, who had a central role in this transformation process, provide a unique lens through which to explore this social change. The article concludes that new rehabilitative, community-based mental health services can better be understood as a transformation of former institutional practices rather than as a definite break with them.

"I started working in mental health in Calgary, well, in January of 1966. Okay, so, January 1966, I got a job with Alberta Hospital in Ponoka, being Calgary's first Community Mental Health Nurse," stated Margaret Mandryk, conveying a powerful message about her pioneering work in psychiatric mental health in Calgary at a time when community mental health nursing was being invented. 1 Perhaps I should argue, "reinvented," because the concept was not entirely new. Originating in the mental hygiene movement of the 1930s, it was reworked, renegotiated, and enacted as nurses constructed a new field of work in the community during the period that has become known as the deinstitutionalization era in psychiatry.2

The purpose of this article is, first, to explore how nurses understood and created their new role and professional identity in the turbulent context of deinstitutionalization. As a case study, I use the development of after care, sometimes referred as follow-up care, for long-term hospitalized patients discharged from Alberta Hospital in Ponoka (AH-Ponoka), a large mental institution in the middle of the Canadian province of Alberta. I focus on the discharge of patients to the city of Calgary in southern Alberta during the 1960s and 1970s. Second, I examine how deinstitutionalization itself shaped their work. I argue that the common understanding of deinstitutionalization as a decrease in numbers of hospitalized psychiatric patients may be a slightly misleading description of the reality of psychiatric care and treatment during this period. Community care developed in the midst of frequent and continued hospitalization of large numbers of patients. The institutional context that broke down within the large mental hospitals had to be recreated in the community to accommodate such a volume of new patients. The experiences of nurses and other mental health professionals, who had a central role in this transformation process, provide a unique lens through which to explore this social change.

Place and identity are important analytic concepts guiding this analysis.3 Oral history interviews with nurses and one health professional who worked in psychiatry in Calgary during the 1960s and 1970s form the primary source material.

Community Mental Health Nursing

Creating new professional roles in the community and transgressing traditional institutional boundaries, community mental health nurses had a central role in the construction of new rehabilitative practices and community mental health services in the 1960s and 1970s. Textbooks on community mental health nursing emphasize how the role and function of psychiatric nurses, once firmly tied to the large mental hospital, dramatically shifted as the treatment of psychiatric clients itself underwent a paradigm shift under the influence of deinstitutionalization. …