In 1841, a 39-year-old teacher walked into an Massachusetts jail and volunteered to teach English.
Her subsequent discovery in that institution changed her life – and eventually changed the lives of thousands of others.
When Dorothea Dix asked authorities why the mentally ill were housed alongside hardened criminals in unheated, unfurnished, and foul-smelling cells she was told “the insane don’t feel heat or cold.”
The war on the poor treatment of people with mental illness was on for the daughter of a Methodist preacher.
Dix took the matter through the courts, and after several battles, won her case – forcing the institution to provide far better living conditions for the mentally ill.
Then she took on several other jails, waging, and winning, the same battle.
Her work created a new awareness of mental illness and eventually spawned the creation of mental asylums – facilities with pastoral settings where people could get treatment.
Those asylums were created all across the United States; the model was brought to Canada in the 1850s. The first Canadian “lunatic asylums” were created to serve those in the Eastern provinces.
By the turn of the 20th century, asylums had opened in the West, including Coquitlam’s Riverview Hospital (left) in 1913, which served the entire Lower Mainland for almost a century.
It was felt by psychiatrists of the day that well-run facilities could dramatically improve the cure rates of those with mental illness.
There were successes, but many asylums were criticized over controversial treatments, such as electroconvulsive therapy and surgical lobotomies.
By the 1970s, several psychotropic drugs had been developed, allowing many of the mentally ill to be medicated and treated in the community.
The move was politically popular, because it was perceived to be kinder and was more economical than institutionalization.
Within a decade, most of the asylums had been shut down.
In the 1980s, services started ramping down at Riverview, and by 2012, it was closed.
The sprawling site is now slated for a housing development.
During its 30 years of being phased out, Riverview’s large patient population was relocated into the community – some went to group homes, others went to assisted living arrangements, and many were left to care for themselves.
For the latter group, critics say there was little or no professional follow-up, meaning they didn’t receive the care they required, including monitoring of much-needed medications.
They languished and became the homeless, addicted, and poverty-stricken that are now an unfortunate part of the cityscape.
NightShift Street Ministries has fed the hungry every night for nine years in Whalley, while also offering counselling and other services.
MaryAnne Connor (below), a pastor with NightShift, said the bulk of her clients have mental health issues.
“At least 60 to 80 per cent of the people up here are suffering from mental illnesses,” Connor says. “And the bulk of those are also suffering from addiction.”
Social service providers throughout Surrey often point to the closure of Riverview, and the subsequent lack of community supports, as the reason homeless shelters, food line-ups, and Surrey streets are largely filled with those struggling with mental illness.
While the province does provide some group homes and assisted living, it’s clearly not enough, according to Surrey Coun. Judy Villeneuve, who has fought for more social infrastructure in the city for the last 24 years.
The nature of mental illness complicates matters, she said. Many people without the ability to take their medications on a regular basis are choosing to be without the necessary supports.
“By legislation, people with mental illness have the ability to make their own decisions on where they want to live,” Villeneuve said.
One in five of those with a mental illness slip into substance abuse, become disorderly or engage in criminal activity, and end up in the justice system.
Many who go through court are re-institutionalized – this time in jail – bringing mental health care back to where it was 170 years ago, before Dorothea Dix turned it on its ear.
According to 2010 Finances Fact Sheet produced by the B.C. Alliance on Mental Health and Addiction, there are about 136,000 adults in B.C. with severe addiction issues and/or mental illness.
Of those, up to 15,500 are homeless and another 26,500 are at imminent risk of homelessness.
Access to treatment can be hard to find.
Surrey’s Dr. Caroline Ferris, who mainly treats people with mental health issues, said if people have both mental health issues and addiction, they’re going to have an extremely hard time getting help.
For the most part, people with concurrent disorders (mental health and addiction) are in prisons, at shelters, or on the streets, she said.
Asked if that’s the best place for them, Ferris said, “Of course not, God. Go to the winter shelter, it’s bedlam in there.”
She said that nowadays, “jails are the default asylums.”
For years, Surrey Mayor Dianne Watts lobbied the province to set up a sobering centre. Quibble Creek opened across the street from Surrey Memorial Hospital last year. It allows people with addictions to sober up and find help in a medically supervised setting, rather than in jail.
Watts now wants a community court created that will connect the mentally ill who have brushes with the law with the resources they need, instead of locking them up.