Prior to 1905, Saskatchewan patients requiring mental hospital care were sent to Manitoba. In 1907, however, a young provincial health officer, Dr. David Low (1869-1941), was sent by Premier Walter Scott to visit mental hospitals in eastern Canada and the United States in order to prepare recommendations for such care in the province. Low favoured the cottage system, but Dr. C.K. Clarke, a well-known Toronto psychiatrist, demurred; he felt its use would be questionable “for both economic and climatic reasons,” though he admitted that the cottage system “gives ideal conditions for the patients themselves.” Low's plan, which included removing “all evidence of restraint in the management of the insane,” was abandoned: the Saskatchewan Hospital North Battleford, a large pavilion-style mental institution, was built between 1911 and 1913.
Low's opinions were shared by Dr. James Walter MacNeill (1873-1945), who was born in Prince Edward Island and graduated with an MD degree from McGill University in 1901. After practicing in New Brunswick he moved to Hanley, Saskatchewan, in 1906 and served as a family doctor there until 1912. In 1908 he was elected to the provincial legislature and remained as a Liberal member until 1913. He was interested in social issues, and played a significant part in initiating the Homesteads Act that ended the right of a settler to sell the homestead without the consent of his wife.
In 1913 MacNeill spent eight months in England and the United States, studying psychiatry and familiarizing himself with mental hospital organization in order to prepare for his new role as the first medical superintendent of the Saskatchewan Hospital North Battleford. He remained there until 1945, periodically visiting other centres to keep himself up to date. In 1943, because of his concerns over the housing of the mentally handicapped at the Weyburn Hospital, he undertook a survey of eight institutions in eastern Canada and the United States, and made recommendations to the government that ultimately led to the building of the Moose Jaw Training School.
When MacNeill arrived at the North Battleford hospital in 1914, Cecilia Wetton reported, “The atmosphere was that of a prison, with cage beds, straitjackets, bars on the windows and a high walled airing court in which patients milled.” She stated that MacNeill ordered the demolition of the airing court, removed the bars from the windows, forbade the use of mechanical restraints, and banished the use of the term “asylum,” for which he substituted the word “hospital.” Patients were treated as human beings with illnesses and in need of help. MacNeill was particularly interested in the therapeutic value of work as a source of meaning in a person's life. It was in this spirit (not in a commercial one) that he launched the farm and irrigation projects at the hospital and made the grounds a beauty spot. He was also receptive to new therapies such as metrazol and insulin, but was appropriately cautious in his assessment of them. He launched a two-year ward attendant training program at North Battleford in 1930, and at Weyburn (where a second mental hospital had been built in 1921) in 1931. He did much to ensure that persons charged with serious crimes had the opportunity of an examination by a psychiatrist in order to rule out mental illness.
As admissions to mental hospitals increased, MacNeill struggled with the constant problem of overcrowding: in 1913 provincial magistrates committed patients to the mental hospital, and in 1936 provision was made for voluntary admission in addition to magistrates' certificates. The patient population of the two hospitals soared from 2,000 in 1930 to over 4,000 in 1946, creating severe difficulties. Staff shortages resulted during World War II, and the mingling of mentally ill patients with the mentally handicapped was much criticized by surveyors and made management more difficult.
Surveyors were encouraged by MacNeill to visit and assess the two hospitals. They came mainly from the Canadian National Committee on Mental Hygiene (now the Canadian Mental Health Association), but there were also inspections from other professional groups such as the American Psychiatric Association. They all had high praise for Dr. MacNeill and the hospital at North Battleford; since they often meted out censure on their visits to other facilities, there is no reason to doubt their objectivity. MacNeill retired on May 31, 1945, expressing satisfaction at seeing the hospital develop “into one of the finest institutions of its kind in the North American continent.” A month later he died unexpectedly following a surgical procedure. MacNeill had been a beacon of light in a pessimistic era. He was a firm disciplinarian with staff, but his gentleness and dedication with patients was legendary. Since 1931 he had been in charge of all the mental services in Saskatchewan as its Commissioner of Mental Services, and he was justly proud of the honorary degree awarded to him by the University of Saskatchewan in 1941 for his outstanding services to the mentally ill.
At the end of World War II the advent of the government of Premier T.C. Douglas created a halcyon period for mental health services. Dr. D.G. McKerracher (1909-70) became commissioner of Psychiatric Services on November 1, 1946. The “new” era emphasized community rather than institutional care. In 1950 a revised Mental Health Act was passed, with admission becoming almost entirely a medical function. Then in 1951 two important appointments were made: Dr. Abram Hoffer became director of the provincial psychiatric research program; and Dr. Humphrey Osmond (1917-2004) was appointed first as clinical director and later as medical superintendent of the Saskatchewan Hospital, Weyburn. Dr. Hoffer's contribution has been underestimated, perhaps because some of his concepts have not been widely accepted by the medical profession. However, he launched many research programs and stimulated adventurous, questioning, experimental and optimistic attitudes at a time when these had been lacking. He encouraged younger researchers, and boosted morale in the mental services generally. His interests were wide: two major ones were the biochemical basis of schizophrenia, and orthomolecular medicine (using vitamins including nicotinic acid). He published many books and papers that have generated and will continue to generate lively interest and discussion. He was acclaimed by patients and colleagues alike as an outstanding physician and researcher.
Dr. Osmond was associated with the Saskatchewan Hospital Weyburn from 1951 to 1961, during which time he transformed the hospital by attracting distinguished researchers from both academic and service disciplines to an institution that had been regarded by some as a backwater. He, too, published extensively. He was particularly interested in the possible therapeutic effects of hallucinogens and first coined the term “psychedelic.” He also appeared in Aldous Huxley's book, The Doors of Perception, which describes Huxley's experience with mescaline. Hoffer and Osmond worked closely together. The departures of Osmond in 1961 and Hoffer in 1967 left major gaps in the provincial mental health research program.
The 1950s saw the development of the Saskatchewan Plan. This was a comprehensive proposal for all phases of emotional or mental treatment to be given within a health region, without recourse to a remote large mental hospital in which it was all too easy to forget about the patient. A team would provide continuity of care. Dr. F.S. (Sam) Lawson (1903-70), the Director of Psychiatric Services in Saskatchewan from 1955 to 1966, concurred strongly that the plan should be built around new, smaller mental hospitals. Kioshi Izumi (1921-96), a Regina architect, drew designs in conjunction with Osmond for such units in order to facilitate a therapeutic environment; the first was built at Yorkton in 1964. Dr. McKerracher, following his work in Saskatoon with Colin Smith, favoured general hospital units. In the end a compromise resulted, with the actual units having some of the characteristics of both. The decline in the actual numbers of patients in psychiatric institutions began about 1963; predictions of the total number of beds required under the Saskatchewan Plan turned out to be considerable over-estimates. Meanwhile the Mental Health Act had been rewritten in 1961, with admission to a mental hospital becoming discretionary and detention more difficult. Between 1960 and 1963 it was shown at University Hospital, Saskatoon, that a small open psychiatric ward in a general hospital could cope with all types of mentally ill patients. It became clear, however, that better support and after-care were necessary if results were to be sustained; psychiatric home care programs were thus launched in Saskatoon and spread across the province. Then in the Saskatchewan Hospital Weyburn, with Drs. F. Grunberg and H.G. Lafave providing leadership in finding alternatives to admission and developing improved after-care planning, the numbers of in-patients began to fall sharply: between 1963 and 1966 the population there dropped from roughly 1,500 to 500 patients. The causes of this tremendous decline can be debated, but major factors were certainly the effects of newer treatments on symptomatology, in conjunction with improved social programs. By 1971 the in-patient population had dropped so markedly that the Saskatchewan Hospital Weyburn was “phased over” into a 63-bed psychiatric centre and a 300-bed extended care facility. In North Battleford a similar process soon followed. New Centres or psychiatric wards were opened in hospitals in Saskatoon in 1955, Moose Jaw in 1956, Yorkton in 1964, Prince Albert in 1968, Regina in 1975 and 1978, and Swift Current in 1978. Out-patient and after-care services increased greatly. Between 1963 and 1980 the patient population in the two mental hospitals had decreased from 3,100 to 270 - one of the largest reductions in the world - through careful pre-discharge planning.
In the 1960s the Ad Hoc Committee (1966), the Frazier Report (1967-68), the Prefontaine Report (1968), and the paper “Crisis and Aftermath” pleaded for improved community services, which were needed as a result of de-institutionalization, and these demands were largely met. However, problems of funding and organization of the programs now dominate the agenda and need to be thoroughly evaluated.
Colin M. Smith