Below is an excerpt from a paper written by H.G. Lafave, A.R. Stewart, F. Grunberg and A.A. MacKinnon in 1967
The Weyburn Experience : Reducing Intake as a Factor in Phasing Out a Large Mental Hospital
The inpatient population of the Saskatchewan Hospital, Weyburn, dropped from 1519 in January 1963 to 421 in June 1966. The hospital serves the one-half million population of the southern half of Saskatchewan. The reduction of over 1000 beds was realized despite the fact that the number of alternative psychiatric beds in service in the region rose only from 60 to 100.
This report discusses how a change of such magnitude took place. In particular our main purpose is to concentrate on factors influencing intake into the hospital system. It is our thesis that when hospital admissions are reduced as a result of providing suitable substitutes to hospitalization, considerable reductions in inpatient populations can be achieved. We contend that undue attention has been placed upon discharge and transfer as primary methods by which hospital populations can be reduced.
The Saskatchewan Hospital, Weyburn, is one of two mental hospitals, each of which was originally intended to serve approximately half of the one million population of the province. Both of these institutions could serve historically as stereotypes of "large, isolated, segregated, undifferentiated, mental asylums"
Until recently, the Weyburn Hospital provided the main psychiatric service for a catchment area of about 500,000. Built in 1921 and designed for a capacity of 950 beds, the common pattern of overcrowding followed through the years. In 1946 the hospital housed a peak population of 2600 patients. The establishment of provincial facilities for the mentally retarded resulted in a decrease in population to approximately 1800. The expansion of services in areas within the Weyburn perimeter saw the population stabilize from the year 1957 to 1962 at an average of slightly over 1550, with negligible fluctuations. At the end of 1957 the hospital census was 1554, and on December 31, 1962, the population stood at 1548.
In late 1962, a re-examination of the function and purpose of the hospital led to a complete reorganization directed towards a community-oriented philosophy of patient care and increased extramural psychiatric services. The outstanding feature of this plan as executed was a dramatic drop in the patient population at Weyburn without a proportional increase in hospital beds in other facilities.(It is important to note that there are no private psychiatric facilities in Saskatchewan : all existing units come under the provincial public health service.)
How was this reduction realized? Obviously a complex pattern of interacting factors was involved, including increased outpatient follow-up, emphasis on community psychiatry, an active rehabilitation program, and the utilization or development of community facilities for geriatric care. The separate impact of these programs will be reported elsewhere. This paper focuses on admissions. The immediate conclusion of critics of the Weyburn phenomenon is that discharging patients indiscriminately was the method whereby our patient population was reduced by 73 per cent in a 3 year period. There is no question that an active treatment program combined with energetic efforts at rehabilitation resulted in the return to active community life of a large number of patients. More important, however, was the establishment of a broad based, community-centered service. In brief, the Weyburn phenomonen is largely a result of drying up the source, not opening up the floodgates.
Factors in Reducing Intake
It is impossible to extricate the events at Weyburn from the overall psychiatric program in the province. Each established or additional service has its effect on all the others.This is particularly true in this province where the Saskatchewan Plan, advocates the construction of small regional facilities close to the population served and to available medical services. The Weyburn program is part of this overall plan and adheres to its principles.
Three factors had the most pronounced effect on the decrease in admissions at Saskatchewan Hospital, Weyburn : 1/ cooperation with, and coordination of, existing psychiatric services in the communities served; 2/ the establishment of the Yorkton Psychiatric Centre; and 3/ the development of the Weyburn Psychiatric Centre from within the existing hospital complex to provide total service to its own catchment areas.
Our conclusion to date is that the Saskatchewan Plan represents a breakthrough which can seal the fate of the large, isolated custodial unit. From a professional point of view, the Saskatchewan Hospital at Weyburn could be closed down completely. However, because of the location of the hospital in an isolated, small community, the resulting impact on local economic conditions could dicate a political decision to maintain the large mental hospital. Many serious problems, such as resettlement of staff, confront the public administrator. The decision to close down the Weyburn Hospital is now an economic and political one. It is not an easy decision. The authors maintain, however, that there is no justification on psychiatric grounds for its continued existence.