The Politics of Mental Health Care in Nova Scotia: The Case of the Halifax County Hospital, 1940-1976

AFTER THE SECOND WORLD WAR, significant changes occurred in the care of the mentally ill in Canada as the government moved toward the adoption of national health insurance. Reforms were encouraged by the introduction in 1948 of federal health grants channelled through the provinces to train mental health professionals, construct new facilities and support research. In return for the injection of federal funds, the mental hospitals controlled by the provinces were required to admit patients free of charge. Subsequently, mental hospitals were excluded from the provisions of the Hospital Insurance and Diagnostic Services Act of 1958, an exclusion that became more serious as the federal health grants were phased out. Some of the provinces – Ontario (in part), Quebec and Nova Scotia – eventually corrected this anomaly. Nova Scotia, which adopted hospital insurance in 1959, extended coverage to its mental hospitals in 1966 and 1967.1 The records of one of those hospitals, the Halifax County Hospital (HCH), the hospital that is the subject of this paper, indicate that the new government financing was implemented in halting, uncertain stages. While the hospital’s management and administration welcomed federally enhanced provincial funding for construction, drugs, staffing and programming, the fate of the patients depended on system-wide improvements that were slow in coming. Ultimately, it was the social-welfare legislation of the late-1950s and mid-1960s (also made possible by federal funding) as much as the health care reforms that determined mental health practice. Each mental hospital in Canada experienced the political and economic changes of the post-war period differently and was influenced not only by federal and provincial policies but also by its location, staff, management and the composition of its patient population. All of these hospitals, however, shared certain key developments. Hospital practice was revolutionized by changes in treatment, especially by the transition to community care and the introduction of effective drug therapy. Prominent among the measures that led to the depopulation of the mental hospitals were the unlocking of doors, encouragement of short-term leave, introduction of new social therapies and rehabilitative programming, establishment of out-patient services, day-care and night programmes, access to sheltered workshops, initiation of support

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