If I had been psychiatrist-in-chief from 1965 to 1994…

I would still probably be a man and would be known as the executive director of the newly-renamed Douglas Hospital. What an honor to preside over the ribbon-cutting ceremony at the official opening of our Services for Retarded Children. In attendance: Dr. Dominique Bédard, director of the Psychiatric Services Division of the Ministry of Health; Dr. Denis Lazure, associate director; the Right Rev. R.K. Maguire, Bishop of Montreal (Anglican), and the Most Rev. LT. Whalen, Auxiliary Bishop of Montreal (R.C.).

With the increasing popularity of our after-care services, which doubled in size in 4 years and were treating 1,400 patients by 1965, we would ask ourselves whether it would not make sense to develop an outpatient program that would treat patients before they would be admitted. It would sound radical, but we would dare to imagine that our treatments were good enough to enable us to totally bypass hospitalization. Not to be deflated by the “I told you so” we would hear the first year, when only 39 patients were referred to our Screening Clinic, our perseverance would pay off, as we would become increasingly convinced that outpatient treatment was where modern psychiatric treatment was heading.

Alfred Perry would not have recognized the hospital he inaugurated, with its new Behavior Therapy Unit using state-of-the-art techniques such as relaxation, desensitization, and assertive and aversion therapy; and a recently-opened Data Processing Center that promised to soon buy a computer for the hospital. In 1967, we would become the first psychiatric hospital to be accredited in Canada, but it would seem that the more we accomplished, the more was expected of us.

Our Planning Council’s 1970 hospital objectives were particularly daunting; reduce in-patients beds, improve staff-patient ratios; continue increased emphasis on out-patient treatment; eliminate dependence on patients for essential hospital work and their replacement by staff (there goes the budget); augment medical staff; improve the Perry, Porteous and Northwest pavilions; improve rehabilitation services and develop comprehensive psychiatric services for the surrounding population.

Having decreased our inpatient population by almost 40% in 5 years, going from 1,892 to 1,200 beds, we could not fathom how we could be expected to close more beds. I would be quite stressed by the objectives and not quite know where to begin. Despite my trepidations, we would manage to launch our first community mental health clinic in LaSalle in 1972. As services were now being offered according to sectors, and not on the basis of language, we would be treating increasing numbers of French-speaking patients and would have to reorganize our services accordingly. In addition to the numerous challenges we faced within the hospital, the Ministry would introduce laws that would really complicate medical leadership.

With the introduction of Bill 65 in 1971, the position of medical superintendent would be abolished and we would have to appoint a director of professional services. In addition, admission of involuntary patients would become very complicated. Whereas it had been previously up to the medical superintendent and the referring physician to decide who could be hospitalized against their will, we would now be saddled with having to perform 2 psychiatric examinations, fill out legal documents, and obtain approval from the courts.

By 1972, with the passing of the Mental Patients Protection Act, we would be transformed from an institution where the majority of patients were involuntary to a hospital where only 10-15% of admissions were being held against their will. Perhaps the extra paperwork made people think twice before committing patients to hospital.

In 1977, as I would be getting ready for the Auxiliary Fundraising Ball, being held at the posh Windsor Hotel, I would reflect on the theme "Let's Build Bridges, Not Walls" and sense that were progressing, despite the unfavorable accreditation report of 1973. By 1979, our new research center would open and one year later our brain bank.

Finally, in 1981, we would become a World Health Organization Collaborating Centre for Research and Training in Mental Health and the stage would be set for the Douglas to become an internationally-renowned institution in the mental health field. Over the next 10 years, as we focussed on raising funds in order to carry out our ambitious projects in research, teaching and care, we would be indebted to our Foundation, for their unrelenting efforts would help us make our dreams come true.

The Douglas had become a big institution with a tripartite mission. In 1994, when at a crossroads with respect to leadership, we would recruit our first non-medical director general who would decide to create a department of psychiatry. At last, the Douglas Hospital would have its first real psychiatrist-in-chief.


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