IntotheFuture:theCoquitlamHealthCampus

AVisionfortheRiverviewLands
PreparedbyDr.JohnHigenbottam
JAHconsulting
June2014

File #: 01-0485-20/PHSA1/2014-1 Doc #: 1724437.v1

IntotheFuture:theCoquitlamHealthCampus

Contents

ExecutiveSummary ............................................................................................................................................ 5
ThePast ............................................................................................................................................................. 9
Ideology, Policy and Riverview................................................................................................................ 9
RethinkingDeinstitutionalization ................................................................................................................... 10
Closing Riverview and Unstable, Traditional Seriously Mentally Ill People ................................... 11
TheEmergenceoftheSeverelyAddictedandMentallyIll(SAMI)People ......................................................... 11
TheNeedforSpecializedPsychiatricHospitalizationandRehabilitation/ResidentialCare................................. 13
ServicePlanning............................................................................................................................................ 14
EducationandTraining.................................................................................................................................. 15
RiverviewsBuildings..................................................................................................................................... 15
The Future ..................................................................................................................................................... 16
CoquitlamsVisionaCampusofCare ........................................................................................................... 16
SpecializedPsychiatricTreatmentandRehabilitation.................................................................................16
AcuteCareHospital...................................................................................................................................17
ResidentialandRehabilitationHousing......................................................................................................18
EducationandTrainingCentre...................................................................................................................18
HealthandWellnessBusinessPark............................................................................................................18
RecreationalDevelopment........................................................................................................................19
OtherUsesoftheSite................................................................................................................................20
Phase1......................................................................................................................................................22
Phase2......................................................................................................................................................22
Phase3......................................................................................................................................................22
FinancingRiverviewRedevelopment ................................................................................................................. 23
RiverviewLegacyFunding.............................................................................................................................. 23
CostAvoidance:AcuteCareHospital,PoliceandSocialServicesCosts ............................................................. 23
RelocationofBurnabyCentreforMentalHealthandAddictionPrograms ....................................................... 24
AcuteCareHospital ...................................................................................................................................... 24
HealthandWellnessBusinessPark ................................................................................................................ 24
Summary ...................................................................................................................................................... 25
Summary of Recommendations ............................................................................................................... 26
References ....................................................................................................................................................... 29

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JAHConsulting:
Dr. John Higenbottam, Principal
Dr.JohnHigenbottamisaclinicalpsychologistwhohasextensiveexperienceasaclinician,educatorand
healthsystemsadministrator.HehasheldseniorhealthleadershippositionsinBritishColumbia,
includingVicePresident,VancouverHospitalandHealthSciencesCentre,VicePresident,Vancouver
RichmondHealthBoardandVicePresident,BCRehab.Dr.Higenbottamalsoservedfor12yearsas
AssistantAdministratorandVicePresident,RiverviewHospital.WhileatRiverview,hewassecondedto
theBCMinistryofHealthtodevelopaprovincialstrategicplanforbraininjuryservices.

AsVicePresident,VancouverHospitalandHealthSciencesCentreandlater,theVancouverRichmond
HealthBoardDr.HigenbottamwasresponsibleforPsychiatry,RehabilitationandContinuingCare
servicesandlateraddedtheEmergency,SpinalandOrthopedicDepartmentstohisportfolio.Duringthis
timeheledanintegrationofVancouverHospitalandStPaulsmentalhealthservicesaswellas
developingtheBCNeuropsychiatryProgram.Healsoservedasahealthservicesaccreditationsurveyor
forAccreditationCanadafortwentyyearsandhadtheopportunitytosurveymostofthehospitaland
communitymentalhealthservicesinCanadaaswellasBermuda.

Inadditiontoseniorleadershipandclinicalpositions,Dr.Higenbottamhasheldanumberofacademic
positionsincludingAssociateAdjunctProfessor,DepartmentofPsychology,UniversityofVictoria,
AssociateDean,DouglasCollegeandClinicalAssociateProfessorintheDepartmentofPsychiatry,
UniversityofBritishColumbia.Inthelatterrole,heteachesinthemedicalundergraduateandpsychiatry
residencyprograms.

Hehasauthoredasubstantialnumberofarticlesandpresentedatmanyconferencesonmentalhealth
issues,particularlyonmentalhealthsystemsandservicesaswellaseffectivepractices.

Dr.Higenbottamcurrentlyhasahealthcareconsultingpractice,JAHConsulting.HeisalsoManager,
PsychosocialRehabilitation(PSR)AdvancedPracticeandCoordinator,GraduateDiplomaProgramin
PsychosocialRehabilitation,DouglasCollege.JohnisalsoCoChair,CanadianAllianceforMentalIllness
andMentalHealth(CAMIMH),Canadasmajorallianceof18mentalhealthprofessionalandstakeholder
organizations.HealsoservedwiththeMentalHealthCommissionofCanadasServiceSystemsAdvisory
Committeeforafiveyearterm.HehasrecentlybeennamedastheincomingEditorinChiefofthe
CanadianJournalofCommunityMentalHealth.

Dr.Higenbottamsmajorclinicalandresearchinterestsfocusonseriousmentalillness,psychosocial
rehabilitationanddevelopingeffectivementalhealthsystemsandservices.

Dr. Stephen Holliday. Associate

Dr.StephenHollidayisaregisteredpsychologistwithover30yearsofexperienceinmentalhealth
serviceplanning,deliveryandevaluation.

Dr.HollidayhasworkedatvariouslevelsofmanagementinpublichealthprogramsincludingRiverview
Hospital(Manager,GeriatricandClinicalResearchDivisions),St.VincentsHospital(AssistantHead,
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DepartmentofPsychiatry),theCoastGaribaldiHealthAuthority(Manager,SeatoSkyMentalHealth
Services)andVancouverCoastalHealthAuthorities(Manager,MentalHealthServices,Director,
AddictionServices,CoDirector,BurnabyCentreforMentalHealthandAddictions).

Dr.HollidayisanexpertondevelopingservicesforpeoplewithSevereAddictionsandMentalIllnessand
wasresponsibleforthedevelopmentoftheclinicalmodelinitiallyintroducedattheBurnabyCentrefor
MentalHealthandAddictions.HesubsequentlyworkedastheClinicalPracticeLeaderfortheVancouver
CoastalHealthComplexConcurrentDisordersProgram.

Acknowledgements

Thepreparationofthisreportinvolvedconsiderableconsultationwithpractitionersandadministrators
inthementalhealthandhealthcaresystemsofBritishColumbiaandotherprovinces.Theauthorwishes
toacknowledgetheirsignificantcontributionsandsupportforthemajorrecommendationsofthis
report.

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ExecutiveSummary
In2012,RiverviewHospitalclosedafteralmost100yearsofserviceinBritishColumbiasmentalhealth
servicesystem.Forthefirsthalfofitslife,Riverviewwasthemajorpsychiatrichospitalintheprovince
andwasinternationallyrecognizedforitstreatmentprograms.Duringthesecondhalfofitslife,
Riverviewsimportanceandroledeclinedwithitspatientpopulationascommunitytreatment
alternativesweredeveloped,particularlygeneralhospitalunits.Riverviewsnewrolebecame
specialized,providingtertiaryservicesforpersonswhosetreatmentneedsexceededthecapabilityof
thegeneralhospitalunits.

Beginninginthe1980saseriesofdeinstitutionalizationprogramssawthehospitaldownsizedleadingto
itseventualclosure.Unfortunately,thishasresultedinalossofRiverviewsspecializedtreatment
capabilityforthegroupoftraditionalpersonswithseriousmentalillnessrequiringspecialized,longer
termtreatmentwhichexceedsthecapabilitiesofcommunityhospitalsandservices.Atthesametime,a
newgroupofSeverelyAddictedMentallyIll(SAMI)individualshasemergedwhohavecomplex
treatmentneedsandwhoarenowplacinggreatpressureonhospitalemergencydepartmentsand
psychiatricunitsaswellaspoliceandsocialservices.

TheclosingofRiverviewhasthusledtounintendedconsequencesintheformofthepresentcrisisin
Vancouver,theLowerMainlandandotherpartsoftheprovince.

InturnthishasresultedinconsiderablepublicandcivicgovernmentpressurefortheProvincetouse
Riverviewasamentalhealthfacility.Infact,in2008andagainin2013theUnionofBCMunicipalities
(UBCM)passedresolutionsaskingtheProvincetoretaintheRiverviewLandsforthepurposeofa
mentalhealthfacility.

SincetheRiverviewLandsliewithinitsboundaries,Coquitlamisveryconcernedabouttheirfuture.This
concernissharedbythegeneralpublicwhoisopposedtoresidentialandcommercialdevelopmentand
wishtoseethesiterededicatedtothetreatmentofmentalillnesswhilepreservingitsnaturalbeauty
includingheritageassets.Thesepublicviewshavebeenstronglyexpressedinthepastandreconfirmed
atrecentopenhousesconductedbyBCHousingonthesitesfuture.

Coquitlamhasinitiatedthepresentexercisetocreateavisionwhichrecognizesthesignificanceofthe
RiverviewLandsandproposesusesthataremostappropriatetothelandsandinthebestinterestsof
thepeopleofBritishColumbia.AnoverridingprincipleisthattheRiverviewLandsshouldbeusedfor
publicpurposesthatpreservethenaturalbeautyandecology.Consistentwiththisprinciple,Coquitlam
Councilremainsopposedtosellingparcelsofthelandforsuchpurposesasmarkethousing.

Primarily,CoquitlamsvisionisforthepreservationanduseoftheRiverviewLandsasahealthand
wellnesscampusdedicatedtomeetingtheneedsofthepeopleofBritishColumbia,thepeopleof
Coquitlamandneighboringcommunities.ThisvisionisconsistentwiththeCityofCoquitlamRiverview
TaskForceReport,FortheFutureofRiverview,endorsedbyCoquitlamCityCouncilin2005andspeaks
specificallytooneofthefourrecommendedusesforthefutureoftheRiverviewLands.

Accordingly,theprimaryrecommendationofthisreportistoreestablishspecializedpsychiatric
treatmentcapabilityontheRiverviewsitetogetherwiththesynergisticpsychiatricprogramsforthe

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SeverelyAddictedMentallyIll(SAMI)population,whicharecurrentlyprovidedbytheBurnabyCentre
forMentalHealthandAddiction.

ThesecondmajorrecommendationofthisreportistoestablishanAcuteCareHospitaltomeetthe
needsofthepeopleofCoquitlamandsurroundingcommunities.Thedevelopmentofanacutecare
hospitalontheRiverviewLandswillproviderapidaccesstoemergencyservicesaswellasambulatory
treatmentcapability,whichwilldivertalargeportionofcasesfromRoyalColumbiansEmergency
Department.ThiswilleliminatethechronicallysevereovercrowdingatRoyalColumbianHospitaland
complementtheservicesprovidedtoTricitiesresidentsbyEagleRidgeHospital.

ThisreportalsoproposestheuseoftheRiverviewLandsforothercomplimentarypurposesincludinga
Health,MentalHealthandWellnessEducationandTrainingCentre,aHealthandWellnessBusinessPark
aswellasdedicatedpublicparkandrecreationalspacethatpreservesthenaturalandheritagevalue.
TheseproposedusesareconsistentwiththerecommendedusesforthefutureoftheRiverviewLands
asoutlinedintheCityofCoquitlamRiverviewTaskForce,FortheFutureofRiverview,which
recommendedthedevelopmentofclustersofexcellenceintheareasof:

MentalHealthandWellness.
Research,educationandinnovation.
Heritagelandscapeandoverallecologyofthelands.
Heritageartsandculture.

Acompletesummaryoftherecommendationscontainedinthisreportcanbefoundbeginningonpage
26.

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Background

TheRiverviewLandswerethesiteofBritishColumbiasprovincialpsychiatrichospitalfrom1913to
2012.Thislargetract,whichisnowwithintheboundariesoftheCityofCoquitlam,wasoriginally
chosenforitsnaturalbeautyincludingslopinglandscape,viewsofmountains,theCoquitlamandFraser
Riversandsurroundingforests.Overtheyearsthebeautyofthesitewasenhancedwithlawns,gardens
andtreesanditbecamethesiteofBCsProvincialBotanicalGarden.

Thehospital,whichfirstopenedin1913,wasknownasTheHospitalfortheMindatMountCoquitlam.
Subsequently,itwasrenamedEssondaleinrecognitionoftheeffortsoftheProvincialSecretary,Dr.
HenryEssonYoung,initscreation.Whileoriginallyestablishedtoservethegeneraladultpopulation,
overtheyearsthehospitalexpandedtoincludeseparateadultandgeriatricservicesnamedRiverview
andValleyviewrespectively.AchronologyofthehistoryofthesiteiscontainedinAppendix1.

Thehospitalexperiencedsteadygrowthinpatients,staffandfacilitiesuntilthe1950sreachingapeak
patientpopulationof5500in1956.Aslowdeclineinthepatientpopulationgreatlyacceleratedinthe
1970sand1980swiththeopeningofgeneralhospitalpsychiatricunitsandcommunitymentalhealth
centersthroughouttheprovince.

Bytheearly1980s,thepatientpopulationatRiverviewhaddroppedtoapproximately1,200.However,
theshiftinservicesfromdirectreferraltoatertiarycaremodelmeantthatadmissionswererestricted
topatientswhoseproblemswereofsuchseverity/complexitythattheyexceededthecapabilityof
generalhospitalpsychiatricunitsandcommunityprograms.

Duringthistime,ProvincialGovernmentplanningwasforfurtherreductionsinthepatientpopulation
throughtransferstocommunitylivingsituations.Thisdownsizingwastobeaccompaniedbyreductions
toRiverviewsoperatingbudget.Aspartofthisdownsizingprocess,surpluscapacitybuildingsonthe
sitebegantobeclosedbeginningwiththeoriginalprovincialhospitalbuilding,WestLawn,in1983.

Subsequently,aseriesofmentalhealthplansweredeveloped,allofwhichrecommendedfurther
downsizingandthedevelopmentofaRiverviewreplacement.The1990provincialmentalhealthplan,
forexample,spoketothemaintenanceofaspecialized,358bedtertiaryhospitalwithnewconstruction
ontheRiverviewsite.

By1998planningchangedagainandtheprovincialmentalhealthplanreleasedinthatyearstatedthat
whileRiverviewwouldbeanimportantresourcefortheforeseeablefuture,itshouldbeclosedwithin
sevenyearsandtheservicecapacitytransferredtonewsmaller,communityfacilitiesthatwouldbe
strategicallylocatedthroughouttheProvince.

In2000,theprovincecreatedregionalhealthauthoritiestomanagehealthservices.Inthenew
organizationalstructure,Riverview/ValleyviewwasplacedundertheadministrationoftheProvincial
HealthServicesAuthority(PHSA).ThePHSAimplementedthestrategyproposedinthe1998planof
transferringfundsfromtheRiverviewoperatingbudgettothenewlycreatedhealthauthoritieswhoin
turnwerechargedwithdevelopingtertiary(longtermspecialized),communitybasedprogramsto
replacetheremainingRiverviewprograms.Thisprocesswasconsideredtobecompletedin2012and
Riverviewwasclosed.

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Whilethesepoliciesweresuccessfulinclosingthehospital,therehavebeenseriousunintended
consequences.Thecreationofadditionaltertiarycarecapacityhasbeengenerallypositivebuttheloss
ofRiverviewsspecialized,longtermtreatmentcapabilityhasledtoanincreasednumberofhighly
unstableindividualslivinginthecommunity.Thisinturnhasledtoaverysignificantincreasein
psychiatricemergencyadmissionsandpoliceinvolvementwithseriouslymentallyillpeople.

ThesituationhasbecomeparticularlyseriousinVancouverandotherLowerMainlandcommunities,
includingCoquitlamandNewWestminster,wheretherearelargernumbersoftheseunstable,seriously
mentallyillpeople.TheproblemsinVancouver,forexamplehavereachedsuchalevelofseveritythat
theMayorandChiefofPolicearecallingthecurrentsituationacrisis.

SincetheRiverviewLands,whilethepropertyoftheProvincialGovernment,liewithinitsborders,
Coquitlamhaslonghadinterestinthefutureofthesiteandhasbeenanactiveparticipantinthe
ongoingplanningprocess.In2003,CoquitlamsMayorandCouncilcreatedtheMayorsRiverviewTask
Force,whichwaschargedwithdevelopingacommunityvisionandcomprehensiveplanforthefuture
usesoftheRiverviewLands.Theirreport(CityofCoquitlamRiverviewTaskForce,2005)FortheFuture
ofRiverviewrecognizedtheheritagesignificanceoftheRiverviewlandsandrecommendedthe
developmentofclustersofexcellenceintheareasof:

Mentalhealthandwellness.
Research,educationandinnovation.
Heritagelandscapeandoverallecologyofthelands.
Heritageartsandculture.

Centraltothisvisionwasthedevelopmentofmentalhealthandwellness,research,education,
botanical,ecologicalandheritage,artsandculturalservices.

In2005theTriCitiesChamberofCommercealsosuccessfullyincorporatedtheutilizationofthe
RiverviewLandsasasiteforhealthcare,wellnessandcommunityservicesintopolicyattheBCChamber
ofCommerce.

In2008,theCityofCoquitlamcommissionedDonaldLuxtonAssociates,architects,todevelopa
statementofsignificance.Thisstatement(DonaldLuxtonAssociates,2008)recognizestheimportance
oftheRiverviewLandsintermsofhistory,heritagevalueandcharacterdefiningelements.

CoquitlaminitiatedthepresentstudytocreateavisionthatrecognizesthesignificanceoftheRiverview
Landsandproposesuses,whicharemostappropriatetothelandsandareinthebestinterestsofthe
peopleofBritishColumbia.AnoverridingprincipleisthattheRiverviewLandsshouldbeusedforpublic
purposeswhichpreservethenaturalbeautyandecologyaswellasheritageelements.Consistentwith
thisprinciple,Coquitlamremainsopposedtosellingparcelsofthelandforsuchpurposesasmarket
housing.

Asanalternativetoresidentialandcommercialdevelopment,Coquitlamsvisionisforpreservationand
useoftheRiverviewLandsasamentalhealth,healthandwellnesscampusdedicatedtomeetingthe
needsofthepeopleofBritishColumbia,thepeopleofCoquitlamandneighboringcommunities.

CoquitlamsvisionfortheRiverviewLandspreservestheirnaturalbeautywhilerecognizingtheir
enormousvaluepotentialtomeetthehealth,mentalhealthandwellnessneedsofcitizens.
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PriortopresentingCoquitlamsvisionforthefutureoftheRiverviewLands,thepasthistoryandthe
presentsituationwillbediscussedtoprovidecontextforthevisionandrecommendations.

ThePast
Ideology, Policy and Riverview

InordertounderstandRiverviewshistoryofdevelopment,expansionanddecline,itisnecessaryto
considerthechangingpsychiatrictreatmentideologythathasinfluencedthegovernmentand,
provincialhealthauthorityplanning.

IntheearlyyearsofthetwentiethcenturywhentheHospitalfortheMindatMt.Coquitlam,later
Essondale,wasdeveloped,thedominanttreatmentideologywasprovidingasanctuaryorasylumwhere
psychiatricpatientswouldreceivecareinastressfreesetting.Atthetime,thisideologyprevailedin
Canadaandledtheprovincestodevelopprovincialhospitals,usuallyinruralsettings.

Sincetherewerenoeffectivepsychiatrictreatmentsavailable,therewasanexpectationthatpeople
wouldrequirespecializedhospitalizationorresidentialcareformonthsoryears.Infact,manyofthe
psychiatricdisordersthatthenledtolongterminstitutionalizationarenowroutinelyandeffectively
managedbyeitherfamilyphysiciansorpsychiatristsinprivatepractice.

Bythe1950sRiverview,likemostprovincialmentalhospitals,hadbecomeseriouslyovercrowded
However,intheearly1950s,thefirsteffectivedrugtreatmentsforschizophreniaandthemajormood
disordersbecameavailable.Forthefirsttime,itbecamepossibleformanypeopletobedischarged
fromprovincialpsychiatrichospitalsandreturntolifeinthecommunity.

Beginninginthe1960s,aspsychiatrictreatmentbecamemoreavailableandeffective,thetreatment
ideologyswitchedfromafocusonlongtermcareininstitutionstoshorttermhospitalizationand
communitybasedtreatment.Inturn,thisledtoawidespreadmovementtodeinstitutionalizemental
healthpatientsasthelongtermhospitalwasseenasnolongerhavingaprimaryroleincareand
treatment.

InCanada,Saskatchewanledtheprovincesintransferringlargenumbersofpatientsfrompsychiatric
hospitalstocommunitylivingsituations.Theotherprovincesrapidlyfollowedsuitanddeveloped
programstodischargeprovincialpsychiatrichospitalpatientsbacktothecommunity.The
deinstitutionalizationmovementpeakedinthe1970sand1980sandby1990manyoftheprovincial
hospitalsinCanadaandStatehospitalsintheUnitedStateshadeitherdramaticallydownsizedorclosed.

InBritishColumbia,thedeinstitutionalizationideologywastranslatedintomajorchangesinmental
healthpolicy.Accordingly,inthe1980stheprovincecommittedtoanewstrategyinwhich,asan
alternativetoadmissiontoRiverview,generalhospitalpsychiatricunitswouldbecreatedinthemajor
communitiesoftheprovince.Patientswouldbedirectlyadmittedtothoseunitsandonlyreferredto
Riverviewifmorespecialized,longertermtreatmentwasrequired.

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Inaddition,theprovincecommittedtothedevelopmentofanetworkofcommunitymentalhealth
centresaswellasthedevelopmentofspecializedcommunitycareteamsinGreaterVancouver.These
centresandteamsweremeanttoprovideaftercaretopatientsbeingdischargedfromRiverview,many
ofwhomwerebeingplacedincommunityresidencesandgrouphomes.Thesecentreswerealso
intendedtoprovidestorefrontmentalhealthservicestopeopleatriskforbeingadmittedtohospital.

Themainunderlyingassumptionwasthatitwasbestforpeopletoremainandbetreatedintheirhome
communitiesratherthanininstitutions.Importantly,itwasbelievedthatcommunitybasedcarewould
besubstantiallycheaperthaninstitutionalcare.

RethinkingDeinstitutionalization
Despitetheearlyenthusiasmforclosingprovincialpsychiatrichospitals,mostprovincessoonrecognized
thatmovinglargenumbersofmentallyillpeopleintothecommunitycreatedanumberofsignificant
challenges.Althoughdeinstitutionalizationinalljurisdictionswasaccompaniedbythetransferofsome
fundingtocommunityservices,inactuality,theinvestmentnecessarytodevelopcomprehensive
communityhousingandsupportprogramsexceededthedollarsavailable.

InBCthismeantthatmanydischargedRiverviewpatientsrequiredservicesinexcessofwhatwas
availableorthatcouldbereadilydeveloped.And,asmostofthesedischargedpatientswere
unemployed/unemployable/disabled,thosewhowerenotsupportedingrouphomesgravitatedtothe
lowincomeneighborhoodssuchasVancouversDowntownEastSidewheretheyendedupinsqualid
SROHotelsorhomelessandlivingonthestreet.Thefailuretoprovidethehousingandsupportsthese
peoplerequire,suchasAssertiveCommunityTreatment(ACT)Teams,hasbeenidentifiedasamajor
reasonforVancouverspresentmentalhealthcrisiswithanexponentialincreaseinpolicecontactsand
psychiatricemergencyvisitsinvolvingtheseriouslymentallyill.

SimilarexperiencesacrossCanadahaveledmostprovincestorecognizethataneedremainsfor
specialized,longtermpsychiatriccarefacilitiesoftheRiverviewtype.Itisnowrecognizedthat,despite
advancesinmedical,acuteandcommunitymentalhealthcare,thereremainsasignificantnumberof
formerandnewpatientswhoeitherrequirespecialized,longertermtreatmentthatexceedsthe
capabilityofgeneralhospitalpsychiatricunitsand/orwhoaresounstablethatevenextensive
communitysupportsarenotsufficienttoallowthemtoliveinthecommunity.

Accordingly,mostprovinceshaveretainedorredevelopedtheirprovincialpsychiatrichospitals.
Saskatchewan,whichledthedeinstitutionalizationmovementinCanadaforexample,isnow
redevelopingitsprovincialpsychiatrichospitalinNorthBattleford.Similarly,Ontariohasmaintained
andredevelopedseveralprovincialpsychiatrichospitals.Additionally,Ontariobuiltandopenedanew
provincial,tertiarypsychiatrichospital,OntarioShores,whichisnowrecognizedasamodel,specialized
ortertiary,provincialpsychiatrichospitalaswellastheCentreforAddictionandMentalHealthin
Toronto,whichisprobablythebestknownexampleofamentalhealthcampusinCanada.

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ThePresent

Closing Riverview and Unstable, Traditional Seriously Mentally Ill

People

AlthoughRiverviewcloseditsdoorsin2012,forallpracticalpurposes,itclosedmuchearlier.For
approximatelythepasttenyears,ithasbeenverydifficultorimpossibletoadmitpatientstoRiverview
onreferralfromthegeneralhospitalpsychiatricunits,suchasVancouverGeneralHospital(VGH)andSt.
PaulsHospital.Accordingly,majorreferringhospitalssuchasVGHalwayshadasubstantialnumberof
patientswhorequiredbutcouldnoteasilyaccessRiverviewsspecialized,longertermtertiarytreatment
capability.Thisresultedininappropriatelylongpatientstaysinthegeneralhospitalpsychiatricunits
and/ordischargebacktothecommunitywithahighprobabilityofrepeatedpsychiatricemergencyre
hospitalizations.

Overtime,thishasresultedinthecreationofasignificantgroupofcommunitydwelling,highneeds,
peoplewithunstablementalhealth,significantbehavioralandcognitivedeficitsanddisturbedand
disruptivebehavior.

PeoplewithinthisgrouparecurrentlybeingconsideredforsupportbyAssertiveCommunityTreatment
(ACT)teamsorforresidenceinhighsupportgrouphomes.However,moreunstableindividualswill
continuetohavetreatmentneedsthatexceedthecapacityofthosespecializedservices.

TheEmergenceoftheSeverelyAddictedandMentallyIll(SAMI)People
DuringtheyearsinwhichRiverviewwasbeingdownsized,therewasadramaticincreaseindruguseand
addictionwithinthementalhealthpopulationingeneralandthedeinstitutionalizedpopulationin
particular.Thisincreasehasbeenattributedtoanumberoffactorsincludingtheemergenceof
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affordablestreetdrugs,particularlystimulantsincludingcrackcocaineandmethamphetamine,the
concentrationofmentalhealthclientsinlowincomeareasthatwerecentresofthedrugtradeanda
shortageofpsychiatricrehabilitationfocusedoutreachteams.Bytheearly2000s,theproblemhad
becomesevereenoughthataspecificsubpopulationcalledSAMI(SeverelyAddictedandMentallyIll)
hadbeenidentifiedandtargetedforservice.

TheSAMIpopulationischaracterizedbythesimultaneouspresentationofseverementalhealthand
severeaddictionproblems,typicallyaccompaniedbyhighlyproblematicbehaviourincludingaggression,
anddisinhibition,amarkeddifficultyinconnectingwithandbenefittingfromstructuredcommunity
services,andhighprevalenceofbraininjury,systemicdiseasesandseveretrauma.

ThereisnowawidespreadrecognitionthatthemostseriouslyimpairedmembersoftheSAMI
populationrequiredhighlyspecializedtreatmentanddedicatedfacilities.Experienceinworkingwith
theSAMIpopulation,includingthedevelopmentoftheBurnabyCentreforMentalHealthand
Addiction,hasdemonstratedthattheshortandlongtermcareneedsofthisgrouparesignificantly
greaterandincludedspecializedacute,tertiaryandlongtermresidentialoptions.Theseneedsare
recognizedintherecentMinistryofHealth(2013)planningdocument,ImprovingHealthServicesfor
IndividualswithSevereAddictionandMentalIllness.

Figure1isaschematicdiagramwhichillustratestheformationandcharacteristicsoftheSAMIgroup:
Figure 1

Serious Health Problems and Significantly Decreased Life Expectancy

Polysubstance

Disconnection from the Health Care System

Use
Chaotic, Disturbed and Dysregulated Behaviour

Homelessness

Untreated or Poorly Managed

Serious Mental Health and
Behavioural Problems

Criminalization

Victimization

Disconnection
from Community

Deinstitutionalized or
Never Institutionalized
People with Serious
Mental Health Problems

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Poverty

Unrecognized
or Untreated
Severe Trauma

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TheNeedforSpecializedPsychiatricHospitalizationand
Rehabilitation/ResidentialCare

Insummary,thedownsizingandclosingofRiverview,whileleadingtonumerousimprovementsin
mentalhealthcare,hasledtothecreationoftwogroupsofindividualswhopresentwithtreatmentand
carechallengesthatarenotbeingmetandwilllikelyneverbemetbycurrentorplannedacutecareor
communityservices.

Thefirstisthesubgroupoftraditionalseriouslymentallyillpersonswhoarehighlyunstableand
presentwithspecificbehaviouralandcognitivedeficitsthatpreventthemfromfunctioningandliving
successfullyinthecommunity,eveninhighlysupportedsettings.Thesecondsubgroupconsistsof
individualswithsevereaddictionandmentalillness(SAMI)whopresentwithcomplexphysical,cognitive
andbehaviouralchallenge,whosecasesarecomplicatedbyexposuretosignificanttrauma,andwho
havemajordifficultyineithermaintainingcommunityresidenceorreceivingtraditionalservices.

Figure2illustratesthecharacteristicsofthesetwogroups,whicharesubgroupsofthelarger
populationsofpersonswithSeriousMentalIllnessandSevereAddictionandMentalIllness(SAMI):
Figure 2
Groups Requiring Long term Treatment
and Rehabilitation/Residential Care

Severe Addiction and Mentally Ill (SAMI)

Group

Traditional Seriously Mentally Ill

Group
Schizophrenia,
Bipolar Disorder

Severe Addiction +
Schizophrenia,
Bipolar Disorder
Mood Disorders,
Trauma/PTSD,
Impulse Control
Disorders,
Neurodevelopmental
Disorders

Complex behavior problems, Cognitive

Impairment, Attachment Issues, Personality
Disorders , Skills Deficits

Disorganization, Apathy, Cognitive Deficits,

Behavioural Deficits, Social Skilll and Life
Skills Deficits

Thus,deinstitutionalizationunintentionallyledtothecreationoftwosubgroupsofpeoplewith
significantmentalillnessthatwereunderservedorfailedtobenefitfromcommunitybasedprograms.
Someofthesepeople,suchasthosewithunresolvedproblemsrelatedtopsychosis,becamedetached
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fromthesystemandsocietyingeneral.Manyofthesepeople,andparticularlythoseexhibiting
cognitiveandinterpersonallimitations,remainoccupantsofsingleroomoccupancy(SRO)orpartofthe
homelesspopulation.Theirinabilitytofullyengageandbenefitfrommentalhealthandsocialprograms
hasoftenresultedinthembeingcondemnedtolivesofisolationandsqualor.Othersbecameinvolved
withdrugs,becamemoreseriouslyillandoftenendedupleadinglivescharacterizedbychaos,
encounterswithpolice,homelessness,severehealthproblemsandearlydeath.Thepresencein
communitiesofincreasednumbersofpeopleinbothgroupshasledtoaseriousoverloadingofhospital
emergencyservices,particularlyintheLowerMainland.

Itisalsoimportanttounderstandthattheincidenceratesforseriousmentalhealthproblemshave
remainedconstantovertheyears,whichmeanthateachyearanumberofnewcasesemerge,someof
whichwillfallintothegroupsdescribedabove.Thismeansnotonlythatthesystemproblemswill
continueovertime,butthatthesegroupswillcontinuetogrow.Accordingly,thecurrentsystem
problemswillincreaseovertimeratherthandiminish.

ServicePlanning
Therehasbeensomeplanninganddevelopmentofservicestosupportthemoreseverelyillmembersof
thetraditionalmentalhealthpopulation.OneexamplehasbeentheworkundertakenbyFraserHealth
Authority(FHA)todevelopspecializedlongtermresidentialfacilitiesontheRiverviewsite,suchas
ConnollyLodge.Thisworkishighlyrelevantinthatitspecificallyaddressesthesubgroupofpatients
whorequireveryhighlevelsofsupportanddobestinashelteredenvironmentalsetting.

VancouverCoastalHealth(VCH)isalsoplanningtodevelopadditionalACTteamsandhighintensity
supportedhousing.TheVCHwork,whilenecessarytofillspecificgapsintheirservicecontinuum,isnot
likelytomeettheneedsofthemoreunstable,morecompromisedandmorevulnerablemembersofthe
traditionalgroup.

PlanningfortheSAMIgroup,whilelessadvanced,iscurrentlyunderway.TheMinistryofHealth(2013)
planningdocumentidentifiesspecificshortandlongtermactivitiesthatarepotentiallyrelevanttothe
Riverviewsite.ThefirstistheredevelopmentoftheBurnabyCentreofMentalHealthandAddiction
andadditionofasecurefacilitytoprovidestabilization,assessmentandindividualcaseplanning
servicesforcomplexclients.Thesecondisthedevelopmentofastrategytomeetthelongterm
residentialneedsofSAMIpatientswhoareseenattheBurnabyCentre.

Inthecontextofthisplanningactivity,itisimportanttonotethattwolongtermresidentialprograms
werepreviouslyprovidedontheRiverviewsite.TheseprogramsweredeliveredinBrooksideand
LeesidebuildingstomeettheresidentialandrehabilitationneedsofBurnabyCentreclientswhohad
completedtreatmentbutforwhomresourceswerelackingintheirhomecommunities.Oneofthese
programsservedwomenwithhistoriesofextremetraumawhiletheotherservedmenwithunstable
psychoticillnesses.Theprograms,whichwereoperatedbyCoastMentalHealth,weresuccessfuland
provideatemplateforthedevelopmentofsimilar,additionalresidentiallivingprograms.Unfortunately
theseparticularprogramswerediscontinuedin2013.

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IntotheFuture:theCoquitlamHealthCampus

EducationandTraining

Throughoutitsexistence,Riverviewservedasaneducationandtrainingresourceformentalhealth
workersthroughouttheprovince.Atvarioustimesnurses,physicians,psychiatryresidentsandother
membersofthealliedhealthprofessionsreceivededucationandtrainingonthecampus.Riverviews
libraryandeducationaloutreachprogramswerealsovaluableresourcessupportingmentalhealth
professionalsthroughouttheprovince.

TheeducationalservicesprovidedatRiverviewwerecrucialinimprovingtheoverallcapacityofthe
healthcaresystemandservedasthecatalystforintroductionofnewconceptsandpractices.For
example,thedevelopmentofpsychogeriatricservicesinBCwascentredonValleyviewprogramsthat
includedonsitetrainingforbothnursesandphysicians.

WithRiverviewsclosingavaluablementalhealtheducationandtrainingcapacitywaslost,whichis
havinglongtermconsequencesforBCscapacitytoeducate,trainandsupportpractitionerswhowork
withtheseriouslymentallyillandseverelyaddictedandmentallyillpeople.

RiverviewsBuildings

WhileRiverviewsmajor
buildingshaveonlybeenclosed
forarelativelyshortperiodof
time,manyhavedeteriorated.
Accordingly,thebuilding
inventorynowrequiresvarying
degreesofrepair.Thereisa
desirebyCouncilandthe
communitytoseeprudent
repairandmaintenanceofthe
buildingstopreservethese
significantassets.Thiswill
facilitatethebuildingsbeing
repurposedinthefuture.

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IntotheFuture:theCoquitlamHealthCampus

The Future
CoquitlamsVisionaCampusofCare
CoquitlamsoveralllongtermvisionistocreateahealthandwellnesscampusofcareontheRiverview
grounds.Thiscampuswillconsistofasetofintegratedclinicalcare,educationandtraining,longterm
residentialandrehabilitationprogramsandservices.Theseprograms,togetherwithrelatedhealth,
commercialandpublicuseswillpreserveandoptimizetheuseofthesite,consistentwithRiverviews
historicalrolebutwithinamodernhealthcareframework.
TheprogramsandservicesenvisionedfortheRiverviewLandsare:

SpecializedPsychiatricTreatmentandRehabilitation

Asdiscussed,thereisaclearneedtoreestablishthecapabilitytoprovidespecializedpsychiatric
treatmentandrehabilitationforindividualswithseriousmentalillnesswhoseshortandlongterm
treatmentneedsexceedthecapabilityofgeneralhospitalpsychiatricunitsandwhoweretraditionally
servedbyRiverviewaswellasforpeoplewithsevereaddictionsandmentalillness(SAMI).

Accordingly,itisrecommendedthatapsychiatrichospitalbeestablishedontheRiverviewsiteto
providethisspecializedtreatmentandrehabilitationcapability.Thehospitalwillbedevelopedasa
centreofexcellencefortreatment,researchandeducationwithseriouslymentallyillandseverely
addictedandmentallyillpeople.Thehospitalsprogramswilleffectivelymeetthetreatmentneedsof
boththesepopulations,reducingthepressuresongeneralhospitalpsychiatricunits,communitymental
healthservices,policeandsocialservices.Assuchtheseprogramsareessentialtoaddressingthemental
healthcrisisintheLowerMainlandandotherpartsoftheprovince.

Thelongtermvisionisforconstructionofapurposebuilthospitaltobelocatedinthegeneralareaof
thepresentNorthLawnbuilding.
Thecolocationoftheprogramsfor
theseriouslymentallyillandthe
severelyaddictedmentallyill
populationspresentssignificant
advantagesintermsof
commonalitiesandsynergies
amongtheprogramsforstaffing,
treatmentapproachesandsupport
services,whileaddressingthe
distinctlydifferentneedsofeach
group.

Intheshortterm,itis
recommendedthattheBurnaby
CentreforMentalHealthand
Addictionprogramsbemovedfrom
thecurrentWillingdonsitetothe
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IntotheFuture:theCoquitlamHealthCampus

Riverviewcampus.Themostsuitablebuildingintermsofsizeandconfigurationappearstobethe
CentreLawnBuilding,thelastmajorbuildingtoclose.

AcuteCareHospital
AlthoughCoquitlamisoneofthelargestandfastestgrowingcitiesinBC,itdoesnothaveitsownacute
carehospital.ThismeansthatitscitizensmusttraveltoRoyalColumbianHospitalwhentheyrequire
emergencyandotheracutecarehospitalservices.Theythenusuallyendurelongwaitsbecauseoftraffic
aswellasthechronicallysevereovercrowdingofRoyalColumbiansEmergencyDepartment.

ThislackofanacutecarehospitalinCoquitlamisalsoamajorreasonforthesevereovercrowdingat
RoyalColumbian.Infact,thelargestproportionofRoyalColumbianspatientsnowcomefromtheTri
citiesareaandparticularly,Coquitlam.

TheRiverviewLandsareanideallocationforanacutecarehospitalwithanemergencydepartment.The
landisavailableandhighlysuitableintermsofeaseofaccessandproximityforthecitizensofCoquitlam
andtheTricities.Additionally,thishospitalwillmeettheclinicalsupportneedsfortheproposed
specializedpsychiatrichospitalandotherclinicalservicesonthesite.

Itisrecommendedthatinitiallytheacutecarehospitalprovideemergencyandambulatorycareservices
withthecapabilitytomeetthepopulationneedsofCoquitlamandtheTricities.Additionally,the
hospitalwouldoperatesufficientmedicalbedstosupportitsemergencydepartment.

Thehospitalwouldnottakecasesofseveretraumaand/orindividualsrequiringlifesupport.Those
caseswouldbetriagedtoRoyalColumbianHospitalwhichistheregionaltraumacentre.

Whileinitially,thehospitalcanbeestablishedwithinanexistingRiverviewbuildingsuchasValleyview
300,itisrecommendedthatapurposebuilthospitalbebuiltonthesite,preferablyintheNorthLawn
area.Thishospitalshouldbedesignedwiththepotentialforfuturegrowthtomeettheneedsofthe
areasexpandingpopulationaswellastheabilitytoprovideotheracutecareservicesincludinggeneral
andspecialtysurgery.

ThedevelopmentofthisacutecarehospitalontheRiverviewLandswillproviderapidaccessto
emergencyservicesaswellasanambulatorytreatmentcapability,whichwilldivertalargeportionof
casesfromRoyalColumbiansEmergencyDepartment.Thiswilleliminatethechronicallysevere
overcrowdingatRoyalColumbian.Additionally,theseemergencyserviceswillcomplementtheservices
providedtoTricitiesresidentsbyEagleRidgeHospital.

ThishospitalwilldivertalargeproportionofpatientsfromRoyalColumbian,resultingnotonlyinmuch
improvedservicesforthecitizensofCoquitlamandtheTricitiesbutalsothecitizensofNew
Westminster.Accordingly,itisrecommendedthataportionofthefundingdesignatedforRoyal
ColumbianHospitalredevelopmentbeusedforthedevelopmentofthishospital.

InthetransitiontoanacutecarehospitalontheRiverviewLands,orintheabsenceofone,itis
recommendedthatanUrgentCareCentrebeestablishedtoprovidefastaccesstoservicesaswellas
ambulatorytreatmentcapability.WhereUrgentCareCentreshavebeenestablishedtheyhavebeen
costefficientandeffectiveatdivertingcasesfromhospitalemergencydepartments.

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IntotheFuture:theCoquitlamHealthCampus

ResidentialandRehabilitation
Housing

Itisrecommendedthattheareas
occupiedbyresidentialcottagesandthe
variouslodgessuchBrooksideand
Leesidebededicatedtosupporting
clientswhorequireeitherlongterm
supportedlivingoranextendedstayina
rehabilitation/recoveryenvironmentasa
preparationtoreturningtocommunity.

Itisalsoimportantthatadditional,high
qualityresidential/rehabilitationhousing
unitsoftheConnollyLodgetypebedevelopedtomeetlongtermrehabilitation/residentialneeds.In
theinterestsofefficient,highqualitydevelopmentandoperation,itisrecommendedtheseunitsbe
developedandoperatedbyanexperienced,nonprofithousingprovidersuchasCoastMentalHealth.

EducationandTrainingCentre
Themosteffectivewayofcreatingasustainedprogramthatwillenrichthebroadermentalhealth
communityistodevelopastrongeducationandtrainingprogram.Tothisenditisproposedthatthe
redevelopmentofthesiteincludeacommitmenttocreateamentalhealth,healthandwellness
educationandtrainingcentre.Thiswillbedevelopedinconjunctionwithcollegesanduniversities.
Thiseducationandtrainingcentrewillalsosupportcentresofexcellenceforeducation,trainingand
researchinmentalhealthandaddictionaswellasrehabilitationandrecovery.
Thesecentresofexcellence,developedinpartnershipwithuniversitiesandcolleges,areanideal
additiontoacampusofcareandwillprovideprovincial,nationalandinternationalprofileforthe
campusofcare.TheCentreforAddictionandMentalHealthworkinginconjunctionwiththeUniversity
ofTorontoisagoodexampleofthistypeofpartnership.
ItisproposedthatthespacecurrentlyoccupiedbytheHenryEssonYoungandAdministrationofficesbe
dedicatedtotheseresearch,academicandtrainingactivities.

HealthandWellnessBusinessPark
Certaintypesofhealthandwellnessrelatedbusinessesonthesitewouldnotonlygeneraterevenuebut
wouldsupportclinicalandtrainingactivities.Thesebusinesseswouldincludemedicallaboratories,
medicalclinics,diagnosticimaging,medicaltechnologyandmedicalsupplycompaniesthatsupportor
complimenttheProvincialhealthcareservices.Diagnosticimaging,laboratoryandotherspecialized
serviceswouldalsoincreasetheeaseofaccesstotheseservicesforsiteresidents.Similarly,the

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IntotheFuture:theCoquitlamHealthCampus

presenceofmedicaltechnologycompaniescanresultinresearchpartnershipsandpriorityaccessto
services.
Otherhealthandwellnessbusinessessuitableforthesitemayincludeprivateand/orfaithbased
addictionstreatmentandrehabilitationprograms.Additionally,thehealthandwellnessbusinesspark
wouldbeanideallocationforotherprivatephysicalrehabilitationprogramsforexampleforbraininjury
includingstroke.
Inthisregard,thecurrentzoningisP1CivicInstitutional.Thisallowsforcivictypefunctionssuchas
governmentoffices,educationalinstitutionsandhospitals.Commercialactivitiesthatareaccessoryto
theprincipleusearealsopermitted.
ItisrecommendedthattheportionofthesiteadjacenttotheLougheedHighwaybeusedasthesiteof
theHealthandWellnessBusinessPark.ThelandforthisparkwouldbeleasedfromtheProvincial
Governmenttoappropriatehealthrelatedindustrialuses.

Thisareawillbeveryattractivetohealthandwellnessrelatedbusinesseswithitsidealgeographic
location,proximitytoclinicalprogramsandaccesstotransportationcorridors.Itwillalsohavedirect
accesstoQNet,astateoftheartfibreopticnetworkconnectingthecomplementarybusinessestofast
andreliableinternetconnectivity.

Theleasecostsandtaxespaidbytenantswouldbeanimportantsourceofrevenuetopayforthecosts
ofservicingandoperatingthesitetoassistwithmakingthesitesustainableandrevenuegenerating.

RecreationalDevelopment
Devotingspacetorecreationandparticularlytorecreationthatisaccessibletobothresidentsof
Riverviewprogramsandthepublicatlargeisanimportantaspectofredevelopment.Accesstogreen
spacesandtorecreationalactivitiesisknowntohavebeneficialeffectsonrecoveryfrommentalhealth
problems.Also,thenaturalbeautyoftheRiverviewLandsaswellasthebotanicalsignificanceofthesite
makeitidealfortheoutdoor/recreationalopportunitiesthatwouldservebothindividualsintheclinical
andrehabilitationprogramsaswellasthecommunityatlarge.
Recreationaldevelopmentshouldrespecttheimportantnatural/botanicalspacesonthesitebutalso
leveragethesitesrecreationalpotential.Thegoalwouldbetosensitivelyutilizetheexistinggreenspace
tocreateoptionsthatareaccessibletothepublicandthatalsocreateopportunitiesforresidentsofthe
proposedprogramstohavemorenormalizedexperiences.
PresentlyalargeparceloflandatthesouthendoftheRiverviewgroundsisfreeofbuildingsand
coveredwithmaturetreesandgrass.Thisland,whichliesbelowandtothesouthofPenningtonHall,
wouldbeanidealsiteforaparkandpublicrecreationarea.ThisareaisaccessiblefromtheLougheed
HighwayaswellasfromthemainareasoftheRiverviewCampus.Thisspacemaybeusedforpicnic
areas,playgroundsandshortwalkingtrailsorrelatedactivities.
ThesitepresentlyoccupiedbyPenningtonHallisideallysuitedforredevelopmentasasmallpublic
recreationalfacility.Developingsuchafacilitywouldbeinkeepingwiththehistoricuseofthesite,as
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IntotheFuture:theCoquitlamHealthCampus

PennHallwasusedformanyyearsasarecreationfacilityforstaffandpatientsintheRiverview
programs.Thereissufficientspacefortheconstructionofasmallcommunitycentrewhichcould
providephysical,socialandeducationalactivitiestoresidentsofboththecampusandgreater
community.
Withinthiscontextofsomeparksandrecreationuse,itshouldalsobenotedthattheCityisonrecord
statingthattheexistingarboretumandlandscapefeaturesbepreservedaspertheapproved2008
UBCMRiverviewLandsResolution.Thesitehassignificantnaturalandheritagevaluesthatneedtobe
respected.

OtherUsesoftheSite
ThesitepresentlyhousesaBCAmbulanceServicesStation.Thisisanideallocationwiththe
developmentofanAcuteCareHospitalwithanEmergencyDepartmentorUrgentCareCentre.

Anotherpotentialuseofthesitewouldbeasthelocationforadetoxcentreforthetreatmentof
personswithalcoholandsubstanceuseproblems.Anumberoftheexisting,smallerbuildingswouldbe
excellentforthispurpose.
Itisrecommendedthatother,appropriatepresentandfutureusesofthesitebeencouragedincluding
filming,AmateursRadioGroup,HistoricalSociety,etc.

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IntotheFuture:theCoquitlamHealthCampus

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IntotheFuture:theCoquitlamHealthCampus

DevelopingtheCampus
Itisrecommendedthecampusbedevelopedasfollows:

Phase1

Relocatethe BurnabyCentreforMentalHealthandAddictionprogramsforSevereAddiction
andMentalIllness(SAMI)programstoasuitablebuildingontheRiverviewLands,suchasCentre
Lawn.

OpenSpecializedPsychiatricTreatmentprogramsintheCentreLawnBuildingtoservicethose
whorequirelongertermspecializedtreatmentfortheirseriousmentalillness.

DevelopanAcuteCareHospitalintheValleyview300Building.

DevelopLongTermResidentialandRehabilitationServicesinproximitytothecurrent
residentialprograms.ThesewillbelocatedinexistingLodgeandCottagebuildings.

DevelopanEducationandTrainingCentreforMentalHealthandAddictionsandRehabilitation
andRecovery.ThiswillbecenteredatthecurrentHenryEssonYoungAdministrationBuilding.

DevelopaHealthandWellnessBusinessParkwithtenantsincludinglaboratoryanddiagnostic
services,medicalresearchcentres,medicalandalliedhealthservices,diagnosticimagingand
medicalsupplyservices.ThisHealthandWellnessParkwillbelocatedontheportionofthesite
adjacenttotheLougheedHighway.

DedicatetheSouthwestendofthesiteforpublicuse(parkandrecreationaluses).

Phase2

DevelopadditionalLongTermResidentialandRehabilitationUnits.

DeveloparecreationalfacilityinthePenningtonHallarea.

Phase3

Developanew,purposebuiltclinicalcentreintheNorthLawnareatorelocatetheprograms
fromCentreLawnaswellastheAcuteCareHospitalfromtheValleyview300Building.

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IntotheFuture:theCoquitlamHealthCampus

FinancingRiverviewRedevelopment
ThedevelopmentandoperationoftheproposedprogramsontheRiverviewsitewillrequire
considerablecapitalandoperatingfunding.Thereareseveralpotentialsourcesoffundingwhichare
consideredhere:

RiverviewLegacyFunding
Asdiscussedearlier,overtheyearstherewereseveralmentalhealthplanstoredeveloporreplace
Riverview.IntheseplansthecommitmentwasmadethatproceedsfromanysaleofRiverviewlandand
assetswouldbeplacedinalegacyfunddedicatedtomentalhealthservices.Similarly,theRiverview
operatingbudgetwastobepreservedanddedicatedasannualizedfundingforprovincialmentalhealth
programs.
Theoperatingbudgetwasintheorderof$100millionannuallywhentheprogramofaggressive
downsizingbeganwhichledtotheclosingofthehospital.Althoughaportionoftheoperatingbudget
wastransferredtothehealthauthoritiestodevelopandoperatecommunityresidentialand`tertiary`
mentalhealthprograms,thetotalamounttransferredisconsideredtobesignificantlylessthanthe
hospital`sformeroperatingbudget.
Accordingly,itisrecommendedthattheMinistryofHealthdeterminetheproportionoftheformer
Riverviewoperatingbudget,whichwasnotusedforRiverviewreplacement,andmakethisavailableas
operatingfundingfortheproposed,specializedprogramsandservices.

CostAvoidance:AcuteCareHospital,PoliceandSocialServicesCosts
ThedownsizingandclosureofRiverviewhavecontributedtothecurrentseriousmentalillnesscrisisin
theprovince,particularlyinVancouverandtheLowerMainland.Thecrisishasbeenassociatedwith
emergencydepartmentovercrowdingandamajorincreaseinpoliceandsocialservicecosts.Vancouver
Policeestimatethatatleast20%oftheirmemberstimeisnowdevotedtoattending,transportingand
waitinginemergencydepartmentswithpeoplewhoareseriouslymentallyill.TheCoquitlamRCMP
detachmentalsoindicatesthatasignificantportionoftheirtimeisdedicatedtorespondingtomental
healthissues.Forexample,in2012thedetachmentrespondedto824callsundertheMentalHealthAct.
Thoseresponsesledto324apprehensionsofindividualswithmentalhealthissues.Thewaittimesfor
officerswhothenhavetokeepcustodyofthepatientsuntiltheyareprocessedatahospitalwereas
highasninehours.
Whileitisdifficulttoquantifythecostsofpolice,emergencyandsocialservices,itisclearthatthere
establishmentofRiverview`sspecializedpsychiatrictreatmentcapabilitywillresultinmajorcost
avoidanceintheLowerMainlandandothercommunitiesoftheProvince.TheProvincialGovernment
shouldbeurgedtoconsiderthissituationandreallocatehealthbudgetsinconjunctionwith
redevelopingRiverview.

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IntotheFuture:theCoquitlamHealthCampus

RelocationofBurnabyCentreforMentalHealthandAddictionPrograms
TherelocatedBurnabyCentreforMentalHealthandAddictionprogramswillbeoperatedwiththeir
current,annualizedfunding,i.e.theirfiscalandhumanresourceswillbetransferredwiththem.There
willalsobesomeeconomiesachievedthroughsharedsupportandclinicalserviceswiththepsychiatric
programs.ItisfurthersuggestedthatthecapitalfundsfromthesaleoftheBurnabysitebeusedfor
capitalinvestmentontheRiverviewLands.

DevelopinganAcuteCareHospital
ThedevelopmentofanAcuteCareHospitalwillresultingreatlyimprovedaccesstoemergencyand
ambulatorycareservicesforthepeopleofCoquitlamandsurroundingcommunities.Thishospitalwill
alsodivertasignificantproportionofpatientsfromRoyalColumbianHospitalsEmergencyDepartment.
Infact,thelargestproportionofRoyalColumbianspatientsnowcomefromtheTricitiesareaand
particularly,Coquitlam.
Accordingly,itisrecommendedthataportionofthefundingforRoyalColumbianHospital
redevelopmentberedirectedtodevelopinganAcuteCareHospitalontheRiverviewsite.Inthe
transitiontoanAcuteCareHospitalontheRiverviewLands,orintheabsenceofone,itisrecommended
thatanUrgentCareCentrebeestablishedtoprovidefastaccesstoservicesaswellasambulatory
treatmentcapability.WhereUrgentCareCentreshavebeenestablishedtheyhavebeencostefficient
andeffectiveatdivertingcasesfromhospitalemergencydepartments.Theseserviceswillcomplement
theservicesprovidedtoTricitiesresidentsbyEagleRidgeHospital.

HealthandWellnessBusinessPark
ItisproposedthatthestripoflandadjacenttotheLougheedHighwayextendingeastfromtheCrease
ClinicareabeusedasHealthandWellnessBusinessPark.Thelandforthisparkwouldbeleasedbythe
ProvincialGovernmenttoappropriatehealthrelatedindustrialuses.Suggestedtenantswouldbe
laboratoryanddiagnosticservices,healthresearchunits,diagnosticimagingcompanies,medicalclinics
andmedicalsupplycompanies.
Thisareawillbeveryattractivetohealthandwellnessrelatedbusinesseswithitsidealgeographic
location,proximitytoclinicalprogramsandaccesstotransportationcorridors.
Theleasescouldbeanimportantsourceofrevenuetopayforthecostsofservicingandoperatingthe
site.TheCitycouldalsoconsiderpossibletaxincentivesasanimpetustoencourageinvestmentinthe
RiverviewLands.

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IntotheFuture:theCoquitlamHealthCampus

Summary
Foralmost100years,RiverviewHospitalplayedakeyroleinBritishColumbiasmentalhealthservice
system.Forthefirsthalfofitslife,Riverviewwasthemajorpsychiatrichospitalintheprovinceandwas
internationallyrecognizedforitstreatmentprograms.Duringthesecondhalfofitslife,Riverviews
importanceandroledeclinedwithitspatientpopulationascommunitytreatmentalternativeswere
developed,particularlygeneralhospitalunits.Riverviewsnewrolebecameprovidingspecialized,
tertiaryservicesforpersonswhosetreatmentneedsexceededthecapabilityofthegeneralhospital
units.
Beginninginthe1980saseriesofdeinstitutionalizationprogramssawthehospitaldownsizedand
closed.Unfortunately,thisresultedinalossofRiverviewsspecializedtreatmentcapabilityforthegroup
oftraditionalpersonswithseriousmentalillnessrequiringspecialized,longertermtreatment.Atthe
sametime,anewgroupofSeverelyAddictedMentallyIll(SAMI)individualshasemergedwhohave
complextreatmentneedsandwhoarenowplacinggreatpressureonhospitalemergencydepartments
andpsychiatricunitsaswellaspoliceandsocialservices.
TheclosingofRiverviewhasthusledtounintendedconsequencesintheformofthepresentmental
healthcrisisinVancouver,theLowerMainlandandotherpartsoftheprovince.Inturnthishasresulted
inconsiderablepublicandcivicgovernmentpressurefortheProvincetouseRiverviewasamental
healthfacility,asthe2008and2013UBCMresolutionsontheRiverviewLandshighlight.
Accordingly,theprimaryrecommendationofthisreportistoreestablishspecializedpsychiatric
treatmentcapabilityontheRiverviewsitetogetherwiththesynergisticpsychiatricprogramsforthe
SeverelyAddictedMentallyIll(SAMI)population,whicharecurrentlyprovidedbytheBurnabyCentre
forMentalHealthandAddiction,inaccordancewithcurrentbestpractices.
ThesecondmajorrecommendationistoestablishanAcuteCareHospitaltomeettheneedsofthe
peopleofCoquitlamandsurroundingcommunitiesaswellassupportthepsychiatricandrehabilitation
programsonthesite.
ThisreportalsoproposestheuseoftheRiverviewLandsforothercomplimentarypurposesincludinga
Health,MentalHealthandWellnessEducationandTrainingCentre,aHealthandWellnessBusinessPark
aswellasdedicatedpublicparkandrecreationalspacethatpreservesthenaturalandheritagevalue.

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IntotheFuture:theCoquitlamHealthCampus

Summary of Recommendations
Itisrecommendedthat:
1. Ahealth,mentalhealthandwellnesscampusofcarebedevelopedontheRiverviewLands.This
campuswillconsistofasetofintegratedclinicalcare,educationandtraining,longterm
residentialandrehabilitationprogramsandservices.
2. AspecializedpsychiatrichospitalbeestablishedontheRiverviewsitetoprovidespecialized
treatmentandrehabilitationcapability.Thehospitalwillbedevelopedasacentreofexcellence
fortreatment,researchandeducationwithseriouslymentallyillandseverelyaddictedand
mentallyill(SAMI)people.
3. TheSAMItreatmentcapabilitybeprovidedbyrelocatingtheBurnabyCentreforMentalHealth
andAddictionprogramstotheRiverviewsitewheretheycanbecolocatedwithinthehospital.
Thecolocationoftheprogramsfortheseriouslymentallyillandtheseverelyaddictedmentally
illpopulationswillpresentsignificantadvantagesintermsofcommonalitiesandsynergies
amongtheprogramsintheareasofstaffing,treatmentapproachesandsupportserviceswhile
separatelyaddressingthedistinctlydifferentneedsofeachgroup.
4. Intheshorttermthepsychiatrichospitalbelocatedinoneoftheexistingbuildings.Thebuilding
thatismostsuitableintermsofconfigurationandfacilitiesisCentreLawn.
5. Inthelongerterm,apurposebuiltpsychiatrichospitalbeconstructedintheareaofthepresent
NorthLawn.
6. AnAcuteCareHospitalbedeveloped,whichwillprovidegreatlyimprovedaccesstoacutecare
andparticularlyemergencymedicalservicesforthepeopleofCoquitlamandsurrounding
communities.Thishospitalwillalsodivertasignificantproportionofpatientsandreducethe
pressuresandovercrowdingofRoyalColumbianHospitalsEmergencyDepartmentandsupport
theproposedmentalhealthusesontheRiverviewsite.
7. Intheshortterm,theAcuteCareHospitalwithanemergencydepartment,ambulatorycareand
medicalbedsshouldbeopenedintheValleyview300building.
8. Inthelongerterm,apurposebuiltAcuteCareHospitalbeconstructedinthegeneralareaofthe
presentNorthLawn.
9. AportionofthefundingforRoyalColumbianHospitalredevelopmentberedirectedto
developinganAcuteCareHospitalontheRiverviewsite.

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IntotheFuture:theCoquitlamHealthCampus

10. Theareasoccupiedbyresidentialcottages,theValleyviewUnits,excludingtheValleyview300
Building,andthevariouslodges(Brookside,Leeside)bededicatedtosupportingclientswho
requireeitherlongtermsupportedresidentiallivingoranextendedstayina
rehabilitation/recoveryenvironmentasapreparationtoreturningtocommunity.Highquality,
purposebuiltresidential/rehabilitationfacilitiesofthepresentConnollyLodgetypeshouldbe
constructedforthispurpose.
11. Theseresidential/rehabilitationunitsbedevelopedandoperatedbyanexperienced,nonprofit
housingprovidersuchasCoastMentalHealth.
12. Theredevelopmentofthesiteincludeacommitmenttocreatetwocentresofexcellenceone
inmentalhealthandaddiction;theotherinrehabilitationandrecovery.
13. ThespaceandfacilitiescurrentlyoccupiedbytheHenryEssonYoungEducationCentreand
AdministrationBuildingbededicatedtoresearch,academicandtrainingactivities.
14. TheportionofthesiteadjacenttotheLougheedHighwaybedevelopedasaHealthand
WellnessBusinessPark.Thiswillattracthealthrelatedcommercialbusinessesandgenerate
revenuetosupportdevelopmentandsustainoperations.
15. Othercurrentandproposedusesofthesiteincluding:filming,museums,amateurradioclubs;
andBCAmbulanceServicesbesupported.
Thesecurrentandfutureusesare
appropriateanddonotconflictwiththe
proposedclinical,educationaland
residentialuses.
16. Thesouthendofthecampus,includingthe
siteofPenningtonHallandtheareabelow
beusedforparkpurposesandasmall
recreationfacility.Thededicationofthat
portionofthesitetoparksandrecreation
wouldservethecommunityatlargeaswell
asproviderecreationopportunitiesfor
thoseindividualsresidingonthegrounds.
17. Thenaturalandheritagevaluesofthesite
bepreserved.Thereissignificanthistorical
valuetotheRiverviewlandsthatneedsto
berespected.

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IntotheFuture:theCoquitlamHealthCampus

Appendix1ABriefChronologyoftheRiverview
Lands
1904TheBritishColumbiaGovernmentacquireda405hectaretractoflandatthejunctionoftheFraser
andCoquitlamrivers.101hectares(Theuplands)laterbecamethesiteofRiverviewHospital.The
lowerlandsbecameColonyFarmandwerecultivatedtoproduceagriculturalproductsforthehospital.

1908HenryEssonYoung,theProvincialSecretary,approvedfundingforthebuildingoftheHospitalfor
theMindatCoquitlamontheuplandssite.

1911JohnDavidsonwasappointedBritishColumbiasProvincialbotanistanddevelopedthefirst
Provincialbotanicalgardenandarboretumontheuplandssite.

1913ThefirstmajorhospitalbuildingwasopenedandadmittedpatientsfromNewWestminster.The
building,laterknownasWestLawn,remainedinuseuntilthe1980s.In1913,thenameofthehospital
waschangedtoEssondaleinrecognitionoftheroleoftheProvincialSecretaryinitsdevelopment.

1924TheAcutePsychopathicUnit.LaterknownasCentreLawnwasopened.

1930Thethirdmajorbuilding,theFemaleChronicBuilding,laterknownasEastLawn,wasopened.

1934TheVeteransBlockwasopened.ThislaterbecametheCreaseClinic.

1955TheNorthLawnbuildingwasopenedasahospitalunitforthecareandtreatmentofpsychiatric
patientswithtuberculosis.

1956ThiswasthepeakyearforEssondalewithover4300patientsand2200staff.From1956therewas
asteadydeclineinthepatientpopulationassociatedwithadvancesinpsychiatricmedicationand
increasedcommunitytreatmentoptions.

1965EssondalewasrenamedRiverviewHospital.ThesitewassharedwithValleyview,whichoperated
withseparateadministrationandbuildingsandprovidespsychogeriatrictreatmentservices.

1974Dr.FrankMcNair,aRiverviewpsychiatrist,openedKelownaMentalHealthCentrewithRiverview
staffandresources.Thiswasthefirstcommunitymentalhealthcenteropenedintheprovinceand
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IntotheFuture:theCoquitlamHealthCampus

markedthebeginningofthedevelopmentofcommunityalternativestoadmissionstoRiverview.Atthe
sametime,MinistryofHealthpolicywastodevelopinpatientpsychiatricunitswithintheprovinces
generalhospitalsasanalternativetoRiverviewadmissions.

ThedevelopmentofcommunitybasedalternativestoRiverviewinthe1970sandearly1980s
significantlydecreasedadmissionsandtherewasaconsequentdeclineinthepatientpopulation.

1986RiverviewandValleyviewwereamalgamatedunderasingleadministrationknownasRiverview
Hospital.

1990AprovincialmentalhealthplanrecommendedthetransferofmanylongtermRiverviewpatients
toregionalfacilitiesintheirowncommunities.Theplanalsorecommendedthereplacementof
Riverviewwithaspecialized358bedtertiarypsychiatrichospitaltobedevelopedasaprovincialcenter
ofexcellenceforresearch,educationandbestclinicalpracticesforseriousmentalillness.

1998Theprovincialgovernmentproducedanothermentalhealthplanwhichononehandstatedthat
Riverviewwouldhaveasignificantrolefortheforeseeablefutureandontheotherhandrecommended
thatthehospitalbeclosedwithinsevenyears.(TherecommendationthatRiverviewwillclosewasmet
withstrongopposition,bothbythepublicingeneralandCoquitlaminparticular).

2000Theprovinceestablishedregionalhealthauthorities.Theplanningprocessbegantofacilitatethe
transferofRiverviewpatientstocommunityfacilitieswithintheseauthorities.TheProvincialHealth
ServicesAuthoritywasgivenfullresponsibilityforRiverviewhospital.

2002ThepatientpopulationofRiverviewwasreducedto800andexpectedtoshrinkto125by2005.

2003FraserHealthAuthorityopenedConnollyLodge,a23bedresidentialfacilityontheRiverview
lands.ConnollyLodgewasregardedasaprototypeforotherlongtermhousingtobedevelopedonthe
Riverviewlands.Subsequently,FHAopenedCottonwoodandCypressontheRiverviewgrounds.

20072012TheremainingRiverviewpatientsweretransferredtofacilitieswithintheprovinceshealth
authorities.Withthefinaltransferscompleted,Riverviewclosedafter100yearsserviceasthe
provincialpsychiatrichospital.

References

CityofCoquitlamRiverviewTaskForce(2005).FortheFutureofRiverview.

DonaldLuxtonAssociates(2008)StatementofSignificance.

MinistryofHealth(2013)ImprovingHealthServicesforIndividualswithSevereAddictionandMental
Illness.Retrievedfromhttp://www.health.gov.bc.ca/library/publications/year/2013/improvingsevere
addictionandmentalillnessservices.pdf

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