Lesson 1: From Institution to Community

Caring Minds (Grades 7-12) > Self-Determination and Activism > Lesson 1: From Institution to Community

Lesson 1: From Institution to Community

Starter: The Institutional World (5 minutes)

  • Show students video clips, images, or poetry which depicts patient conditions in institutions. (RESOURCE 1A)
  • Discuss findings and overall impressions. What was it like for the patients? How would they have felt? Do you think the patients were treated fairly? What rights or abilities did they have to make their own decisions? Do you think their stay in the institution helped them? How or how not?

Discussion: From Institution to Community (5-10 minutes)

  • Explain to the students that today they are going to explore the concept of self-determination and activism in the context of mental health decision-making.
  • Discuss with the students that some people with mental health difficulties (especially continuing difficulties) do not get to make their own decisions even when they are capable. These people can feel like they have no say in what happens to them, or no one will listen, and this is compounded when they face stigmatization and discrimination. This was true in the past and also happens today.
  • Before the shift to care in the community, people with mental illness were often committed to residential institutions where they were treated for their condition., usually over a period of months, but sometimes for years. Many patients were institutionalized without consent. Others were not told anything about the treatment they were receiving. Doctors and family members made the decisions for the patients. The institution was a very separate world from the community, with its own rules and routines.
  • Between 1960 and 1990 many Canadian mental health institutions were closed down because of escalating costs, increased use of pharmaceutical treatments, emerging understandings of patient rights, and movement toward community care models. More and more mental health patients were living in the community and receiving care outside of an institution. However, the transition to the community was often a rocky one. Former patients were often stigmatized, finding it difficult to secure employment and safe and affordable housing. A number of people with mental health conditions continued to have little to no rights over their care and treatment. For some, their lives have included negative encounters with police. The open doors of the institution were often followed by closed community attitudes and practices.
  • For all good intentions, the community mental health movement has resulted in limited resources for some people in need of care and provision. Some have ended up in a tangle of revolving doors between the hospital ward, the criminal justice system, and the street. Yet in spite of the negatives, most former patients believe that the mixed freedoms and hardships of community living remain preferable to the limited autonomy of institutional life.

Activity 1: Has it ever happened to you? (10 minutes)

  • Ask the students to think of a time when they were not able to control a decision (at school or at home), a time when someone else made the decision for them and they had no say in the matter.(e.g. school rules or home curfew)
  • Ask the students the following questions:
    • What was it like?
    • How did it feel to have someone else controlling the situation?
    • Did you try to get control of the situation? If so what you do? Did it work?
    • How did other people around react to the situation?

Activity 2: Institution versus Community (20-30 minutes)

  • Have students read accounts of being in the institution and in the community. (RESOURCE 1B)
    • Students then bring to the group their observations of the loss of rights in an institution versus the difficulties of living in the community with mental health issues. Create a chart together with three columns:
      1. Aspects of Institutional Life
      2. Aspects of Community Life
      3. An Ideal Situation
    • Ask: Compare this to your own experiences inside school (an institution) and outside school (in the community). What are some of the similarities and differences?

Closure (5 minutes)

  • Have students reflect on the following:
    • How might you have felt if you were a mental health patient institutionalized or living in the community with limited resources and/or rights ?

* This can be done either as a journal entry or class check in.



1A The Institutional World
1B Institution versus Community