{"id":1333,"date":"2025-04-14T22:47:24","date_gmt":"2025-04-15T02:47:24","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/accessiblehealthcare\/?post_type=chapter&p=1333"},"modified":"2025-04-28T11:04:46","modified_gmt":"2025-04-28T15:04:46","slug":"care-as-control-and-containment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/accessiblehealthcare\/chapter\/care-as-control-and-containment\/","title":{"raw":"Care and the Institution","rendered":"Care and the Institution"},"content":{"raw":"

Care as Control and Containment<\/span><\/h2>\r\nOntario began building large \u201ccare\u201d institutions in the mid-1800s. Among these were the Provincial Lunatic Asylum (now CAMH) and institutions for the \u201cfeeble-minded,\u201d which would later become facilities such as the Huronia Regional Centre, a former institution in Orillia for individuals with developmental disabilities. Institutions were often portrayed as helping people in need. Indeed, the word \u201casylum\u201d suggests a place of refuge.\r\n\r\nTo learn more about life inside one of Ontario\u2019s largest institutions, the Huronia Regional Centre, explore this article, No human dignity: What life was like at the Huronia Regional Centre.<\/a>\r\n\r\nEarly institutions\u2014residential schools, asylums and workhouses\u2014were undifferentiated spaces of confinement that gradually specialized by purpose, such as rehabilitation centres, development education centres, psychiatric hospitals and prisons (Ben Moshe et al. 2014). Within the walls of the asylums and institutions designed for the \u201cfeeble-minded,\u201d experts could create an environment that exemplified the principles of a well-ordered society and thereby \u2018cure' inmates of insanity, deficiency, and deviancy. Similarly, Indian Residential Schools were rationalized as a means of \u2018saving\u2019 Indigenous children from the \u2018death of their race,\u2019 which was considered inevitable for the success of the Canadian colonial project and the building of the nation.\u00a0 Eugenicist ideas encouraged the segregation of \u201cundesirable\u201d people in institutions to prevent them from reproducing. Part of the power of institutions lay in the authority and authority of medical and scientific experts to deem who was a good citizen, and who should be contained. By the mid-20th century, deinstitutionalization efforts emerged, yet institutional thinking persisted, merely shifting from large institutions to underfunded \u201ccommunity-based\u201d settings. Several of the large institutions were repurposed for long-term care.\r\n
\r\n\r\nRelated Reading:<\/strong> Read the 2021 article on the legacy of institutionalization and how former residents of Huronia have continued to call for its full dismantling:\r\nFormer HRC Residents \u2018Want the Buildings Torn Down\u2019<\/a>.\r\n\r\nFurther Reading (Scholarly Article):<\/strong> For more on the settler-colonial roots of psychiatric institutions in Canada, see:\r\n\r\nDowbiggin, I. (1995). \u2018Keeping this Young Country Sane\u2019: C. K. Clarke, Immigration Restriction, and Canadian Psychiatry, 1890\u20131925. The Canadian Historical Review, 76(4), 598\u2013627. https:\/\/utppublishing.com\/doi\/abs\/10.3138\/CHR-076-04-03?journalCode=chr<\/a>\r\n<\/em>\r\n\r\nNote: Access to this article may require institutional or university library login.<\/em><\/small>\r\n\r\n<\/div>\r\n

Deinstitutionalization<\/span><\/h2>\r\nIn the 1960s, disability activists began to call for deinstitutionalization. They wanted disabled people to move out of institutions and live in the community. The deinstitutionalization movement did lead to the closure of many institutions. Ontario\u2019s last three institutions for people with developmental disabilities, including the Huronia Regional Centre, closed in 2009. For more about the Huronia\u2019s history, see the following timeline.\r\n\r\nhttps:\/\/exhibits.wlu.ca\/s\/huronia\/page\/about-huronia<\/a>\r\n\r\n \r\n\r\n[caption id=\"attachment_1337\" align=\"alignnone\" width=\"1024\"]\"Black The Asylum for the Insane, Orillia, Ontario, August 1909. This institution was later renamed the Ontario Hospital School and eventually the Huronia Regional Centre. Source: Community Archives. Public domain.[\/caption]\r\n

Institutional Thinking<\/span><\/h2>\r\nEven so, \u201cinstitutional thinking\u201d or \u201cinstitutional logic\u201d persists in many systems of care. As disability advocate of Pat Worth from People First put it institutional thinking is \u201c is not just a place; it is the way people think\u201d (Worth, 1988<\/a>). This kind of thinking can manifest outside of physical institutions, shaping policies, bureaucracies, and interactions.\r\n\r\nFor example, the Ontario Disability Support Program (ODSP) reflects institutional thinking through its rigid processes and gatekeeping. Applicants must undergo medical verification to determine whether they are \u201ctruly\u201d disabled and \u201cdeserving\u201d of ODSP. This process often involves multiple assessments by healthcare professionals evaluating a person\u2019s impairment and its impact on their life. The bureaucracy, complexity, and medical oversight involved in this process illustrate institutionalization through policy rather than place.\r\n

Institutional thinking has also contributed to transinstitutionalization<\/em>, defined by the Department of Justice Canada as \u201cthe migration of a particular population from one system to another\u201d (Department of Justice, 2006<\/a>). For example, someone may be discharged from a psychiatric hospital only to end up incarcerated due to lack of support. Similarly, \u201ccommunity\u201d settings like halfway houses, group homes, or assisted living environments may continue to enforce control and restriction, perpetuating institutional logics.<\/p>\r\n

Some present-day healthcare institutions are even located on the sites of former institutions of control and confinement. For example, the Huronia Regional Centre has been repurposed as a long-term care facility, forcing some people to return to sites of past confinement in order to receive care.<\/p>\r\n\r\n

\r\n\r\n\"Video\r\n

Media Moment<\/h3>\r\nTime: 25 minutes<\/strong>\r\n
Watch the following twenty-five minute TVO interview with health journalist Andr\u00e9 Picard as you consider what you\u2019ve read about healthcare and institutions. Consider, what are the care opportunities within these institutions?<\/div>\r\n
\r\n\r\nTurning Our Back on Long-Term Care | TVO Interview<\/a>\r\n\r\n<\/div>\r\n<\/div>\r\n

Care beyond the clinic<\/span><\/h2>\r\nMost people prefer home care to institutionalized care. It is also the least expensive option\u2014cheaper than both hospital care and long-term care. However, there are many barriers to accessing home care. Individuals and their loved ones must navigate confusing eligibility requirements and long waitlists. According to a 2022 report by the Ontario-based home care initiative Bring Health Home<\/em>, more than 15,000 people in Ontario were on waitlists for home care, and fewer than 50% of new referrals were being accepted. Applying for home care often involves multiple interactions with various healthcare services and providers, such as the referring physician, the hospital, and the home care provider (or, in some cases, multiple providers). To learn more about barriers to receiving healthcare beyond the clinic, engage with the Enabling Accessible Healthcare mini-documentary<\/a>.\r\n

Care Poverty and Care Gaps<\/span><\/h2>\r\n\u201cCare poverty\u201d and \u201ccare gaps\u201d refer to the absence of care in certain communities. Suburban, rural, or remote areas of Ontario often lack healthcare resources, including the ability to provide 24\/7 ER services. Consider the example of restricted emergency room hours in the South Grey Bruce region and recent ER and urgent care closures across Ontario, particularly in rural communities:\r\n