We fret about
the future of the Riverview lands as if they were an idyllic
place fixed in time, where any change to the way we use the
lands, or any imaginative idea for them, is hard to
We should instead ask ourselves how the lands can
best be used to help those who suffer from serious mental
illness — the historical legacy of Riverview — and take it
With that as our imperative, we’re proposing, as the
backbone of the lands, an “intentional community” in which
those with serious mental illness, stabilized in acute and
tertiary care, will live together with others without a
mental illness in an integrated community purpose-built to
help the seriously mentally ill flourish.
We’ve named the proposed community Riverview
Village. It’s a new and innovative option for the future.
A little bit of clinical background will help to
understand the rationale, because the introduction of
antipsychotics for those with schizophrenia has changed the
paradigm from the days of the old Riverview Hospital.
Before antipsychotics, there was no satisfactory
treatment for psychosis, with its delusions, hallucinations,
paranoia, and related symptoms like catatonia.
Antipsychotics deal with these symptoms and in most cases
stabilize people, after which they can be discharged from
hospital. It’s why we no longer need a huge, institutional
treatment complex on the Riverview lands, with a
correspondingly huge number of patients and staff.
What happens after discharge, though? Antipsychotics
don’t help reintegrate people into society or expand their
horizons. And, indeed, there’s a whole other range of
symptoms, ongoing chronic symptoms, that for many of those
with schizophrenia pose great difficulty. Profound loss of
motivation often accompanies such illness (“avolition” it’s
called, in clinical language). Poor social interactions are
another difficulty, exacerbated for many by their having
fallen ill in their late teens when social skills are
Dampened feelings and responsiveness, trouble with
rhythm and clarity of speech, slowed movement, and cognitive
deficit can be other difficulties.
These problems do not respond well to existing
treatments. Unlike antipsychotics for psychotic symptoms,
for example, there’s currently no effective medication for
them. Also, unlike acute-care treatment which is relatively
brief, these challenges may last for the rest of people’s
lives. Many people end up isolated and languish, with
limited activities and seemingly bleak futures. They are
said to be “in the community,” which sounds nice, but
they’re not “of the community.” As long as they don’t cause
trouble, we may in fact not have any contact with them at
The intentional community we’re proposing both
recognizes and addresses this new paradigm, where
antipsychotics allow for deinstitutionalization but
continuing chronic symptoms endure.
In the proposed community, those with a mental
illness will establish real relationships with those without
a mental illness, breaking their isolation. A community
centre will anchor the village and a wide range of
activities. Meaningful work will be arranged for those who
can manage it. An arts hub is proposed, with studios and
retail shops, whereby the mentally ill can connect with
artists and craftspeople, and where those with an aptitude
become part of that artistic community and sell their work.
Community facilitators will help bring people together and
keep the community vibrant.
Most of all, Riverview Village will give those with
serious mental illness a true sense of belonging. It will
bring the strength of community to bear, something already
demonstrated in existing intentional communities with
There will be critical clinical benefits as well
from this community engagement and support. Relapses — going
through the “revolving door” in and out of acute care or the
justice system — will be reduced, with economic savings as a
bonus. Acute and tertiary beds will be freed up, and also
freed up by the increased access to housing.
Keep in mind what the goal is here: to help those
with serious and persistent mental illness contend with
their residual chronic symptoms and achieve a better quality
Make no mistake, either, about how challenging those
difficulties are and the degree of attention we should give
to them. Even if they’re not dramatic and intrusive like
psychosis, they’re every bit as serious in their own way.
Dawn Velligan and Larry Alphs, two American specialists on
the subject, remind us, in a clinical article in the
Psychiatric Times, “it may be that the negative (chronic,
enduring) symptoms of schizophrenia … contribute more to
poor functional outcomes and quality of life for individuals
with schizophrenia than do (psychotic) symptoms.”
This is where the Riverview lands offer a unique
possibility — a community that those with a serious mental
illness will be able to consider their own and where they
will have the best chance to flourish.
is president of the Riverview Village Intentional Community