Serving severely mentally ill people in a major Canadian city.

Over the past twenty years, GVMHS has been the single organization taking ultimate responsibility for the seriously mentally ill throughout the city. It uses central coordination coupled with community-based teams and partnership programs with other agencies to strike a useful balance between integration and flexibility. GVMHS's mission throughout that time has been to provide everyday community support, networking, case management, rehabilitation, and counseling services to as many seriously mentally ill persons with concomitant disabilities as possible. To carry out that mission, GVMHS has developed some innovative solutions for the problems of community support--problems such as psychiatric emergencies, crises, community demands for service outside the mandate, and workload management. GVMHS has also developed dual-diagnosis, multicultural, multiagency case coordination for the multiproblem client (Buckley and Bigelow, 1992), specialized family and child programs, and specialized geriatric programs. This has all been possible only because financial support is available on an ongoing basis at a level adequate to provide good, dependable services. GVMHS has been proven an effective service in a number of studies (Bigelow and Beiser, 1978; Beiser, Shore, Peters, and Tatum, 1985). It has also demonstrated good cost-efficiency (Bigelow and McFarland, 1989) and abundant innovation and adaptation to emerging challenges (Bigelow, McFarland, Russell, and Sladen-Dew, 1990). It has proven that dedicated, well-trained professionals working at the community level will work hard and smart and that an agency and its staff will stick to the mandate of serving people with serious mental illnesses and disabilities even under pressure to do otherwise. The intriguing thing is that this productivity is not driven by competition, incentives, or threat: none of these factors presses upon the Greater Vancouver Mental Health Services Society from without and none is built in. The excellent performance of GVMHS seems to derive from the professional dedication and motivation of the clinical staff and its administration.