Making the Case for Investment in Mental Health: Scientific Administration of the Canadian Psychiatric Hospital

Thomas Foth, Cheryl S. McWatters, University of Ottawa

This study examines how hospital boards and administrators ‘made the case’ to invest in cost-saving technologies to reduce the financial burden of medical care.  Extending our earlier research into the merging of medical/nursing and management knowledge to scientifically manage the psychiatric hospital and to govern the population at large, we investigate the case for investment in fever units (high-temperature cabinets) at the Ontario Hospital, Toronto. From the beginning of the 20th century, hospital efficiency had become the outstanding preoccupation of administrators and psychiatrists. After World War I, accounting techniques were used to gather information about the nation’s efficiency and to plan and determine provisions for ‘those who could not provide for themselves’. The net present value of men was calculated, enabling the computation of the nation’s loss of value through specific mental diseases. These results were linked to the costs for mental health interventions, making it possible to determine the ratio between investments and outcome. The language of accounting was soon being adopted by psychiatrists in order to argue for specific investments in mental health.

In 1939, the senior psychiatrist A.J. Bromley, MD of the Ontario Hospital, Toronto used this rationale to promote the idea to invest considerable capital and operating funds in the implementation and maintenance of a so-called ‘fever unit’ dedicated to the treatment of patients with Neuro-Syphilis. He argued that even though it would constitute a huge financial investment, it would reduce the overall loss for the nation as it would shorten the time of hospitalization and enable those treated to return to work and stay at home – continuing to produce value to the nation.