Building for the future of mental health care

Posted on June 26, 2008 in Health Debates, Inclusion Debates -BNStory/mentalhealth – Building for the future of mental health care: Proponents hope the new ‘mixed village’ on Queen Street will help heal minds and change attitudes, Tenille Bonoguore writes

For decades, it was the physical embodiment of the illnesses it sought to heal.

Detached and stolid amid the burgeoning city, the mental hospital on Queen Street West was so inwardly preoccupied, so broodingly blank that the bustle around it might as well have never existed.

Now, gambling on a massive dose of experimental medicine, the Centre for Addiction and Mental Health is refashioning itself from the inside out. A series of new buildings is merging hospital with home, in the hope that a change of physical atmosphere will help make people healthier.

No one knows whether it will work. Even its loudest proponents, such as CAMH’s senior medical adviser David Goldbloom, dish caution alongside their optimism, fully aware of mental-health medicine’s pocked history.

“I anticipate fully that what I do will one day be said to be wrong,” Dr. Goldbloom said. “We hope we’re getting it closer to right.”

The public will get its first look at CAMH’s redevelopment today. Three bright and airy transitional housing blocks for people re-entering society and a glass-panelled building for group therapy and administration will be open for tours at the corner of Queen West and the newly made White Squirrel Way after a street fair starting at 10:30 a.m.

In the old wards, elevator doors slide apart to reveal a landing restricted by angled bars overlooking an internal dining room, both sides of which feel as trapped as the other. Stark corridors with institutional colour schemes lead to cell-like rooms, adorned only by sealed windows. It’s the outside world as art, something to see, but not to touch.

Washroom facilities are few. Glassed-in walkways contain the hospital’s many patients and few visitors. Almost every window faces another CAMH building.

In contrast, the new transitional housing looks and feels like a university residence. Dotted with artwork, wooden panels and carpeting, each floor has six units with ensuite washroom and a communal kitchen, living and dining area that also serves as nurse’s station.

Windows reveal the attached backyard patio garden and CAMH’s iconic brick wall – built by employees and patients in the 1880s – and the surrounding neighbourhood. Patients can stay for up to 28 days, and will have their own key. The windows open.

When complete in 2020, CAMH will contain both medical and private buildings, extensions of the streets that currently stop at Queen, parkland and retail space. (Retailers will have to show they’ll work with CAMH to be included in the “mixed village.”)

The message is clear: There will be no more shame and hiding. In line with the past decade’s radical change in mental health care and awareness – which has helped the issue creep out of familial shadows to become a still-difficult but acknowledged issue – CAMH is almost daring the world to challenge its place in society.

For the city, and for the international health officials closely watching the CAMH development, it’s a challenging shift in dynamic.

The facility occupies about 10 city blocks, making it prime real estate in the gentrifying corridor that has been earmarked by the City of Toronto for densification.

Not everyone is expecting an easy transition. While neighbouring businesses support the project, former CAMH inpatient Stephen Crawford says tearing down old buildings won’t automatically dismantle the public stigma against mental illness and addiction.

“I find the community at large doesn’t really want the hospital to be here,” said Mr. Crawford, an amiable 31-year-old living with a form of bipolar disorder. “But the people you see screaming and yelling and not acting right are probably the ones not coming here.”

Raised in Mississauga, Mr. Crawford knew of CAMH’s reputation long before he learned of its ability to help the ill. If people fully understood CAMH, he said, “they’d be proud to have it in their community. It really does great work.”

“I think there will be problems [with integration],” he added later, “but I don’t think it’s anything that can’t be overcome.”

The 600-bed hospital tried to wipe clean its reputation in the 1970s by changing its address from 999 to 1001 Queen St. W. (The new transitional housing units will have their own addresses.) Then in 1998, four institutions were merged to create CAMH.

The shifts in treatment that have occurred since that merger are being expressed through this redevelopment, says the centre’s president, Paul Garfinkel.

Community integration has been attempted in other cities, Dr. Garfinkel said, but the CAMH project “in its vision and magnitude, is unique.”

“[The redevelopment] says we’re connected,” he said. “We’re tired of isolation. Isolation doesn’t help. Our structures aren’t everything … but structures can sure point the way.”

That message should become even clearer next year, when the inward-facing tower blocks are knocked down.

“We want people to begin to feel that CAMH is part of the city, and there isn’t this barrier between the two worlds,” says Terry Montgomery of Montgomery Sisam Architects, one of three companies involved in this first stage of redevelopment.

“We’re hoping environment makes a difference. We’ll see through the [resident feedback] study if that’s true.”


Facts and figures

Centre for Addiction and Mental Health statistics for 2007/08:

22,182 People treated

3,698 In-patient admissions

436,193 Out-patient visits

2,800 Staff

471 Doctors

167,605 Volunteer hours

49.2 Average length of patient stay, in days

Top substance treatments Alcohol, crack/cocaine

Top mental diagnoses, Schizophrenia disorders, mood disorders

Tenille Bonoguore

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