A proposal for a new approach to mental illness and addiction care

The Centre for Addiction and Mental Health (CAMH) is proposing to redevelop its Queen Street site in order to implement innovative new approaches in treating mental illness and addictions.

The plan is to transform its west-end Toronto property – where Ontario’s first Provincial Lunatic Asylum was built in 1850 – from a traditional psychiatric facility to a dynamic centre for mental health and addiction care, research, education and prevention. It would be the central hub for CAMH’s activities, with many connections to services offered in the various communities in which clients live.

In 1998, under the direction of the HSRC, CAMH was created through the merger of the Clarke Institute of Psychiatry, the Addiction Research Foundation, the Donwood Institute and the Queen Street Mental Health Centre. This was a critical step in better integrating addiction and mental health programs and services. Following an extensive review of its services in consultation with its stakeholders including hospitals, health-care providers, clients and families, community agencies, government and neighbours, CAMH plans to create a health care, research and education village that will encourage interaction and collaboration between staff working in the two fields to promote advances in understanding and prevention.

CAMH plans to consolidate the majority of its operations onto one site. The proposal is to redevelop the site so its facilities, now set apart from the neighbourhood on its 27-acre site, become integrated with the surrounding community and help address the current barriers to care. To address the issue of stigma, which remains a significant barrier to treatment, CAMH is planning to “de-institutionalize” the institution and replace it with an Urban Village with public streets, sidewalks, public and private green spaces and a variety of buildings, each with its own street address and front door. Evidence shows that the best environment for treating people with mental illness and addictions is one that is familiar. CAMH’s vision is to create a real community setting for client care by opening up the site to a variety of public and private sector uses from education and research facilities to storefront restaurants, cafes, shops and community facilities that are open to the public.

CAMH is also planning new approaches to its facilities design. CAMH recognizes that the needs of people in the most acute stages of their illness differ from those of people in other stages of their treatment and care. To address this CAMH proposes to introduce new care environments for people with specialized needs. It is planning “alternate milieu” units in small apartment-like settings, which offer more home-like environments and are conducive to innovative programming, including opportunities for clients to rebuild lost life skills and work towards moving back into the community.

“We are suggesting an approach to mental health and addictions care that has not been seen before, and we hope this approach becomes a model that is recognized worldwide,” said Dr Paul Garfinkel, President and CEO of CAMH. “The changes we are making will allow us to provide care that reflects today’s best practices, and create an adaptable space that allows us to change our practices as the understanding of mental health and addiction expands.”

CAMH recognizes the need to work with the larger health-care system to define its role, facilitate work with other providers, reduce fragmentation, and avoid duplication of effort. CAMH plans to develop partnerships with other providers – from hospitals to community-based organizations – to ensure that clients receive the most appropriate level of care at the most appropriate location. Under the current model of care, there are multiple access points – which leaves it up to the person who needs help to determine which services they may need. CAMH plans to address this by implementing a centralized assessment process and assigning every client a care facilitator, responsible for ensuring the client gets access to the programs that they need.

Today, as many as 75 per cent of people who need care receive none at all – and this percentage is higher among members of diverse, ethnocultural communities who, in addition to stigma, face language and cultural barriers. CAMH’s new model of care is designed to help reach out to a broader range of communities, and put strategies in place to ensure people receive culturally competent services.

In order to move forward on this exciting plan, approval is needed from the Ministry of Health and Long-Term Care and the City of Toronto. As such, CAMH’s Functional Program and Facilities Master Plan are being considered by the MOHLTC, and the City is reviewing CAMH’s application for Official Plan Amendment and Zoning By-law Amendment.