Alternate Milieu – Hospital Care Setting with a Difference

The Centre for Addiction and Mental Health is proposing to redevelop its Queen Street site in order to implement new approaches in treating mental illness and addiction. The plan is to transform CAMH’s 1001 Queen Street West property from a traditional psychiatric facility to a dynamic centre where mental health and addiction care, research, education and health promotion and prevention will be integrated. The proposed redevelopment project, which still requires final approvals from the Ministry of Health and Long-Term Care, will be in an urban village setting with the site’s 27 acres becoming more integrated with the surrounding community. It will be a hub satellite model with smaller satellites throughout Toronto, surrounding regions and Ontario, bringing services closer to where people live.

As part of these plans, CAMH will be introducing an Alternate Milieu (AM) setting for inpatient care.

In the consultations that CAMH conducted regarding the redevelopment, the feedback from all stakeholders indicated that a more traditional hospital setting is appropriate for some people in the acute phases of their illness, but that it is not an ideal care setting for clients in more advanced stages of their treatment and recovery. The evidence suggests that the best environment for treating people with mental illness and addictions is one that is familiar and more home-like.”Based on the consistent feedback from clients, families and staff and on best practices from around the world, we are confident that this new approach to care settings will help some people respond more effectively to treatment and as a result, be able to spend less time in hospital,” said Dr. Patrick Smith, Vice President, Clinical Programs. Smith also stated that for other people who have been in the hospital for a long time, this setting would provide a better rehabilitation environment enabling people to transition to the community more effectively with reduced readmissions. The research has found that in jurisdictions where hospitals providing mental health care have moved to this type of inpatient care model, staff and clients have indicated higher levels of satisfaction with the care experience.

The Alternate Milieu setting will be different from the traditional inpatient setting and will reflect best practices and be on the leading edge of mental health and addiction treatment settings. Physically, the AM buildings will be smaller in size with several six-person individualized units within each building. The units will have more private spaces for clients to read and relax, and more living spaces including kitchen, dining, living room, television and computer rooms similar to a home-like environment.

The clients being served in the AM setting will still have a full range of multidisciplinary care providers to meet their complex care and specialized treatment needs, but in an environment that is conducive to innovative programming, including opportunities for clients to rebuild lost skills and work towards moving back into the community. Clients in AM settings are able to move between buildings and access other clinical care services on site and/or in the community and participate in leisure and socialization activities as appropriate.

The Alternate Milieu setting has the flexibility required to meet a range of client needs, including, for example, short-term addiction treatment, building upon the residential model of treatment currently provided at CAMH’s Brentcliffe site. For clients with longer term care needs, the AM setting is a further development from the Integrated Rehabilitation Unit (IRU) that CAMH has been piloting at their Queen Street site since October 2002. The IRU houses clients who require a stable, long-term setting and active rehabilitation. Some renovations were made creating as home-like a setting as possible within the existing facilities including new furnishings and personal keypad locks on client rooms allowing each client privacy and security – something they had earlier on identified as being important.

However, the concrete walls and other elements of the current buildings on the Queen Street site do not allow CAMH to go far in providing this type of care environment. The IRU is still too large a unit, with a total of sixty beds located on two floors and room sizes are still well below recommended standards. In keeping with CAMH’s goal of normalizing the care setting, the AM settings are a critical piece of the redevelopment, allowing the flexibility necessary to provide an environment that is more home-like and healing.

CAMH has been studying examples of innovative and effective inpatient care models from around the world, and now has the opportunity and the need to re-think their care delivery and their complete physical structure at the same time.

“This is truly a great opportunity for CAMH and we are excited about being able to provide the care in the way we’ve planned,” said Dr. Smith. “Our clients, family members, staff, physicians and volunteers deserve this standard of care delivery today. We look forward to making our new care model a reality.”