Dr. Paul Garfinkel is feeling good. As the President and CEO of the Centre for Addiction and Mental Health (CAMH), he’s been looking forward to the day that he can see, in real bricks and mortar, the start of a renaissance in the treatment of mental health and addictions in Canada.
Though it’s still a few months before CAMH’s innovative new Alternate Milieu (AM) Units will be up and running, the four new buildings (three AM units, and one outpatient/administration building) are steadily approaching completion on the western edge of CAMH’s Queen Street West site in Toronto. They comprise the first phase of the hospital’s ambitious site redevelopment project, called Transforming Lives Here- a planned ‘urban village’ where cutting edge hospital facilities will integrate with shops, restaurants, homes and businesses. However, the three AM units are more than just the start of something big – they are noteworthy in their own right.
“These buildings will let us begin transforming the care we provide to people who have mental health and addiction problems,” says Dr. Garfinkel. “These are client-centred facilities designed around best practices of care that will support our patients’ dignity, recovery, and transition back into the community.”
The state-of-the-art units will provide a home-like environment for clients in the Addictions Program (48 beds) and the Mood & Anxiety Program (24 beds). The design of the buildings themselves will play a role in supporting client recovery.
Every client will have his or her own private unit. The four-storey buildings will have six single-bedroom units per floor, each with its own private three-piece bathroom and individual key card. Every floor will also have common areas – a living room, dining room, a kitchen, and a private lounge that clients can use for visits with loved ones. The buildings purposely limit space for staff and clinical services on the units to keep it as home-like as possible. Instead, clients will attend clinical and support programs and activities at other locations on the site and in the community.
Breaking away from traditional institutionalized care, treatment in the AM units will follow a recovery-based model of care, one that shifts the focus from illness to wellness, health and hope. Client-directed care helps foster feelings of independence and autonomy, develops a sense of empowerment and creates an atmosphere of respect and responsibility.
It’s a care model that the Addictions Program currently follows at their location north of downtown, where they run a 12-bed specialized medical withdrawal inpatient unit, one of the only ones in the province. When they move to the new AM Units on Queen St. West, the unit’s capacity will double to 24 beds, augmenting the program’s ability to support and care for clients with concurrent disorders. The other Addictions beds will house the integrated inpatient program.
“The Alternate Milieu Units weave the best features of mental health service delivery and the recovery model of care from the addictions field. This creates a unique environment which allows us to customize service provisions for clients,” says Christina Bartha, Administrative Director of the Addictions Program.
For Addictions clients, the AM Unit beds will be used for direct admission for withdrawal management, and additionally, will support residential treatment for adult clients with addictions and concurrent disorders.
For clients in CAMH’s Mood & Anxiety Program, the units are designed as a ‘step-down’ from core facility beds for clients who are past the crisis stage of their illness but who still need inpatient treatment for mental illness, addictions or both. The Alternate Milieu environment will help clients prepare to reintegrate back into daily living in the community.
“We’re going to try and create a sense of community for our clients,” says Karen Martin, Administrative Director of the Mood and Anxiety Program. “The home-like environment is quite inviting and conducive to the involvement of family or whomever the client’s significant support circle is. We’re going to have treatment groups for family members or significant others. I think there’s an opportunity to better meld that part of a person’s life into the care and treatment that is going to be more comfortable for family members than a hospitalized setting.”
A central component to the AM units is adaptability, and not a one-size-fits-all approach. “We have a lot more flexibility with the management of folks in these beds that will be more reflective of what their actual needs are, as opposed to pushing them through a very acute hospitalized stay,” explains Martin. “It’s going to be very much focused on how people can integrate into the community individually.”
As neighbours, the Addictions Program and Mood & Anxiety will have the opportunity to cultivate collaborations with each other, reflective of CAMH’s goal to better integrate the treatment of mental health and addiction, which often occur concurrently. This will also provide unique opportunities for staff to receive comprehensive training in concurrent disorders.
“The Alternate Milieu Units represent an enormous leap forward for the integrated treatment of mental health and addiction, and the recovery-based model of care,” says Dr. Garfinkel. “And this is just the first of many exciting steps CAMH is taking to transform the lives of our clients, right now and in the future.”
The Centre for Addiction and Mental Health (CAMH) is Canada’s leading addiction and mental health teaching hospital. Integrating clinical care, scientific research, education, policy development and health promotion, CAMH transforms the lives of people impacted by mental health and addiction issues.