CAMH CEO writes Toronto Star Guest Editorial

New model for mental health

People, not buildings, provide asylum

Mar 08, 2007 04:30 AM

Paul Garfinkel
The Toronto Star

At the western edge of the Centre for Addiction and Mental Health's land on Queen Street West at Ossington – the site of care for people with mental illness since 1850 – cranes tower over a construction site.

We are beginning a dramatic transformation of the property to create a place that fuses the best in clinical care, education, research, health promotion and prevention. While the physical construction has generated interest and excitement, as well as some inevitable controversy, the new buildings must not overshadow the equally transformative changes that are happening inside them and in the wider field of mental illness and addictions treatment.

Imagine if half of all cancer patients or heart attack victims received no care whatsoever. Surely, an outraged public would demand instant action; health ministers would be forced to address the problem immediately, or resign.

Fortunately for those who do suffer from physical ailments, this is not the case. Sadly, though, it is the reality in mental illness and addictions – half of those who need care receive none. Ultimately, we are working toward delivering in our own field the same evidence-based and specialized care that has so dramatically improved how we treat physical illnesses.

It is important to recognize that addictions and mental illness are not moral failures, and are instead human experiences and disorders that require specialized diagnosis and care. Over the past 15 years, researchers have made dramatic advances in the psychological treatment, medications, and rehabilitation approaches that can enable recovery from mental illness and addictions.

In fact, these advances have contributed to rendering CAMH's existing campus, or asylum, obsolete, and are now allowing us to challenge its design and move beyond its confines and drawbacks. Even if there were no such progress toward recovery, the human reality is that the existing buildings are unacceptable in the 21st century of health care; they are cramped, undignified, disrespectful of the needs of individuals, and hardly inspiring of hope.

While I do not doubt the compassion of those who built the original Toronto Lunatic Asylum or our current concrete-and-cinder-block campus, their structures can introduce further problems to those who find themselves within. Specifically, the buildings are isolating and can foster dependency and the loss of valuable life skills. The benevolent aspects of asylum in the broadest sense of the word – sanctuary, safety, and support – are provided by people, not by buildings.

Current research and evidence point toward a new model of care that influences architecture – where the individual mental health or addiction patient will play a leadership role in their own care program. Where there will be transition beds – private rooms with swipe card locks and their own addresses from which patients will travel to their own programs and appointments. Where the physical facilities will allow our clients to build a support system in the community before leaving the hospital and regain skills and independence to reintegrate.

Reintegration into the community, when safety and security permit, is not only desirable but will lead to a better quality of life. When this philosophy of reintegration is combined with our evolving client-centred approach to treatment, CAMH will deliver a care model that emphasizes the needs of the individual over the institution in a respectful and dignified setting.

So, when I am asked why we are embarking on this huge redevelopment project, I answer that the advances in evidence-based treatment and research have raced far ahead of the concrete confines of our campus. We must make a dramatic physical change that will enable CAMH to apply the best treatments available so that people with mental illness and addiction can experience an improved quality of care and an enhanced quality of life.

In 2020, when the redevelopment is complete, things will be different. Care will be provided in an open and welcoming urban village, in direct contrast to the rather foreboding and isolating presence our current architecture creates. Our new CAMH buildings will be side-by-side with shops, housing and businesses, which will help lift the stigma that surrounds mental illness, and the old asylum site in particular, by integrating it into the neighbourhood.

A number of our clients will be employed by these businesses or, even better, will be running their own. We are already improving access to the system of care and helping people navigate how and where to go for help. It is through this combination of better access, better care, better design and better integration that we will reach the 50 per cent of people who are not receiving the care they need.

In the end, we want this transformation to extend far beyond the services we provide and the environment in which we provide them. For mental illness and addictions to truly achieve parity in both care and compassion with physical illnesses, each of us must reconsider our assumptions. A new physical environment for CAMH is unquestionably necessary but also clearly not sufficient. New buildings are just part of a story of hope for people with mental illness and addictions.

Dr. Paul Garfinkel is president and CEO of the Centre for Addiction and Mental Health.