Mental patients integrated

Originally erected in 1850 as the Ontario Lunatic Asylum and enclosed on all sides by a solid brick wall, Canada’s largest hospital for treating mental illness is undergoing a radical transformation that could make it a model for the rest of the country.

Alex Bustos

Alex Bustos

TORONTO — Originally erected in 1850 as the Ontario Lunatic Asylum and enclosed on all sides by a solid brick wall, Canada’s largest hospital for treating mental illness is undergoing a radical transformation that could make it a model for the rest of the country.

The Centre for Addiction and Mental Health is tearing down walls both literally and figuratively, revamping its 25-acre site in Toronto to create an urban village that will integrate its buildings and the people it cares for into the surrounding neighbourhood.

“It reflects changes in the understanding of what’s necessary for people who have mental illnesses and addictions to live their best life, to fulfil their potential in life, which in some cases can be limited by their illness,” says Dr. Catherine Zahn, president and CEO of CAMH.

That means helping a person struggling with a mental illness and-or addiction to reintegrate into society — to return to their home, hold down a job, to be a good family member and friend, says Zahn.

“And the best way to do that is when and if an individual who has mental illness is capable of it, to start right away, to have them in an environment that most closely resembles the real world.”

The multi-phase process of overhauling the nine-square-block CAMH site in the city’s vibrant Queen Street West neighbourhood began two years ago with the building of four “alternative milieu” units that provide transitional housing for in-patients prior to discharge.

Recently, the hospital broke ground for three buildings that comprise the next phase of its rebuild, among them a 60-bed Intergenerational Wellness Centre for youth and geriatric patients that includes Canada’s first in-patient facilities for teens with both mental illness and addictions.

But the revamp isn’t just about new buildings.

New streets wind their way through the site, connecting and blending CAMH with the neighbourhood’s local cafes, businesses and residences.

“The idea is that there is very little value in closing people with mental illness off from the community and vice versa,” says Zahn.

“The opening up to the community from the perspective of our patients just carries that metaphor forward that to fully recover they have to be rehabilitated, that the community has to be part of their healing process.”

Zahn says the integrated CAMH campus, dotted with plenty of green space, trees and gardens, is meant to help erase the stigma that isolates people suffering from such illnesses as schizophrenia, bipolar disorder or severe depression.

“It includes transforming attitudes about people with mental illness, so reducing stigma but also reducing prejudice,” she says. “The unknown is always a stimulus for prejudice. So getting to know the organization better, opening it up, is an important stimulus to reducing prejudice and subsequently reducing discrimination.”

Angela Foot has already felt the power of that inclusiveness.

In early 2006, she was referred to CAMH because she had hit her “own personal rock bottom” and was suicidal. Her diagnosis of bipolar disorder finally explained the many years she had struggled with violent mood swings — alternating between long periods of mania when she couldn’t sleep and then weeks to months plunged in the depths of depression — that destroyed relationships and finally left her unable to work.

As an out-patient, Foot was prescribed a number of treatments, including various group therapy sessions that took place in one of CAMH’s institutional buildings. But recovery was slow, she says.

In December 2008, she was admitted to one of the new alternative milieu units, a street-front apartment-like building that provides a home-like, stepping-stone residence for patients before discharge back into the community.

“It was so different than what my experience was in the day-treatment program, which is in one of the older buildings,” says Foot, 36. “Because those four new buildings are on the street, with sidewalks and trees and benches and so on, it feels like you’re a part of the community and a part of the outside world.”

Designed to be airy and light-filled, each floor includes a shared kitchen, dining area and TV lounge, with individual rooms for residents fitted out with private bathrooms and showers.

The living quarters are a long way from the outdated notion of a huge room lined up with beds, says Foot. “You have this sense of dignity, I guess, over taking control of your illness but not feeling like you’re a complete freak show.”

“If you create an environment that is not so isolating, it may in fact speed up your recovery or enable you to take better advantage of all of the treatments that are available to you,” says Foot, who lived in the unit for a month before being discharged back home as an out-patient.

“Had I at that point been in the new building . . . my experience could have been very different.”

Alice Liang of Montgomery Sisam Architects Inc., part of a consortium of architectural firms hired to refine the master plan and erect the first phases of the rebuild, says brick, residential-type windows and other materials were used to make the new buildings harmonize with existing structures in the neighbourhood.

The designs also incorporate energy-saving elements such as green roofs and are meant to be sustainable, she says. “Thirty years from now, if the hospital no longer needs those buildings they can easily be converted into private residences or apartments.”

“The important aspect to really stress from our architectural perspective is that we took this on not to create a monumental building (like) the ROM museum or the (Ontario) Art Gallery,” Liang says of the recently redesigned iconic Toronto landmarks. “We really see these buildings as good solid designs that are good neighbours that really work with the community and support the whole notion of integration.”

But CAMH didn’t rely only on professionals when deciding how to make its buildings more patient-friendly. It went right to the source.

Alex Bustos, a 20-year-old out-patient who’s been receiving therapy for depression and substance abuse since early 2009, says he and other young people at CAMH were consulted about what would make “kids of our age feel most comfortable, to feel like they’re at home . . . not like an institution, which is kind of scary and cold.”

That included everything from room design and paint colour to the type of flooring and furniture style, says Bustos, who has been free of his marijuana habit and alcohol addiction for three months.

Bustos, who will soon get his high school diploma and is considering going into social work, calls his treatment and recovery at CAMH “awesome.”

“There’s more hope in my life, more purpose to live. Before I was struggling, so I felt hopeless. Life is good.”

Of course, notes Zahn, CAMH is a hospital and will still provide long-term care, as it has all along.

“We have patients here who are very, very ill and they do require secure environments . . . And there’s no intention to diminish the care of people who require that type of an environment.”

It will take another five to 10 years before the entire campus has been completely transformed to conform to the urban village vision, she says.

But as antiquated structures are demolished to make way for the new, the blurring of lines between those being treated for mental illness and the rest of the world has already begun, says Zahn, quoting one patient’s reaction.

“Finally we can see out — and they can see us.”