Toronto Star April 30, 2011

Centre for Addiction
and Mental Health
SECTION V
SATURDAY
APRIL 30, 2011
thestar.com
FOCUSED ON LEARNING
ON ON1
Individual attention in a school setting, V2
CRISIS
IS EVERYDAY
WORK HERE
Patients arrive at the CAMH emergency room in severe distress and will need immediate and specialized care
MEGAN OGILVIE
HEALTH REPORTER
A woman, found naked on a downtown street
corner ranting about dangerous holes in the
ozone layer, is brought in by police.
A man, deeply depressed and struggling with
alcohol addiction, is escorted by his mother-inlaw. Both are worried he might take his life.
A university student with top grades wants
help for her soaring anxiety and tells staff she
has thought about lying on a streetcar track so
she could be cut in half.
An elderly woman with a long history of
schizophrenia has stopped taking her medication. Even though her husband helps her into
the waiting room, she thinks he is dead. A moment later, she believes he is Jesus Christ.
These are some of the people who have come to
the emergency room at the Centre for Addiction
and Mental Health on a recent Thursday night.
Each has arrived in distress. Many are very ill,
on the precipice of a crisis, and need immediate
and specialized help.
They have come to the right place.
More than 4,000 people are seen at CAMH’s
emergency room every year. Unlike the other
big downtown hospitals, it doesn’t have a busy
ambulance bay or a brightly lit emergency sign
hanging out front.
This ER is just a few strides from the bustling
sidewalk along College St., near its intersection
at Spadina Rd. Many of us do not even know it is
there.
Those in the mental health and addictions
community, whether they are patients, agencies
or family physicians, count on the expertise at
the CAMH emergency room. People suffering
from mental health conditions and substance
abuse problems can be treated at any emergency room in the city. But an ER specializing in
psychiatry will likely ensure patients are seen
quickly, assessed appropriately and provided
with the most up-to-date care, says Dr. David
Goldbloom, senior medical adviser at CAMH
and a psychiatrist who works one or two shifts a
month in the ER.
He believes CAMH’s specialized ER provides
the best opportunity to give mental health and
addictions patients a positive experience when
they are in crisis, which will help with the remainder of their care. This is especially true
when it’s the patient’s first time seeking help.
“First impressions are lasting. This can set the
tone for people about their willingness to stay
engaged in care,” says Goldbloom.
Laurie (not her real name) gets comfort from her sister as she tells her story to staff in the emergency room
at the Centre for Addiction and Mental Health. She has been treated for depression in the past.
CAMH continued on V4
RICK EGLINTON PHOTOGRAPHY/TORONTO STAR
Campus shaped by new attitudes to mental health
Massive redevelopment
involves community to
break down boundaries
CHRISTOPHER HUME
ON ON1
STAR COLUMNIST
In a city built for people, even the
most vulnerable amongst us feel
they belong. Though Toronto likes
to think of itself as such a city, that is
only partially true, and then, only
recently.
Indeed, like most cities around the
world, Toronto historically preferred to shut away those who are ill
or poor, those whom we believe
pose a threat, and others who, well,
just aren’t like the rest of us.
In recent years, however, such attitudes have started to change. Now
we aspire to integrate communities, not segregate them. The new
ideal is connection, not isolation.
Examples abound: Think of the Ca-
nadian National Institute for the
Blind, Bloorview Kids Rehab, Princess Margaret Hospital . . . the list
goes on.
But now comes a project that does
for a whole community what these
earlier remakes did for a single
building.
When completed in 2012, the Centre for Addiction and Mental
Health on Queen St. W. will have
been returned to the city as an entire campus, a whole new neighbourhood, a mid-rise, mixed-use
development like many others in
the city, only nicer, more urban and
thoughtful.
The historic CAMH campus, originally the location of the Provincial
Lunatic Asylum, has a Dickensian
past. In the 1860s, when the first
institution was constructed, it was
cut off from the city by a large brick
wall.
CAMPUS continued on V4
Angela Foot, 37, a former patient at the mental health centre, says the 19th-century wall that once surrounded
the property, visible in the background, should stay because it “represents what should never happen again."
V2
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SATURDAY, APRIL 30, 2011
ON ON1
CENTRE FOR ADDICTION AND MENTAL HEALTH
Home visits
helped him
get his life back
Teaching more than ABCs
BILL TAYLOR
ANDREA GORDON
SPECIAL TO THE STAR
FAMILY ISSUES REPORTER
This is a success story.
Still, the names have been changed to shield
identities and perhaps protect a job. Such is
the stigma that attaches to mental illness,
even when you’ve put it behind you.
So call them Cathy and John, mother and
son, as they talk about how CAMH gave John
his life back. He’s in his late 20s.
“Back in 2005, I was very, very sick,” says
John. “I was thinking I was being followed,
that people were spying on me. I was hearing
voices.
“I couldn’t sleep because I’d be talking to the
voices in my head. I couldn’t go outside because I was afraid and maybe I’d be hostile. I’d
look at photos and not recognize anyone.”
Dr. Ofer Agid, the psychiatrist who leads
CAMH’s Home Intervention for Psychosis
outreach team, shares his experiences in a
phone interview.
HIP offers in-home treatment, rehabilitation and education for young people experiencing their first episode of psychosis.
Schizophrenia, Agid says, involves a terrible
Catch-22 — the patient needs treatment, but
may be afraid to go outside to get it.
The disease usually begins in the late teens
or early 20s. The slower the response, the
worse the prognosis.
“If we treat the patient as early as possible,
we will probably prevent the downward trajectory,” Agid says. “Deterioration, lack of
function, brain shrinkage . . . we can be very
successful.
“Our patients are not always motivated to
come to us. So we don’t wait. We go to them.”
Cathy recalls the stress and fear. “I couldn’t
take the TTC with him or eat in a restaurant. I
wanted to help but. . . Through friends, I
heard about CAMH.”
“My mom was very smart,” says John.
The team is seldom warmly welcomed by
patients. “I’ve had them spit on me and use
filthy language,” says Agid. “They’re not extremely happy to see us, but it’s very rare that
we’re kicked out.
“That does happen. But we come back. I tell
them, ‘We’re guests of your parents.’
“We must remember that we’re running a
marathon.”
John had quit school. “I’d figured I’d never
be able to hold a job and maybe I’d stay in my
house for my whole life, sitting on the couch
watching the days go by.”
His case has had the best possible outcome,
in full remission, Agid says.
“Many of our patients, even if they’re in
remission and functioning, will never be able
to fully appreciate the treatment or see the
benefits,” he says. “There will always be some
residual psychotic symptoms.”
To help him overcome his fears, John says
Agid “walked me around the block and said,
‘Look, nothing’s happening. No one’s following you.’ He challenged me. He said, ‘Can you
believe in yourself? Can you go out and find a
job and then hold down that job?’ ”
“And go back to school,” Cathy puts in.
John did both. He’s flourishing in a detailoriented field that demands accuracy and
carries a lot of responsibility.
“I live a normal life,” he says.
All the same, he doesn’t want his employers
to know what he’s been through. Just in case.
It’s the middle of Monday morning math and
7-year-old Emma is showing signs of unravelling.
She squirms while teacher Hahn To uses
PowerPoint to demonstrate where decimals
belong in dollars and cents. Emma is good at
numbers but hasn’t mastered patience or
self-control.
“It’s boring,” she moans, slumping in her
chair. Soon she is waving her hands to obscure the projector as her classmates giggle.
In her regular classroom, Emma (not her
real name) used to be banished to the hall.
She might refuse, have a meltdown, maybe
throw something or hit. These are the kinds
of showdowns that got her hauled to the
principal’s office and regularly sent home.
Not today. This is the Catch class at CAMH,
a day-treatment program for kids ages 6 to 8
who can’t cope in a regular school. The oneyear program, a partnership with the Toronto
District School Board, takes kids across the
city with behavioural problems, attention
disorders and other mental health issues. It is
among a dozen such programs the TDSB
runs for primary students.
Instead of removing or punishing the children when they act out, staff here try to
prevent breakdowns by intervening early,
and walk them through steps on how to deal
with anger and frustration.
“Kids don’t just come to school with a backpack full of books, they come with a lot of
emotional issues,” says Melanie Mizzoni,
child and youth worker with the program.
“I hope we give them, at the very least,
people who care about them. We want to
show them school doesn’t have to be a bad
experience so they realize ‘I don’t have to be
the bad kid.’ ”
At the first sign that Emma is struggling,
child and youth worker student Jenna MacNaughton crouches beside her, whispers encouragement and reminds her she can remove herself for a break. It works for a while
and the other students forge ahead, calculating the cost of groceries on the screen. Then
Emma’s impulses take over, her arm starts
swinging in front of the projector and she
squeals.
When MacNaughton tries to lead her from
her seat the girl goes limp and sinks to the
floor. Mizzoni helps carry her gently to the
adjacent carpet, where she disappears under
a table, pink high-top running shoes up
against the underside as she spins around on
her back.
But she’s quiet, and in a place where she
won’t distract the others until she regains her
composure. Twenty minutes later, Emma is
at the front of the class with her soccer ball for
show-and-tell, explaining “it is really special
because my brother gave it to me.”
In a typical primary classroom, one teacher
has up to 24 kids to keep on track. In the
Catch class, there are eight students and two
child and youth workers along with the
teacher. They provide constant reinforcement for each small victory — “Good job
ignoring him when he is in your personal
space,” Mizzoni says to one student with a
short fuse — and clear outlines of what is
expected. There is a lot of talking and listening.
Tailored class gives children
attention and tools they need
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RICK EGLINTON/TORONTO STAR
Jenna MacNaughton, a child youth worker and third-year George Brown student, attempts
to get a student’s interest during a morning math session in the Catch class at CAMH.
A student teacher attends several days a
week and students have regular access to a
social worker, nurse and CAMH psychiatrist.
Their parents attend 14 weeks of parenting
sessions to help them deal with their kids’
challenges.
On the carpet each morning after “O Canada,” the children select a sticker for the “feelings” chart. This morning, the youngest boy,
who just turned 6, chooses “in the middle.”
He didn’t get to go to his daddy’s house on
the weekend and misses him terribly.
“I went to my room and stayed in it and shut
the curtain until the afternoon,” he says quietly.
He nods when Mizzoni asks if he was sad,
and compliments him for “using your words”
to tell his mother he was upset.
The chance to express himself may have
helped. Later during spelling, the little boy,
who was repeatedly kicked out of kindergarten, is attentive. He raises his hand. “Thank
you for helping me,” he says to a classmate.
These are children still young enough to get
excited when one of them reports losing a
tooth. Later, they line up to hug the plush
turtle puppet who visits twice a week to teach
them the steps for managing conflict.
Yet they had already established reputa-
tions for being aggressive and out of control at
their former schools. They have been picked
on, ostracized, gone without play dates. Many
have never been invited to a birthday party.
It’s a lot to turn around in a year, and the
teachers say many other children could use
this attention. The program has been running for more than a decade, but there is no
data on how the kids fare over the long term.
But without early intervention, the cycle of
acting out and falling behind is likely to get
worse. Children with untreated mental
health problems are at risk of dropping out,
delinquency and addiction.
In the Catch program, bad moments are
chances to learn. On a previous school day,
outdoor recess was fraught with disputes and
tears. But during a discussion before heading
out on Monday, the kids chime in on what
they need to do differently. “I need to mind
my own business,” says Chimar, 7. “I need to
stop yelling and not be rough,” adds Emma.
And they do.
Next year, they will be back in regular
schools, most in special education or behaviour classes. Many are apprehensive, but a
liaison worker is already coordinating with
next year’s teachers and will monitor the kids
through the fall.
SATURDAY, APRIL 30, 2011
ON ON1
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TORONTO STAR
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V3
CAMH
School no longer something to dread
Teens with addiction
and mental health
challenges benefit from
supportive classroom
MEGAN OGILVIE
HEALTH REPORTER
For years, Sam Franchi dreaded going to school.
Crippling anxiety made it hard for
him to leave the house and most
days he felt lost and lonely in his big
Toronto high school.
It didn’t help that he was addicted
to alcohol and marijuana — substances he used to calm his anxiety,
but which also affected his focus in
class. To Franchi, dropping out of
school seemed the only, and best,
solution.
But last year, Franchi heard about
a special program at the Centre for
Addiction and Mental Health
where teenagers with substance
use and mental health issues can
get treatment and go to school in a
safe, supportive environment. He
started in October and, six months
later, the 19-year-old says he now
looks forward to getting up and going to class.
“Nothing is impersonal about it,”
says Franchi, a soft-spoken, slight
teen with a shy smile. “There’s a
place for me here.”
The program, called Recovery and
Education for Adolescents Choosing Health or, more simply,
REACH, helps students between
the ages of 16 and 21 accumulate
high school credits while undergoing treatment for mental health
concerns and substance abuse
problems.
The small class of eight means
staff can work one-on-one with
each student. And with an average
of four staff on hand, including a
Toronto District School Board
teacher, social workers and a child
and youth worker, there is a lot of
time for individual help.
“We try and make an environment that encourages them to
come and we work on attainable
RICK EGLINTON/TORONTO STAR
Sam Franchi, left, and Kathleen Galliah are in a class of eight students in the REACH program, which helps youth
aged 16 to 21 get high-school credits while receiving help for mental health and substance abuse problems.
goals,” says teacher Robin Pape,
adding that many of her students
felt alienated at their former
schools.
“We work with them by asking,
‘What strategies can we put in place
for you to be as successful as possible while you are here?’ ”
For some students, a helpful strategy is a morning wake-up call to
remind them to come to school.
Others need a step-by-step plan
that outlines how to complete evening homework assignments.
Pape says she has enough time and
flexibility to help students while
they write a paper, not just assign a
grade when it is completed.
“We can give them the attention
they may not be getting in the regular school system and give them
that immediate feedback to encourage them to keep going,” Pape
says, noting she tailors courses to
each student’s interest and graduation requirements.
While in the REACH program,
Franchi has obtained credits for
Grade 12 English and introduction
to anthropology, sociology and psychology.
He is now pursuing Grade 12 psy-
chology and literary studies.
“The writing assignments are really good for me,” he says, putting
his palm on a paperback copy of
Oscar Wilde’s The Picture of Dorian
Gray.
Franchi’s classmate Kathleen Galliah also likes reading and writing.
But instead of literary studies, the
21-year-old, who struggles with an
array of mental health and addiction issues — including bipolar disorder, obsessive compulsive disorder and cocaine addiction — is
studying philosophy and structural
poetry.
“I’m not bored when I’m here,”
says Galliah, who has a history of
dropping out of high schools and
who has been sober for one year.
“School isn’t something I dread.
It’s something I almost get excited
for.”
Both Franchi and Galliah agree
the support of staff is key to their
success, but add it’s their close-knit
classmates who really understand
their daily struggles.
“I feel comfortable around them,”
Franchi says. “They are always
there to talk to.”
REACH accepts students
throughout the year. Referrals
come from the legal system, clinicians, mental health and addiction
agencies and the students themselves.
The eight students, who each may
be working towards different
grades and credits, work together at
one big table, rather than individual
desks.
In addition to the tailored curriculum, REACH provides treatment
for mental health and addiction issues through group, individual and
family counselling. Students can also take lifestyle courses to help with
coping skills or learn ways to overcome trauma.
A psychiatrist and social workers
have offices on the same floor as the
REACH classroom and are available for counselling if a student is
having a bad day.
Although students who come to
class high on an illicit substance are
not immediately turned away, as
they would be in high school, they
must meet certain expectations to
remain in the program, Pape and
her colleagues say.
“As long as they keep coming and
are engaged, I feel like that is a success for students,” says Saadia Ahmed, a social worker with REACH.
“Sometimes, smaller successes can
snowball into larger successes.”
Franchi says success for him will
be graduating from high school and
going on to college or university —
something he never thought would
be possible.
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V5
CENTRE FOR ADDICTION AND MENTAL HEALTH
Mental health, addiction problems hit people of all backgrounds
CAMH from V1
Upwards of 60 per cent of the patients who come to this ER each year
are new to the mental health system.
Even though he has been a psychiatrist for 25 years, Goldbloom continues to be struck by the breadth of
society, from professionals to students, the homeless to the affluent,
affected by mental health and addiction issues.
“It’s also the young and old,” he says.
“You see elderly people, where you’re
worried about things like dementia
superimposed on mental illness.
Then you see young people at the
earliest stages of the trajectory
through mental illness and how
that’s going to shape and influence
the course of their lives.
“Our job is to minimize that impact.”
IT IS 8:30 A.M. on a Friday morning
and emergency room staff are meeting in a small conference room to
review the previous nights’ cases and
to make a plan for the day. Sitting at
the round table are psychiatric nurses, social workers, staff psychiatrists,
residents and medical students. They
have a well-practised and efficient
routine.
The team reviews each of the six
patients who were admitted last
night to “the back,” an eight-bed
emergency assessment unit where
patients stay while they are being
assessed and while staff determine
which, if any, of the CAMH in-patient
units best suits their needs.
In addition to the student, the elderly woman, the patient brought in
by police and the man with crippling
depression, the team hears about a
man with schizophrenia who had
stopped taking his medications and a
woman having a psychotic episode
who came to the ER on her own.
Dr. Paul Kurdyak, a staff psychiatrist and head of CAMH’s emergency
crisis services, listens carefully and
offers instruction as each patient is
discussed.
“People not taking their medications,” he says to the group with a wry
smile. “That’s the theme of the day.”
Throughout the morning, the six
patients will be evaluated by a psychiatrist while social workers gather
as much information about them as
possible. They may call family members and family doctors, other hospitals and agencies, or glean details recorded during previous stays at
CAMH.
Goldbloom says this critical component of the emergency evaluation is a
bit like detective work. Every piece of
information, whether from the psychiatric assessment or a family doctor’s file, helps determine a diagnosis.
“It’s a jigsaw puzzle and every piece
is important to gain a complete portrait of a person,” he says. “That portrait emerges as you put all the pieces
together.
Social worker Erica Eugenio attends to a patient who was brought in earlier
and is waiting for a vacant bed and treatment.
Police officers remove handcuffs from
a homeless woman who was brought in
following an altercation. She will be
assessed by a team of professionals.
“You need to take the time and understand the problem to understand
the person, and then to think about
solutions. This is true for all emergency rooms.”
A SHORT TIME LATER, Kurdyak is
sitting in an examination room with
André, the man who came to the ER
the previous night with his motherin-law.
André is tall and thin — painfully so
— with deeply hollowed cheeks and
grey, papery skin. His shoes have
been taken away and pale blue hospital booties cover his socked feet.
He tells Kurdyak that he has lost 20
pounds since October, the month his
depression got worse and took over
his life. He also reveals that he drinks
heavily, was addicted to cocaine and
has been to rehab seven times. The
chart says André has attempted suicide in the past.
Over the course of the hour, Kurdyak asks questions about André’s
childhood, his job, his current state of
mind and his daily routine. He finds
out André has twin toddlers, lives
with his in-laws and that he and his
wife are struggling to stay together.
He also finds out André likely was
raised by abusive parents and that he
has not treated his own family well.
Kurdyak doesn’t take notes. He
keeps his expression neutral. He
watches André’s body language and
facial expressions to see what his
manner reveals about his mood.
Throughout the assessment, André
crosses and uncrosses his legs. His
hand shakes as he sips water from a
Styrofoam cup. He lists the ways life
hasn’t always been fair. He cries
when the discussion turns to his children and how he hasn’t, sometimes,
been a very good father.
“I want to fix what’s in my head,
A syringe is filled with
Loxapine, an antipsychotic drug
used in dealing with agitated
patients.
doctor,” he says, tapping his forefinger to his temple.
At the end of the hour, Kurdyak tells
André that he will get help, but that it
might not be the kind he is looking
for. André wants to be admitted to
CAMH today to be treated for depression. But Kurdyak believes André has not been honest about the
extent of his addictions and the role
they play in his illness and current
circumstances.
Kurdyak recommends André first
go to medical detox, which, depending on the wait list, may not happen
for another week. Once he has been
treated for his addictions, he can then
see if his depression is still an issue.
André is not happy with Kurdyak’s
evaluation and abruptly leaves to go
back to his bed in the emergency
assessment unit. He mutters a curt
“thank you” before closing the door.
Kurdyak says André’s reaction is
not uncommon for people who come
to the ER.
Those who arrive voluntarily often
want to be hospitalized immediately,
which, depending on the extent of
their illness and the scope of appropriate community supports, may not
be the best treatment option. Then
there are the people who are brought
against their will. Some do not want
to be hospitalized, even though they
are likely quite ill and require inpatient care.
“There’s this tension of either forcing people to stay or forcing people to
go,” says Kurdyak.
He notes 60 per cent of people with
addiction problems also have mental
health issues, which means a multifaceted treatment approach is often
required.
“We really look at the evidence to
see whether or not hospitalization is
best.
In the waiting room of the emergency department, a couple waits to see a doctor. Addictions and mental health problems need many different kinds of solutions, not just medical ones.
“Our job is to manage the crisis. But
there are other resources, other than
this hospital, that can be used to unravel the last two or three decades of
problems that are causing the underlying illness or addiction.”
AS KURDYAK and two other psychiatrists evaluate the six patients in the
emergency assessment unit, the
waiting room at the front of the ER
begins to fill up.
By the early afternoon, there are
about eight people waiting to be assessed. Among them are a real estate
agent who is at risk for committing
suicide, a young man who believes he
can telepathically communicate with
CSIS, and a 71-year-old woman who,
in the depths of depression, can no
longer care for herself.
Each person who comes to the ER is
first seen by a nurse at the triage
station to determine the basics of his
or her circumstances. As in all emergency rooms, the sickest patients get
top priority.
Large white boards in the nursing
stations keep track of patients who
are waiting for assessment and list
those who either need to be discharged or admitted to a CAMH inpatient unit. Each patient is assigned
a nurse and social worker. And critical notes — “AWOL risk” or “diabetic” for example — are jotted by their
names.
The nursing stations — one facing
the waiting room and one facing the
emergency assessment unit — are always bustling. The doors, all of which
can only be opened with a key, never
stay closed for long.
Inside, psychiatrists and social
workers type assessment notes and
consult on cases. Program assistants
store patients’ belongings and take
juice to people in the waiting room.
Someone is almost always on the
phone trying to locate a spare bed in
an inpatient unit.
It is abundantly clear this is a team
environment.
Mental health and addictions require many different kinds of solutions, not just a medical one, says
Goldbloom. Social workers are critical in the ER, he says, because they
find practical ways to help people
with their illnesses, from connecting
patients with outside agencies to
helping them locate safe housing.
“Because if you are homeless, if you
are broke, if you are being beaten up
and you have a mental illness on top
of that, the solution will not exclusively be in a pill.”
Medications are the primary treatment tools in this ER. There are no
surgical suites or imaging machines,
just a locked cabinet that dispenses
an array of drugs.
By late afternoon, most of the six
patients who were in “the back” this
Facility is dramatic proof
of a change in attitudes
CAMPUS from V1
Though sections remain, the same
area today has become an extension
of the city that surrounds it.
This isn’t to say our Victorian forebears were nasty and cruel (though,
of course, they were), but that they
believed the best way to treat the
mentally ill was to hide them away, as
much for their protection as ours.
The fortress-like structure was torn
down in the 1960s to make way for a
well-intentioned concrete complex
that still stands. It is cold, cramped
and disconnected. It feels thoroughly
institutional, in the worst sense of the
word, as if designed for theoretical
correctness, not actual human usage.
“Mental illness has been marginalized for a long time,” says CAMH
president and CEO, Dr. Catherine
Zahn. “It’s the last sector to be normalized.
“The intent of the redevelopment is
to attack the mental walls that are so
out of keeping with what we know
now about mental illness. We are
planning a realignment to something
that looks like a neighbourhood. It’s
the perfect metaphor for what we
want to do.”
Zahn inherited the project from her
predecessor, Dr. Paul Garfinkel, who
with architect Frank Lewinberg
launched the rebuilding program
more than a decade ago.
As Karen Martin, director of the
CAMH Mood & Anxiety program,
points out, one of the big issues was to
eliminate the shame many patients
feel. In a world already prejudiced
against mental illness, a place such as
CAMH comes with certain stigma.
Making the centre architecturally
different and setting it apart from its
surroundings exacerbates those differences. Hiding them behind walls
makes it even worse.
“The only way to get people to this
sort of place is to remove the stigma,”
explains Alice Liang, an architect
with Montgomery Sisam. “The question is how we make it as home-like
as possible.
“We brought a non-institutional
perspective to the project. That was a
radical move. Our job was to provide
the most interactive care environment. It needs to be quietly elegant,
not iconic. To blend in is more important than to stand out. We’re making
buildings that are in harmony with
what’s around. It was a civic project,
not just an architectural one.”
Liang, who has been working with
CAMH for a decade, talks about the
difficulty changing traditional ways
of doing things at the bureaucratic
level.
“It took us a couple of years to convince staff,” she recalls. “We spent
two or three years having discussions
with the ministry (of health) about
morning have been discharged, admitted to another unit in the hospital
or are waiting to be taken to their new
bed.
The university student is markedly
less anxious and has been discharged. She and the ER staff believe
she will do better at home, where she
can continue with her studies. A
community psychiatrist will continue to monitor her mood and medications.
The elderly woman who mistakenly
believed her husband had died is
back to being herself. Appropriate
medications brought her out of psychosis and she now knows her name,
where she is and why she is here. In a
few hours, she will move to CAMH’s
Geriatric Admission Unit for continued treatment.
The woman found naked on a street
corner will stay in the ER’s emergency assessment unit so she can be
closely monitored until one of the six
acute secure beds open up at the hospital.
And André is already in medical detox. He left the ER just two hours
after his assessment.
As a nurse wipes their names from a
board, a new set of patients quickly
fills the space. A resident peers
through the window to look at the
cluster of patients in the waiting
room. She predicts it will be a busy
night.
A drawer of medication. CAMH’s ER is unlike other hospital emergency
rooms, which rely on medical equipment. Here drugs can play a key role.
WHAT THE CENTRE FOR ADDICTION
AND MENTAL HEALTH DOES
A multiform role: Treatment, research, training,
information, prevention, policy input
Members of the clinical response team follow an agitated patient
(in orange) who wants to leave the unit.
Things such as shoe
laces and belts are
taken from people
when they are
admitted. Many
patients here have
considered suicide.
The Centre for Addiction and Mental
Health (www.camh.net) is Canada’s
largest teaching hospital in the field of
mental health and addictions. It has
530 inpatient beds.
CAMH provides a broad range of
services:
• Inpatient and outpatient clinical care
for people with a range of mental
illness and addiction problems through
all stages of life. It cares for 25,000
clients each year.
• Research “from the neuron to the
neighbourhood” to understand, treat
and prevent mental illness and addiction better.
• Training and education for psychiatrists, psychiatric nurses, social work-
ers and other related health professionals.
• Health promotion, information and
prevention strategies delivered to
health professionals online
(www.knowledgex.camh.net) and to
the community through staff in 27 sites
across Ontario.
• Public policy input and expertise to
the different levels of government.
The hospital’s revenues for 2010 were
close to $303 million. Donor support is
an important component of this total.
More than $20 million were raised in
2009/10 through the contributions of
people, corporations and foundations.
Learn more at
www.supportcamh.ca
PHOTOGRAPHY BY RICK EGLINTON/TORONTO STAR
Having her own shower
and a bright, cheery room
mean the world to her
Trading stifling setting
for a welcoming one
eased patient’s decision
MEGAN OGILVIE
HEALTH REPORTER
At the CAMH campus on Queen St. W., new buildings under construction are popping up behind the old ones.
private bathrooms. But they were
necessary to the design of a dignified,
comfortable and healing environment.”
Though much of the 27-acre campus remains a construction site, the
buildings that line the new White
Squirrel Way on the west end of the
property provide a glimpse of what
lies ahead.
Rather than a few large structures,
CAMH will have more smaller buildings. Facing White Squirrel, these
pleasant three- or four-storey glassand-brick boxes could be townhouses, small shops, or even art galleries.
But this is where some of CAMH’s
neediest patients live during their
stay, which can last as long as 28 days.
Here they learn to regain control
over their lives as they become part of
the immediate community of housemates, up to six per building.
One of these new structures, the
McCain Building, is the first such
place named for a philanthropist. In
its own quiet way, this is dramatic
proof of how attitudes are changing.
Just decades ago, these facilities
were designed for incarceration as
much as healing. Now, they are a
short walk from Queen St. W., visible,
accessible and fully part of the larger
community. That makes it easier for
patients as well as their visitors.
“This isn’t home,” Martin admits,
“but it’s home-like.”
In fact, one of the handful of midrise buildings under construction on
Queen at the foot of Ossington Ave.
will offer affordable housing. Another will contain an intergenerational
wellness centre and a third, offices. In
addition to Montgomery Sisam, the
architects involved, Kuwabara Payne
McKenna Blumberg, and Kearns
Mancini, rank among Toronto’s most
respected firms.
Though there will be 650 in-patient
beds, it’s important to remember that
the facility receives about half a million walk-in visits annually.
The restored street grid will help
them come and go, as will the new
sense of openness and physical connectivity.
“We want to contribute to the city,”
says Zahn. “There’s a growing awareness that institutions need to give back
to the community. The redevelopment
forced us to ask about what our civic
responsibilities are. These buildings
are based on the principle that recovery is possible. The buildings themselves are conducive to recovery, but
they were also designed to look ‘normal,’ comforting and orienting.”
None of this should sound radical,
but if it is, let the revolution begin!
When Angela Foot was told she
could benefit from in-patient care at
the Centre for Addiction and Mental
Health, her first response was to refuse the help emphatically.
The young woman, who was struggling with bipolar disorder, had completed two months of day treatment
at the centre’s Mood and Anxiety
Inpatient Unit (MAUI) and was
afraid to spend four consecutive
weeks in the cramped space.
Its cinderblock walls, stuffy, small
rooms and institutional feel were an
overwhelming deterrent, even
though she knew she needed help to
overcome her suicidal thoughts.
But Foot’s doctor assuaged her
fears by explaining she would be
among the first patients to be treated in the Alternate Inpatient Milieu
Program, or AIM, which is housed in
three four-storey, glass-and-brick
buildings on the west end of the
property.
Foot learned the space, open to patients since November 2008, was
bright and open, that she would
share a floor with just five other patients, and she would have her own
bedroom and her own bathroom.
Foot accepted the treatment.
“I probably would have refused
without a bathroom,” says Foot, now
37 years old and healthy.
Formerly a successful director of
marketing and sales for a software
company, Foot was diagnosed with
bi-polar disorder when she was 32.
When she came to CAMH for treatment, first as an out-patient in 2006,
and then as an in-patient in 2008,
Foot was isolated, suicidal and had
extended manic periods where she
could not sleep for weeks.
It sounds like a silly obstacle, but a
bathroom, a private room and welcoming surroundings can make the
difference in helping patients decide
to seek mental health treatment, say
clinicians and staff.
Removing the institutional atmosphere, they say, encourages people
to come for help and reduces the
stigma that still lingers.
Foot adds a different perspective:
“When you are so ill, the proximity
to a shower is a really big thing. See-
Older parts of the hospital will be
redeveloped to fit with the model.
In the McCain Building, patients can have their own bedroom and
bathroom. Their close proximity makes a big difference.
ing it from the bed and knowing it’s
just six steps away really helps.”
While grateful for the treatment
she received at MAUI in 2006, Foot
shivers when she recalls its warren
of rooms, narrow, maze-like hallways and stifling setting.
“There is a real sense of disorientation and mayhem there,” she says.
“It’s loud and disorientating. It
smells like a closed-off environment.”
On a recent spring day, Foot wanders the halls on the fifth floor of
MAUI. Cheery, electric green paint
does little to hide the inhospitable
cinderblock walls. The temperature
is uncomfortably warm. It feels like
an out-of-date hospital.
Minutes later, Foot smiles as she
walks into the McCain Building,
which houses AIM and where she
spent four weeks in 2008. The entrance is bright and airy. The rooms
are spacious and have broad windows. It feels like a friend’s condo.
One of the things Foot liked most
about her time at AIM was being
able to walk down White Squirrel
Way and along bustling Queen St. W.
for an afternoon stroll.
“It allows you, literally, to feel like
you are not so nuts,” she says, sitting
in a sunlit window bay on the second
floor of the McCain Building. “I
could walk down to Queen Street
and see streetcars and people-watch
and see normal things, like people
putting money in parking meters. I
could go for coffee. . . . It felt a little
bit like university.”
Patients are allowed to bring their
bedding and artwork to make the
light-walled rooms feel like home.
Foot brought a fluffy white duvet
and a stack of photos.
“It becomes your own little oasis,”
she says. “This place gave me a
month to myself to work on me, to
work on getting better.”
V6
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ON ON1
CENTRE FOR ADDICTION AND MENTAL HEALTH
Where delusional does not equal criminal
Working to steer people
away from the criminal
justice system when it
makes sense to do so
BILL TAYLOR
SPECIAL TO THE STAR
The man is articulate, pausing
sometimes to choose his words.
“I’ve been hospitalized numerous
times,” he says. “But basically I regarded myself as being abducted. I
think people were paid thousands
of dollars to abduct me, maybe.”
Dr. Michael Colleton asks him
why.
“To steal my liver,” the man says
matter-of-factly.
He’s not stupid, but he is clearly
delusional. That’s why he and Colleton are sitting in a room next to
mental health court in the Old City
Hall basement.
There’s more than one way to dispense justice. The best, for some
offenders with psychiatric disorders, is to keep them out of the
courtroom altogether.
Mental health court is already
very different in its approach, with
Crown attorneys, defence lawyers
and judges working together to try
to keep low-risk offenders out of the
criminal justice system.
Rather than punishment, the
court seeks to offer them the support they need to get their lives back
on track.
Colleton is the first part of that
process.
A psychiatrist with CAMH’s Law
and Mental Health Program, he
does preliminary assessments. Depending on his recommendation,
the person may never even stand
before the judge.
“The question is whether special
consideration should be given because of their mental state,” he says.
“Broadly speaking, it’s intended for
people with serious mental illness
but relatively minor charges who
are out of custody.”
The man he’s talking to is in his
late 30s and charged with breaking
and entering and weapons offences
after he was accused of pulling a
knife on the owner of a junkyard.
The man had slept in a car there.
He was arrested, he says, “by real
police or maybe they were fake police, I don’t know. I want to charge
them with kidnapping. They tried
to steal my liver seven or eight
times, maybe.”
“Let’s back up a little,” Colleton
says.
He walks the man through his
past. Education? Grade 11. Where
does he live? In a hostel. Married?
No. Children?
“Er . . . yeah . . . a lot, maybe.”
He sees them every day, he says.
“They live in Canada?” Colleton
asks.
What I’m looking
for is evidence
of serious mental
illness
DR. MICHAEL COLLETON
“No,” the man says.
He’s held various jobs, he says,
from bartending to working in a
fast-food joint.
He used hard drugs “a long, long
time ago,” and enjoys marijuana
and beer “socially.”
Colleton asks if anyone in his family had a drinking or drug problem.
The man chuckles.
“Other than them not being able
to get enough? No.”
He rambles off track, talking about
his fear of the dogs that he says
constantly attack him, the abductions, the dangers that haunt him.
He peppers his speech with “basically” this and “basically” that. Of
his arrest, he says, “they kidnapped
or abducted me and took me to
what you call prison or jail, whereby
which I am now at court.”
He hasn’t been hospitalized lately,
he says, “except I went with a rotten
tooth. They weren’t inclined to extract it, whereby which I left.”
Colleton asks about the liverstealing.
“They thought they’d make money off it . . . When I’m in a jail cell, I
can tell when someone’s sucking
half my liver out.”
Colleton is usually at mental
health court twice a week.
“I get a referral, either from the
Crown or duty counsel or court
support workers, saying here’s a potential candidate,” he says. “What
I’m looking for is evidence of serious mental illness — some connection between illness and charges.
“An easy example would be someone with a known history of schizophrenia who goes off medication,
becomes psychotic and threatens
someone with violence. They might
have been hospitalized after the arrest, treated and gone back to their
normal self. If there’s no significant
risk factor, that would be a clear
case for diversion.
“It’s not generally that easy. There
are other reasons for criminal acts.
It might be substance-related or a
drunk in a bar fight . . . that doesn’t
cut it from my perspective.
“They may steal simply because
they want money and it’s not connected with their condition. My job
is to find the reasons.”
Under a diversion program, the
person is supervised and given help
with housing and any necessary
medical, psychiatric, substanceabuse, financial or anger-management counselling.
If everything goes well, the charges can be withdrawn.
The Crown doesn’t have to accept
Colleton’s assessment. But this, he
says, can go both ways.
“There are times I’ll say, ‘This isn’t
a good candidate’ and the Crown
will say, ‘We’ll try it, anyway.’ ”
After a 45-minute interview, Colleton says the man is a reasonable
candidate for intervention and the
“concrete benefits” it could bring.
“I’m not a criminal,” the man insisted. “I would love to be able to
work and live like a normal human
. . . food in the fridge, clean clothing,
not to be harassed.”
RICK EGLINTON/TORONTO STAR
Michael Colleton is a psychiatrist in CAMH’s Law and Mental Health
Program. He assesses whether an illness may have been a factor in crime.
HealthZone_7236_8407
SATURDAY, APRIL 30, 2011
ON ON1
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TORONTO STAR
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V7
CAMH
Support helps him live with purpose
CAMH and Mainstay
work to provide housing
for people at risk
JUDITH GERSTEL
SPECIAL TO THE STAR
Homelessness can be both the
cause and the effect of a downward
spiral for some people with mental
health problems.
Megas, who didn’t want his last
name used, is not one of them,
Megas has three homes.
Nine years ago, at the age of 22, he
was diagnosed with schizophrenia
and treated at CAMH.
Now, Core BMX and Boards, a
bike shop on Queen St. in Leslieville, is his “second home,” he says.
“No, it’s my third home. My second home is my grandma’s.”
His first home?
It’s an apartment in a building
owned and managed by Mainstay,
Canada’s largest provider of housing for mental health consumersurvivors.
Mainstay is one of many non-profit agencies CAMH works with to
help recovering clients integrate into the community and regain independence.
“We’ve developed a special partnership with Mainstay,” says John
Trainor, director of community
support and research at CAMH.
“We refer clients to their units and
we provide ongoing support. It’s
good to work with them because,
even though they’re primarily a
landlord, they’re an enhanced, specialized mental health landlord.”
That special partnership exists beyond the upper-level executive and
management offices of the two
large organizations.
Just as importantly, there’s a
street level partnership between individuals such as housing support
worker Math Radfar, who is a Mainstay employee assigned to Megas’
building, and Renee Ryan, a CAMH
occupational therapist who is Megas’ continuing care worker.
Radfar says he mediates conflicts
RICK EGLINTON/TORONTO STAR
Megas says the bike shop is a second home. He volunteers there, moving stuff, cleaning up and helping people out. Right now, he’s into skateboarding.
between tenants and helps them
pay their rent on time.
But “we’re not doing therapy,” he
explains. “When there’s a mental or
behavioural crisis, we get help from
CAMH to deal with those difficulties. We have very close ties with
them.”
Knowing “someone’s there for
him every day” is important, says
Megas’ 45-year-old aunt, Nancy
Cheesman.
It’s her mother, Megas’ grandmother, who raised him from the
age of 5 along with her own children.
Cheesman calls Megas several
times a day and accompanies him
to doctors’ appointments. If he has
an early appointment, he stays over
at her apartment, which she shares
with her mother and which Megas
regards as his second home.
But having his own home, with
appropriate support, has made a
huge difference in Megas’ life.
“He has not been in the hospital
once in about four years,” says
Cheesman.
“I feel like I’m part of the commu-
nity again,” Megas says. “I’ve been
taking my pills daily, and I’ve been
doing everything perfectly fine with
my schizophrenia.”
“Mainstay,” says Cheesman, “ is a
foundation for him, a safe place to
live. And there are a lot of activities,
so he has something to do. Otherwise, he can’t get up in the morning
because there’s nothing.”
Thursday is movie night with popcorn at Mainstay’s head office on
Queen St. W. On Tuesdays, there’s
cooking class with someone preparing a meal and everyone eating
together.
“I know Megas made some eggs,”
Cheesman says. “I added some
sauce to the spaghetti.”
High-support housing — support
available 24 hours a day on site — “is
a huge priority,” says April Collins,
administrative director in the
schizophrenia program at CAMH.
It’s a constant presence that supports people with serious mental
illness relearn life skills, she explains.
Collins says some people who
have been in the hospital for six to
eight years have been able to move
into the community because of
high-support housing.
“And they’re thriving,” she says.
“They didn’t need hospital level
care but there wasn’t a system in
place to provide proper support. By
partnering with housing and support agencies” — such as Mainstay,
Homes First Society and Pilot Place
Society — “we’ve been able to see a
change in recovery-based care.”
An important part of recovery,
Collins emphasizes, is access to
meaningful work.
Megas not only has three homes,
he also has two volunteer jobs.
He coaches breakdancing classes
at Secord Community Centre, calling on his expertise as a member of
the internationally renowned
breakdancing group, Boogie Bratz.
And he helps at the Core bike shop
near his home.
“He feels good when he’s there,
helping people,” says Cheesman.
“Everybody knows his situation
and they make him feel right at
home. It’s right around the corner
so he can go there to hang out.”
Chris Taylor, owner of Core, says
Megas talks with customers, moves
things around, cleans and sweeps.
“I go to the bicycle shop all the
time to visit my friends and whatever they need, I’ll do,” says Megas.
“He’s here quite a bit, almost a
regular fixture,” says Taylor. “And
he represents the shop outside of
the shop and he does a great job
with that.”
Megas was interested in biking at
first, but he’s focusing on skateboarding now.
Cheesman explains some thinking went into the location chosen
for Megas.
“They knew he liked to be active,
so they picked that spot at Coxwell
for him, with the (Ashbridges Bay)
skateboard park nearby.”
Skateboarding, says Megas,
“teaches you about yourself.
“When you’re on your board,
when you’re rolling, it feels like you
could be flying.”
The important thing about flying,
of course, is to land safely, to be
grounded again, and to always be
able to come home.
8:00pm may 11, 2011
the party
location: 99Sudbury
host: George Stroumboulopoulos
entertainment: Special acoustic performance by Metric
A fundraising event for the Centre for Addiction and Mental Health Foundation.
Admission includes entertainment, an exclusive art auction, spectacular food,
and special musical performances to keep you dancing all night long.
tickets
$150 per person | $1,500 for a package of 12 tickets
To order tickets online, visit unmasked.ca
A tax receipt will be issued for the maximum amount
allowable by cra guidelines.
for information: 416 535 8501 x6169 | [email protected]
Presented by:
After Party sponsor:
Supporting sponsors:
With support from:
V8
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TORONTO STAR
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SATURDAY, APRIL 30, 2011
ON ON1
CAMH is transforming lives
– and we couldn’t do it without you!
In 2005, the Centre for Addiction
and Mental Health launched a bold
and transformational fundraising
campaign for the hospital – the largest
in the world for mental illness and
addictions.
We are closing in on a $100 million
campaign milestone – to help
redevelop outdated buildings on
our Queen Street campus and to
support a major research thrust at the
hospital’s College Street site.
And a very special thank you to a group that
is working tirelessly on behalf of CAMH –
Our Outstanding
Campaign Cabinet
Honorary Chair, Transforming Lives Campaign
Hon. Michael Wilson, C.C.
Chair
Barclays Capital Canada
Campaign Co-Chairs
Jamie Anderson
Deputy Chairman
RBC Capital Markets
Michael McCain
President & CEO
Maple Leaf Foods Inc.
Thomas V. Milroy
CEO & Deputy Chairman
BMO Capital Markets
Campaign Cabinet
THANK
YOU !
Deborah Alexander
Executive Vice President
General Counsel & Secretary
Scotiabank
Alfred Apps
Counsel
Fasken Martineau DuMoulin LLP
Paul Beeston, C.M.
President & CEO
Toronto Blue Jays & Rogers Centre
THANK YOU to the clients and families
whose courage has opened our hearts and
our minds and continues to inspire us.
THANK YOU to the thousands of individuals,
corporations and foundations whose
compassion and continued financial support
helps CAMH better understand, treat and
prevent mental illness and addictions.
THANK YOU to our dedicated staff,
researchers, clinicians and allied health
professionals – who care for those in need
today and tomorrow.
You too can be part of history.
Show your support for CAMH and help transform
the lives of those with mental illness and addictions
at www.supportcamh.ca/TorontoStar
Arnold L. Cader
President
The Delphi Corporation
George A. Cope
President and Chief Executive Officer
BCE and Bell Canada
Donald Lenz
Managing Director
Newport Partners
Ana P. Lopes
Corporate Director
The Tapscott Group Inc.
Robert MacLellan
Chairman
Northleaf Capital Partners
Kelly Meighen
President
T.R. Meighen Family Foundation
Susan Mullin
Vice President Philanthropy
CAMH Foundation
Richard Currie, O.C.
Past Chairman
BCE Inc.
Timothy R. Price
Chairman, Brookfield Funds
Brookfield Asset
Management Inc.
Robert C. Dowsett
President
Robert Dowsett Consulting
Valerie Pringle, C.M.
Broadcast Journalist
Samuel L. Duboc
EdgeStone Capital Partners
Harry Rosen, C.M.
Executive Chairman
Harry Rosen Inc.
John R. Evans, C.C.
Chair Emeritus
MaRS Discovery District
Michel Fortier
Managing Director, Debt Capital Markets
National Bank Financial Inc.
David Goldbloom
Senior Medical Advisor, Education
and Public Affairs
Centre for Addiction and
Mental Health
Darrell Gregersen
President & CEO
CAMH Foundation
John S. Hunkin
Former CEO
CIBC
Sandra Simpson
President
Selkirk Investments
Herbert H. Solway
Founding Member & Counsel
Goodmans LLP
Diana Tremain
President
The Howitt/Dunbar Foundation
Annette Verschuren
Former President
Home Depot Canada
Donald A. Wright
President and CEO
The Winnington Capital
Group Inc.
And join the conversation on Twitter @endstigma and www.facebook.com/endstigma