Healing beyond the hospital
Patients ‘take ownership’ of their illness with treatment in community
When it comes to caring for people with mental health disorders, many of us think of forbidding institutions with drab colours and doctors in white coats. Think again. Rather than being treated in hospitals and clinics, mental health patients today might be cared for in community settings and even in their own homes, where they can thrive. Beyond the walls of the Centre for Addiction and Mental Health, partnerships between the facility and outside organizations are central to the healing process, integrating services and making them available to the wider community.
“You want to bring your care as close to where people live as possible,” says Dr. Kwame McKenzie, a senior scientist and deputy director of the schizophrenia program at CAMH, adding that through such partnerships, an increasing number of even severe schizophrenia patients are able to function independently. “You need to get people out of hospital beds and into the community with the right supports to move forward.”
McKenzie, who is also a professor of psychiatry at the University of Toronto, works out of a loft at 862 Richmond St. W., a CAMH satellite location in the Queen West district that focuses on treatment of schizophrenia. Far from a stereotypical, antiseptic doctor’s office, the clinic is on the second floor of a renovated industrial building, with lots of exposed brick and natural light.
The look of the office is not the only difference. Patients are seen by Assertive Community Treatment (ACT) teams that include doctors, nurses, social workers, occupation therapists and vocational counsellors, as well as peer support workers who have recovered from mental illnesses themselves and can, therefore, relate to and mentor patients.
“It’s so much more compelling when treatment comes from firstperson experience,” says Dr. Ken Harrison, a physician in CAMH’s schizophrenia program at 862 Richmond. “We can talk about hope, but here’s someone who represents living, breathing, tangible hope.”
Often hospital settings don’t work for people with severe and persistent mental illness, he says. They present a stigma, for example, and mental health patients often fear that they will be readmitted. Some people experience “white-coat syndrome,” developing symptoms in doctors’ offices they wouldn’t necessarily have sitting at their kitchen table. Decentralized locations are more satisfying for staff and closer to where clients live, Harrison says. Some 40 per cent of his appointments are in clients’ homes, workplaces or nearby coffee shops, to which he often bicycles. Seeing people off-site allows the care teams to “learn about what the other 23 hours of their days are like,” he says. Dr. Priya Watson, an adolescent and child psychiatrist in CAMH’s Child, Youth and Family Program, says that it’s important to see patients in a larger context. She works with international communities in countries such as Ethiopia as well as with immigrants to get to the root of mental illnesses among individuals and wider populations. Watson treats youths with anxiety and mood issues and is an expert in “transcultural psychiatry,” which focuses on such areas as disorders among immigrant children. Many of them experience post traumatic stress disorder from the change, separation and emotional stress they undergo, and can end up dis- playing symptoms such as depression, panic attacks, phobias and flashbacks. Watson says that caring for these kids must involve the community, including their schools and teachers, parents and other family. “We take a 360-degree approach,” she says, for example having children referred to the program by teachers and social workers and then connecting immigrant parents with the services they need. “There’s so much stigma,” adds Watson, who is assisting with major programs involving the University of Toronto and the University of Addis Ababa to increase mental health services in Ethiopia, as well as to study the impact of migration on mental health. Partnerships are key to improving mental health services and allowing patients to integrate into the community, McKenzie says. One recent initiative of the schizophrenia program is Regeneration House, a 40apartment complex in the Eglinton-Oakwood area that has been established through a partnership between the building’s landlord, Regeneration Community Services and CAMH. Through such programs, he says, patients with chronic mental illness who were once “warehoused” in hospitals have been able to move into private accommodations. There they are often much more optimistic about fulfilling their dreams, aspirations and potential, he says. “It makes sense from a system point of view.” Harrison adds that there is still a long way to go, but at least initiatives like Regeneration House and the team approach in the schizophrenia program allow people to be “the drivers of the ship” and focus on their thoughts and goals. “The whole idea of recovery is about people taking ownership of and managing their illness.”