The Ongoing Evolution of CAMH

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The Ongoing Evolution of CAMH

As the Centre for Addiction and Mental Health continues its ambitious redevelopment, we take a look back at its previous transformations.

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In early 2015, CAMH will enter the third phase of its current redevelopment project. Since its beginning in 2005, the process has transformed the institution’s architecture and operations, linking the storied site to the larger evolution of Queen Street West and the renaissance of Toronto’s downtown west side.

This redevelopment aims to create a small but complete nine-block neighbourhood while establishing better connections with the wider community. New retail and residential uses have already been incorporated in and around the facilities, including the Ossington-Queen Street Rental Apartments—the first non-CAMH building—which features affordable housing units and retail shops at ground level.

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The new site plan emphasizes urban blocks, as seen in this rendering from Phase 1A. Courtesy of the CAMH Master Vision.

Approval for the project’s third phase, known as 1C, was announced in September 2011 with a visit from then-premier Dalton McGuinty. Phase 1C construction, scheduled for completion in 2020, will include two new buildings: the Complex Care facility featuring in- and outpatient services with supportive programming and the Acute Care building with inpatient units and a 24/7 emergency department (both originally located at CAMH’s College Street site). The new buildings will co-locate work spaces to encourage collaboration between researchers and clinicians. Construction is expected to begin in late 2016 or early 2017.

Planned road extensions for Stokes Street and Workman Way—both as of now confined to the borders of the CAMH grounds—will provide links with the surrounding area via Shaw Street and Adelaide Street West, respectively.

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A memorial plaque for the 19th-century CAMH patient labourers stands next to the wall they once built, now preserved as a heritage component of the site.

This is by no means the first time CAMH has reinvented itself. Originally called the Provincial Lunatic Asylum when it opened in 1850, it was renamed Asylum for the Insane about 20 years later, then Hospital for the Insane, and then simply Ontario Hospital in 1919. It then became the Queen Street Mental Health Centre in 1966. It’s been known by its current name only since 1998, when it was formed through the merger of the Queen Street Mental Health Centre, the Clarke Institute of Psychiatry, the Addiction Research Foundation, and the Donwood Institute.

Over the years, the site has also seen a number of physical transformations. In the 19th century, the prevailing belief—influenced by the theories of American physician Dr. Thomas Kirkbride—was that an orderly physical environment and firm social structure would help cure “abnormal” or mentally ill behaviour. This theory was reflected in asylum architecture across North America. The Queen Street West site featured rigid lines and angles—believed to restore order and reason in the mind—and walls around the site that divided patients from the general populace.

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A sketch depicting the Provincial Lunatic Asylum in the 19th century, as designed by architects John Howard and Kivas Tully. Image courtesy of CAMH History of Queen Street Site.

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The cell-like confinement of the 19th-century building as viewed from the outside. Photo courtesy Toronto Public Library Digital Archive.

By the mid-1900s, deteriorating conditions and changing public perceptions of mental illness led to calls to address the Toronto asylum’s outdated structure and treatment model. The institution had come to represent the dark ages of mental healthcare, increasingly appearing as little but a warehouse for the mentally ill, poor, and disorderly. Overcrowding was severe, while confinement and surveillance, rather than successful treatment, seemed more of a focus. Redevelopment was on the horizon, and the buildings were demolished in 1976.

The first redevelopment was spurred by the fall from grace of Kirkbride’s “order as therapy” model. The institution moved to decentralize authority and de-emphasize the relationship between physical design and behavioural treatment. From this emerged the “mental health campus” model, which featured multiple scattered, detached treatment units rather than one massive centralized building. The greater availability of pharmaceuticals at the time contributed to a decline in the perceived need for the confinement and surveillance of patients. This era proved to be short-lived, as the changes to built form were soon seen as just a mask for the same old approach to treatment. The campus model was obsolete within 25 years and is remembered now as having been a largely superficial attempt to modernize the administration of mental health care.

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The former Queen Street Mental Health Centre in 1972 in the foreground of the 19th-century structure’s impending demolition. Courtesy of CAMH Historical Photos.

The current redevelopment marks the third iteration of the CAMH site at 1001 Queen Street West, formerly 999 Queen Street West (the address was changed in 1979 as a symbolic means of distancing the new centre from its infamous past). It aims to invest in the future of the site and neighbourhood, as well as the development of mental health and addictions treatment as a whole. Addressing Phase 1C and the goals of the overall project, CAMH CEO Dr. Catherine Zahn emphasized the “need to transform care for people with addictions and mental illness, replacing outdated facilities with new, therapeutic buildings specially designed for independence, dignity, and recovery. We need to change attitudes while we revitalize our community.”

The redevelopment also looks to rectify the mistakes of previous phases by adopting a postmodern approach that departs from the strict patient boundaries and top-down authority of the past. The new CAMH is founded on patient empowerment through the contemporary Clubhouse model of treatment, in which authority is fragmented as “members” (rather than patients) take more responsibility in their own voluntary treatment. Front and centre in the plan is the integration of the site with the broader community through an Urban Village format. The Urban Village is based on a mixed-use site plan that includes housing, commerce, and recreation and incorporates CAMH facilities, staff, and members.

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An open space along the heritage wall programmed for CAMH use.

The redevelopment’s Vision and Master Plan, prepared between 2002 and 2008, imagine the establishment of a new dynamic between CAMH and the West Queen West strip. They refer, for example, to social mixing, which parallels the mixed-income strategy being used to redevelop Toronto’s “tower-in-the-park” style public housing (think Regent Park, Lawrence Heights, and Alexandra Park). “Casual mixing between staff, clients/patients and visitors of CAMH with the surrounding community,” reads the Vision’s Executive Summary, “will occur naturally on public sidewalks, parks, shared community facilities, and the cafes, restaurants and shops that will occupy the street level of buildings. CAMH uses will be integrated with other uses to create a safe, comfortable and welcoming place where the stigma of the institution can disappear into the rhythm of normal daily activities associated with city living.”

The Master Plan reflects the principles of the Urban Village, outlining a variety of land uses and local services that will bring staff, patients, and other community members together. The redevelopment involves a network of public streets, public and private open spaces, a series of cohesive development blocks, and a mix of CAMH and non-CAMH buildings. The Vision lays out the opportunity for CAMH to participate in the ongoing revitalization of the West Queen West neighbourhood, while combating the stigma formerly associated with the site, and with mental illness more generally.

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Buildings on Queen Street West seen from the CAMH site.

Not unlike the strategy being used to re-imagine the landscape of Toronto’s major government housing projects, CAMH’s approach strives to break down the built barriers of isolation often attributed in part to a faith in mid-century architectural modernism. Having adjusted its institutional model, it is now better positioned to integrate itself within the vital and economically ascendant West Queen West. The area has undergone substantial demographic change in recent years—no longer gritty downtown periphery, it’s teeming with new life and upstart independent businesses.

CAMH has reinterpreted the notion of an Urban Village within the context of its redevelopment. It hopes to foster inclusion and de-segregation, appreciating the many ways our social environment may influence mental health. While the redevelopment reflects a departure from the environmental determinism of the past, it also affirms that there is still a role to play for physical design in the shaping of human behaviour. By better integrating its buildings and services into the surrounding community, CAMH hopes to lift the stigma of mental illness and support its members’ growth.

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