Centre for Addiction and Mental Health
|Centre for Addiction and Mental Health|
CAMH Russell Street site
|Location||Toronto, Ontario, Canada|
|Care system||Public Medicare (Canada) (OHIP)|
|Hospital type||Addictions and Mental Health|
|Affiliated university||University of Toronto|
|Lists||Hospitals in Canada|
The Centre for Addiction and Mental Health (CAMH) or, in French, the Centre de toxicomanie et de santé mentale, is a mental health hospital in Toronto, Ontario, Canada. (The acronym CAMH is most commonly pronounced "Cam-H".) The hospital was formed in 1998 from the amalgamation of four separate institutions. CAMH has 530 inpatient beds and 3000 staff, physicians, and scientists, with an annual operating budget of over $300 million. Its central facilities include 90 distinct services across inpatient, outpatient, day treatment, and partial hospitalization models.
Among the focuses of the organization are the assessment and treatment of schizophrenia, mood and anxiety disorders, personality disorders and a clinic for gender identity disorder in children There is also a focus on addictions to alcohol, drugs, and problem gambling at the former ARF site. CAMH also has a Law and Mental Health Programme (forensic psychiatry and forensic psychology) and is a major research centre.
CAMH is a teaching hospital with central facilities located in Toronto and 10 community locations throughout the province of Ontario. CAMH is fully affiliated with the University of Toronto and is a Pan American Health Organization and World Health Organization Collaborating Centre.
- 1 Facilities
- 2 Administration
- 3 Mood and Anxiety Clinic
- 4 Workplace safety issues
- 5 Child Gender Identity Clinic
- 6 Public safety issues
- 7 Public policy statements
- 8 Research
- 9 References
- 10 External links
CAMH was formed from the 1998 merger of the Queen Street Mental Health Centre with the Clarke Institute of Psychiatry, Addiction Research Foundation, and Donwood Institute. The main part of the hospital is at 1001 Queen Street, on the site of what was the Provincial Lunatic Asylum that opened in 1850.
Queen Street Mental Health Centre
The Provincial Lunatic Asylum opened on January 26, 1850. It was subsequently re-named Asylum for the Insane, then Hospital for the Insane, then Ontario Hospital (1919), and then the Queen Street Mental Health Centre (1966). It had also been called the Toronto Lunatic Asylum and 999 Queen Street West.
The original buildings were constructed in a series of rigid lines and sharp angles, consistent with the belief at the time that orderly physical structure would facilitate orderly mental states for the patients. High walls segregated the patients from the community, establishing a long-standing stigma about the facility Integration the hospital grounds into the surrounding community was emphasized as a goal for CAMH's redevelopment project.
The Queen Street Site of CAMH contained the Samuel A. Malcolmson Lecture Theatre, named for the site’s Chief Psychiatrist and Clinical Director of Forensics. In 2009, however, Malcolmson was subject to a disciplinary hearing of Ontario’s College of Physicians and Surgeons, following that he sexually abused a patient and fathered a child with her. Malcomson pleaded “no contest” and resigned his license to practice. The lecture hall was renamed the Queen Street Auditorium. 
Clarke Institute of Psychiatry
The institute was founded in 1966 and officially opened by Ontario Premier John P. Robarts. It was named the Clarke Institute of Psychiatry, after Charles Kirk Clarke, a pioneer in mental health in Canada. The institute took over the clinical, teaching, and research functions of the Toronto Psychiatric Hospita], located at 2 Surrey Place, which opened in 1925 under Clarence B. Farrar. The Institute served as the main psychiatry teaching hospital for the University of Toronto and was the headquarters for the Department of Psychiatry in the Faculty of Medicine. In 1965, an agreement between the University of Toronto and the Clarke Institute agreed that the Professor and Head of the Department of Psychiatry of the University would also be the Psychiatrist-in-Chief of the Clarke Institute.
The first Medical and Executive Director of the Clarke was Charles Roberts, and the first Psychiatrist-in-Chief (and Professor and Head of the Department of Psychiatry at the University of Toronto) was Aldwyn B. Stokes. When Stokes retired in 1967, the administration was reorganized, and Robin Hunter became Medical Director and Psychiatrist-in-Chief.
Fredrick H. Lowy served as Psychiatrist-in-Chief of the Clarke from 1974 until 1980, followed by Vivian Rakoff from 1980 to 1990, and Paul E. Garfinkel from 1990 until the Clarke's 1998 merger into CAMH.
Upon its merger into CAMH in 1998, the Clarke building become known as the College St. site of CAMH.
In 2015, CAMH’s facilities at the College St. site were put in jeopardy following notice of a rent increase from $1.2 million to $4 million per year, at the renewal of its 20 year lease. CAMH valued its property at $25million, whereas Brookfield valued it at $100million, which would cause the hospital’s. The hospital’s landlord, Brookfield Asset Management, turned down CBC’s interview requests. A government arbitrator was appointed who valued the properly at $55 million, yielding a rent increase that CAMH was reportedly able to pay.
Addiction Research Foundation
The Addiction Research Foundation (ARF), then named the Alcoholism Research Foundation was founded in 1949, when H. David Archibald, who had studied at the School of Alcohol Studies at Yale University, was hired by the Liquor Control Board of Ontario. His mandate was to determine the scope of alcoholism in Ontario. He was named executive director when ARF opened and remained in that post until 1976. Focusing initially on outpatient treatment, their first facility was Brookside Hospital in 1951, expanding to branch offices and new locations in 1954, the same year they set up in-house research. In 1961, formally renamed the Alcoholism and Drug Addiction Research Foundation of Ontario, ARF expanded its mission to include drugs. In 1971, they expanded to a clinical teaching hospital called the Clinical Research and Treatment Institute. In 1978 ARF opened the School for Addiction Studies and expanded their international role in policy development and research. Following provincial hospital restructuring in the 1990s, ARF was folded in 1998 into CAMH.
Founded by physician R. Gordon Bell in 1967, it had 47 beds and a 4-month waiting list in the 1980s. Focusing on substance abuse, boasted a 65% recovery rate for general population and an 85% recovery rate for physicians.
CAMH has been undergoing a three phase redevelopment centered at its Queen Street site, with four goals: 1) Deliver a new model of care and provide a healthy environment that promotes recovery; 2) Bring together the best research, clinical, education, health promotion, and policy experts in one place to change the future of mental health and addictions; 3) Revitalize the City of Toronto by opening up their site and by creating an inclusive new nine-block neighbourhood that benefits all and, 4) Change attitudes by breaking down barriers to eliminate the stigma of mental health.
The Campbell Family Mental Health Research Institute was established with a $30 million donation in 2011 from Linda Campbell, Gaye Farncombe, and Susan Grange, each granddaughters of Canadian magnate Roy Thomson and nieces of Ken Thomson. CAMH CEO, Catherine Zahn, said research on the brain is the most promising pathway to progress in mental illness research.
Bell donated $10 million to CAMH in 2011, reportedly the largest corporate gift in Canada to mental illness. President and CEO of Bell, George Cope, said “The Bell team is proud to be an integral partner in the CAMH community and for its central entry point—the Bell Gateway Building—to so visibly carry our name.” The Bell Gateway Building was planned to serve as the central hub for the Queen Street site of the hospital.
In 2012, CAMH announced the completion of three new buildings: the Bell Gateway Building for the central administration, a utilities and parking building, and the Intergenerational Wellness Centre which includes 12 new beds for youth ages 14-18.
Margaret McCain, the former lieutenant-governor of New Brunswick and widow of McCain Foods cofounder Wallace McCain, donated $10 million to CAMH in 2012 to establish the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health.
In 2013, the Slaight Family donated to $50 million to health care institutions, of which CAMH received $10 million. The donation permitted the opening of a centre dedicated to identifying and treating early signs of mental illness in youth.
CAMH opened the Gerald Sheff and Shanitha Kachan Emergency Department, in 2014, funded by a $2.5 million donation from the named couple and a $4.2 million grant from the Ontario Ministry of Health and Long-Term Care.
Upon CAMH’s formation, Peter Catford was appointed Vice President for Information Technology. In 2002, Catford outsourced the public hospital’s computer needs to H.I. Next, a private company which Catford founded and co-owned. When the Toronto Star reported on what it deemed an apparent conflict of interest regarding the spending of public monies, the hospital would not reveal how much it paid Catford or his company, nor would CAMH disclose any details of its contract with H.I. Next or what other firms bid on the work. Catford commented only that "I feel honoured to work with (CAMH) and I feel like it has been done ethically." In interviews with the Toronto Star, Dev Chopra, executive vice-president of CAMH first said there was nothing inappropriate about Catford's role. "We got into it with our eyes open. There is no conflict." However, Chopra later said there were "some optics from a conflict perspective" noting the hospital might revisit the issue that day. Catford left his CAMH position two days later, but the Star reported that hospital officials said changes were being considered months before the Star published its story about the issue.
Mood and Anxiety Clinic
Soon after CAMH was founded, its administration was embroiled in a scandal involving Eli Lilly, who donated $1.5 million to CAMH, and Dr. David Healy, a prominent critic of Prozac, the widely used antidepressant manufactured by Lilly. CAMH hired Healy to be the head of its Mood and Anxiety Program, but withdrew the job offer after hearing about Healy’s views.
CAMH aggressively recruited Healy, and CAMH Physician-in-Chief, David Goldbloom, offered Healy a job as the head of the Mood and Anxiety Program. Healy accepted and soon after gave a lecture in which he reiterated his views about Prozac increasing risk of suicide. A few days later, Goldbloom withdrew the job offer, saying “Essentially, we believe that it is not a good fit between you and the role as leader of an academic program in mood and anxiety disorders at the centre and in relation to the university….We do not feel your approach is compatible with the goals for development of the academic and clinical resource that we have.”
The decision caused an “uproar” among Canadian academics, with the Canadian Association of University Teachers calling CAMH actions “an affront to academic freedom in Canada.” Scientists from 13 countries, including Nobel laureates Julius Axelrod and Avid Carlsson, protested CAMH’s actions as did the Society for Academic Freedom and Scholarship (SAFS).
Healy sued CAMH and the University of Toronto, alleging breach of contract, defamation, and denial of academic freedom. The lawsuit sought damages of $9.4 million, including $2.6 million from CAMH CEO Paul Garfinkel, and $1.4 million from the U of T Dean of Medicine. The university distanced itself from CAMH: According to U of T President, Robert Birgeneau, “Everyone is trying to blame the university for something that happened at one of our hospitals.”
The lawsuit was settled with Healy receiving an appointment as visiting professor as the University of Toronto. The president of the Canadian Association of University Teachers, Vic Catano, said “We see the settlement as a complete vindication for Dr. Healy.”
Workplace safety issues
In 2007, following a series of attacks on staff by patients, the Ontario Ministry of Labour asked CAMH to develop a workplace violence and policy program. In 2008, the Ministry of Labour laid nine workplace safety charges against CAMH in response to allegations by staff that they had been attacked by patients. CAMH was fined $70,000 in 2009 for two attacks against nursing staff in 2007 and 2008. In 2014, the Ontario Ministry of Labour laid charges against CAMH for failing to protect workers from workplace violence following an attack earlier that year.
Child Gender Identity Clinic
Psychiatrist Susan Bradley founded a clinic in CAMH to work with gender dysphoric children, youth who believe they are or want to live as the other sex. Bradley collaborated for many years with psychologist Kenneth Zucker, and they established the clinic as the largest gender identity service in Canada and an international center for research. In their studies, 80% of the children grow out of the behavior. They therefore different approaches with children than adolescents because, over time, children are more likely, over time, to identify with their birth sex.
Regarding adolescents, Zucker “will support a teenager or adult who wants to transition using hormones and surgeries.” Regarding children, however, Zucker says “We are trying to help a child feel more comfortable with the gender identity that matches their birth sex” and that they use a variety of techniques to “help a child think more flexibly” about their gender. According to the New York times, Zucker does this by "encouraging same-sex friendships and activities like board games that move beyond strict gender roles." He said a child could be asked to make a list of pros and cons about being different genders so that the child realizes that “there are both good and not so good things about being a boy and being a girl.”
Activists have criticized Zucker’s approach, claiming that it amounts to reparative therapy. In 2015, following complaints from activists, CAMH commissioned an external review of the clinic. The review was inconclusive, reporting it “cannot state that the clinic does not practice reparative approaches.” Upon the release of the report, CAMH announced that it was closing the clinic and that Zucker was no longer at CAMH. Activists celebrated the news, calling upcoming community consultations “a major step toward establishing a service that will support families, and hopefully receive government funding to do so.” A petition of over 500 sexuality and gender diversity experts decried it, calling CAMH’s decisions “politically motivated” and showing an “indifference to research and scholarship.” 
Public safety issues
There have been public safety concerns regarding violent or dangerous patients escaping custody from CAMH’s forensic wards. After filing a freedom of information act request with the police, the Toronto Star reported that CAMH had nearly as many AWOLs as all other Toronto hospitals combined (2,060 and 2,371 for the period 2004 to 2014).
One of the most widely reported incidents involved Thomas Brailsford, who was institutionalized after beheading his mother and being deemed a "danger to himself and others." Brailsford took off from a taxicab on his way to a medical appointment, representing his second escape in a year.  In an interview with Toronto columnist Jerry Agar, CAMH’s chief of forensic psychiatry, Dr. Sandy Simpson said “Clearly, we will be reviewing this carefully to look at how we assessed the risk in this case.” Subsequently, Kate Richards from CAMH media relations said “We have tightened aspects of these procedures and can report that we've had no further incidents of this type. For security reasons, we are not able to discuss these changes in detail but we are confident that the changes implemented in this case have been effective.” Agar wrote that he has “been eager to have Simpson back on the radio show to discuss what measures have been put in place to ensure that Brailsford, and others who have escaped CAMH custody, are unlikely to do so again” but did not receive any response. Five months later, CAMH responded saying “Dr. Simpson is not available for a follow-up interview.”
Public policy statements
CAMH issues statements about local and provincial regulations on addictive behaviors.
CAMH policy opposes the privatization of alcohol sales, citing evidence that the increase in availability increases alcohol-related harms and associated costs. They supported that the Liquor Control Board of Ontario should maintain its monopoly on alcohol sales. CAMH referred to “the plan to allow the sale of VQA wines at farmers’ markets across the province” as “cause for concern” because it would increase access to alcohol. Similarly, together with other health organizations, CAMH called for a provincial alcohol strategy, ahead of Ontario’s plan to permit the sale of beer in grocery stores.
In a 2014 policy document, CAMH expressed support for the legalization of marijuana with strict control regulations. According to CAMH's director of social and epidemiological research, Jurgen Rehm, "There should be a government monopoly on sales. There should be a minimum age for purchase and consumption. There should be controls on availability. There should be … a ban on marketing, advertising and promotion and plain packaging."
According to CAMH CEO, Catherine Zahn, "Only through legalization can we implement a public-health approach, treating cannabis use as a health issue and not one to be addressed through law enforcement and the court system. This is the approach we take with tobacco and alcohol. As with alcohol, a legal cannabis market can be regulated with controls that address risk factors associated with use"
CAMH has opposed the expansion of Toronto’s Woodbine Racetrack. In a policy statement, CAMH said increased availability of gambling results in increased harms and predicted that a large portion of any increased revenues from the racetrack would come from people with gambling problems. The hospital said “We provide consultation services and train OLG employees on how to intervene with customers who are showing signs of being in trouble [, but that] it should also be understood that there is no evidence to indicate that these efforts have a significant impact on decreasing the prevalence of problem gambling in casino venues.”
CAMH reports being the largest research facility in Canada for mental health and addictions, including over 100 scientists over 150 research trainees. In the 2014-2015 fiscal year, CAMH received $44,384,230 in research funding and published more than 500 research articles.
Notable researchers at CAMH and its predecessor institutions have included R. Michael Bagby, Ray Blanchard, James M. Cantor, Norman Doidge, Kurt Freund, Ronald Langevin, Philip Seeman, David A. Wolfe, and Kenneth Zucker.
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