Care

			The continuing improvements in the Centre's programs and services reflect a commitment to more effective treatments through a client-centred philosophy of care.   Society, Women and Health Program Mental health ... in the context of women's lives SWH volunteers with clients "I feel safe," says one client. "It's the first time I've been listened to," adds another. Their remarks speak volumes about the frustration many women feel in seeking mental health treatment -- and their relief at finding the Society, Women and Health program (SWH). SWH is operated jointly by the Centre and the Sunnybrook & Women's College Health Sciences Centre (S&WC). Its services include gender-based pharmacological studies, group therapy for abuse survivors, outpatient therapy, treatment for psychological trauma from severe workplace accidents or incidents (for women and men), and Canada's only women-only inpatient unit. What makes SWH different, is that "We focus specifically on mental health in the context of women's lives," says the Centre's Barbara Everett, PhD, SWH acting administrative director. Aftermath of trauma One of the most salient features of that context is trauma, which, in the aftermath of childhood abuse, accidents or assaults, often results in mood disorders, depression or post-traumatic stress disorder. Yet symptoms have "often been treated in isolation without taking into account that many women often come from impoverished or abusive backgrounds," says Everett. Enter SWH. "Our priorities are to treat and study trauma arising from violence in association with mood disorders and substance abuse ... and to look at how these things come together in women's lives to cause complex mental health difficulties," says Dr. Barbara Dorian, the program's clinical director. Treating mental illness in the context of trauma is a challenge the "medical community has been grappling with for years," says Everett. "This program is addressing this challenge with expert clinical and research programs."		En Français | Help | Search | Events | CAMH Library | Guide to CAMH | Donate Now   On this page Society, Women and Health Program Shared Care Treatment across a Wide Age Span The Law and Addiction Special Groups, Special Needs Day Treatment for Youth  Intensive Mental Health Treatment The Importance of Housing Enhancing Capacity throughout Ontario Prime For further information Related Pages PDF Version of the 1999/2000 Annual Report Message from the Chair and President Understanding Prevention Care Statistics Salary Disclosure Act Board of Trustees Senior Management Group Vision, Mission, and Values Financial Statements (PDF Version only) How to Reach Us

			Shared Care Seaton House Shared Care staff House calls for the homeless When Boris Rosolak walked into the Seaton House shelter for homeless men that morning, something extraordinary happened. Steve* engaged him in a conversation. "Usually, he'd just talk and laugh loudly to himself," says Rosolak, manager of Seaton House. However, for the first time in 10 years, "Steve was relating to the people around him in a healthy way." Rosolak has no doubt what triggered the change: the Shared Care Clinical Outreach Service. Funded by the Ministry of Health, and staffed and administered by the Centre, Shared Care teams work on location at host sites. Each team has a nurse, outreach worker, general practitioner and consulting psychiatrist, and provides continuous treatment to people who are homeless and experiencing serious, persistent mental illnesses. Seaton House is one of seven Toronto hosts that partner with the Centre. First line of defense Host sites are frequently "the first line of defense for people who are suffering," says Rosolak. "They need 'house calls' in the places where they go." Carol Zoulalian, the Centre's manager of the Shared Care Clinical Outreach service agrees. "Our clients are vulnerable, disenfranchised people who rarely seek out medical care. Many of them have serious illnesses like schizophrenia, and have never been diagnosed or treated before." Founded on a model of shared primary care, the teams offer a client-centred approach to medical and mental health treatment to encourage integration into the community. Rosolak tells the story of a client who carts around heaps of metal paraphernalia wherever he goes. "Stereo parts, discarded computer bits ... He's always taking things apart." His behaviour was often perceived as "quirky" and isolated him from others. Shared Care worked with him, "very effectively," says Rosolak. "He started fixing trinkets for people. It gave him a way to participate in the community that was appropriate for him." Holistic care Since its start in 1998, Shared Care has grown in clients, staff and resources. "At first, we were only in men's and women's hostels," says Zoulalian, "but found we were able to reach a greater number of women, in particular, at community resource centres. So that's where we've gone." In 1999, funding was approved for two new team members, specialists in helping clients secure housing. Funding was also approved to partner with Houselink Community Homes where Shared Care teams will operate out of two new sites. Zoulalian points out that the hosts have a long history with the clients, while the teams have medical expertise. "Together, we provide a holistic continuum of care," says Rosolak. "We can't be complacent just because people make it to the shelter," he adds. Helping people better their quality of life is also vital. "There's no such thing as too much success."

			Treatment across a Wide Age Span Psychotic Disorders The Psychotic Disorders Program provides consultation and treatment to children/adolescents and families when a child experiences symptoms of a psychotic disorder. As a joint program with the Centre and the Hospital for Sick Children, it is also linked with the Centre's Schizophrenia and Continuing Care Program. Geriatric Psychiatry Program In 1999 the world celebrated the International Year of the Older Person. The clients of the Psychogeriatric Assessment Consultation and Education (PACE) program participated by designing and constructing a "Reminiscence Quilt" representing their interests and hobbies. The quilt was displayed at various events in the community and at the Centre's health fair in November. The Law and Addiction Drug Treatment Court The Drug Treatment Court, the only program of its kind in Canada and an innovative alternative to the criminal justice system for people with a recognizable drug addiction, celebrated its first anniversary in December 1999. The court's primary objective is to increase public safety by reducing drug addiction, and crimes committed to support a drug habit, through a combination of treatment and court monitoring. More than 100 clients participated in the first year, and 10 graduated from the program. The efficacy and cost-effectiveness of this alternative program is being assessed over a four-year period by Centre researchers. Across Canada and internationally, there is growing interest in building on this model. Pilot Addiction Program The Centre has just piloted its first addiction group in the Medium Secure Unit of the Law and Mental Health Program (formerly known as the Forensic Program), which has provided valuable information for future services that deal with addiction in this population. Provincial Corrections Methadone Policy The recently released Ontario Prison Survey has documented that injection drug users continue to inject drugs and to share injection equipment while incarcerated. One effective measure to decrease frequency of injection and prevent the spread of blood-borne diseases is methadone maintenance. Staff of the Addiction Medicine Program helped to develop a new policy with Ontario ministry officials to ensure that individuals who have been methadone patients prior to incarceration will still have methadone maintenance while incarcerated.   Special Groups, Special Needs Les/Bi/Gay Service This year, a 12-week group for lesbian and bisexual women was developed and implemented. The Les/Bi/Gay Service continues to offer specialized services to lesbian, gay and bisexual individuals and couples who have concerns with substance abuse. Programs for Women Women's Addiction Services and Family Services (in addiction) provide a supportive atmosphere for parents to address issues relating to how their substance use affects parenting and how to make improvements. The Women's Addiction Service's "Getting Started" groups engage and prepare women so that they are more committed and likely to remain in treatment. Acquired Brain Injury The Centre, in partnership with Ontario Substance Abuse Bureau, Toronto Area Addiction Services Coalition and the Acquired Brain Injury Network, co-sponsored a workshop on addiction and acquired brain injury to educate clinicians who work in these areas. Eating Disorders A concurrent treatment clinic for eating disorders and addiction has opened in the Concurrent Disorders Program, on a pilot basis, with one group for women and one for men. The men's group is the first of its kind in Canada. After initial evaluation to test the evidence that treating both disorders at the same time proves more effective, an ongoing treatment clinic will result. Literacy Training Action ABC is the only program in Canada that provides literacy training to people recovering from substance abuse. In August 1999, Action ABC, in partnership with the Addiction Programs at the Centre, provided these on-site services to our clients. Serving the Chinese Community Previously it was difficult to adequately serve Chinese-speaking opiate-addicted clients in the Addiction Medicine Clinic due to the language barrier. Through a partnership with Chinese Family Life Services (CFLS), this clientele now receives better service and ongoing case management provided by CFLS. Nicotine Dependency A large percentage of people with schizophrenia smoke. To help improve their health, a joint project with the Schizophrenia and Continuing Care Program and the Nicotine Dependency Program was started to focus on the health risks of smoking and to assist clients in their attempts to stop smoking. Returning to Work Work Adjustment and Employment Support works with people who have experienced a serious mental health problem who want to return to work. Participants are offered an opportunity to ease back to work by means of volunteer job placements and vocational counselling. This year an "Around the Water Cooler" education and support group was added to give participants a greater opportunity to discuss work-related concerns.		CAMH Publications Don't have Adobe Acrobat Reader? Get it here, for free.

			Day Treatment for Youth  Staff (facing) and high school students Starting over Nineteen year-old Julie* doesn't mince words. "I lived the life of a hustler," she'll tell you. "I dropped out of school, lived on the street, stole, used drugs, sold drugs, got busted ..." Finally, it all became too much. A friend had gotten drug treatment at the Centre. So Julie went, too, and found out about a new program. High High The new program is the Substance Abuse Day Treatment/School Program for Youth. But some students just call it "High High." It's the Centre's alternative school for secondary students up to the age of 21, whose addictions, often accompanied by mental health problems, contributed to their "falling through the cracks of a regular high school," says Lyn Watkin-Merek, service manager of Youth Programs at the Centre. The program began in late 1998 with one classroom and one Toronto District School Board teacher. It has grown to two classrooms and two teachers and can accommodate up to 16 students. The average stay is three months. Says Watkin-Merek, "The goal is to help students gain control over their addiction and return to mainstream schools or enter the workforce, depending on what they want for themselves." Academics, treatment, research "We offer students a unique mix of academics and treatment for addiction and mental health problems," says Watkin-Merek. Often, it's the first diagnosis and treatment the students have ever received. They attend group therapy on-site four days a week, and have private sessions with a Centre psychiatrist and drug counsellor. The classes include courses in life skills, English and Math. The program also has a research component. "Our approach is very new," says Watkin-Merek. "There are no manuals, no reservoir of research. We're spending the next three years developing a training package with a manual and various tools for therapists. We're also doing a study to outline the characteristics of kids who require intensive day-treatment, like this program, and distinguishing those from the characteristics of kids who would be better served by less intensive outpatient treatment." Seeing in different ways For Julie, the program is already making a difference. Individual counselling gives her "a chance to express things I'd always kept inside before." And the group sessions "create a support system. We've all been through the rough times and the hopelessness. We're all struggling with our habits. We've become our own teachers." Julie's come a long way in a few months. "When I started, I couldn't see beyond the present." Now, she has firm goals. No hard drugs. No alcohol. Limited use of marijuana. University. "I see everything in a totally different way now. I'm motivated. I care. I want to make a difference," she says. "I wanted to feel this way years ago, but I couldn't. Sometimes you don't know you're wrong until a door opens and you see an alternative."		* not her real name

			Intensive Mental Health Treatment Dual Diagnosis Funding was received this year from the Ministry of Health and Long-Term Care through the Assertive Community Treatment Team envelope to mount a Dual Diagnosis Resource Service (for individuals with a developmental disability and mental health needs). This is a specialized community-based service, in partnership with the Griffin Centre, that aims to prevent hospitalization, to enable clients to remain where they live or work and to provide time-limited treatment, support and education to families, caregivers and service providers.   Bipolar Treatment Patients with bipolar disorder often receive inadequate treatment, and part of the difficulty involves limited familiarity with the illness among doctors. The Bipolar Treatment Optimization Program offers a solution: patients and their families are given a six-month intensive and multidisciplinary treatment program, while, at the same time, their family doctors receive comprehensive education and training on mood and anxiety disorders. Schizophrenia and Weight Gain A troublesome side-effect of antipsychotic medication can be significant weight gain. Since monitoring and combating this weight gain is an important part of promoting treatment, compliance and general health among patients with schizophrenia, the Schizophrenia and Continuing Care Program has established an outpatient weight assessment and treatment clinic for patients with schizophrenia. The Importance of Housing Homelessness Initiative The Neuropsychiatry Program and Community Support and Research Unit in partnership with Regeneration House Inc. have developed an innovative housing program for people with severe mental illness and neuropsychiatric impairments. The program offers 10 single units in a high-support housing setting to people who are at risk for homelessness due to a major mental illness and co-occurring neurological disorder. Estonian Housing Staff from the Community Support and Research Unit have extensive expertise with severe and persistent mental illness, expertise that they have been sharing globally. They carried out their fourth international development project in the Baltics, which was funded by the Canadian International Development Agency through the Foundation for International Training. They have helped to provide technical assistance and training for innovative housing programs and policy development in Estonia. Assistance to Refugees In the past year the Joint Program in General Psychiatry with Mount Sinai Hospital, in partnership with the Culture, Community and Health Program, provided psychiatric help for Kosovo refugees. The team generously offered time and expertise to receive and screen refugees dealing with trauma-related issues and to attend clinics at sustainment sites. They have also developed a clinical support system for members of communities affected by the trauma of war and a way to respond to similar urgent psychiatric needs in the future. Eva's Place The Centre's Youth Addictions Treatment Service has collaborated with Eva's Place to develop a harm reduction shelter for teens. This initiative, which is funded through the City of Toronto's Homeless Initiatives Program, provides teens with shelter while they deal with their addiction.   Enhancing Capacity throughout Ontario Setting the Course Consultants in community programs have provided support to planning groups that are redesigning addiction systems across the province. Centre staff collaborated with the Ontario Substance Abuse Bureau to develop admission/discharge criteria for various levels of service and support assessment protocols. First Contact Young substance users are often reluctant to seek professional help, or they may drop out of treatment after only a few sessions. To meet their needs, First Contact, a four-session intervention was developed in partnership with the Ontario Youth Managers Coordinating Group, using the assistance of clinicians and clients, to address their addiction. The collaboration included the production of a manual to engage youth in addiction treatment and the actual training of youth workers in treatment protocol throughout the province.

			Prime PRIME time for prevention Schizophrenia is one of the most severe and devastating of mental illnesses. It strikes people in their youth, and is characterized by prominent paranoid delusions, hallucinations and deterioration in functioning. In 1999, the Centre launched the Prevention through Risk Identification Management and Education clinic (PRIME) -- a clinical and research initiative to determine whether treating individuals at very high risk for developing schizophrenia could prevent or delay the onset of the illness. Joining the Centre in the study are Yale University, the University of Calgary, the University of North Carolina, and Yeshiva University's Hillside Hospital in New York. The study is investigating two main areas: whether new antipsychotic drugs are beneficial and preventive for pre-psychotic individuals, and whether there are changes in the brain during this period. Reaching those at risk Early intervention is "consistent with the way medicine approaches other diseases," notes Dr. Robert Zipursky, clinical director of Schizophrenia and Continuing Care (SCC) at the Centre. "Treat illness early for the best outcomes." With schizophrenia, however, reaching people early has proved highly problematic. On average, people with schizophrenia aren't diagnosed until one to two years after psychosis. "Deterioration in functioning may begin long before that," says Zipursky. "We want to see people before they meet the full diagnostic criteria." That's where PRIME comes in. Run by Dr. Irwin Epstein as part of the Centre's SCC program, PRIME provides outpatient counselling, support and medication for people who are at very high risk for developing schizophrenia, but have not yet experienced acute symptoms. SCC's First Episode Psychosis Program has been working for years with people at high risk genetically, that is, children of people with schizophrenia. Newly emerging diagnostic criteria allow the PRIME clinic to also include people at high risk symptomatically, that is, people whom we can now better assess as presenting pre-psychotic symptoms. Since it opened, PRIME has received about two referrals a week. Zipursky and his colleagues have been making numerous presentations in the medical community to raise awareness about PRIME and pre-psychotic symptoms. "Communicating with psychiatrists, pediatricians, family doctors, guidance counsellors, parents and students is a huge component of our program," says Zipursky. Improving quality of life Zipursky reflects that treatment for schizophrenia has come a long way. "Forty years ago, schizophrenia meant institutionalization." Today, 80 per cent of people treated after their first psychotic episode go into symptom remission and return "not necessarily to normal, but to a good level of function." "Psychosis doesn't happen overnight," says Zipursky. Treating people before they reach that point may provide new ways of improving their quality of life.		Dr. Robert Zipursky and client

			For general information on addiction and mental health: Call the R. Samuel McLaughlin Addiction and Mental Health Information Centre Toll free in Ontario 1-800-463-6273 or local (416) 595-6111 www.camh.net/mclaughlin DISCLAIMER: The Centre is not able to provide diagnostic, treatment or referral services through the Internet. Individuals should contact their family doctors, or their local mental health or addiction agency for further information.		© Copyright Centre for Addiction and Mental Health 33 Russell Street, Toronto Ontario, Canada M5S 2S1. Telephone: (416) 535-8501 The Centre is fully affiliated with the University of Toronto. A Pan American Health Organization and World Health Organization Collaborating Centre For inquiries regarding the content of this page, contact Please direct technical questions or comments about this site to If you are a spammer or spam-harvesting robot, please send mail to imaspammer-on@lists.camh.net.
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