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Journal of Urban Design and Mental Health 2016;1:8
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Turning the City Inside Out for Mental Health
Jan Golembiewski
Queensland University of Technology
Queensland University of Technology
The mid 1980’s saw an unlikely alliance between the neo-conservative Regan and Thatcher governments and the users of the psychiatric asylums. Together they joined forces to declare that the asylum model of care was dead. These huge, overcrowded Victorian edifices sitting in their sprawling grounds had become the signature of the total institution and synonymous with stigma. The following decade saw a rush to invent more appropriate, smaller and more controllable units. The vast grounds were no longer needed. In many cases, new facilities were erected on the same sites, and old buildings and surplus lands were restored and repurposed (with heritage orders) and leased out or sold off. The story was repeated all over the world.
The asylum in Toronto was slow to take the jump, but when it did, the scheme was unique and established a new model of care that worked for the city as a whole - including the patients. The model was appropriated elsewhere (like Glenside, in South Australia), and here’s why.
The site for the Center for Addiction and Mental Health (CAMH) was a 17 ha site in between Queen St W and King St W. If you know it, it’s where King Street runs into the tunnel under a railway line. Four addiction and mental health facilities had been constructed around the site to house patients based on the acuity and specificity of their conditions.
Urban Strategies won the contract to redevelop the whole site with a simple concept – to remove the high walls, extend the local roads into the site, and to turn the asylum inside out. Instead of being inward-facing, the units were given street addresses connected to the urban grid. Parts of the site were leased out, and other parts sold off. The park lands – once no-man's-lands between the asylum and the walls are now shared and are used as places where patients and the public come together in an informal setting. The streets that were cut into CAMH have been developed as housing, commercial, retail and as allied health – but there’s a special agenda. The café and a couple of the other shopfronts are for occupational therapy: in these shops, the patients relearn the skills of daily life and reintegrate into society by cooking, serving customers and taking orders. Across Queen St, the Starbucks and other retail outlets are thriving. They no longer look out onto a mysterious brick wall, but into a park.
This isn’t to say all is ‘normal’ in this little area of Queen St. It’s not – and who wants normal anyhow? The people on the street and in the cafés are just a little bit more colourful. Among the crowds are the purple shirts: the mental health nurses who are there for their patients and to keep an eye out generally. If you go to one of the occupational therapy cafés, you don’t want to be in a hurry. The waiters constantly confuse the orders, so espresso drinkers have to put up with banana milkshakes (possibly with their espresso drowning at the bottom) but there’s no secret about who you’re being served by and everyone expects a little chaos. The truth is that it’s fun and just being a customer makes you feel like you are doing your little bit to help society’s most vulnerable people. Perhaps that’s why the café is packed and has a queue outside; it’s a step away from the aseptic and uninspired life of conformity you’ll find elsewhere.
Outside, the park is particularly busy too. Eccentric people sit around, some alone, others in groups. There’s a woman knitting a flag. It’s already 20 metres long, and words are being formed in the stitching – so far it says: CAMH THANK Y.
Across Queen St. There’s still the colour, although far more professional, and in these places the service is what you’d expect… unless you’re one of the patients. There’s an unspoken rule across Queen St: If the patients don’t have money or get confused, their purchases are on the house. ‘We love the patients,’ one of the café owners says. ‘They gave us the park, they gave us this district. The least we can do is give them a cup of coffee.’ It’s a community in the best sense of the word. At CAMH, the urban design has turned the asylum inside out, and in doing so, the stigma of mental illness has been banished forever.
The asylum in Toronto was slow to take the jump, but when it did, the scheme was unique and established a new model of care that worked for the city as a whole - including the patients. The model was appropriated elsewhere (like Glenside, in South Australia), and here’s why.
The site for the Center for Addiction and Mental Health (CAMH) was a 17 ha site in between Queen St W and King St W. If you know it, it’s where King Street runs into the tunnel under a railway line. Four addiction and mental health facilities had been constructed around the site to house patients based on the acuity and specificity of their conditions.
Urban Strategies won the contract to redevelop the whole site with a simple concept – to remove the high walls, extend the local roads into the site, and to turn the asylum inside out. Instead of being inward-facing, the units were given street addresses connected to the urban grid. Parts of the site were leased out, and other parts sold off. The park lands – once no-man's-lands between the asylum and the walls are now shared and are used as places where patients and the public come together in an informal setting. The streets that were cut into CAMH have been developed as housing, commercial, retail and as allied health – but there’s a special agenda. The café and a couple of the other shopfronts are for occupational therapy: in these shops, the patients relearn the skills of daily life and reintegrate into society by cooking, serving customers and taking orders. Across Queen St, the Starbucks and other retail outlets are thriving. They no longer look out onto a mysterious brick wall, but into a park.
This isn’t to say all is ‘normal’ in this little area of Queen St. It’s not – and who wants normal anyhow? The people on the street and in the cafés are just a little bit more colourful. Among the crowds are the purple shirts: the mental health nurses who are there for their patients and to keep an eye out generally. If you go to one of the occupational therapy cafés, you don’t want to be in a hurry. The waiters constantly confuse the orders, so espresso drinkers have to put up with banana milkshakes (possibly with their espresso drowning at the bottom) but there’s no secret about who you’re being served by and everyone expects a little chaos. The truth is that it’s fun and just being a customer makes you feel like you are doing your little bit to help society’s most vulnerable people. Perhaps that’s why the café is packed and has a queue outside; it’s a step away from the aseptic and uninspired life of conformity you’ll find elsewhere.
Outside, the park is particularly busy too. Eccentric people sit around, some alone, others in groups. There’s a woman knitting a flag. It’s already 20 metres long, and words are being formed in the stitching – so far it says: CAMH THANK Y.
Across Queen St. There’s still the colour, although far more professional, and in these places the service is what you’d expect… unless you’re one of the patients. There’s an unspoken rule across Queen St: If the patients don’t have money or get confused, their purchases are on the house. ‘We love the patients,’ one of the café owners says. ‘They gave us the park, they gave us this district. The least we can do is give them a cup of coffee.’ It’s a community in the best sense of the word. At CAMH, the urban design has turned the asylum inside out, and in doing so, the stigma of mental illness has been banished forever.
About the Author
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Jan Golembiewski is a registered architect, serves as Adjunct Professor in the Faculty of Creative Industries at Queensland University of Technology in Australia, and is a leading researcher in architectural design psychology. His PhD traces phenomenological experience back to the neurological mechanisms that cause them. He is on the editorial board of three academic journals and has guest edited a special edition on ‘Designing the Psychiatric Milieu’. Jan regularly judges the International Academy Awards for Design and Health.
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