Learning tools and techniques rather than restraints and sedation
CAMH, the Centre for Addiction and Mental Health, leads the way in women’s mental health treatment. They have a gender-specific inpatient unit which caters to all women, including transgender women. It provides a supportive environment overseen by knowledgeable staff who run psychoeducational groups within a relaxed setting where women are supported by women. It is a refuge outside of isolation; a safe environment to process difficult emotions.
The Women’s Inpatient Unit is located at the College Street campus of CAMH. With a nurse to patient ratio of 1:4, they have accommodation for 20 patients . With a nurse to patient ratio of 1:4, they have accommodations for 20 patients with an average length of stay of 14 to 15 days. Most of the patients have some form of trauma, depression, PTSD or borderline pathology and are admitted through the emergency department usually during an acute crisis.
The unit is headed by Dr. Suvercha Pasricha, the Lead Psychiatrist for the Women’s Inpatient Unit and an Assistant Professor at the University of Toronto. “I don’t know of anything in Canada like this,” Pasricha said. When asked about the unit’s mandate, she said, “Our mandate or our goal is to treat every woman with [the] utmost respect and dignity and attend to their individual needs.” The program began under the leadership of Dr. Barb Dorian who came to CAMH with staff from the Women’s College Hospital. Dr. Pasricha assumed the leadership role in 2008 and brought about some critical changes.
The program had always been trauma-informed trauma-sensitive, Pasricha said, specifically treating people who are acutely ill and have had trauma in their background, but in 2008, Dr. Pasricha implemented DBT (dialectic behavioural therapy) principles into the program, to help women who have been impacted by trauma and may not have learned healthy coping skills in childhood or hadn’t experienced good role modelling growing up. “[DBT] really shaped our program because the admission became very structured and goal-driven. Discharge dates are set early so admissions are very efficient here.” She and her colleagues developed the trauma education and the dietitian started the nutrition group that is facilitated along with a variety of others ranging from coping with anxiety to spirituality. They are currently looking at adding a relapse prevention group.
Kelsi Hopkins, a former patient of the women’s inpatient unit at CAMH, liked the groups and found them relatable, saying they taught actual strategies to cope with day to day issues. She particularly appreciated the different perspectives offered by the staff and students who facilitated the groups.
A biopsychosocial model, bio (medicine) psycho (psychotherapy) social (social support network building), the Women’s Inpatient Unit works as a team of professionals – among these are psychiatrists, nurses, social workers, a recreation therapist, a dietician, psychologists, a nurse educator and a doctor. “It’s a very cohesive team,” Pasricha said.
One of the most beneficial characteristics of this unit is the all-women aspect. In her 2003 paper, Mainstreaming Women’s Mental Health – Building a Canadian Strategy, Marina Morrow, PhD says, “…women report that they feel more comfortable and gain more benefits from women-specific peer support groups but few such supports are available, especially for women with mental illness who have had experiences of physical or sexual violence. These kinds of supports are critical for recovery.” Dr. Pasricha gives credit to that environment, “A very positive thing about the unit, it’s the milieu that’s created, it is based on Sanctuary model of care. A lot of peer support takes place during people’s stay.” Pasricha said.
Hopkins found her experience at other units “drastically different,” who said the staff opted to sedate her rather than deal with her. Another former CAMH client who asked to remain anonymous spoke of her experience, “When I am admitted into other hospitals, I am always put in lockdown where I am in a glass room with nothing but a bed; where no one comes to talk with me until I am stable enough to go home.” And where restraints may be used in most hospitals, Pasricha said CAMH elects the use of the least restraint policy. The “trauma-informed way” practiced in the Women’s Inpatient Unit is to teach people skills, to use ice packs or weighted blankets rather than restraining them.
The budget to operate this exclusive unit is the same as any other unit at CAMH, Pasricha said. She was told at one time that each patient cost about $1,000 per day to treat. Although the unit doesn’t specifically need additional funds for its maintenance, Pasricha did add, “I would love to have more research funding and expertise added to our unit so that we can replicate and write about this kind of program.”
Pasricha cited one of her challenges in running the program as working with the ongoing need for cutting the length of stay. She’d like the option of approving longer admissions, but there is just too much demand for the service. “Our emergency department is so busy that’s it’s hard work. It’s hard on everybody, but we try.” She also would like to find more time and expertise to write and publish.
As for her experience working at CAMH, she says, “It’s very gratifying, the work that we do,” but adds, “We have to do our part and write and publish about it.” When asked how the community could support the Women’s Inpatient Unit, she suggested, “I think advocating for it, writing about it, talking about it.” Donations for research are greatly appreciated. With more research, more ways to help more people can be discovered.