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Two worlds collide at the junction of Ossington Avenue and Queen Street West.

One is the epitome of Toronto cool - fashionable clothing boutiques, avant garde art galleries, chic cafés. The other is its antithesis: Ontario's Centre for Addiction and Mental Health (CAMH), with its troubled inventory of patients and decaying buildings.

For years, these two entities - trendy bohemians and a population living on the brink - have managed to sustain a peaceful, but largely separate, co-existence. All that is about to change, with consequences that can't be predicted.

CAMH has embarked on a hugely ambitious, $100-million, 11-year renewal project - dubbed Transforming Lives - that aims to tear down the walls, real and conceptual, that have long kept it isolated. The institution's newly minted president and chief executive officer, Dr. Catherine Zahn, hopes the renovated campus, with integrated treatment clinics, training and research facilities, will become a kind of "urban village" woven seamlessly into the larger fabric of Toronto.

In plain terms, this means that its vastly increased caseload will soon be commingling with workaday Torontonians - paying bills at the same banks, sipping cappuccino at the same cafés - on 11 hectares (27 acres) at the creative heart of the city.

Such normalization, it is maintained, will best promote rehabilitation and help erase the lingering social stigma attached to mental illness and addiction. The de-stigmatization effort even applies to nomenclature: There are no more "patients," just the more politically correct "clients."

But while local shop owners generally support the plan, serious questions - and risks - remain. Nothing quite like what CAMH is undertaking has been tried before - anywhere - and no one, therefore, knows whether it will work.

The new treatment paradigm is the antithesis of the philosophy that inspired the site's creation. When it opened in 1850, the Provincial Lunatic Asylum aimed to provide a bucolic sanctuary for the mentally ill, surrounded by acres of treed parkland and a thick brick wall, five meters high, built by the inmates.

Now, as local art-gallery owner Jamie Angell observes, "Providing housing where patients can learn to live with others, as opposed to the isolation associated with the past, [is]a step in the right direction. And when the project is complete, there'll be a significant increase in retail space - a big benefit for other retailers. It will help keep the street abuzz."

Or, as Dean Hughes, vice-president of community development for the CAMH Foundation, puts it, "we want to completely reinvent the way people deal with and treat mental illness and addiction. We're in a very hip, up-and-coming neighbourhood. As Queen Street reinvents itself, that's what CAMH is doing as well."

Phase One of the vision, first articulated a decade ago, is already complete: four new client-centred low-rises at the western end of the property, for those with addictions and anxiety disorders. Local store owners say their integration has been handled flawlessly.

Phase Two begins early this year, with demolition of the obsolete administrative quarters and construction of four more buildings along Queen Street. These include, in the abstruse language of health bureaucrats, centres for "intergenerational wellness" and "discovery and knowledge exchange." Opening CAMH's once-sealed universe, Ossington Avenue (now dead-ended at Queen Street) will be extended south to Adelaide Street, which will run east-west across the property. Other new thoroughfares will crisscross the campus.

One of the four new buildings will provide 179 units of subsidized housing, as well as street-level retail operations (banks, mini-marts, coffee shops, laundries).

When the project is complete, toward the end of the next decade, the only visible remnant of the site's turbulent history will be a single stretch of the old brick restraining wall, at the south end.

In many ways, says Toronto architect Mark Guslits, the Regent Park redevelopment, which he oversaw, posed some of the same planning challenges as CAMH faces. "The idea is to contextualize it," he says. "Open it up. Let traffic go through it, so that it's no longer a dead end, literally or figuratively."

But some experts doubt the power of physical landscape to change results - i.e., client behaviour. "Social issues can't be erased through design," argues urban planner Mia Hunt. "Living in an 'urban village' won't normalize the behaviour or chemistry of someone coping with schizophrenia."

Urban anthropologist Sharon Kelly, part of whose recent doctoral dissertation focused on CAMH, has other concerns. "Transparently, the redevelopment is a good thing, but there are definitely risks. Will clients be truly integrated into the new site, or is this just a way to take them off the street?"

And while the total number of beds is not expected to increase, the out-patient quotient will rise considerably through expansion of services and programs. Adds Ms. Hunt: "The local community may be quite upset when they see a dramatic increase in client presence."

To its credit, says Mary Sue Rankin, owner of the Edward Day Gallery on Queen West, "CAMH has tried very hard to keep us in the loop. I do think what they're doing is a good idea, although it will be disturbing for some, because all change is difficult."

Susan Piggott, CAMH's vice-president of community engagement, concedes that the institution courted support from residents and client groups, discussing everything - from building heights to environmental risk to green space to the number of parking spaces - at monthly planning meetings. "There had been a legacy of mistrust, but we've managed to turn that around."

It helps, of course, that the neighbourhood is heavily populated by artists and an equally liberal-minded immigrant population. Ironically, many residents were initially drawn by low rents, which (in turn) were a consequence of the very stigmatization health officials are now seeking to dispel. The Centre's redevelopment will likely contribute to the area's gentrification, Ms. Piggott acknowledges, raising the cost of commercial and residential leases, not only for the bohemian crowd but some of the institution's own clients.

Other issues persist. Kevin Stolarick, research director of the Rotman School of Management's Martin Prosperity Institute at the University of Toronto, argues that, for some portion of the CAMH population, it's precisely the world outside - noise, traffic, garbage, drugs, rampant commercialization - that often provides triggers to mental illness and addiction. When integration is the order of the day, CAMH may no longer function as a sanctuary for those that need it.

Moreover, at least 50 per cent of the site will eventually be leased or sold to private interests. "Will business owners, renters and condo owners have a disproportionate say in how things run?" wonders Ms. Kelly. At what point might commercial considerations clash with public-sector priorities and the needs of patients, she asks - and who will prevail?

And, since roughly half of all mental patients also become drug-dependent, will the neighbourhood become a magnet for predators?

Aware of the risks, Dr. Zahn nonetheless insists that the caseload cannot be wished away. "This population is already there," she says. "So how much better is it if they have a safe, clean, well-lit place, in a park-like atmosphere, more conducive to self-management and self-healing? The physical transformation is just a metaphor for the other stuff. Every shovel in the ground, every crane, is a cause for optimism."

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