In a new park that bears his name, Dr. Paul E. Garfinkel said you will regularly spot him sitting on a bench and looking up to see the transformation of the Centre for Addiction and Mental Health (CAMH) around him."I have always felt it was a treat to do this and one does it with a sense that you are going to pass it off to the next generation, hopefully in better shape than you found it," Garfinkel said. "I feel like I am leaving it in that fashion."
Dr. Garfinkel, President and CEO of CAMH, has been the guiding force in physically transforming CAMH, located at 1001 Queen St. W - which has been home to a mental health facility for 150 years - from an antiquated, institutionalized campus into an inclusive "urban village".
Old buildings are being torn down, taking with them a dated approach to the treatment of mental health, making way for a new kind of hospital that integrates with the community.
A small new park created at the corner of Queen St. and White Squirrel Way, which was handed over to the City of Toronto, exemplifies that goal of integration and for that reason, was named the Dr. Paul E. Garfinkel Park at a ceremony on Friday, Sept. 25.
Garfinkel, who lives at Bloor Street and Spadina Avenue, is retiring in December and although he plans to spend some time out of town immediately following his retirement, he looks forward to watching the rest of the redevelopment take shape.
"I feel very satisfied and proud of what we have been able to do," he said. "Twelve years at a job like this is a good run."
Garfinkel is a nationally and internationally renowned psychiatrist, researcher, academic leader, hospital administrator, humanitarian and advocate. He was appointed an Officer of the Order of Canada earlier this year and is the author of several books.
Garfinkel takes a holistic approach to psychiatry and described his practice as "understanding and treating problems of thinking, feeling and behaviour".
"Why would a woman of privilege starve herself in a world of plenty? Why would someone eat four times the normal amount and throw up three times a day? Why do people become so sad that they can't get out of bed? For me those are intriguing questions and they don't have a single answer," he said while sitting in his office last week.
Garfinkel attended medical school in his native Winnipeg before moving to Toronto in 1969 to intern at Toronto Western Hospital at the age of 24.
In 1970 he joined the residency program at the University of Toronto and was assigned to the Clarke Institute of Psychiatry.
From 1970 to 1974 he worked at various Toronto hospitals before joining the Clarke Institute as a staff psychiatrist in 1975.
"I started to work on a little unit that dealt with mind/body problems and I was interested in anorexia nervosa," he said.
Looking back, Garfinkel said he was a little hesitant to get into psychiatry in the beginning.
"I was considering a career in internal medicine," he said. "But, I was a little bit younger than most people finishing medical school so I felt like I could try (psychiatry) and if it didn't work out I could go back into medicine."
In his first year as a resident at the Clarke Institute, Garfinkel was involved in the treatment of a young girl of 17 or 18 that led to him cementing his career path.
"She ended up dying tragically and it was very upsetting," he said. "The staff were not united in their views about things. The family was upset, I was upset and it made me want to try to understand how a young otherwise healthy woman could starve to death in an affluent country."
Working with eating disorders settled his unease about the decision to focus on psychiatric problems or medical problems because he said they involve a bit of both.
"These are people who have chemical changes and hormonal changes, psychological problems, but they also had to deal with a culture that demanded perfection and performance and thinness," he said.
By the late 70s, Garfinkel said he was really enjoying what psychiatry was about and appreciating how privileged he felt to be taken into someone's private world as a psychiatrist. So, in 1982 he moved to Toronto General Hospital to be head of psychiatry there.
He developed programs for eating disorders, day programs, programs to help ballet schools or modeling schools that might predispose women to these problems, by applying certain principals that could reduce the risk.
Following the merger of Toronto General and Toronto Western he served as chief of psychiatry at both and later became a professor at the University of Toronto all the while maintaining what he calls a satisfying clinical practice.
"To sit and be with someone who is ill or troubled, experience and learn, is a privilege," he said.
In 1990 he was offered Chair of the Department of Psychiatry at the University of Toronto, a role that also required he become the director of the Clarke Institute.
By the mid 1990s the province was changing the way it approached medicine. There was more emphasis on collaborative work between organizations but it was also clear there were economies of scale, Garfinkel said. With its 88 beds, the Clarke Institute was not very economical to run and it was a very small player in the hospital world in Ontario.
"By the mid 1990s it became clear that Clarke was not going to do well in how the future was taking shape and I started to look to opportunities to maybe connect the Clarke to other places.
"We were trying to organize things voluntarily which is hard to do, but then the government set up a health services restructuring committee, an independent arm that was looking to amalgamate different hospitals," he recalled.
CAMH was formed in 1998 as a result of the merger of the Clarke Institute of Psychiatry, the Addiction Research Foundation, the Donwood Institute and Queen Street Mental Health Centre and Garfinkel was named CEO.
"Right from the start what we wanted was an integrated model," he said "If we say we are understanding the whole person we should try to look at it from a complete perspective."
They wanted to integrate mental health and addictions treatments, research education and care with health promotion. The third area of integration was to bring the hospital together with the community and normalize care as much as possible.
"To treat people with a mental illness or an addiction just like if they had arthritis, diabetes or heart disease, as long as health and safety permits," he said.
That is where the redevelopment of CAMH comes in. The facilities of CAMH were scattered all over the city. There were 30 offices throughout the province, but there was no hub or heart of CAMH.
They chose to make the building at 1001 Queen Street, with its 27 acres of land, in the centre of Toronto, the hub.
After years of planning, the transformation of the site began in 2006. The first phase of Transforming Lives Here, the Queen Street redevelopment project, is complete and operational and the next phase is in full swing.
"There will be many buildings that aren't ours scattered throughout our buildings," he said. "So it is truly a village, a place for people to walk or cycle or drive. Maybe they will go to a restaurant here or live on this property, and in between they will be with people who are getting treatment or care or working here."
The city made the decision to name the park after Garfinkel on the recommendation of Deputy Mayor Joe Pantalone, Trinity-Spadina.
"He is a city builder not only because he has led the integration and development of CAMH... but also he is a city builder because he very much understands that you have to build the social infrastructure of a city and provide a place where mental health is approached in the right context," Pantalone said.
Usually, Pantalone said, the City celebrates road builders and engineers, but not often those who are looking after the spiritual and social wellbeing of residents, but it was clear that the creation of this park was the perfect opportunity to recognize the contributions Garfinkel has made.