Canadian Association of Occupational Therapists

A different path: Providing community housing for people with mental illness in Montreal
by Marnie Lamb

How diverse is the profession of occupational therapy? Lise Boies trained as an occupational therapist, but her career took a different path. As the department head of a government-funded specialized community housing program, Lise is using her training to develop housing that answers the needs of those with mental health problems.

The program, which is associated with the Louis-H. Lafontaine Hospital (a large psychiatric institution for adults), aims “to develop an innovative approach for people with special needs.” Lise has developed various types of housing, including dwellings for younger people with substance abuse problems; and two types of housing for clients who have been released from the hospital and need transitional housing. The first type involves 90-day housing for clients with psychosocial problems but who will eventually be able to live independently in the community; the second is longer-term housing for clients with more severe disabilities and who are waiting to be moved into a permanent facility. Clients must be referred by a social worker, who acts as liaison between the program and outpatient clinics, inpatient wards and emergency services.

In Lise’s program, a client’s occupational and environmental goals are paramount, and in assigning housing Lise and her team “try to respect [the client’s] desires more than worrying about such issues as building capacity.” Lise tells of one client who came to live in community housing after a long-term hospitalization. Diagnosed with obsessive-compulsive disorder, the woman had lived in a strict environment where she would be punished if she engaged in obsessive-compulsive behaviour: if she washed her hands too often, she would be refused permission to use the washroom. Lise’s team respected the woman’s disability and fostered a more supportive environment by creating a schedule based on the client’s meaningful activities and allowing her greater latitude in, for example, returning past her curfew. As a result, the woman’s obsessive-compulsive behaviour decreased, and she proudly achieved her goal of taking public transportation by herself, something she had not been able to do for 15 years.

That community housing works, Nadine Larivière can attest. An occupational therapist and colleague of Lise’s, Nadine talks about a community housing project she was involved in several years ago that helped change the lives of her clients. The project began during a downsizing at the geriatric psychiatric department and involved creating a 15-client housing development for aging clients who had been hospitalized for an average of 30 years. Several clients were anxious about the move, but Nadine alleviated their fears through counselling and through having the clients actively involved in choosing and decorating their bedrooms. One client, a woman with bipolar disorder and whose last hospitalization had lasted 12 years, was eager to move in but was also very unstable. The move was so successful, however, that she did not experience another episode of depression or mania after leaving the hospital, and was never re-hospitalized. She was able to visit her grandchildren, and her quality of life improved dramatically.

Although hospitals have been involved with community housing for decades, the sort of programs that Lise and Nadine have developed are relatively new, as is the involvement of occupational therapists. Lise suggests that these therapists are a valuable part of the community housing process because they are able to provide a “systematic and global assessment of the occupational performance of clients,” and hence are able to comprehend a client’s special needs.

Despite the success stories, much remains to be done. As Lise warns, Montreal is a “large city with many social problems.” Lise’s facilities currently house 59 clients, but some of these facilities have waiting lists of two years. Montreal’s lack of affordable housing does not help. “It’s hard to get people out of our programs, not because they’re not ready but because there’s a lack of housing available,” Lise says. Client satisfaction, however, keeps therapists like Lise and Nadine going. Clients are pleased when therapists address not only their needs but also their desires.

Photo: David Dolsen

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