'They make you doubt your sanity.' Staff describe toxic workplace at top mental health hospital

Yahoo

4 days ago

Many staff inside the country's leading mental health institution say they are suffering their own trauma from a toxic workplace rife with discrimination and bullying.
Anonymous employee feedback from health-care providers at Toronto's Centre for Addiction and Mental Health (CAMH) include widespread staff complaints about a work culture they say left them with mental health challenges including anxiety, depression and even suicidality.
When they attempt to address their grievances, many say they were met with retaliation and a lack of accountability.
'I would throw up before work,' one employee said. 'I know no one would support me.'
Some staff blamed the workplace culture at CAMH for mental health challenges. 'They make you doubt your sanity,' one respondent wrote.
Some respondents explicitly noted a gap between the hospital's mental health mission and the psychological state of its employees.
'It is ironic that an organization that provides mental health support is so disconnected from the mental health of its staff,' said one respondent.
Another wrote: 'The fact that the organization puts out statements about anti-racism that don't align with what we experience internally, it's a problem. They don't walk the talk internally.'
CAMH, hailed as a leading international mental health voice that provides training on staff mental health to major employers in Canada, said it has reviewed the criticisms by staff and taken active steps to address them.
'I know this is what happens in workplaces — It is very different when you hear it from colleagues,' said CAMH equity director, Kwame McKenzie in an interview. 'It's very poignant. It's very raw. It makes you think of the urgency that you need to do something different.'
The responses were gathered in 2021 and 2023 by an external consulting group and the hospital's equity office respectively, and were obtained by the Investigative Journalism Bureau through freedom of information legislation.
The internal reviews, which unfolded during COVID and the emergence of the Black Lives Matter movement, are only the latest attempts to understand longstanding issues at CAMH.
Following a 2019 internal survey that raised concerns of racism, hospital administrators decided additional indepth interviews were needed to better understand the experience of employees. In 2021 and 2023, a total of about 2,000 employees — nearly half the hospital's staff — took part in separate workplace reviews.
In 2021, a working group conducted in-depth interviews with 50 staff members representing a wide range of positions across the hospital that documented widespread allegations of harassment, bullying and intimidation.
Some employees described toxic workplace environments and traumatic encounters with colleagues and leadership that led to significant mental health challenges. 'The story is consistent across participants — the themes are raw and clear,' the report concluded.
One respondent said they became suicidal after repeated bullying and exclusion: 'I internalized how bad they made me feel about myself.'
The respondent pool included staff identifying as Black, white, First Nation, Asian and from other racial groups, and reflected a wide range of religious affiliations.
About 70 per cent of respondents expressed they experienced discrimination based on their racial and cultural background. One in eight reported feeling discrimination based on religion, and a third felt discrimination based on age. CAMH has been recognized multiple times by Mediacorp Canada on its annual list of Canada's Best Diversity Employers.
Another key theme in the surveys is staff feeling unsupported by management after filing a grievance.
'We went to grievance and won. My manager did not want to fire him because they were friends.'
About half of participants said they didn't know how to file a complaint, and 43 per cent said they would not refer colleagues to job opportunities at CAMH.
I know this is what happens in workplaces — It is very different when you hear it from colleagues
Kwame McKenzie, CAMH equity director
In 2023, CAMH followed up with a survey that was completed by 45 per cent of the hospital's staff. The results continued to highlight equity concerns.
McKenzie, a psychiatrist and director of health equity at CAMH for more than a decade, commissioned the surveys to help the hospital collect concrete data to improve the workplace, he said. While he acknowledged the findings being made public could raise difficult questions, he said the hospital is committed to transparency and improvement.
'We wanted to do it because we wanted to find out what was… upsetting staff in order to try and create some solutions,' said McKenzie. 'We are actually really proud of that fact, that we're a sort of organization that has the courage to try to do it.'
Eight current and former CAMH nursing staff interviewed for this story described a culture that is often punitive and driven by blame.
Jacqueline Boyce, a current nurse at CAMH for more than two decades, wasn't surprised by the findings. She said she's witnessed countless alleged inequities firsthand and understands the deep mistrust many staff feel toward the organization, as well as the fear among nurses of speaking out. She said most remain silent out of fear.
'If you speak up, they can come after your job,' she said. 'If you feel that's a threat, you just stay calm, your voice becomes powerless and nothing is done.
'People, they take whatever's handed out to them and shut up, right? Their safety is in being quiet.'
CAMH was an early adopter of the National Standard of Canada for Psychological Health and Safety in the Workplace, launched in 2013. It promotes a culture where staff are encouraged to report errors or concerns without fear of punishment.
But another current nurse, whose identity is being protected due to fears of retribution, said raising issues or defending her work frequently resulted in disciplinary meetings and veiled threats from leaders, leaving her feeling unsafe and anxious for her job.
'I would go home and just cry,' she said, her voice breaking as she recalled interactions with managers over the years. 'How would you feel working in a mental institution and every time you come in you feel (you're walking on) pins and needles. Would you be able to function in this environment?'
Many of the concerns raised by staff at CAMH are echoed by health-care workers across Canada who cite staff shortages, heavy workloads and safety concerns for increasing burnout, absences and high turnover.
But there are unique challenges for staff in mental health care who must manage both their own emotions and those of clients in extreme distress, said Kim Foster, a mental health nurse and researcher who has studied the well-being of the mental health clinical workforce in Australia.
'It's difficult to provide psychological care if you yourself are not feeling psychologically safe,' said Foster. 'We're a mental health service. We should be practicing what we preach.'
But the challenges are often more deep-rooted than a few bad apples in management, she said.
'I do think managers get blamed for a lot of things that are perhaps not always their fault,' she said. 'They themselves are often working in stressed, pressured environments. If you haven't got managers who are experienced, or you have a culture in senior management that doesn't support staff, that of course makes things difficult.'
Psychologist, N. Zoe Hilton, professor in the department of psychiatry at the University of Toronto and research chair at the Waypoint Research Institute in Penetanguishene, Ont., led the Trauma Among Psychiatric Workers Project, a multi-hospital study designed to understand how workplace factors impact trauma experiences among nurses and other hospital staff.
Part of the study, published in 2020, surveyed 761 staff across three psychiatric hospitals in Ontario and conducted interviews with two dozen workers. They found 29 per cent of participants met the clinical screening threshold for PTSD, depression or anxiety.
'I think that's really important research that CAMH has done,' said Hilton. 'I think it's important for giving that voice to staff who may not be able to speak out in their workplaces.
CAMH's McKenzie said he takes staff accounts of a troubled workplace culture seriously. 'I'm always mortified to hear when our (staff) are disappointed in us or upset by us and think we should do better,' he said. 'There's a hell of a lot (of supports for clinical and non-clinical workers) at CAMH — there needs to be. If we've got people saying, 'we want more,' we need to be able to listen and work out what we can do in order to improve things for individuals.'
CAMH promotes itself publicly as a leader in workplace wellness, advising companies like Maple Leaf Foods and Sun Life on how to improve employee well-being and organizational accountability.
People, they take whatever's handed out to them and shut up, right?
Jacqueline Boyce, CAMH nurse
The hospital hasn't followed its own advice, said current and former staff who spoke with the Investigative Journalism Bureau.
One nurse, whose identity is being protected due to fear of retribution, said that although she's aware of resources, she has avoided them. Her past experiences have left her fearful that anything she shares could be used against her.
'You lose trust because of the experiences that you go through — the trauma,' she said. 'You hurt me already and now you're telling me you set up someone to come help me. You think I'm going to accept that?… It's not safe for me.'
Instead, she draws on support from her religious community outside of work and uses her vacation days as informal mental health leave.
Staff feedback also suggests a double standard in how patient abuse toward staff is addressed. 'Patients calling me the 'N' word was the norm, no one had consequences,' one nurse said. 'If a white nurse was made uncomfortable, the patient would have been secluded. But for Black nurses, this is just our job.'
Discriminatory patient care was also identified as a factor in staff mental health concerns, according to the CAMH research.
CAMH's own 'Dismantling Anti-Black Racism,' published in February 2021, says Black patients at CAMH are restrained 44 per cent more than white patients.
In a statement, CAMH said the decision to publicly release the restraint data was an intentional 'step toward acknowledging systemic inequities and holding ourselves to a higher standard to do better.'
McKenzie said the disparity has significantly decreased since then through training and policy changes in the hospital.
'I don't think we have solved this problem,' he said. 'But I think that the plan of getting the data, showing the data and starting the conversations across CAMH about how we can improve and move towards equity have made a start. There's a long way to go before we can honestly say that we have totally equitable services at CAMH.'
The path ahead
Survey respondents in the CAMH reports made recommendations for addressing the issues including forming an independent, employee-led committee to address workplace violence and discrimination, an independent ombudsperson to mediate complaints and clear accountability mechanisms.
CAMH has introduced several equity initiatives in recent years, including employee resource groups focused on anti-harassment and anti-discrimination, as well as better data collection.
In a statement, CAMH said it recognizes its responsibility to provide ongoing mental health support for staff, not just in times of crisis, but as a sustained commitment to employee well-being.
As of January 2024, the hospital said it increased mental health coverage for unionized and management staff and introduced unlimited coverage for Ontario Nurses Association members. In response to staff feedback, coverage was expanded to include off-site and private providers. Employees also have access to an employee family assistance program.
'We're not perfect, but we're giving it a bloody good try,' said McKenzie.
In her two decades at CAMH, Boyce said she has seen some positive movement. But decades of inequity, she said, are a lot to unpack.
At 66, the longtime nurse doubts the kind of meaningful change needed to address trauma, discrimination and bullying will happen in her lifetime.
'We chose this work to be advocates, to be caregivers… but who takes care of the caregiver?'
The Investigative Journalism Bureau (IJB) at the University of Toronto's Dalla Lana School of Public Health is a collaborative investigative newsroom supported by Postmedia that partners with academics, researchers and journalists while training the next generation of investigative reporters.
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