Toronto Western Hospital (TWH), long informally known as the “Chinatown hospital,” has always stood at the intersection of place, culture and care. Its Asian‑focused outpatient psychiatry program, Asian Initiative Mental Health (AIM), was one of the few hospital‑based services in Canada explicitly built to meet the linguistic, cultural and psychosocial needs of Asian communities. Now, under the rationale of “integration,” the program has been dismantled. So, what does “integrating” culturally specific care look like when it disappears?
Alongside CAMH’s AMANI program (formerly SAPACCY), which supports Black youth, AIM stood out as one of the very few hospital-based health programs in Canada created specifically to serve a distinct cultural community, in this case, the Asian community. These programs matter because they respond to documented barriers: language, culturally different expressions of distress, community stigma and distrust in generic mental health settings. Without them, segments of the population still receive care but receive it far less well.
Hospital leadership has avoided calling this an outright “closure,” instead saying the Asian psychiatry service is being “integrated” into other services. But this framing masks a process that has been, at best, disrespectful, dismissive and crass. Patients were not formally notified and a request for the hospital to provide patients with a translated letter explaining the change was not acted on. Clinicians were laid off. Public statements continued to tout resource increases – until a Toronto Star article outlined what had already happened.
The process has been tone-deaf: a hospital serving Chinatown should recognize its relationship to the Asian community, not act as though that identity is irrelevant. When people’s care disappears under the guise of “integration,” communities are left scrambling. Those who benefitted from the specialized program lost access to culturally competent providers; others were forced into systems that do not speak to their needs.
Hospitals are not just bureaucracies or service providers. They are stewards of the public good.
Hospitals are not just bureaucracies or service providers. They are stewards of the public good. They maintain the commons: the shared trust, shared resources and shared responsibilities that hold together societies with diverse populations. When a hospital abandons culturally specific programs, it is not merely rebalancing a ledger; it is retreating from its ethical core.
Equity demands more than equal access in theory. It requires care that is responsive to differences in culture, language and lived experience. When immigrant and racialized communities’ needs are dismissed as “special treatment” rather than essential care, we normalize exclusion. We allow health systems to treat some health needs as optional.
If health care is truly to be local – if hospitals draw their mandate from the communities around them – then how can we accept the integration of a culturally specific program at TWH in Chinatown without serious harm?
Does “integration” become a polite euphemism for erasure, especially when changes happen without informing patients, without transparent process and without acknowledging the deep relationships between clinicians, patients and community?
What message does this send, not only to Asian patients, but to all racialized communities, when their culturally specific care is treated as expendable?
And in the long run, what happens to the commons when certain people feel that public health institutions do not see them, or choose to ignore them?
In asking these questions, we call for professional reflection and institutional humility. If the health systems we trust are to keep their legitimacy, they must show how integration preserves, not dilutes, culturally responsive care; how local hospitals recognize local communities; and how equity is lived, not just articulated.
Because when culturally specific care is allowed to vanish under another name, we all lose a piece of the commons we rely on.
