As a growing number of students line up for mental health services, Ontario university counselling centres look for more resources and alternative care models to mitigate wait times. How much longer can students wait for help?
By Charlotte Arnold, Vjosa Isai, and Katie Raskina
She was quickly running out of options. Between dealing with an abusive relationship, caring for her child and being in and out of court, this Ryerson student was heavily saddled with stress. The student, who wishes to remain anonymous because of the personal nature of this information, contacted Ryerson’s Centre for Student Development and Counselling (CSDC) in July after feeling as though she displayed symptoms of post-traumatic stress disorder. She was told it would be over a week before her first appointment.
“To be honest, even a week and a half felt long to me,” she said. “I thought, ‘Oh my god, how can I wait that long?’ Because you reach out when (it feels like) ‘This is one of my last options.’” And with fewer students in school during the summer months, her wait for a counselling appointment wasn’t nearly as substantial as what it would be in the fall and winter terms.
Despite concerted efforts to address the issue, wait times for mental health-care services at Ryerson’s counselling centre persist, and it has students and faculty members concerned. When The Ryersonian spoke with experts at four other Ontario universities, it was discovered that ours isn’t the only one grappling with a growing queue for one-on-one appointments. The experts agree the increased demand is leaving centres with less of a capacity to provide these important services to students. As health-care providers will attest, the stakes are high.
Sunnybrook Hospital researcher Dr. Mark Sinyor studies mood disorders and suicide prevention, and, in an email to The Ryersonian, spoke about the risks when students feel they can’t get the help they need, when they need it. “The demand often far exceeds the services available,” he said. “This is an issue because sadness, anxiety and hopelessness are often features of mental illness that can be reinforced (by a wait).”
Matt Forbes, 21, has been going to the CSDC for a year. Forbes first reached out after years of fear that seeking counselling would “waste everyone’s time.” Forbes went to the centre to manage feelings of anxiety and depression and has been satisfied with the quality of care received.
When Forbes called to book a “first contact” appointment, the response was that the wait would be two weeks. “I was a little frustrated to be honest,” Forbes said.
“In my mind, this (reaching out for help) was a big step for me. The wait time allowed my anxiety to build.”
Forbes had to wait a further three weeks for a second appointment.
When a student contacts the centre for the first time, they must fill out an administrative form that helps counselling staff assess their level of need and priority status. The three main categories are: crisis, where a student’s safety is at risk; priority, where a student is extremely distressed but their safety is not immediately at risk; and routine, for those who do not fit in to the previous categories.
Just like an emergency room, there are different wait times depending on urgency.
Sitting down for a first appointment usually takes less time than waiting for a follow-up appointment. If the situation is deemed crisis, counsellors see the student within 24 hours. Regardless of the fluctuation in demand, this 24-hour guaranteed appointment is a standard that Ryerson is proud to maintain, said John Austin, executive- director of student affairs.
The CSDC reserves time for two same-day appointments daily to serve students with safety concerns. If the student’s situation is priority, they are currently waiting one to one-and-a-half weeks for a first sit-down. Ten same-week appointments are booked off for priority-level students.
The centre’s goal is to have routine level students in for an initial appointment no longer than two weeks after they book it. But due to the number of students who have signed up, routine-level students are currently waiting one month.
“I’m not happy about that,” said Dr. Sarah Thompson, clinical co-ordinator for the CSDC.
Wait times for ongoing treatment, meaning all appointments after the initial one, are longer.
This fall term, students who are labelled crisis are waiting a week, and priority are waiting two to three weeks. Students labelled routine, who are already waiting a month for an initial appointment now have to wait between three to six months for one-on-one therapy, Thompson said. There are about 100 students currently in this queue, which is during a peak waiting time.
Austin says students are provided with a variety of resources to help manage their condition while they wait, including a list of symptoms to look out for, group therapy information, and the promise of immediate attention if their level of need escalates.
The counselling centre changed the nature of its “first contact” appointment over two years ago in an attempt to mitigate the risks associated with long wait times. Thompson calls the first appointment “a single session intervention.”
During this 50-minute appointment, counsellors ask students about the most important issue they are dealing with. They focus on that issue during the appointment and ensure students leave with a least one strategy that can help them that day, such as a stress management technique or a strategy to develop a different understanding of their problem.
“We know that by the time a student sees us some have been waiting three hours, many have been waiting a month,” Thompson said. “We want to do as much as we can in that first session.”
Katie Coombes, now in her fourth year at Ryerson, said that her one-week wait for ongoing care was manageable because of the strategies she learned in this first appointment.
Coombes used Ryerson’s counselling services during her first year, when she was having trouble adjusting to living away from home. At her initial meeting with a counsellor, she was told to keep a journal, make plans for her day and exercise. The counsellor also gave Coombes her phone number and said she could contact her anytime.
“Because of them, I didn’t drop out,” she said.
Behind the line
“The challenge is if we open up new first appointments and see people faster, it means those on our wait-list for ongoing care wait longer,” Thompson said. “At some point, we have to choose where we are going to set the point to balance those who are waiting for care with those who are waiting to get through the front door.”
The appointment backlog can be attributed to more people getting in line. According to CSDC data, the centre saw an appointment increase of four per cent from last year to this year.
Wait times fluctuate during the term, and can coincide with rising student stress levels. In November of last year, the centre saw a spike in students in a crisis situation, with 35 students coming in with safety concerns. When this happens, counsellors have no choice but to stay later to meet with these students, Thompson said.
The CSDC staffs 15 full-time counsellors, one part-time counsellor to meet the unique demands of high-performance athletes on campus, and two to three interns to serve the student population of 42,936. Seven are situated in the centre in Jorgenson Hall, while nine are dispersed in satellite offices across campus. Just five years ago, in 2010 to 2011, there were about 10 full-time counsellors.
Funding to the CSDC has also seen an increase. The centre’s budget is mostly made up of base funds from the university and contributions from the faculties, and can also include one-time-only contributions.
In the 2012 to 2013 school year, its total budget was about $1.46 million, with $1.1 million in base funds and another $330,000 supplied by various faculties.
This school year, its budget has risen to $2.02 million, $1.4 million of which comes from base funds, and a nearly doubled contribution from faculties, at $609,000.
This year was the only instance of the CSDC dipping into student services fees, with $37,000 of the budget contributed in this way. Austin said that the amount each student paid towards it is “negligible.” Last academic year, the counselling centre saw 1,886 students for individual appointments and 247 in group therapy.
Austin says another $2 million alone “won’t fix the problem.” However, interim Ryerson president Mohamed Lachemi said he thinks more funds couldn’t hurt.
“We are spending more money. We are allocating more money,” he told The Ryersonian. “I think it’s not enough, to tell you the truth.”
The University of Waterloo employs roughly the same amount of counsellors as Ryerson, even though its student population, at 35,900, is 18 per cent lower. Each student at Waterloo has a limit of 10 counselling sessions per academic year. It’s not known how enforced that limit is; while Ryerson has a similar protocol, Austin says it’s difficult to turn people down after their allotted sessions run out.
From September to August, Waterloo’s counselling centre sees about 2,600 students in individual appointments. And because of Waterloo’s co-op program, students are at Waterloo year-round compared to spring and summer terms at Ryerson. As a result, counselling services do not experience a significant drop in demand during the year.
Fifty per cent of the budget for counselling services at Waterloo is paid for in student fees, and the other half by the university.
For instance this year, Waterloo’s counselling services’ overall budget is $2.4 million, with $1.1 million coming from student ancillary fees, and $1.3 million from the university.
Students at Waterloo have a say in how much of their student fees they contribute for counselling services.
To request an increase in funding, Waterloo’s counselling centre must first have its funding proposal approved by a student advisory committee.
Chris Lolas is on this committee, and also serves as president of Waterloo’s Federation of Students. Mental health issues are one of his top three priorities in his role as student union leader. “Because it is something we value so much on this campus, we generally approve (funding) increases,” said Lolas.
“It’s the reality that students will have to pay for counselling, but we are trying to pay less and have the university pay more because I do think it’s a vital service that the university needs to provide for students,” he said.
Once funding is approved by this student committee, counselling services must go to the university and make the same request.
Dr. Tom Ruttan, a Ryerson alumnus and director of counselling services at Waterloo, says in his 13 years as director, he has never seen the university refuse a funding request that was already backed by students. “Having it backed by students carries an enormous amount of weight when we go to the provost, or the vice-president’s office,” he said.
However he says funding is only half the battle.
“The second part of that challenge is to meet that need in a way that’s healthy for the people providing the service,” Ruttan explains.
‘I’m not alone’
While the aim is to get students in for a private appointment, one-on-one counselling is not always the best strategy for every student. Ruttan says other mental health care tools can be equally, if not more, effective.
“It cannot just be individual appointments now, there’s just too great a need,” he said.
Ruttan points to the University of Guelph as an example of a great group therapy program. He has even borrowed some of Guelph’s strategies for Waterloo.
Sinyor stands by group programs as an alternative to one-on-one sessions.
“Evidence suggests that many people actually prefer groups because they are destigmatizing and allow learning from others’ experiences,” he said. “By implementing these sorts of strategies, the need for one-on-one support may diminish and resources could be freed up for those who need them.”
Ryerson offers an array of group counselling services. Forbes said they’ve been very beneficial. “There’s trust because everyone is in the same situation.”
Thompson agreed. “When you look right and you look left and you start to hear your story or similar stories coming out of other people’s mouths, you realize, ‘Oh my god, I’m not alone.’”
“There are ‘me toos’ on campus and we want to help connect you,” Thompson added. “The only thing worse than being in a lot of pain is being in a lot of pain alone.”
There are other things that can be done to reduce the demand for individual counselling, according to Sunnybrook researcher Dr. Sinyor. He said, “More general programs encouraging healthy living including diet, sleep and exercise” cannot be underestimated.
‘Get to the other side’
The expectations placed on post-secondary institutions to provide mental health care continue to grow. Austin points to wait times, costs, and quality of care at Ryerson as being more efficient than those in greater society, and questions whether this standard is fairly imposed on universities.
But Austin adds that equally undeniable is the fact that a large part of the anxiety that students live with is related to school, like demanding curricula and financial worries directly connected to the university experience.
In order to alleviate some of the pressure on the centre, Austin encourages professors to spread the word about group treatment and to look at ways of making courses more manageable to students struggling with their workload.
As for the student dealing with symptoms of PTSD, she didn’t seek help after that first visit. “Sometimes you just need to connect with friends and that kind of thing,” she said. “I was able to get more help from my personal support system.”
She said that she was recommended group treatment, but felt too “vulnerable” to share with strangers. She acknowledged that she could have pushed harder for one-on-one counselling, and understands why students choose the centre.
“It’s convenient, it’s close to campus, it’s close to classes,” she said.
Forbes, on the other hand, remains a patient at the centre, and encourages others to reach out, even if they’re afraid.
“With me, a lot of my troubles came from feeling scared to ask for help, scared to appear inadequate or lesser or stupid,” Forbes said. “And I still have troubles with that, but at least I’m able to take a step back and say, ‘Should I be scared? Is this helpful fear or is this just useless?’”
Forbes also said the services the centre offers are worth the wait.
“I’m getting to a point where, before all I could see is right now, and I assumed it would always be that way. Now I see the possibility that I can get to the other side.”
This article was published in the print edition of The Ryersonian on Dec. 2, 2015.
This article was edited from a previous version to update the student population at Ryerson University and the University of Waterloo.