The Front Line

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(Lillian Greenblatt/Ryersonian Staff)

As conversations surrounding mental health increase, more students are feeling comfortable reaching out to their campus’ mental health services. Campaigns like Bell Let’s Talk encourage young people to voice their struggles with mental health, in hopes of creating a public dialogue and combating the dangerous silence that many fall victim to.

But with this surge in students seeking support, waitlists for counselling and other services are only growing and gaps in these services are becoming increasingly apparent. Fostering an environment where people feel safe talking about their mental illness is a critical step toward de-stigmatizing it, but with this comes the need for new conversations. It’s time to talk. Not just about mental illness, but about what universities will need to do, as they increasingly become front-line care for a generation more candid about mental health than ever before.

For Bill Walker, Progressive Conservative critic of health and long-term wellness, this steadily growing trend of university and college campuses delivering mental healthcare triage can be attributed to a “natural shift.” Perception surrounding mental illness is starting to change and more young Canadians are seeking out mental health services, he said. “Canada’s population of young people is becoming more expectant.”

This generation is being told to advocate for their mental health. And they’re listening.

Most of the talk about access to mental health services on Canadian campuses focuses on wait times. The correlation between more students demanding help and longer wait times for accessing that help provides the ideal cause-and-effect scenario. Naturally, wait times are increasing across Canadian campuses. As reported in The Ryersonian last semester, students whose needs were labelled routine and had already waited a month for an initial appointment, had to wait between three to six months for one-on-one therapy.

In Ontario universities, there’s a current average wait time of one to three months for consistent care, said Lindsee Perkins, student board member of the Ontario Undergraduate Student Alliance. She noted that with an increased frequency of appointments comes an increased wait time. Compared to other provinces, Ontario has longer wait times, said France Gelinas, health and long-term care critic for the NDP of Ontario. “But no one can say ‘oh we have good access to mental health services for all students’.”

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A sign for the Centre for Student Development and Counselling, located in Jorgenson Hall. (Mikaila Kukurudza/Ryersonian Staff)

Wait lists for mental health supports become a bigger issue when the focus shifts from campus to community. As long as the wait lists are in Canadian universities, they are longer in the community. According to a fact sheet from the Canadian Institutes of Health Research, young people, age 11 to 25, experience more mental health issues than any other age group, but they have the least access to mental health treatment. Services are designed with older adults or much younger children in mind, meaning the population most at risk most often slips through the cracks.

“It is sad to say that the availability of mental health services on campus is about as good as it gets in Ontario,” said Gelinas. For her, university campuses are a sort of comparative victory.

Before last year, University of Winnipeg had one counsellor for every 10,000 students, said Peyton Veitch, President of University of Winnipeg’s Student Association. Students responded by petitioning and campaigning to hire additional full time counsellors. The most direct way to combat wait times for mental health services is to hire more counsellors to take on the case-load. As of this Fall, the university was able to hire three full time general counsellors. They are practising together in a new wellness centre, which launched in January. It’s going to house the three counsellors, along with other health practitioners, said Veitch. “It’s going to be a really holistic approach to student health-mental and physical.” The pride in his voice is detectable, even over the phone.

But the conversation surrounding access to mental health services should not start and finish with waitlists. This issue is more nuanced and cannot realistically be remedied by simply hiring more counsellors (and in many cases, this is not a financially-feasible solution). “There are more important questions than wait times, which we’re hearing from students, which is different from the past,” said Jenna Omassi, Vice President Academic and University Affairs at University of British Columbia. Omassi pointed to the coordination of services as being an important gap in mental health services on the campus. It is students being juggled from service to service, ineffectively, that causes the most issues, she said.

“How do we ensure that they’re not starting over and telling their story over and over when they go to different services?”

Omassi said it is great if a student can get an appointment the next day, but if they have to continually tell their story to new people each time they are shuffled between services, it would almost be better to wait longer and have some integration between the services they are using. One thing that’s being looked into at UBC, she said, is whether there is a way to allow students to sign off to allow services at the university to share information about them, between one another. “It would be much more effective to have services talking to each other and creating a dialogue between them.”

Students are expecting universities to adjust, but adjusting requires more than just the will to do so. Universities must work under the restrictions placed upon them, namely financial limitations. Universities generate funding through two avenues: tuition and government grants. As is the case in community healthcare, mental health continually lacks in funding.

“Even with the good will of the university, there is a hierarchy of sexiness in the healthcare system and mental health is at the bottom of the pile,” said Gelinas.

“It’s always the same. Mental health is the poor cousin of physical health.”

This lack of government support for mental health resources is especially true in Ontario, where, according to the Council of Universities, universities educate more students with less provincial funding per student than universities in any other province.

When universities need to improve any service and government funding is not an option, they need to find ways of increasing revenue through tuition costs. This was the case at UBC, where, last year, the university had one of the worst ratios of counsellors to students. Omassi attributed this abysmal ratio to how quickly the student population had grown, but also because of funding freezes in university finances. To remedy the situation, UBC turned to a solution of increased housing prices. The 20 per cent increase was met with a lot of unhappiness, said Omassi, but the university did gain $2.5 million as a result. About $1.5 million of that increase has gone toward hiring additional counsellors, psychiatrists, and student health services staff, said Omassi. This is not only to balance the ratio, but also to provide the student population with counsellors who are qualified to work with racialized students, international students and Indigenous students. The other $1 million, said Omassi, is going to funding long term change in the way in which the university gives out services, specifically for counselling services, access and diversity and student health services.

More and more, universities are telling their students that there is help and to seek support. Now, faced with this wave of students seeking that support, universities are going to have to find alternative methods for delivering the services that reinforce and reward speaking up about mental illness. Hiring more counsellors to address the vastly unbalanced counsellor to student ratios is a significant step toward improving services. But it doesn’t solve all the problems. What might helps the “stepped care” model of counselling, first introduced in the UK and now spreading to Canada and the US. It has been suggested as a way to more efficiently fill the gaps preventing students from properly accessing campus mental health services.

“Stepped care is a systematic method of delivering and monitoring treatment, in which you start first by delivering the least intensive intervention,” said Peter Cornish, associate professor and director at the student wellness and counselling centre at at Memorial University of Newfoundland. Cornish was the first to implement a fully developed system of stepped care for mental health, which he has introduced at Memorial. The program has different intensities. Some levels of the program have coaching built in. Some levels- the more intense ones, noted Cornish- have software containing built in video conferencing, so that students can talk with a counsellor. The most intense levels have more complex homework and exercises.

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A student browses a self-help cellphone application, used in some levels of the stepped care model of counselling. (Mikaila Kukurudza/Ryersonian Staff)

Fahim Rahman, VP academic of University of Alberta’s student union, pointed to the need for some sort of “quick-case-management”, which would quickly address the needs of students who are not in dire need. “I think we need to look at proactive ways to ensure that students who are going through a rough time can come forward and get their concerns addressed. So that the burden doesn’t increase over time and instead they can address before it spirals out of control.” Essentially, Rahman is pointing to the need for an approach that would more efficiently help students who have less intense needs.

Usually, there is a 90 to 95 per cent dropout rate of anything classified as self-help. “One of the problems with any kind of self help program is adherence to the program,” noted Cornish. “It’s human nature that people might try something like a gym membership and then they don’t really use it. But, what we do with our program is that when we send somebody to one of these online programs, we follow up with them and offer a coaching process.” When coaching is introduced, Cornish said, the rate of adherence drops to the same as one on one counselling.

“The myths about connecting online have been dispelled,” said Cornish. For instance, people with anxiety can make more direct eye contact on video, as opposed to in person. In a country where anxiety is the most common concern among university students, waiting in a waiting room, or seeing a counsellor face-to-face can be too difficult, said Cornish. “Online you can be familiarizing yourself with treatment options and getting a taste of what treatment would be like.”

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A student browses an online therapy program, used in some levels of the stepped care model of counselling. (Mikaila Kukurudza/Ryersonian Staff)

In this model of care, students would seek out a walk-in clinic on their university of college campus. This way, said Cornish, people are seen the same day.

“If you make everybody wait for one-on-one therapy, there’s no way the system can handle the demand that they currently have.”

Since the implementation of the stepped care model at Memorial, Cornish said, wait times have been eliminated. This can be largely attributed to the program’s foundation of time-flexibility, he said. The program doesn’t offer one-on-one weekly appointments right off the top. If a student is insistent that their problem is more severe than what can be remedied by online programming and they want traditional counselling, they are told to come back the next week, for thirty minutes. Then, the following week, the time might increase to an hour.

Bell Let’s Talk only launched its first campaign in 2010. It is safe to say that this tidal wave of students seeking triage from their university and college campuses is only going to gain momentum as fairly new dialogues like this grow and strengthen. In preparation for this continual shift in public perception of mental illness, universities are going to need to adjust their own repertoire of resources. Perhaps now is the time for new approaches to emerge, ones that will extend beyond wait lists, toward more holistic horizons.

This article was published in the print edition of The Ryersonian, on Feb. 3, 2016. 
 

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