CRISIS ON CAMPUS
Universities across the country are struggling to cope with a spike in requests for mental-health services from students who feel hopeless, depressed and suicidal. Charlie Fidelman reports on a worrying trend.
One Monday morning in March, a lonely and homesick 19-yearold undergrad took his own life in residence at the University of Waterloo, Ont.
“I can’t believe this is real,” his 16-year-old brother wrote the next day in an agitated social media post filled with grievances against the school.
“My brother is gone and I’ll never be able to tell him I love him ever again.”
As the post grimly noted, his brother was the second “brilliant mind” at Waterloo to have “died like this” during the semester.
That same month, the University of Ottawa also mourned a student who took his own life.
At the University of Guelph, four students are known to have died by suicide since the academic year began last fall.
Universities across the country are facing a mental-health crisis on campus, sparking an explosion in demands for services from students who feel hopeless, depressed and suicidal.
At McGill, the number of students seeking mental-health or counselling services on campus jumped 57 per cent in the last three years.
With requests for help far outstripping campus resources, beleaguered universities are struggling with the same kind of challenges seen in the public health-care system at large.
While statistics help expose the scope of the problem, a definitive answer to the bigger, more important question remains elusive: Why is this happening?
On Friday, a national conference on campus mental health wrapped up in Toronto.
“The number and severity of mental-health issues are increasing on campuses across the country,” notes the website for the event, “and higher-education institutions must ensure they have the most up-to-date information, tools and strategies to respond.”
The goal of the conference was to bring experts together and work toward a targeted approach for promoting mental-health awareness and ensuring adequate and appropriate responses to campus needs, according to chairperson Gaya Arasaratnam.
Arasaratnam, the director of health, wellness and support services at Concordia, said the university has seen not only a spike in the number of students seeking help, but also “a move toward more complex mental-health problems.”
McGill, too, is “feeling overwhelmed,” according to Ollivier Dyens, the deputy provost for student life and learning.
“The demand is increasing — has increased dramatically in the last few years — not only at McGill but across the education system in Quebec and North America,” he said.
Those observations are reflected in the results of a Canadian survey of colleges and universities published last year that estimated one in five post-secondary students are depressed, anxious or facing mental-health issues.
The survey by the Canadian Association of College and University Student Services reached more than 43,000 students from 41 institutions and revealed an increase in serious mental-health crises such as depression and thoughts about suicide.
In all, 13 per cent of students surveyed said they had seriously considered suicide, a jump of 3.5 per cent from three years earlier.
But does this mean more students have mental-health problems than before — and if so, why?
The survey does not show cause and effect, cautioned CACUSS executive director Jennifer Hamilton.
Still, she said, it’s interesting to note that several health organizations have identified 18- to 24-year-olds has having higher rates of depression and anxiety than other age groups.
It might be that millennials are more open about their mentalhealth struggles than previous generations, and more likely to seek help.
Many have been exposed to awareness and prevention campaigns like Bell Let’s Talk, featuring personalities like Olympic medallist Clara Hughes sharing how she battled depression at the height of her success.
In early May, the Commission scolaire de Montréal dispatched counsellors to its schools to lead discussions about suicide. The move followed the popularity of the Netflix series 13 Reasons Why amid concerns it might glorify or trigger thoughts of suicide.
But bringing the issue out into the open is only the beginning. Equally important is to ensure that students have timely access to mental-health care when they go looking for it.
And that, everyone seems to agree, remains a problem.
“Honestly, campuses are a microcosm of what’s happening in mental health across the country,” said psychologist Patrick Smith, national CEO of the Canadian Mental Health Association.
“Demand for services far outstrips the availability of services” because of years of chronic underfunding for public mental-health care and prevention.
Not everyone — especially not students — can afford to pay out of pocket for private counselling, or are lucky enough to work for an employer that offers private insurance covering mental-health care.
Last year, Starbucks Canada asked its staff — mostly college students — about their concerns surrounding mental health and was surprised to find that access to services and counselling ranked high.
In response, the coffee chain increased its mental-health benefits from $400 to $5,000 a year — among the most generous in the country.
“Does someone need to be a barista at Starbucks before they have their basic counselling services covered,” Smith asked.
Still, he acknowledged, campuses are increasingly recognizing the need to improve resources. More counsellors and staff in student residences are being trained to recognize warning signs among struggling students, for example.
The wait times are not something we are happy with. We want these things to happen but we are struggling with the numbers right now. Ollivier Dyens, deputy provost for student life and learning, McGill University
Many are anxious because of the wait for help. Should they be studying and suffering through stress or take half a day and go see a professional who may or may not be able to help?
“By creating psychologically healthy work places and school settings, we can go a long way to reduce the incidence of mentalhealth challenges before people need specialized services,” Smith said.
Two years ago, Université Laval reorganized its student-assistance centre — and saw requests for help explode by 50 per cent.
Among the changes, students were now able to file an online request to access the service. More than 3,000 requests poured in between the fall and spring.
“It became easier to ask for help,” said Louise Careau, who heads the centre.
But the trouble remains: The staff of 14 full-time psychologists can meet only half the demands, and the wait time for an initial appointment is four to eight weeks — unless there is a perceived risk of suicide, in which case the student is seen immediately.
“We can respond to about 1,500,” Careau said. “We have increasing demands and diminishing budgets.”
At Université de Montréal, the number of consultations last year was 10,464 up from 9,669 in 2013.
Students may ask to see a therapist for issues such as depression, anxiety, family relationships or broken hearts, Careau said.
Sometimes the issues are more education-related — anxiety, motivation, performance and attention problems.
Students face enormous burdens, Careau noted, from competition for employment to pressure from parents to succeed.
If they hope to get into law or medical school, they require high marks as well as work and volunteer experience, and involvement in extracurricular activities.
Some students are so distressed they self-mutilate and require years of therapy.
“The real challenge is how to respond in an era of budget compressions,” Careau said.
“We have to be more efficient so we are working on prevention, offering group sessions and different workshops as an alternative to one-on-one counselling.”
Workshops tackle topics such how to use mindfulness to handle stress, how not to fall into depression and how to cope with emotions, performance anxiety and procrastination.
Université Laval has also trained about 150 staff to recognize signs of distress as part of its suicide lookout network.
As of 2008, every department has professors, directors and education consultants trained as “suicide gatekeepers” to spot and refer students with major depression, Careau explained.
“They are our eyes on campus and then we take over,” she said. “It’s a safety net.”
At McGill, individual therapy appointments at its counselling services have increased by 110 per cent since 2013.
Emergency walk-in appointments by students in acute crisis increased by 18 per cent.
In all, 3,500 students are treated each year at the university.
On March 31, the McGill Students’ Mental Health Working Group released an open letter to deputy provost Dyens criticizing McGill’s “insufficient and inaccessible mental-health services on campus.”
The petition, which circulated on Facebook and garnered more than 1,000 signatures, came on the heels of a recent restructuring aimed at reducing mounting pressures on an overloaded system.
“The more time you put between the sufferer and treatment the more you’re risking students’ lives and well-being,” says one comment on the petition.
“As a severely depressed formerly suicidal student a month is more than enough time for suicide. It’s murder to make us wait.”
As of September, the university streamlined two separate units — counselling and mental health — into one point of entry where students are evaluated by a case manager clinician and then referred.
The integration introduced a “stepped care model” — from online therapy to group therapy and peer support, to one-on-one therapy where deemed necessary.
The integration of services shortened wait times to an average of about four weeks to see a health professional, according to Dyens.
The university is also developing a campus-wide “wellness strategy” involving “mental-first” aid training for staff and policies to promote a healthier learning environment.
“We care,” Dyens said. “Those are our students. We want them to be better. We want them to get the services they need ... as quickly as they can.
“The wait times are not something we are happy with. We want these things to happen but we are struggling with the numbers right now.”
He added: “We do need to hire more client-care clinicians, and that is something we’ll be doing in the immediate future.”
McGill’s student society actively supported the move to stepped care, which it sees as an improvement over the previous system, said Erin Sobat, vice-president of student affairs.
Still, problems persist. The changes have led to concerns about serious gaps in care, particularly for those with acute mental-health problems, Sobat said.
That means vulnerable students who need help the most remain at risk, including foreign students whose options may be more limited when it comes to accessing health care outside the university setting, he noted.
The petition also charges that clinicians were silenced or dismissed when they raised concerns about changes to the system. In December, mental health clinical director Nancy Low was suspended and subsequently dismissed. The university says it will not discuss the circumstances of Low’s suspension.
Sobat and other students say funding for mental-health services should come from McGill’s overall budget and not strictly from student ancillary fees as is now the case.
“That’s not a commitment to student well-being,” Sobat said of the current funding model.
In response, Dyens was clear: “Student services come from student funding.”
And yet, Université Laval works on a cost-sharing model, with the university funding 50 per cent of mental-health services and students accounting for the other half.
In the end, Sobat said, the streamlined system at McGill remains overburdened and understaffed, and hinders students from getting the treatment they need at a time in their lives when it would help them most.
Dyens said students “are not seeing the service as efficiently as we’d like them to see it,” adding: “But if the students are saying this, they are the primary receivers of our services, so we have to take it very seriously.”
Pupils are more than learning vessels on two legs, said Alice Shen, who is in her last undergrad year at McGill and hopes to get into medical school.
When Shen sought campus counselling services two years ago, the wait for a first appointment was three months.
She was having a hard time balancing her school work with a part-time job, a family situation and personal health problems.
“I knew something was wrong but not what,” she recalled of the long wait to see a psychiatrist, psychologist or counsellor.
And as exam time approached, her distress escalated into an emergency, at which point she received immediate care at the school’s drop-in clinic — reserved for students at risk of “self-harming” or suicide.
Shen said she knocked on the clinic’s door several times that semester.
Students with symptoms of anxiety and depression can experience loss of appetite, insomnia, nausea, panic attacks, irritability, shortness of breath, feelings of guilt and hopelessness, and more.
And that anxiety and depression can bleed from one aspect of life into another.
“That was the space you were in, and it happens to many students,” said Shen, who left the clinic with a diagnosis of depression and a document for academic accommodations, which meant a deferral for writing final exams.
Shen acknowledged the university is trying to help, but described its mental-health services as a mere Band-Aid.
“I have friends who are very confused,” she said. “They’re stressed out, finals are coming, you have assignments due, sometimes there’s just one day between the last day and exams.
“Many are anxious because of the wait for help. Should they be studying and suffering through stress or take half a day and go see a professional who may or may not be able to help?”
In her case, Shen was assigned a physician but she asked to switch to another doctor — “someone more relatable” — which meant more delay to get therapy.
“Even when you see someone for the first time, there’s no guarantee of help,” she noted. “The first few appointments were not helpful.”
Despite episodes of depression, Shen decided to stay in school and take on a full course load rather than skipping a semester, which she felt could negatively affect her application to medical school.
“Support staff will tell you your health is important, but students have an internalized mindset,” she said. “Professors tell you when you get here you have to be the top student in Canada. You’ve internalized that you need to excel. You’re trying to compete with everyone else, and mental health falls through the cracks.
“It’s like a sacrifice you need to make.”