Mental-health needs have stretched universities. As they prioritize services for students, the sharply rising need for mental-health care" has created escalating pressures on institutions whose core mandate is to provide higher education and training. Colleges and universities are not treatment centres," says a recent report co-authored by the College Student Alliance, the Ontario Undergraduate Student Alliance, Colleges Ontario and the Council of Ontario Universities.
And this is the key problem.
Providing mental-health care may not be a university’s core function, but demand for care has only risen. A National College Health Assessment in spring 2016 found that 44 per cent of the 43,780 Canadian higher-education students surveyed felt so depressed over the previous year that it was difficult to function, up from 38 per cent in 2013, while 65 per cent experienced overwhelming anxiety, up from 57 per cent in 2013.
At the same time, anti-stigma campaigns and awareness have encouraged students to seek help. So, now that universities are increasing their mental-health services, how has their approach changed –; and what might students look for when seeking help?
"What we've seen over the years is a spiked increase, probably 400 per cent at this point since 2010, of students seeking support for mental-health issues," says Janine Robb, executive director of the Health and Wellness Centre on the University of Toronto's St. George Campus. This required a shift in services away from their earlier focus on learning disabilities, and more toward mental-health care, she says.
"At the same time, you'll recall that back around 2011, 2012, there was a lot of publicity in the media around the crisis on campus, on burgeoning mental-health needs," she added.
Anti-stigma campaigns addressed the need for students to seek counselling or mental-health care “in the same way that they do for physical health. It created that space where people feel comfortable asking for that help,” Ms. Robb says.
The University of Toronto, like other institutions, has sought to strengthen the access points where students can find help, from drop-in student support services to group therapy programs and, if needed, psychiatric care. Sometimes, students may even reach out for help through a financial-services officer or an academic advisor.
But given these multiple access points, one challenge is to create a standardized understanding of what, in fact, a student seeking help might need.
Another is that sometimes students might jump the gun. What they may see as a serious problem, such as intense stress and academic pressure, may be an experience felt by all students.
“In my world – I come from a mental-health background – I find that a lot of terminology that is being used on campus is diagnostic terms,” Ms. Robb says. These might be terms bandied around by some students and peers, when what they are really describing are simply uncomfortable feelings. “That overpathologizes [those feelings], or makes more people think that they’ve got some kind of disorder, but actually it is kind of a normal process,” argues Ms. Robb. So, this is where a more standardized approach across access points is necessary, she says.
“We have been working to understand what we can do to help students strengthen their resilience or grittiness, because students somehow get to campus and think that they are broken,” Ms. Robb says.
"I think that has to do with the competitive environment," she says. These are students who were often top of the class in high school, but are now at a university where everyone was top of the class. "So it really does create a lot of transitional stress."
Another challenge is how quickly services can help a student.
“What we encourage campuses to do as much as possible is to have immediate, same-day access, whether that be through peer support available immediately, and other campus walk-in services, whether with physicians or mental-health providers, just like you have walk-in clinics in the community,” says Peter Cornish, associate professor and director of the Student Wellness and Counselling Centre at Memorial University of Newfoundland in St. John’s. He is a proponent of the step program for institutions, in which schools provide a number of different levels of care – different steps, rather than just concentrating on the more severe cases.
For instance, if a student feels overcome with anxiety and is looking for assistance, that student should have quick access to care to take advantage of that window in which they are seeking help.
"The idea is that when a student has a particular concern and is reaching out, it is an opportunity for capturing their motivation and their interest to make a change in their lives. So, as much as possible, you don't want people to wait," Dr. Cornish says.
"What's changed is that we have expanded the options, [with more] lower-intensity options, so that the students who aren't mentally ill, but could become mentally ill, can actually work on mental fitness," Dr.
Cornish says. "Some students who come in distress aren't psychiatrically ill. They are not mentally ill. They just need some tools that they can use."
Some of these tools can include basic, online resources and printed material, including mental-health workbooks and exercise guides, available to students any time.
Yet, even with this basic level of service for students who are not seeking full treatment, but just resources to understand what they are feeling, services do not just want to send students away with a handful of information.
Rather, they encourage repeated communication between students and student services and aim for an open dialogue to better serve students' needs.
“What is crucial is that we do review these tools, but at the same time, we also teach students how to be discerning,” Dr. Cornish says. This two-way communication, administrators say, helps to shift the focus to particular problems.
"We could see, for example, that the No. 1 pressing issue for our students, similarly to other institutions, was very high levels of anxiety. So, we really tailored our programs to focus on that. The second area was mood issues, issues around isolation and loneliness," says Vera Romano, director of the Rossy Student Wellness Hub at McGill University in Montreal. The Wellness Hub is both a physical clinic and gathering space at the university, as well as an outreach program for the whole campus.
The aim is to tailor the program in a way that suits what students are facing now campus-wide.
"The intention is to be proactive, as opposed to reactive," Dr. Romano says.
“What we see all over North America, if you look at the numbers, is that demand is increasing at a very high rate. The levels of stress seem to be increasing. And we want to be intentional in saying we’re providing the right kind of care at the right time, to the right students when they are presenting problems – and not giving this a one-size fits-all [response], which really was the more traditional way.”