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Winter 2011/12 | Vol 15 No 2

Focus

Campus in crisis

Support services help students make the grade

By Avril Roberts

“Every semester I have this debate with myself: Am I going to warn people that I’m crazy and that I may go crazy during the semester and that I’m going to require specific kinds of assistance? Or am I going to shut up about it and see how it goes? If it goes well, they’ll never know. And if it doesn’t go well, I’ll deal with it then.”

That’s how Elizabeth, a member of the Toronto-based Mad Students Society, describes her first experience at university. It’s an experience that is becoming increasingly familiar to counsellors who work in college and university counselling and disability support services across the country.

At York University in Toronto, Mental Health Disability Services has seen a 52 per cent increase in student registration over the past five years, with 891 students in 2010/11. “Compared with students who have chronic (physical) illness and other medical disabilities, students with mental health disabilities represent the fastest growing population of students with disabilities on our campus,” says Dr. Marc Wilchesky, executive director of Counselling and Disability Services.

“There is a perception among counselling centre directors that the severity and complexity of problems are increasing dramatically,” says Dr. Rice Fuller, counselling director at the University of Fredericton in New Brunswick. The Center for Collegiate Mental Health, a consortium of college counselling centres based at Penn State University, is conducting large-scale research to examine the issues. The University of New Brunswick will be a participant, along with other Canadian universities.

Dr. Enid Weiner, manager of York’s Mental Health Disability Services, agrees that student mental health is a growing concern: “Not only are more students presenting to disability offices; it’s also a different population. We see students with schizophrenia, post-traumatic stress disorder, bipolar disorder and major depression, and we see a tremendous number of students with anxiety disorders.” This is mirrored in findings from the Canadian Campus Survey 2004 and the National College Health Assessment 2010 (U.S.-based but with some Canadian post-secondary institutions), which show that depression and anxiety are prevalent concerns.

“Compared with students who have chronic (physical) illness and other medical disabilities, students with mental health disabilities represent the fastest growing population of students with disabilities on our campus.”

Such findings don’t come as a surprise. Immersed in a competitive environment and away from home and supports, often for the first time, students can have a hard time adjusting. For those with mental health problems, the pressures can be particularly challenging. University students interviewed for this story describe some of the obstacles they face:

Fear of discrimination. “To say what’s wrong with me is in my mind a really risky move in academic places.”

Being away from usual supports and resources. “You come to university at 18. I was transitioning out of the youth health system, but I didn’t have connections established yet in the adult system. The transition was huge.”

Self-identifying as having a mental health disability. “I registered with disability services because it was seen as the responsible thing to do, and all of a sudden, I became a disabled student.”

Coping with episodic illness. “Last year was a really tough year. I spent three months in hospital.”

Lack of awareness of campus resources. “Academic accommodation wasn’t available in high school, so I couldn’t even begin to conceptualize what would be helpful.”

Isolation. “I had moved to another city to attend university. I didn’t know anyone. I found it difficult to engage in any of the communities on campus.”

Managing symptoms and medication side-effects. “I was struggling, sitting in the library and crying most days.”

Extra expenses. “I had to pay $3,500 for a psychological assessment so I could get academic accommodations. Just having the diagnosis wasn’t enough.”

Universities and colleges typically offer various levels of disability support and counselling and medical services. Brock University in St. Catharines, Ont., has taken it one step further. It may be the only university in Canada with a transition to university program that has a component specifically for students with mental health disabilities.

Students about to begin their first year can register for Smart Start, an academic orientation program the university runs for seven weeks in the summer. Students who indicate they have a mental health disability are contacted by the transitions co-ordinator from Services for Students with Disabilities, who explains the supports and academic accommodations available. Students who submit the relevant documentation are matched to a case manager. The first meeting happens during the orientation, with a follow-up recommended for early September, explains Mary Ann Gadula, the program’s transition co-ordinator. Of the 119 students with a disability who participated in Smart Start in 2011, 22 had a mental health disability.

At York University, the primary focus of Mental Health Disability Services is to provide educational support. A major goal is to encourage students to become as independent as possible and become better self-advocates. Weiner is concerned that “many students are coming in with a diagnosis of anxiety disorder but no effective tools to handle it.” And when reduced course load is suggested as a possible way to manage school demands and mental health, “some students get terribly offended,” says Weiner. The program also offers psychoeducational groups and workshops on topics such as managing academic anxiety and procrastination that are open to all students.

Another valuable service is peer mentoring by upper-year students. Kristin, a graduate student and peer mentor, says the three biggest concerns she hears from first-year students are how to approach professors with an accommodation letter, including how much to disclose and how to handle potential negative reactions; what financial assistance is available; and social isolation.

At a commuter university like York, with more than 53,000 students, first year can be overwhelming. “If you are dealing with mental health issues and stress, you often don’t have time to attend group support,” says Kristin. “The peer mentor relationship becomes very important in helping to provide perspective for sorting through some of the chaos. Having one person who understands where you’re at, where you’re coming from and some of the things you experience can make all the difference in the world.”

York’s Counselling and Disability Services offers personal counselling services, usually short-term counselling, mainly for crisis situations, and learning skills services for students with all types of disabilities; however, it lacks staff who can assist students with medication management.

“The peer mentor relationship becomes very important in helping to provide perspective for sorting through some of the chaos. Having one person who understands where you’re at, where you’re coming from and some of the things you experience can make all the difference in the world.”

McGill University in Montreal, Q.C., offers full psychiatric services on campus, short of hospital beds. With 21 professionals (11 psychiatrists, plus psychologists and psychotherapists, many of them part-time), the Student Mental Health Service is well-equipped to deal with clinical issues. Anxiety and depression top the list, but the clinic is also seeing more students who have had psychosis. “Because of advances in medication, these students are able to continue their academic work,” says Dr. Robert Franck, the clinic’s director.

Access to services is relatively quick. “We try to keep it to a two-week maximum wait because two weeks is a fair length of time in a semester, especially when students are struggling,” says Franck. There is an emergency drop-in for crisis. Short-term therapies such as cognitive-behavioural therapy and short-term dynamic therapy are offered, as well as medication management. Students who need long-term therapy are referred to community resources.

About 1,200 first-year students visited the clinic last year. Many are encouraged to also seek help from other campus resources such as the Counselling Service, the McGill University Health Centre and the Office for Students with Disabilities.

In the only program of its kind in Canada, McGill has a fully integrated university-based eating disorders program for students with mild to moderate eating disorders. It is staffed by two psychiatrists, a nutritionist and a nurse and treats about 100 students a year. Franck says this kind of service is critical because “untreated anorexia is one of the most fatal conditions in psychiatry, with a 20 per cent mortality rate.” Students with severe eating disorders are referred to Douglas Hospital for treatment and monitoring.

On the other side of the country, the University of British Columbia (UBC) in Vancouver is taking a systemic approach to student mental health with a comprehensive student mental health plan. “The overall aim is to create a mental health–promoting campus culture and environment,” says Dr. Cheryl Washburn, director of Counselling Services. The plan, which is in the process of being rolled out across campus, involves three levels: prevention, identification and intervention.

The prevention level addresses mental health awareness through the B.C.-wide Healthy Minds/Healthy Campuses Project, led by the Canadian Mental Health Association–B.C. Division and the Centre for Addictions Research of B.C. It includes strategies for building a supportive campus environment, for example, through peer programs that facilitate a sense of belonging. Suicide prevention measures are threaded throughout the mental health plan and include training student residence advisors to identify students at risk.

Identification targets students who need to enhance their skills to function well on campus but who do not necessarily require professional assistance. UBC will launch an early alert system this winter. The goal is to train all faculty and staff to identify students with difficulties as early as possible and connect them to supports. The Live Well, Learn Well website promotes mental health awareness and skills development and supplies information about campus resources. Students are also routinely screened for depression at both Counselling Services and Student Health, whether they are seeking help with relationship problems or flu.

The intervention level targets students who need professional assistance. Two years ago, Counselling Services implemented a rapid access system, providing students with a same-day initial appointment. Recently, the clinic hired a case manager to assist students with complex mental health needs who require referrals to multiple services on campus or in the community. For instance, if a student is hospitalized, the case manager liaises with the hospital to discuss the student’s discharge and ensures that appropriate supports are in place to facilitate the student’s return to school.

If a student is hospitalized, the case manager liaises with the hospital to discuss the student’s discharge and ensures that appropriate supports are in place to facilitate the student’s return to school.

“We look at the specific changes that students identify they need to get back on track and follow through with their academic term, and we consider what combination of resources would best help,” says Washburn. “Unless there are issues of risk, the student is the one empowered to make those decisions.”

Progress is also being made at the national level. Realizing that mental health issues on campus cannot be the responsibility of counselling services alone, the Canadian Association of University and College Student Services struck the National Working Group on Post-Secondary Student Mental Health (PDF) in 2011. As described by Washburn, who serves as co-chair, the working group has two main aims: to develop a systemic post-secondary student mental health strategy and to develop a community of practice to support implementation. (See “Student stress rising in the ivory tower” sidebar for more information.)

This is good news for students with mental health issues. Those interviewed for this story agree that completing college or university should be an attainable goal. “I was experiencing pressure that I had to leave school, drop out of life and get well, then come back and stay well for four years,” says Elizabeth, who is now at York University. “That’s like taking away hope from people and discouraging them from pursuing their goals. People have a right to go to school, take a leave of absence if they need it, get accommodation if they need it and be provided with support. It’s possible to go through school as a mad person, and it’s possible to experience periods of distress, press on and just continue.”