Jun 18 - Tracey Szarka - Something’s Gotta Give – But What?

Join Tracey Szarka as she explores the crisis of mental health on university campuses through the lens of her experience working with students at five Ontario universities.

​The complete sermon can be read below:

When I was a student at the University of Guelph in the mid to late 80’s I had many ups and downs – the downs often revolved around failed relationships (or at least, would-be relationships), parental friction (mostly with my dad), and anxiety over what career direction I should take given the whole biology thing was a bust. At one point, I made an appointment with a campus counselor to get some help with my sometimes overwhelming and conflicting feelings.
 
It happened to coincide with Halloween, and I showed up for my appointment dressed as a cat and with my naturally cheery disposition. My memory is hazy – I’m not certain how much of a role my inability to articulate my concerns played versus the general questions the counselor asked, but the meeting concluded with her assuring me that anyone who is comfortable dressing up in public for Halloween is probably doing okay.
 
At any rate, I’m confident that I was not suffering a crisis of my mental health in any concerning way – just the normal emotional roller coaster of youth transitioning to adulthood. And many today might say that the mental health crisis on campuses reported on so widely today is an overblown manifestation of the rollercoaster ride of this overachieving, special-snowflake generation raised by helicopter parents with overblown expectations. But is it? Let’s explore.
 
Full disclosure and disclaimer: I am not a mental health professional, although I have had some professional development in the area, including Mental Health First Aid. I don’t have any answers, only observations from my 20 years working with students in post-secondary education (or PSE). Oh, and some suggestions – I’ve always got suggestions! I am aware that many of you are mental health professionals, so I look forward to hearing your thoughts.
 
First, let’s look at students. Have they changed that much in the last 20 years? Or even the 30 years since I was in school? Why does there seem to be an explosion of PSE students struggling with significant and sometimes life-threatening mental health challenges? Depression and anxiety are the most common, along with addiction and substance abuse, however we’re also seeing an increase in reported cases of more serious issues such as bipolar disorder, eating disorders, post-traumatic stress disorder and other psychiatric diagnoses that tend to manifest in young adulthood. The 2016 National College Health Assessment, which surveyed 43,780 post-secondary students across 42 Canadian institutions, revealed that of those who responded, 8% had intentionally self-harmed over the last 12 months, 13% had seriously contemplated suicide, and 2.1% had actually attempted to take their own life. I have more information on the survey and general statistics that I can share after service if anyone is interested.
 
So what’s different? Certainly every generation has come of age into what seems to be an apocalyptic societal state. Various eras have featured global conflicts, profound economic depression, political tyranny, or uncertainty about what the future will hold. And certainly these are true of PSE cohorts over the last few decades. But here are some general factors that I think are relatively new:

• Our young people are contending with ALL of the above, and not just in their immediate sphere – they get to hear about dysfunction and devastation from across the globe, in real time. All the time.
• The amount of information they are bombarded with is more than the human brain can really process – it’s overwhelming.
• Social media… well, where to start with social media… Aside from contributing to information overload, it has been linked to significantly abbreviated attention spans, reduced facility with social interaction, social isolation, and has facilitated bullying and social aggression – and while these have always been a factor, the damage can be vastly more profound.
• A very competitive, fickle and disheartening job market, and the reality that the lifestyle provided by their parents may not be attainable by many of today’s students. There is also a corollary to this, in the widening divide of haves and have nots – there will be that segment who chose well or were at the right place at the right time, who will rise to levels their parents never dreamed of.
• Parental expectations and pressure. I have advised more students than I’d care to count who were in their program (usually STEM or professional related or bound) because their parents strongly suggested, even insisted it was in their best interests. Many students flounder because of a lack of interest or aptitude for their academic program. That’s not a new phenomenon, but what makes the stakes so much higher is the substantial cost of post-secondary education. University tuition can range from $7-12 thousand per year – that does not include ancillary fees, books, accommodation, meals and various other costs associated with school. The pressure to stick it out can lead to disaster and wasted money – much more than would have been “wasted” if the student had made a change while their grades were still high enough to be able to do so.
• Many PSE programs have very competitive admissions processes. And once admitted, the work is hard, there is LOTS of it, and the pressure to do well is overwhelming. Many students have never had less than an A, never mind failed a course. The pressure to do well is relentless – wherever it may have originate, the pressure has been internalized; students are incredibly hard on themselves.
• A growing number of international students on campuses face many of the same issues as domestic students – add to that significant distance and isolation from family and friends back home, increased financial obligations and pressures, and culture shock. It can often lead to students at serious risk.

 
Older teens and young adults are particularly susceptible to self-doubt, highs and lows, anxiety over school and love and work and making one’s way through life. So is there a higher rate of mental health disorders today, or is there just better diagnosis? The answer is probably YES. In some ways, I wonder if we are seeing significantly more cases of depression, anxiety and other issues partly because the efforts to de-stigmatize mental illness has a smashing success. While the societal factors I’ve mentioned – and so many more – may be leading to a greater prevalence of diagnosable issues, perhaps students are just more willing to seek help because we’ve been telling them it’s okay, it’s normal, there is help available – you don’t have to suffer in silence. Maybe it’s just not invisible anymore.
 
Additionally, these students are often the offspring of a generation who sought out counselling as a way to manage stressful events and periods of their lives – to have that objective ear who can help untangle emotions and motivations, and develop more effecting ways to manage themselves and their responses to the curveballs life throws them. As such, students may predisposed to seeking support in managing challenges.
 
So we have a tsunami of students seeking help from limited campus resources. And this, from my perspective, is one of the biggest contributors to the crisis in mental health on campus. In fact, Peter Cornish, the director of the Student Wellness and Counselling Centre at Memorial University, asserts that the crisis is one of access, not mental health.
 
Except for those students deemed to be at catastrophic risk and are seen immediately, at most institutions students must wait weeks, if not months for an in-person counselling appointment. As a result, students feel as if the institution does not care about them, that they are a number, and that their needs are not being met. They are frustrated and angry about this. And they are speaking out, demanding better services and sharing their stories with the media.
 
After 2 deaths by suicide at the University of Waterloo, and 4 at the University of Guelph in the current academic year, our local paper has covered the issue extensively, with students who are living with mental health issues sharing their perspectives. I’ll share some quotes here:

• UW Student: The university doesn’t take into account the nuances of humanity. The university isn’t a person-centered institution. It’s based on things that build up a company.
• WLU Student: I probably should have taken a year off before coming here. All the responsibility and taking care of myself is something I didn’t get too much exposure to when I was in high school and a kid. It was difficult to get the hang of being independent and a lot if it hit really fast and I never got a chance to recover.
• UW: Student: The culture of UW engineering is very much a culture of superiority. They think very highly of themselves… It made it difficult to admit that I failed a term.

 
An example of balanced reporting, the institutions’ perspectives have also been widely covered. And they raise some very valid points. First of all a significant reality that rarely gets air time: Post-secondary institutions are not social service agencies, and they are not funded as such. But while they are the in the business of education and research, they take great care to ensure services are available for students who are struggling, notwithstanding chronic underfunding from the provinces. From the dollar amount received for each full-time BIU (or student), and tuition & fees paid by student, institutions must create a budget for all expenses related to the education – including non-academic services – of undergraduate students. They do not receive any funds based on the head count for part-time or undeclared students, populations that is increasing.

As I’m sure you can imagine – or remember from your own post-secondary days - student fees, as well as tuition, are political footballs. It seems every year, students protest rising tuition and ancillary fees, often without a true understanding of the budgetary requirements and restrictions. Granted, they are at an all-time high, and predicated to increase over time. However, schools are not out to make a profit. They are revenue neutral in principle, and often have to work hard to avoid sliding into debt.

While student concerns about the prevalence of mental health issues on campus, and the inadequate resources to manage the demand are absolutely valid, students themselves may not be helping the situation as much as they could.
Recently at Laurentian University, students voted against a $70 increase in fees to augment counselling services available on campus. One student who voted in favour was quoted as saying, “…I don't think it's a matter of students not wanting to pay. I think students are just frustrated with the fact that it shouldn't even be a question if mental health services are implemented in schools." I appreciate the semantics, but I fear the lessons of Brexit and Trump are not being learned by this up-and-coming generation.

Additionally, there seems to be a belief that school staff and faculty should be mind-readers and intuit when a student is struggling. I’ve got news for you – students are really great at putting on that game face. For every student who is forthcoming and seeks out support, there’s another who is trying (and often failing) to work it out themselves. We are not mind-readers. We care deeply, we are observant and will follow up with students we see struggling. We notice patterns of maladaptation, changes in behavior, down-turns in academic outcomes. We try to coordinate observations within the limits of the privacy laws, and we reach out to students when we notice something concerning. But we’re not omniscient. And we can’t make students confess their struggles. Even if they do, we can’t force them to accept help, even if we take them right to the counselling and ensure they make an appointment.

Staff and faculty are also not the most constant presence in students’ lives. Typically their friends, room-mates and family are in a much better position to notice changes in behavior and mood. I often read accounts of students upset that nobody on campus helped their friend. I have yet to hear a student say that they advocated for their friend when they noticed them struggling. Please don’t misunderstand, I am not blaming students – it’s just that it takes a village.
Institutions are not perfect. After the second student took his life at the University of Waterloo in March of this year, the school was slow to respond, both to the community and to the family. There can certainly be more transparency in the wake of such tragedies. Wait times for counselling are incredibly long. And while there are actually many readily accessible resources for students, such as 24 hour help lines tailored to PSE students, community resources and, at many schools, student assistance programs which are provided by the same companies that provide employee assistance programs, I think the counselling departments could be more emphatic about letting students know about these resources as an option while they wait for their appointment.

Select staff and faculty members are often chosen to undertake professional development around mental health issues: understanding depression, anxiety, eating disorders, personality disorders, additions and other issues; identifying students (or, frankly colleagues) who may be at risk, or considering suicide; and providing that mental health first aid – what to ask and how, resources to refer students to, and emergency contacts. Because it takes a village, and we are all responsible for making sure our community members are safe. But it’s extremely important to remember that these people are not mental health professionals, nor will many of them ever be comfortable talk to someone in crisis. As an academic advisor at UOIT, I shared the concerns of my advising colleagues that the responsibility for addressing mental health was being downloaded onto us because of the significant lack of counselling resources available on campus. While we are definitely first responders, we are not equipped to be responsible for more than “first aid” and referral. Training staff in general is an important community strategy, but it is not the solution to the problem.

So what is? I’m afraid it’s not that easy. Institutions are experimenting with a variety of models and initiatives. Waterloo announced the creation of a committee on mental health to include students, staff and faculty. The truth is, however, they already had such a committee, as do most schools. They are already aware of issues and working on solutions. However, they often don’t include many if any students – sometimes by design, but sometimes because it is hard to retain students. They are eager to participate, but the reality of their academic existence leave them little time for additional commitments.
Memorial University has recently implemented the Stepped Care Program. The level of intensity of care is proportional to the complexity of the issues. The program is founded on the belief that not everyone needs to see a therapist all of the time. It also models an academic paradigm. The relationship begins immediately with a brief initial consultation, student and counsellor determine whether to take a low, medium or high intensity approach. There are 9 levels of stepped care with increasing intensity:

1. Walk in consultation
2. Informational online self-help
3. Interactional online self-help
4. Drop-in psycho-educational session
5. Therapist-assisted e-mental health
6. Interactive group therapy
7. Intensive individual therapy
8. Psychiatric  consultation
9. Case management referral to tertiary or acute care

From the initial meeting, students can be referred at whichever level makes the most sense for their situation. This reserves the most intensive (and costly) resources for those most in need, while still providing help for students who are looking for more general support during times of stress or upheaval. To put it another way, if you only have hammers, everyone has to wait for a hammer, even if that’s not the best tool for the job. Better to have a complement of needle-nosed pliers, screwdrivers and soldering irons!

If you currently have or will soon be sending a student off for an adventure at college or university, there are many ways to help that student be proactive, especially if they have had, are prone to, or have continuing mental health challenges. First of all, expect that your student will receive a quality education, recognize that the campus community cares, and that there ARE resources on campus – but it is not a social service agency. That means students and their families also have a responsibility for themselves to reach out when help is needed.

Here are some tips:

• If there are pre-existing issues, it’s crucial to arrive with a plan. A plan to manage current issues and to engage support locally, either on campus or privately nearby (if you have coverage or can afford it). Also, be sure to proactively connect with resources on campus and know how to reach out to them when needed. And register with the centre for disabilities. The student may never need accommodations, but it’s much easier to access them when necessary if you are already connected with CSD.
• Prepare your student for the culture shock – for the need to be more independent, for the reality that homesickness and loneliness will hit when they least expect it, and that it’s NORMAL. It will be challenging, it will be an uphill climb, they may not do as well as they (or you) expect not matter how high their secondary average was. Prepare them for LIFE, for making good choices about food, alcohol, laundry, room-mates… And know that they will make bad choices along the way. They just will. Mostly they will learn from them, and mostly they will not lead to irreparable damage.
• Dial down the pressure – a lot! Support and encourage your student to follow their interests, aptitudes and dreams – not yours! Know that it’s actually okay to reduce course load or take time off school in the wake of a massive personal disaster if the student is struggling to the point of incapacity. Know that lots of students who fail courses, and are even suspended, are able to come back and thrive in their program – or maybe it’s a sign that the program isn’t a good fit. I can assure you that the money “wasted” in taking an extra year or two as the result of a program change, a lighter course load, or time off is a drop in the bucket compared to the money, time and self-esteem lost by a student who continues to persevere in a program (for reasons of their own or their parents) to the point of academic disaster, leaving them unable to continue in that program, and ineligible for other programs because of the current state of their transcript.
• If you are concerned your student may be struggling, or even going off the rails, by all means contact the school. The student’s academic advisor is probably the best place to start, but be aware that privacy legislation prevents them from sharing any information, even whether or not they are registered at the school. However a compassionate advisor will work with you to identify resources to best help your student, and will encourage you to direct your student to them. Most are willing to meet with students along with their parents. But it’s important for you to help and support the student advocate for themselves, rather than taking the lead – unless they are unable to (which is different than unwilling…).

That’s a lot to digest, and food enough for thought. I’ll end with another quote from a UW student experiencing depression, anxiety and suicidal thoughts: “At times, we may be fragile, but that is not to say we are fragile all the time. There are times when we may feel broken, but we are not broken. There are times where we feel like nobody cares about us, we need to feel either cared for or validated. We ar not a project but at the same time, we are not a small child that you must hide form the horrors of the world. Treat us alike a person who needs help.”

What do you think? Has there actually been a higher prevalence of mental health issues among PSE students? Is it essentially unchanged, but students are more open about it and willing to seek help? Or have we moved to a paradigm where students are more open and inclined to seek counselling or other resources when they are feeling what could be described as distress that is a normal response to abnormal circumstances – in other words, rollercoaster emotions of life that will ultimately pass with or without intervention.

*****
​When I left UOIT (UG population about 10,000):

• One psychology, one mental health nurse and a social worker, were available only to DC students
• One case manager and a junior case manager on main campus
• Access to private counselling centre for downtown students

 
At UW (UG Population about 35,000):

• 22 counsellors
• 2 psychologists
• 1 mental health nurse
• Physicians
• Pear support groups

 
Suicide rates according to Stats Can:

• 15-19 years: 7.7/100,000
• 20-24 years: 11/100,000

UW, since 2012: 10 suicides, or 5/100,000