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:
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:
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:
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:
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):
At UW (UG Population about 35,000):
Suicide rates according to Stats Can:
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