As more students seek mental-health care, they face long waits – or pay out of pocket – as universities struggle with demand
High
demand for counselling is changing how Canadian campuses get students
the help they need – but many still feel they’re falling through the
cracks
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Julia
Burnham, a fourth-year student at the University of British Columbia,
has been diagnosed with PTSD, panic disorder, social anxiety disorder
and major depressive disorder. She’s spent about $2,500 seeking help
since her first year.
Jackie Dives/The Globe and Mail
Julia
Burnham knows the symptoms well: a simple stop in a busy coffee shop or
crowded bus ride can prompt the sudden, frantic feeling that she can’t
get enough air. For years, she has suffered from full-body anxiety
attacks that can leave her sobbing in a workplace bathroom, or urgently
seeking the safety of her bedroom. A numbing depression follows, which
can keep her housebound for a day or two.
The
fourth-year university student may seem like a perfect candidate for
school counselling services – the kind that postsecondary institutions
have been offering for more than 60 years. But in fact, with her
multiple diagnoses of post-traumatic stress disorder, panic disorder,
social anxiety disorder and major depressive disorder, Ms. Burnham is
exactly the kind of student that many universities now try to refer to
resources outside of their counselling centres.
For
the past three years, Ms. Burnham has been paying $120 a visit to an
external Vancouver psychologist – rather than relying on services
University of British Columbia students can access without charge.
(Counselling services can be funded in part by annual student fees.)
The
number of young people seeking mental-health help, in Canada and
worldwide, has been rising for years, and the phenomenon is stretching
school resources. Under the strain of appointment gridlock, student
criticism and, in some dire cases, suicides on campus, postsecondary
institutions are rethinking their strategies to handle the mounting
need. At UBC, that has meant a new-found focus on referrals. By taking
students with more enduring needs out of internal counselling, the
thinking goes, more students can be seen by the school team, and those
who require more complex support will get the help they need.
The
strategy is getting the university its intended results: Data out of
UBC showed a drastic shift last year, bucking upward trends of other
large schools such as the University of Toronto and Queen’s University.
The number of students in UBC counselling, as well as total
appointments, dropped for the first time in at least seven years – by
542 students (or 13 per cent) and 906 sessions (or 7 per cent.) Dr.
Cheryl Washburn, who directs UBC’s counselling services, says the drop
is “directly tied” to the increase in options outside their centre,
including more access points for services, online programs and resources
in the wider community.
The
numbers at counselling services tell a success story, but the
experience of some students show there is a hidden cost. The increased
demand on mental-health resources is not contained to just universities.
The health-care sector is also feeling the squeeze, meaning public
health practitioners are backed up, too. “Demand for care continues to
exceed the supply of clinically active psychiatrists,” says Mathieu
Dufour, co-chair of the Coalition of Ontario Psychiatrists. Some
students seeking help off-campus, including from external psychiatrists,
have been referred back to their university campuses for care.
For
students who are able to pay out of pocket, options expand to include
psychologists or psychotherapists – but with a going rate of more than
$100 an hour, and sparse coverage under student health-care plans, these
services are only accessible to economically advantaged students.
“I
was really fortunate that I was able to afford the luxury,” Ms. Burnham
reflected, pointing out that she’d also paid less than most patients,
as her psychologist offered students pricing on a sliding scale. All
told, offset marginally by a $300 allowance from her student
health-insurance plan but mostly shouldered by supportive parents, she’s
spent approximately $2,500 seeking help since her first year.
Unlike
other students with continuing needs, Ms. Burnham wasn’t referred to
her psychologist by UBC counsellors – she sought one out directly, in an
effort to avoid long waits and repeated recitations of her history with
mental illness, only to be referred to an external resource anyway.
“I
don’t have the emotional energy to go through another process and
re-explain everything to these people that may or may not actually help
me in the end,” she said.
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On
Julia Burnham's windowsill, a decoration reads: 'She's got house plants
to keep her company.' In a glass jar, she has a collection of her empty
medication bottles. On the inside of her apartment door, a memo reads:
'Just go to class.'
Jackie Dives/The Globe and Mail
Counselling
services in universities originated around the end of the Second World
War, when veterans returning to campuses required specific educational
and vocational supports. Decades later, the purpose of the centres is to
address more broadly students’ mental-health needs. The increased
demand for mental-health support on campuses can be attributed to a
miscellany of factors, from changes in parenting styles to decreased
stigma and increased awareness of students’ mental health. Some experts
point out that increased technology use can be tied to changes in brain
development and modified sleep patterns; some believe young people today
are less adept at emotional self-regulation than past generations,
feeling pressure to succeed, but lacking the proper mechanisms to cope
with failure.
Cross-country data
compiled by The Globe and Mail give a glimpse of the mounting pressure
in university counselling offices. At the University of Toronto, a rise
in appointments has vastly outpaced the rise of the overall student
population. Its population went up 8 per cent from 2012 to 2017; in the
same time frame, appointments rose approximately 40 per cent. Prior to
last year’s drop, UBC’s counselling appointments had risen constantly
for six years, up 89 per cent from 2010-11. The number of students being
seen increased by 74 per cent in the same span.
UBC counselling visits
By school year
Students seen
Sessions
THE GLOBE AND MAIL, SOURCE: ubc
| Year | Students seen | Sessions |
| 2010 - 11 | 2402 | 6942 |
| 2011 - 12 | 2539 | 7131 |
| 2012 - 13 | 2777 | 8270 |
| 2013 - 14 | 2862 | 9093 |
| 2014 - 15 | 3262 | 11146 |
| 2015 - 16 | 3870 | 12012 |
| 2016 - 17 | 4172 | 13108 |
| 2017 - 18 | 3630 | 12202 |
UBC counselling visits
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UBC counselling budget
By school year
THE GLOBE AND MAIL, SOURCE: ubc
×
| Year | Budget |
| 2010 - 11 | 1023409 |
| 2011 - 12 | 1080793 |
| 2012 - 13 | 1192067 |
| 2013 - 14 | 1363247 |
| 2014 - 15 | 1450893 |
| 2015 - 16 | 1900946 |
| 2016 - 17 | 2240940 |
| 2017 - 18 | 2670809 |
UBC counselling budget
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Dalhousie
University in Halifax moved to a new service model for health care in
2017, meaning they’re creating new metrics and a new baseline for
tracking purposes. But data released by the university in 2015 showed a
five-year increase in counselling demand, up by a total of 68 per cent.
“And it’s not slowing down,” they wrote, noting that of the 1,248
students seen for initial consultations in 2013-14, 763 were put on a
wait list averaging 20 days in length. Mental-health appointments at
Queen’s University in Kingston have increased by 73 per cent in the past
five years, far outpacing the school’s 13 per cent enrolment increase
over the same time period. And at McMaster University, in Hamilton, the
counselling service logged more than 11,000 visits last year – 40 per
cent more than they documented in the 2012-13 school year.
McMaster University
counselling visits
By school year
THE
GLOBE AND MAIL, SOURCE: mcmaster universitY. NOTE: the decrease between
2015 and 2017 IS due to counsellor departures and leaves of absence
×
| Year | Total Counselling visits |
| 2012 - 13 | 7934 |
| 2013 - 14 | 9002 |
| 2014 - 15 | 9778 |
| 2015 - 16 | 8513 |
| 2016 - 17 | 8750 |
| 2017 - 18 | 11099 |
McMaster University counselling visits
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The
escalating demand has forced postsecondary institutions to consider
anew what lies within their scope. “Colleges and universities are not
treatment centres,” declares a joint action plan, In It Together,
released by four Ontario postsecondary groups in 2017. Schools’ core
mandate is higher education, and they would stand with their students,
they said, but couldn’t meet the challenge of mental-health demand
alone. The report claimed that acute and long-term mental-health support
falls within the mandate of health-care providers and community
agencies. They cited the pressure schools are under, and appealed for a
distinction to be drawn between their “triage role” and the actual
administering of long-term or acute care.
At
McMaster, dean of students Sean Van Koughnett says they’d have lineups
out the door if their counselling staff tried to handle all the cases
that required continuing treatment. They were lucky, he explained – they
had resources nearby, such as St. Joseph’s Healthcare. The hospital is
strapped by demand itself, but he believes they’re still
better-positioned to handle complex cases.
“The
demand became such that it just wasn’t something that we should try to
continue to manage, or could manage,” he told The Globe in an interview.
They’ve tried, hiring four full-time counsellors and one part-time
counsellor in the past two years with funds from both increased student
fees and the previous Ontario government. A new wellness centre is set
to open within the next year, because even if he had access to more
funds, Mr. Van Koughnett says he just doesn’t have the space to put more
staff right now. Their increased appointments were a better indicator
of capacity than demand, he cautioned, as staff have been continually
going “full tilt,” adding appointments only with more staff to shoulder
the load. “It’s something we’re constantly wrestling with, as to how
much we can do,” he said.
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Dr.
Rina Gupta, director of counselling services at Queen's University in
Kingston, holds a one-on-one session with a patient. She believes staff
are more often working longer hours than required to find time for
students.
JOHNNY C.Y. LAM/The Globe and Mail
Anecdotal
evidence from mental-health professionals suggests that students are
arriving at school clinics with more intricate cases than ever before –
and not all schools have found success in referring their most acute
cases out to community resources. For the past two years at the
University of Toronto, health and wellness centre director Janine Robb
says she’s observed a trend where external resources and external
psychiatry will refer patients back into the school’s care – “because
they have the designation ‘University of Toronto student,’” she
explained in an interview. “So, we’re getting more complex and acute
students, which doesn’t really fit with our short-term model. It’s been a
real task of negotiation.”
She says
that nearby care systems such as Toronto’s Centre for Addiction and
Mental Health will see students in emergencies, and will admit them as
needed. “But there’s no long-term follow-up generally available,” she
said. “This is ridiculous,” she added, noting that the age of most
university students is such that, with early and effective intervention,
the long-term burden of mental illnesses can be reduced.
“It’s really hard, if we need a student to have long-term care, to actually find that care for them.”
That
returns the pressure to U of T, where counselling staff have taken to
dividing up bigger offices to create more spaces to work in. They, like
many other universities, have adopted a ‘stepped care’ approach. That
dictates that treatment starts with the least intrusive, least intensive
tactic. Not all their efforts related to mental health have gone
smoothly: last summer, a new policy drew criticism from students and the
Ontario Human Rights Commission alike. (The policy can place mentally
ill students on mandatory leaves of absence, if the administration
becomes aware of a risk where that student might harm to themselves or
others.) “I don’t think it would have been a first priority for a
university to be providing this much mental-health support,” Ms. Robb
said, speaking broadly of the school’s efforts. “But we also have to
support our students in the ways in which it’s needed. I think we do the
best we can.”
The sheer volume of
students is a challenge in Toronto. Four hours north, at Nipissing
University in North Bay, assistant vice-president of students Casey
Phillips sees the institution’s smaller size as an advantage.
“Sometimes, [larger schools] might not have a student brought to their
attention,” he said. “Or, because of the plethora of services that are
available, navigating those might be sometimes more of a difficulty.”
They
saw 30 per cent more students last year than their counsellors aided in
2012-13. At times, Mr. Phillips says the school is acting as a
temporary aid of sorts – a bridge until a reading week or break, when
students can access services in their hometowns that aren’t available in
the North Bay community.
Across
the board, schools are doing what they can with the resources
available. At Queen’s University, arts student Raechel Huizinga told The
Globe she was seen by an engineering faculty counsellor for months.
“Those types of things wouldn’t surprise me,” said Rina Gupta, the
school’s director of counselling. She said she believes staff are more
often working longer hours than required, to squeeze students in. Their
wellness service has increased total health-care appointments by 37 per
cent since 2015-16, or 13,000 appointments, but wait times still aren’t
going down.
Students get frustrated
at times, sometimes taking to online groups or forums to vent about
their experiences. “There have been a lot of students who have been very
vocal about wait times or not being to access services, and that’s
understandable if students are feeling stressed,” Dr. Gupta said. On a
typical day, she says she often cancels prior commitments to address
students showing up in crisis, who they try to accommodate right away.
“I did that three times yesterday,” she said in a phone call.
Queen’s
maintains a team of physicians, nurses, psychiatrists and occupational
therapists in addition to counsellors. Other schools have their own
combinations of health-care professionals to complement counselling, and
some offer an additional ‘peer support’ option – a hub of student
volunteers that can offer a listening ear. (This has its limitations, as
students cannot prescribe or advise on medications, and they are not
trained mental-health professionals.) Queen’s recently implemented 11 or
12 group options, from therapeutic groups to skill building. They’ve
started looking at adding web-based components to the service, for use
between appointments or while waiting for one. Ultimately, Dr. Gupta
echoed the sentiment expressed by Ms. Robb in Toronto: “We’re trying our
best,” she said.
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Caitlin
Grogan, a student at the University of New Brunswick, tried to transfer
to Dalhousie University in Halifax but transferred back after facing
long wait times for mental-health services.
Michael Hawkins/The Globe and Mail
But
for every school’s efforts – multimillion-dollar budgets that continue
to grow, new wellness centres and redeveloped strategies – there are
still students across the country feeling as if they’ve fallen through
cracks. Before University of New Brunswick student Caitlin Grogan
transferred to Dalhousie in 2016, she called the Halifax school on the
advice of her family doctor, to make sure she could access mental-health
care. Ms. Grogan has borderline personality disorder, and takes
anti-depressant medication regularly. “I was mostly just looking for a
counsellor to see every two weeks and just check in,” she recalls.
What
followed was a series of standbys. The school didn’t book appointments
in advance, Ms. Grogan said, so she waited to arrive in Halifax to set
up an initial intake meeting. Advised to call for a same-day
appointment, she described three days of 9 a.m. calls, during which she
was repeatedly told that no slots were available. She was then prebooked
for a 30-minute assessment, for which she reports waiting another two
weeks. From there, she says she was left to wait for a call, which would
come when there was a counsellor available to see her regularly. Months
passed. Eventually, frustrated, Ms. Grogan transferred back home to New
Brunswick. (Dalhousie declined to comment about Ms. Grogan’s specific
experience, citing confidentiality.)
Upon
her return, Ms. Grogan sought to change things at the school. She
became vice-president of her student union – a position that involves
advocacy on mental-health issues and assisting the assessment of campus
mental-health services. The New Brunswick university is struggling a
little more than usual right now, she said, with one counsellor out on
maternity leave. That means more students are being referred out.
While
postsecondary institutions across the country struggle with similar
issues, Ms. Grogan says a viable solution will take more than new
counsellors. “They’re always going to be full. We can’t hire our way out
of this mental-health crisis,” she said. She urged schools to instead
look into the causes of student distress.
“I’ve just become very passionate about making sure no one falls through the cracks, like I did.”
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