This report describes and summarizes the process and outcomes of a project designed to review and assess the mental health and related services provided to students at University of Waterloo. A primary focus of the review was the programs and services of three University of Waterloo departments: Counselling Services (CS), Health Services (HS) and the Office for Persons with Disabilities (OPD).
…project team, (was) tasked with determining and understanding the mandates, operations, programs, processes, structure and outcomes of the primary wellness units. The project will identify current strengths of existing services as well as make realistic and implementable recommendations that improve support.”
(Project Charter; Office of the Associate Provost, Students; June 1st, 2011)
All recommendations which emerged from this project complement a key aspiration stated in the University of Waterloo Sixth Decade Plan of a commitment to “the highest quality teaching, research, scholarship and services which support the academic enterprise” and that the Institution will “excel in service to students (i.e., provide “one-stop service” to students where possible)”.
Mental health needs of students – a crucial challenge in higher education
Providing adequate and appropriate support for students with mental health concerns in the college and university contexts has become a significant challenge in higher education across North America. Both the number and severity of mental health concerns presenting at campus mental health services have increased. More students now enter university already with a mental illness diagnosis and under or needing psychiatric care or professional counseling (Gallagher, 2011). Data from a Canadian sample of a recent American College Health Association National College Health (ASHA-NCHA) survey, suggests that of 33,747 total students enrolled in September 2011, 337 students (i.e., approximately 1%, conservatively) will have made a suicide attempt during the academic year and 2,024 students (i.e., 6% conservatively) may have “seriously considered” suicide during the year. Suicide prevention and support for students in crisis is a central component of the mandate and responsibility of any campus mental health plan – the data is unsettling.
The institutional burden related to the mental health of students in higher education includes considerations associated with risk management, ethics, responsibility and accountability, service delivery approach, confidentiality and privacy issues, and cost of support in the context of ever more limited resources. Our university is presented with all of these challenges with an added set of complicating factors relating to the diversity of our student population and our co-operative education program.
Higher education in Canada is responding. Recently, a group of university presidents formed a working group that will examine the mental health needs of students. Their report to the Association of Universities and Colleges of Canada will be designed to assist universities and colleges in responding to mental health issues of students in post-secondary education.
The relationship among the service providers and administration on campus
A recent report of the Ontario College Health Association, cogently delineates the many issues and challenges associated with the organizational structure of mental health service delivery on campus:
Although a number of mental health services are located on each campus, the degree of coordination and collaboration between these services varies greatly due to a number of potential barriers that exist. These include physical, departmental, and professional barriers, as well as the lack of time, resources, or will required to overcome these barriers and foster relationships. Physical distance between services prevents spontaneous communication that could occur if people work in the same space. Departmental barriers exist due to reporting structures and cultures that keep colleagues apart. Professional barriers are the most invisible and potentially the most significant obstruction to providing seamless care. They stem from differences in training, professional language, theories, expectations, status, power, and compensation. Communication and trust are vital when professionals share the responsibility of caring for vulnerable individuals with mental health problems. (OCHA, 2009)
Our report clearly indicates that University of Waterloo has not avoided the organizational barriers to ideal mental health service delivery as cited above. The Project Team recognizes that significant elements of this report challenge the status quo and will demand creative approaches to addressing the issues.
Campus consultation: data collection/methodology
The Project Team held regular weekly to bi-weekly 1-2 hour meetings from June 2011 through February 2012. During this time span, the Project Team compiled and consulted a variety of publications related to mental health issues on campus. The Team conducted structured interviews of the three departmental directors, interviewed selected “key informants” from both within and outside the campus, and conducted focus groups with the majority of the staff of the three departments. The Team also conducted a student survey with a focus on mental health programs and services. 1097 University of Waterloo students responded to the survey. The Project Team also attended an Undergraduate Operations Committee meeting where input from Associate Deans across campus was obtained. Many individuals who have contributed to this report have been candid in delineating our unique challenges and concerns while expressing a genuine yearning to work together effectively for the benefit of our students.
Findings from the campus consultation
Results of the stakeholder focus groups
Data from the focus groups was analyzed and coded for themes and patterns. Six themes emerged that guided data interpretation. The six themes, in order of the priority given them by the participants, are the following:
- Breaking down service delivery silos: This theme includes suggestions that advocate for greater collaboration, enhanced communication and structural integration of mental health service delivery.
- Prevention and early identification/intervention: Responses in this category encourage the campus mental health services and the university as an institution to be proactive in considering earlier interventions for students and to identify sources in the campus context that may present preventable distress for students.
- Enhanced student access to mental health services: This theme focuses on the need to enhance ease of accessibility to mental health services on campus. This category also includes considerations related to the stigma associated with students’ willingness to access services, such as potential cultural perceptions in accessing and utilizing mental health services.
- Staff/caregiver well being: Responses included in this theme reflect the need to be aware of, accept and address the reality of caregiver burnout and the need to address increased demands for service from an increasingly diverse and challenging client population.
- Staff development and education: This theme captures suggestions regarding the need for education and staff development aimed at incorporating best practices.
- Recognition of gaps in services: This category of responses includes observations related to gaps in the campus mental health service delivery system.
Key results of the student survey
- The top five aspects of the university experience that have been difficult for students in descending order of degree of difficulty experienced are: managing time effectively; getting enough sleep; managing academics; managing anxiety related to academic success and managing life stressors.
- When asked what is most important to University of Waterloo students, the top six responses in descending order of degree of perceived importance are: programs or advice on managing stress; learning strategies to help manage depressed moods; support during a personal crisis; financial counseling; programs that help students connect with other students who have similar interests; support programs that are sensitive and user-friendly to a student’s unique culture and language.
- Students generally had good awareness of the existence of the primary wellness units but a limited awareness of the scope of their services. What is even more significant, however, is that not all students are aware of the existence of these services. In practical terms, approximately 1 in 10 students (i.e., CS – 11%, HS – 5%, OPD – 15%) are unaware that these support services are available to them.
- When asked in the qualitative section of the survey to comment on what each of the three departments should “stop” and “start” in order to improve the campus mental health support system, the most frequent comments related to wait times for initial and subsequent appointments at CS and concerns expressed regarding availability of appointments and waiting while in the clinic at HS. At OPD, the most frequent comments expressed concerns regarding office procedures such as intake, efficiency and organization of the office.
Overall conclusions and interpretations
The results of the campus consultation and sources of professional literature were used in deriving conclusions and interpretations leading to the project’s recommendations, from which a number of key strategies should emerge related to the following organizing mental health services to work together smoothly; enhancing efficient access to services for students; recognizing the diversity of the student body in facilitating access to mental health services; considering the needs of students with mental health concerns in the OPD context; promoting staff development and education for best practices; providing resources to address staff wellness and care for the caregiver; and encouraging proactive approaches to mental wellness, including prevention and health promotion.