2021 CoSMH Implementation Report

Report Contents

  1. Introduction 
  2. Moving from Recommendations to Action 
    1. CoSMH Structure and Function 
    2. Key Changes Related to Student Mental Health 
    3. Challenges in the Implementation Process
  3. Recommendations for Future Directions 
    1. Continued Focus on Student Mental Health and Wellness
    2. COVID-19 and Return to Campus 
    3. Ongoing Evaluation
    4. Communication
    5. Evidence-informed Decision-making
    6. Expanding Collaborative Partnerships
  4. Acknowledgements
  5. References

Note: The report is also available for download as a PDF


Universities are large, complex organizations composed of a broad range of stakeholders with diverse responsibilities and interests related to education, research, knowledge exchange, entrepreneurship, and development of civil society. Students are engaged in all aspects of university life, making their mental health and well-being essential to the viability of the organization as a whole (Robinson et al., 2016).

Challenges associated with post-secondary education, combined with psychosocial transitions from youth to adulthood, economic and housing instability, isolation from family and prior support networks, and concerns about future employment prospects can have negative effects on student well-being (Dunley & Papadopoulos, 2019; Linden & Stuart, 2020). Additional complexities affect specific groups: international students, who must adapt to new cultural contexts; students with pre-existing mental health concerns; and those from marginalized communities (Dunley & Papadopoulos, 2019; Giamos et al., 2017; Ng & Padjen, 2019). The consequences of enduring numerous stressors are evident in surveys of student mental health in post-secondary institutions across Canada, which have consistently reported high prevalence of symptoms related to anxiety, depression, and stress (Giamos et al., 2017; Linden & Stuart, 2020; Ng & Padjen, 2019; Robinson et al., 2016). For many Canadian universities, tragic events such as student suicides, combined with increased awareness of broader mental health concerns experienced by post-secondary students, has led to initiatives to improve their psychological well-being and safety (Giamos et al., 2017; Linden & Stuart, 2020; Monaghan et al., 2016; Ng & Padjen, 2019; Robinson et al., 2016).

In 2017, the University of Waterloo established the President’s Advisory Committee on Student Mental Health (PAC-SMH) to identify actions the University could take to enhance student mental health. That committee engaged over 700 students, staff, faculty members, and other members of the campus community to develop 36 recommendations for change aimed at improving the mental health and well-being of all students. Within two months of receiving that report, the University established an implementation committee to bring its recommendations to life. 

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Moving from Recommendations to Action

The Committee on Student Mental Health (CoSMH) was established in May 2018 with a mandate of implementing all 36 recommendations in the PAC-SMH report. The key themes of these recommendations included social support, mental health awareness, early intervention and skills building, service levels and duty of care, service improvements, and campus-wide changes to improve student mental health and well-being. By April 2021, all but three recommendations were implemented, with the remainder expected to be completed within the next academic year.

CoSMH Structure and Function

CoSMH was established to oversee the implementation of the PAC-SMH recommendations; provide feedback on the strengths and limitations of the University’s response to the recommendations; offer advice for future initiatives; and outline proposed actions that need to be undertaken by the University to continue supporting student mental health. It was expected that some recommendations would need to be implemented in the context of new information or changes to policies and procedures (e.g., the 2020 edition of the Council of Ontario Universities’ In It Together report). The main objective, however, was to enact the changes recommended by the PAC-SMH committee and working groups.

CoSMH’s membership was formulated as a “network of networks,” with members serving as bridging ties to key parts of the University. These included:

  • student bodies like the Waterloo Undergraduate Student Association (WUSA) and Graduate Student Association (GSA)
  • faculty representatives from all six faculties
  • senior leadership in the University administration
  • Campus Wellness
  • Co-operative Education
  • external partners (e.g., Canadian Mental Health Association Waterloo Wellington)
  • alumni

Members were identified by an initial informal committee composed of:

  • the CoSMH Chair
  • the University’s President and Vice-Chancellor
  • Vice-President Academic and Provost
  • Associate Provost, Students
  • Director of Campus Wellness
  • the President of the Waterloo Undergraduate Student Association

The terms of reference and final committee membership was later ratified by CoSMH as it began functioning. CoSMH members were selected to provide diverse perspectives and capacities to link to a wide range of information sources that would be pertinent to the recommendations.

The Chair reported directly to the President and Vice-Chancellor and the Vice-President Academic and Provost, which provided CoSMH the necessary authority, accountability, and leadership buy-in to support its work. The committee size was kept to less than 20 members to maintain agility in decision-making while still providing adequate linkages to the full campus community. One academic representative was appointed from each faculty based on recommendation of each dean; however, student representation was based on linkages through major undergraduate, graduate, and international student associations rather than on faculty affiliations. Two students at-large were appointed to provide undergraduate and graduate perspectives. Additional considerations in membership included linkages to the PAC-SMH working committees, lived experience with mental health concerns from the student and family perspectives, clinical expertise in mental health service delivery, and scientific expertise in mental health and emerging adults. Many constituency groups were ultimately not formally represented with voting members of CoSMH (e.g., faculty and associations, mature or part-time students, housing services); however, additional linkages occurred through members with multiple affiliations or guests engaged when the required expertise was not present among CoSMH members. Throughout the three-year mandate of CoSMH, the Chair was supported by a non-voting team composed of a project coordinator, doctoral candidate research assistant, undergraduate co-op students, and librarians supporting literature reviews. An Executive Committee composed of the Chair, Associate Provost – Students, Director of Campus Wellness, President of WUSA, and a faculty member provided oversight and problem-solving functions to ensure CoSMH continued to make progress. In addition, several working groups (see Appendix A) were created to address specific topics arising from the PAC-SMH report (e.g., academic recommendations, mental health literacy, resiliency, verification of illness processes, peer support and mentoring).

The core functions of CoSMH included: interpretation and operationalization of the PAC-SMH recommendations; prioritization of the order in which recommendations would be implemented; determination of actions required to respond to each recommendation; review of scientific evidence; and identification of existing gaps across the university. Although CoSMH was established as an implementation committee, there was early recognition that the required response involved an ongoing commitment from the University rather than a discrete, time-limited set of actions. With that in mind, CoSMH identified a recommendation as “complete” if it met one of two criteria:

  • all necessary steps had been taken and no additional work was required (e.g., development of training programs related to specific topics); or
  • changes had been made in response to the recommendation that were required to continue indefinitely as part of the ongoing life of the organization and entities responsible for continuation of that ongoing work were identified (e.g., academic units would work to continue to integrate curriculum focused on mental health; the Wellness Collaborative would continue work on resilience).

About half of the recommendations fell into the latter category.

The PAC-SMH recommendations covered a variety of domains relevant to post-secondary student mental health, including the following themes:

  • administrative procedures
  • educational approaches
  • research
  • health service delivery
  • peer mentorship
  • mental health awareness
  • culture
  • advocacy

As highlighted by the In It Together report, changes of this scope require broad-based engagement through a “whole community” approach, which has often been difficult to achieve in practice (Dunley & Papadopoulos, 2019; Giamos et al., 2017; Monaghan et al., 2016; Ng & Padjen, 2019; Robinson et al., 2016). Comprehensive implementation of the recommendations would not have been possible without collaborative input from various stakeholders on and off campus. In most cases, the actions taken to complete the recommendations were initiated by internal stakeholders without prompting from CoSMH, either as part of the University’s ongoing professional commitments or as an independent endeavour that was highly relevant and presented to the Committee.

CoSMH’s typical actions for each PAC-SMH recommendation included:

  • reviewing available peer-reviewed and grey literature
  • compiling and analyzing pertinent data when required
  • delineating the underlying actions called for in the recommendation
  • identifying key stakeholders with relevant interests, responsibilities, or activities
  • scanning for and documenting work already done by others in the campus community
  • determining whether the work completed or underway met the spirit and intent of the recommendation

In cases where no existing work was underway, CoSMH reached out to appropriate stakeholders to facilitate the necessary actions or established working groups composed of CoSMH members and other collaborators to address the gap and ensure completion of relevant work.

Key Changes Related to Student Mental Health 

Over the course of the last three years, the University of Waterloo has made substantial, meaningful progress in numerous areas affecting student mental health and well-being, offering a novel approach towards addressing post-secondary student mental health in an integrated manner (Monaghan et al., 2016; Ng & Padjen, 2019). A detailed summary of each recommendation and the changes made in response is provided in Appendix C and in the CoSMH Progress Dashboard. However, some illustrative examples are provided below.

Recommendations 1–9: Campus Policies and Practices (seven of nine recommendations in theme area implemented) — Work on two recommendations is still underway: one deals with application of a mental health lens to program reviews, policies, and procedures, and the other relates to a centralized Verification of Condition form. Both are expected to be completed within the 2021 calendar year. Recommendations that were completed resulted in changes to accommodation procedures and related recourse mechanisms. An academic working group produced a report on best practices related to exams and evaluations, and a review was undertaken to reduce avoidable stresses in initial co-op placement processes. New in-person and online resources were developed to help instructors incorporate universal instructional design into their courses. In addition, new protocols were established for communicating information about student deaths and for developing community partnerships to support the response to adverse events.

Recommendations 10–13: Inclusive and Supportive Campus Culture (three of four recommendations in theme area implemented) — Work on a recommendation related to establishing an ombudsperson model for support, advocacy, and tracking data will continue with engagement of the University’s senior administration, WUSA and GSA. Recommendations that were implemented included:

  • application of the WELL Building Standard and Passive House Standard principles to new construction
  • requirement of faculty space committees to consider student mental health issues in use of existing space
  • commitments by all deans to support peer mentoring activities within each faculty
  • inclusion of mental health considerations in the University’s cultural competency strategy

For the latter point, linkages were established between CoSMH and the new President’s Anti-Racism Taskforce (PART) to include a Health and Wellness working group with specific linkages to the University’s Wellness Collaborative to ensure consideration of the intersection of mental health with other issues related to diversity, equity, and inclusion.

Recommendations 14–20: Mental Health Awareness and Communication (seven of seven recommendations implemented) — Implementation efforts included introducing numerous training initiatives for students, faculty, and staff; incorporating mental health content and considerations into the curriculum; and expanding the information available about resources and mental issues. To incentivize faculty and staff members to complete mental health training programs, the Mental Health Literacy Certificate program was introduced by Campus Wellness and will be piloted in Spring 2021. Across the full campus community, numerous student and University-led groups have made efforts to open a dialogue on topics including suicide prevention, trauma, sexual violence, and racial injustice. This work will continue with funding received from a Bell Let’s Talk grant, which will include collaboration between numerous on-campus stakeholder groups, as outlined in Appendix C. In addition to new training content and funding to initiate dialogues across campus, an important procedural change was the adding mental health training to the activities recognized in the service component of faculty members’ annual merit reviews. 

Recommendations 21–26: Prevention and Early Intervention (six of six recommendations in theme area implemented) — Mental health training programs were developed in the areas of resiliency, sexual violence, parental support for students, mental health literacy, and bystander intervention. In addition, mechanisms for coordinating and supporting peer support networks were established, a protocol was developed for review of digital applications for mental health by a student advisory panel and clinical staff associated with Campus Wellness, and new linkages were made with the Canadian Centre on Substance Use and Addiction’s Postsecondary Education Partnership.

Recommendations 27–32: Service Access and Delivery (six of six recommendations implemented) — Major changes to mental health services were made in partnership with the Student Services Advisory Committee (SSAC). This included a large influx of new funding to support a staff ratio of one mental health staff member to every 1,000 students and expansion of 24/7 virtual mental health services. Prior to the onset of the COVID-19 pandemic, the wait times for access to mental health services dropped substantially. For example, for urgent appointments, mean wait times dropped from three days to one day, and the percentage of same-day urgent appointments rose from 8.3 per cent to 64.1 per cent. For standard appointments (e.g., initial intake, ongoing counselling, support coordination), the 90th percentile of wait times dropped from 13.2 days to nine days.

The support for external mental health services also increased significantly with enhancements to the Studentcare extended health-care plan and Empower Me, a virtual mental health service that is available to students 24/7 anywhere the world (an important consideration for co-op students). Additional training was developed for counsellors, new counsellors were embedded within faculties, a stepped care model was implemented for mental health service matching, and a complex care case management team was developed.

Recommendations 33–36: Summary/Broad Recommendations (four of four recommendations in theme area implemented) — As a major organizational commitment to student mental health, the University became a signatory to the Okanagan Charter. Under this agreement the University established the Wellness Collaborative, linking students, staff, and faculty campus-wide with a broad commitment to supporting mental health and wellness of the full campus community. Other commitments include hosting forums on mental health and wellness, developing mental health metrics for performance measurement, and using a health and wellness lens in the University’s planning and to inform its policies and procedures. In addition, the University hosted the first Virtual Conference on Student Mental Health Research and reached out to provincial government officials to advocate for additional and ongoing support for student mental health.

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Challenges in the Implementation Process

After three years of concerted effort by CoSMH members and collaborators from across the campus community, a great deal was accomplished in implementing the PAC-SMH recommendations. When CoSMH was formed, the Committee was able to consult scoping reports that summarized many challenges in addressing student mental health in post-secondary environments. However, there were no publications available to consult about other committees that had tackled these barriers comprehensively and simultaneously (Giamos et al., 2017; Monaghan et al., 2016; Ng & Padjen, 2019; Robinson et al., 2016). Further, partway through CoSMH’s term, adaptations to the COVID-19 pandemic caused disruptions to the Committee’s functional capacity, as well as student mental health needs and priorities. As a result, CoSMH encountered several notable challenges that impeded the Committee’s work, which are described here as lessons learned for future committees that seek to improve student mental health.

Impact of COVID — No challenge was greater than the effects of the COVID-19 pandemic on all aspects of the University in 2020–21. Because most of the campus community was required to work off-site, communication and collaboration became more difficult. This was particularly true for large group meetings. In addition, the competing demands posed by the pandemic meant that campus resources and efforts had to be at least partially directed away from existing priorities to deal with emerging challenges posed by COVID-19. CoSMH meetings included updates and discussion of the impact of COVID-19, but an in-depth response to the mental health impacts of COVID-19 was beyond the scope of the Committee’s mandate.

Turnover of CoSMH Membership — While a number of the original CoSMH members and staff were able to serve on the Committee for its full three-year duration, there was also considerable turnover among faculty and student representatives (e.g., due to graduation, retirement, and sabbaticals). The turnover meant lack of continuity with respect to committee memory and the need for onboarding of new members who required time to catch up with the Committee’s mandate, priorities, and approach to work.

Committee Composition — Efforts to maintain a manageable committee size required some trade-offs in the comprehensiveness of the roles that were covered. Students represented about one quarter of the membership, but feedback provided at the end of CoSMH’s term noted that this was insufficient and that additional and more diverse student membership may have been beneficial. For example, two faculties (Science and Environment) had no student representatives on CoSMH for the duration of its term. While it was presumed that all students could be reached through WUSA and the GSA, an alternative approach of having one faculty member and one student per faculty in addition to WUSA and GSA leadership might have been helpful.

Ambiguity of CoSMH Role and PAC-SMH Recommendations — A challenge noted by several members of the Committee was the ambiguity surrounding CoSMH’s ability to directly implement changes on campus, as well as the lack of clarity surrounding the wording of certain recommendations. While the representation of some PAC-SMH members on the Committee was helpful for clarifying the original intent of the recommendations, this did not always resolve difficulties in determining their nature and scope. Another issue that was raised was how ongoing work relevant to fulfilling recommendations would continue beyond the mandate of CoSMH.

Initiatives and Priorities Not Included in the PAC-SMH report — As an implementation committee, CoSMH was focused on fulfilling the recommendations that had been formulated in 2017. As a result, CoSMH was not able to expand its strategy for completing recommendations to integrate new information and initiatives across campus. For example, the University adopted new approaches towards addressing anti-black racism and other issues of racial injustice highlighted by global movements that gained particular prominence in 2020–21. Collaborative linkages were established between CoSMH and the President’s Anti-Racism Taskforce (PART), and this will continue beyond CoSMH’s mandate through PART’s Health and Mental Health Working Group (see Appendix C).

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Recommendations for Future Directions 

CoSMH’s work in fostering implementation of the PAC-SMH recommendations is now largely complete, with only three recommendations remaining as of April 2021. Although CoSMH was not formally charged with generating a new set of recommendations related to student mental health, as was done for the PAC-SMH report, the Committee members have identified a number of points that will require careful attention on the part of the University.

Continued Focus on Student Mental Health and Wellness

The work done by those who collaborated on the PAC-SMH report and CoSMH’s implementation efforts was a major contribution to improving the University of Waterloo’s response to student mental health. However, much more needs to be done to ensure that the concepts and principles embedded in the PAC-SMH report continue to inform day-to-day life in all aspects of the campus community. In that regard, PAC-SMH and CoSMH initiatives were the preliminary steps forward in what must be an ongoing journey of improvement. 

We recommend that the University undertake a review of the appropriateness and feasibility of implementing the Canadian Standards Association and Mental Health Commission of Canada’s new National Standard for Mental Health and Well-Being of Post-Secondary Students, which is a companion to the CSA standard on employee psychological health and safety being implemented by the University. The University has obtained funding from Bell Let’s Talk in order to complete a review of this matter.

COVID-19 and Return to Campus

The full impact of COVID-19 on physical and mental health will not be fully understood for some time. However, current research has already suggested that the mental health consequences of the pandemic are dramatic and have disproportionately affected emerging adults (Pfefferbaum and North, 2020). COVID-19 posed many new challenges to the mental health of students, including:

  • financial difficulties
  • disrupted career development
  • precarious labour and housing markets
  • global warming/environmental crises
  • social isolation
  • personal health consequences
  • concerns about the health of family members
  • loss of loved ones

Although the return to campus will be a welcome development, it will pose its own mental health challenges as individuals will need to adapt to a return to close interaction with others outside of their household.

We recommend that Campus Wellness, the Wellness Collaborative, and other University stakeholders develop a specific plan for how to respond to the mental health consequences of COVID-19 and for the management of stresses related to the return to campus when the pandemic subsides.

Ongoing Evaluation 

The designation of implementation of at least half the PAC-SMH recommendations as being complete was contingent on the expectation that an identified official, committee, or department in the University would take responsibility for ensuring the work related to the recommendation will continue.

We recommend that the Associate Provost – Students establish a time-limited working group in May 2022 to evaluate the extent to which CoSMH’s expectations related to continuity of work on specific recommendations has continued. This should include consultations with Campus Wellness, the Wellness Collaborative, and student associations to determine the extent to which the changes envisioned in the PAC-SMH report have been realized.


For all organizations, communication between leadership and stakeholder groups is a challenge that requires continuous attention and refinement. All members of the campus community should receive regular updates on how the University continues to prioritize and respond to historical commitments and actions required for emerging mental health concerns.

We recommend that the University adopt regular, effective, transparent communication strategies regarding initiatives and changes made to deal with student mental health needs on and off campus. This includes those related to service provision, policies and procedures, operational matters, academic practices, and performance of mental health services.

Evidence-informed Decision-making

As an organization committed to the use of scientific evidence to inform decision-making, the University can both learn from emerging evidence about student mental health and contribute new knowledge in this area. This includes both qualitative and quantitative evidence obtained through systematic, rigorous methodologies to measure student mental health and well-being. The University’s Virtual Conference on Student Mental Health Research on November 5, 2020 attracted a sizable, diverse audience, and there was considerable enthusiasm for continuing this work in the future. An important gap that the University has committed to address as part of the Okanagan Charter is developing and tracking performance metrics related to student mental health. In addition, efforts to establish meaningful dialogues that engage the full campus community should be supported (as called for in Recommendation #14).

We recommend that the University continue to provide support to develop on-campus expertise in student mental health research. In addition, we recommend that the University expand its efforts to establish a performance measurement approach that will provide timely, scientifically sound, and comprehensive evidence on overall student mental health; utilization patterns and wait times for student mental health services; mental health outcomes for students using counselling, case-management and other mental health services; and support for student mental health and well-being within classroom settings. Evidence from these measures should be routinely reported in a manner that is transparent and accessible to the broad campus community. In addition, we recommend that the University expand its supports for efforts by student groups to engage the campus community in dialogues related to student mental health and well-being.

Expanding Collaborative Partnerships

The PAC-SMH recommendations included establishing and strengthening community partnerships to provide additional supports and services to students through access to additional off-campus mental health expertise. There remain important discontinuities in service provision and information sharing with external mental health services that can be remedied. The COVID-19 pandemic was accompanied by a rise in challenges related to substance use and addictions. While the PAC-SMH report included a number of recommendations in this area, there is a general sense that much more needs to be done, particularly in the aftermath of the changes in substance use that coincides with the pandemic.

We recommend the University engage external stakeholders in discussions to enhance the continuity of care and supports for students with serious mental health concerns who receive services from both Campus Wellness and off-campus health providers. These stakeholders include hospitals, mental health service providers within the community, and the KW4 Ontario Health Team. In addition, we recommend that priority be given to evaluating the needs of students for additional supports related to substance use and harm reduction.

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CoSMH’s efforts to foster implementation of the PAC-SMH recommendations was made possible through the dedication and hard work of our current and past members, guests who participated in our deliberations, and a team that provides tireless support to all aspects of its work. We are grateful for the engagement of students, staff members, and faculty from across campus who provided insights, encouragement, and assistance to our efforts. We also thank the senior leadership of the University for their consistent, unwavering commitment to supporting CoSMH’s work. Finally, we wish to acknowledge the outstanding efforts of all individuals who participated in the President’s Advisory Committee on Student Mental Health to create a comprehensive, meaningful, and actionable framework for enhancing student mental health and well-being.

CoSMH Final Report prepared by: John P. Hirdes, Abigail Simpson, Chris Read, Walter Mittelstaedt, Tejal Patel, Grace Wong, Jerrica Little, Agnes Zientarska-Kayko, Jessica Dowden, Andrew Faller-Saunders, Natascha Deboer, and Patrick Yu.

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Dunley, P., & Papadopoulos, A. (2019) Why is it so hard to get help? Barriers to help-seeking in postsecondary students struggling with mental health issues: a scoping review. International Journal of Mental Health and Addiction 17(3), 699-715.

Giamos, D., Lee, A.Y.S., Suleiman, A., Stuart, H., & Chen, S.-P. (2017) Understanding campus culture and student coping strategies for mental health issues in five Canadian colleges and universities. Canadian Journal of Higher Education/Revue canadienne d'enseignement supérieur 47(3), 120-135.

Linden, B., & Stuart, H. (2020) Post-Secondary Stress and Mental Well-Being: A Scoping Review of the Academic Literature. Canadian Journal of Community Mental Health 39(1), 1-32.

Monaghan, C., Linden, B., & Stuart, H. (2020). Postsecondary mental health policy in Canada: A scoping review of the grey literature: Politique de santé mentale post-secondaire au Canada: un examen de la portée de la littérature grise. The Canadian Journal of Psychiatry, 2020 Oct 5:070674372096173. https://doi.org/10.1177/0706743720961733

Ng, P., & Padjen, M. (2019) An overview of post-secondary mental health on campuses in Ontario: challenges and successes. International Journal of Mental Health and Addiction 17(3), 531-541.

Pfefferbaum, B., & North, C.S. (2020) Mental health and the Covid-19 pandemic. New England Journal of Medicine, 383(6), 510-512.

Robinson, A.M., Jubenville, T.M., Renny, K., & Cairns, S.L. (2016) Academic and mental health needs of students on a Canadian campus. Canadian Journal of Counselling and Psychotherapy 50(2), 108-123.

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