Appendices

Panel participants

• Chris Perlman, Assistant Prof, School of Public Health and Health Systems (Co-Chair)
• Tracy Morgan, Staff, Counselling Services (Co-Chair)
• Weizhen Dong, Faculty, Arts, Sociology and Legal Studies
• Sue Fraser, Staff, Counselling Services
• Kalpita Gaitonde, Staff, School of Public Health and Health Systems
• Margaret McBeath, Graduate Student, PhD, AHS, Public Health
• Raquel Miller, Staff, AccessAbility Services
• Ian Nicholson, Staff, Psychology (co-chair from July to Sept)
• Jonathan Oakman, Faculty, Psychology
• Angela Pereira, Alumni
• Dana Quinn, Physician, Health Services
• Danielle Rice, Alumni, PhD Student McGill University
• Nasim Shojayi, Staff, Student Success Office - Learning Services
• Alaaddin Sidahmed, Undergraduate Student, Applied Health Sciences
• John Snelgrove, Psychiatrist, Health Services
• Ryan Yeung, Graduate Student, Master’s, Psychology
• Jennifer Yuen, Staff, Counselling Services

Executive Summary

The mandate of the mental health experts panel (MH Panel) was to investigate the current services on campus and determine if the current approaches are appropriate. The panel extended this mandate to examine concepts of mental health promotion on campus. Broadly speaking, the panel primarily focused on addressing two key questions: 1) What are the conditions needed to promote mental health on campus? 2) How far can/should an organization like the University go in providing treatment for mental illness?

Additional questions helped guide the responses to these questions, relating to issues of mental health promotions, barriers to service use, and approaches to service provision. To address these questions the panel met every two weeks to engage in detailed discussion of issues, developed working groups for mental health promotion and clinical services, and reviewed an extensive literature of research, practice-based, and University student mental health reports.

A large number of opportunities exist for student mental health promotion. One key condition for promoting mental health is Organizing, planning, and policy at the institutional level. Within this process, the importance of enhancing constructive organizational cultures and climates was emphasized across all departments and units of the campus. A second condition relates to having a supportive, inclusive campus climate and environment, recognizing the importance of built environment, resilience, social capital, as well as inclusivity and equity for student mental health.

Several areas for enhancing mental wellness were identified by the panel. These include the development of a detailed health promotion framework that considers all aspects of wellness, using the Okanagan Charter for Health Promotion. A strategy related to substance use is also needed, both in terms of prevention of the problematic use of alcohol and substances as well as further fostering connections with community partners for treatment. A large area of emphasis relates to enhancing mental health literacy on campus, including for staff, faculty and students. Mental health literacy involves knowing the signs and symptoms of mental health challenges, strategies for mitigating such challenges, and resources and supports available.

The panel takes the position that the University should provide comprehensive mental health services for people with serious mental health issues by providing stepped care and supports, comprehensive counselling and case management strategies, integrated mental health support in family physicians, and appropriate integration with community partners. This includes a review of the human resource capacity for counselling and health services, such as having appropriate skills and expertise, psychologists’ roles, and mitigating stressors identified by counsellors and psychologists. Several additional models of service delivery are also reviewed, including collaborative complex care teams, stepped care, support from peers with lived experience, screening and assessment processes, walk-in and single sessions, and group counselling.

Full Panel Report

Read the Mental Health Experts Panel Full Report (PDF) .

Panel Participants

• Heidi Engelhardt, Faculty, Biology (Co-Chair)
• Janice Cooke, Staff, Centre for Extended Learning (Co-Chair)
• Wendi Adair, Faculty, Psychology
• Bilal Akhtar, Undergraduate Student, Software Engineering
• Clark Baldwin, Staff, Medical Director, Health Services
• Katie Damphouse, Staff, Faculty Association
• Maureen Drysdale, Faculty, St. Jerome's University
• Allegra Friesen, Graduate Student, Masters, Architecture
• Jasmin Habib, Faculty, Political Science
• Craig Hardiman, Faculty, Classical Studies
• Patrick Lam, Faculty, Electrical and Computer Engineering
• Jerrica Little, Graduate Student, PhD, Applied Health Sciences
• Denise Marigold, Faculty, Renison University College
• Kristine Meier, Staff, Counselling Services
• Francis Poulin, Faculty, Math
• Stephen Prentice, Faculty, Kinesiology
• Franco Solimano, Staff, Education Career Action
• Zhongchao Tan, Faculty, Mechanical Mechatronics Engineering
• Hamid Reza Tizhoosh, Faculty, Systems Design Engineering
• Maya Venters, Undergraduate Student, Arts, Political Science
• Alexander Wray, Undergraduate Student, Environment, Planning

Executive Summary

The academic panel had good representation from the University of Waterloo community, faculty, staff and students who volunteered their time and expertise to be part of this very important discussion. We began with the mandate questions provided:

• How do we understand the relationship between academic stress and mental health?
• What is a reasonable level of demand in terms of academic load, scheduling and other planning required by students?
• What is the utility of comparing students against students? How do we balance a culture of wellness and a culture of competition?
• How do we support instructors and their efforts to embed wellness into their pedagogy and the curriculum?
• Are there exemplars of programs and instructors that represent a good balance between academic rigour and mental wellness? Can we learn from these?
• How do we eliminate barriers to academic accommodations for students who need mental health supports and/or are experiencing symptoms of mental illness, but have not been diagnosed?

We met regularly beginning in August 2017 and early on we expanded our mandate questions to a broader question set, as shown on the following page. We used several different methodologies to investigate the questions and develop our recommendations.

We found that there are many great things happening on campus that address mental health issues directly and indirectly, but in many cases awareness and participation rates are low. We also found many areas in which we had recommendations for improvements or additional research.

Our recommendations address issues surrounding course design, competitiveness, co-op scheduling, assessments, midterms and final examinations, verification of illness processes, mental health training, raising awareness of existing programs, student and instructor supports, and more.

We hope to see this initiative continue into the future and build on the momentum that has been created by the committee and panel members.

Full panel report

Read the Academic Panel Full Report (PDF) .

Panel Participants

• Danielle Brandow, Graduate Student, Masters, AHS, Public Health Health Systems (Co- Chair)
• Yao Chen, Graduate Student, PhD, Engineering, Electrical Computing
• Adele Chui, Undergraduate Student, Engineering, Systems Design
• Oriana Coburn, Undergraduate Student, Engineering, Management
• Arun Eswaran, Undergraduate Student, Arts, Psychology
• Josh King, Undergraduate Student, Math, Accounting
• Kaitlyn Kraatz, Staff, Co-op Education Career Action
• Megan Lambe, Staff, Housing Residences
• Emma McKay, Graduate Student, Masters, Math, Applied Math
• Diana Moreno Ojeda, Graduate Student, Masters, Arts, English
• Craig Nickel, Staff, Athletics Recreation
• Jessica Siew, Undergraduate Student, Accounting
• Stephie-Lee Tabujara, Undergraduate Student, Arts, Legal Studies
• Madison Van Dyk, Undergraduate Student, Math, Applied Math
• Bailee Walls-Guertin, Undergraduate Student, AHS, Health Studies
• Mark Welshman, Staff, Custodial Services
• Jada Wong, Undergraduate Student, Arts, Legal Studies
• Shaowei Xu, Staff and Alumni, ITC Project Research Scientist, Psychology
• Matthew Yao, Undergraduate Student, Engineering, Mechanical
• Hannah Beckett, Undergraduate Student, Arts, Political Science

Executive Summary

The student experience panel was selected to include 20 members and encompass a broad representation from the University of Waterloo. Our panel includes representation from key student groups including undergraduate and graduate, co-op and regular, international and domestic, as well as staff members from various departments across campus. Our panel consists of members who are passionate and devoted to making change to address concerns about student mental health and wellness at the University of Waterloo.

The PAC-SMH committee and five panels including the student experience panel were formed after student suicides occurred on our campus community in the past year. A student-led petition brought forward student concerns about student mental health and wellness at the University of Waterloo. Concerns around student mental health are not unique to this University, and must be addressed at a system-wide, Ontario post-secondary level. The In It Together report — written by the Council of Ontario Universities (COU), the Ontario Undergraduate Student Alliance (OUSA), Colleges Ontario (CO) and the College Student Alliance (CSA) — cites the Spring 2016 National College Health Survey that collects information and stats (see below) illustrating the landscape of mental health concerns across Ontario’s postsecondary sector. Below we compare five metrics: provincial averages as cited in the In It Together report versus University of Waterloo’s specific numbers from the Spring 2016 National College Health Survey.

1. ”46 percent of students reported feeling so depressed in the previous year it was difficult to function (increased from 40 percent in 2013);”
   • University of Waterloo: 44.5 percent of students felt so depressed it was difficult to function.
2. “65 percent of students reported experiencing overwhelming anxiety in the previous year (up 58 percent in 2013);”
   • University of Waterloo: 60.8 percent of students experienced overwhelming anxiety in the past 12 months.
3. “14 percent had seriously considered suicide in the previous year (up from 11 percent in 2013);”
   • University of Waterloo: 14 percent had seriously considered suicide in the past 12 months.
4. “2.2 percent of students reported a suicide attempt within the previous year (up from 1.5 percent in 2013);”
   • University of Waterloo: 1.9 percent of students attempted suicide in the previous year
5. “9 percent had indicated that they had attempted suicide, but not in the previous year.”
   • University of Waterloo: 7.5 percent attempted suicide, but not in the previous year.

As illustrated above, the University of Waterloo’s numbers specific to these five key indicators is either below or at the provincial average. It reaffirms the fact that mental health concerns on campus can’t be addressed alone at an institutional level but require a system-wide sector, public health and provincial-facing approach. As a result, our panel recommends the University of Waterloo endorse and actively advocate to the provincial government, using its government affairs/relations apparatus to implement the 26 recommendations in the In It Together report. The report and its recommendations outline sector-wide consensus of the role the provincial government has to play in order to address mental health concerns at post-secondary institutions.

The fact that the University of Waterloo is at or below the provincial average when looking at the five key indicators mentioned above does not lessen the severity of mental health concerns on campus nor the responsibility the institution has to address these concerns. We might compare relatively well to our counterparts across the province; however, our low rankings in student experience/satisfaction suggest our efforts are falling short and more can be done. According to the Maclean’s 2018 University Rankings, the University of Waterloo ranked 12th out 15 in student satisfaction. This ranking encompasses both academic and mental health supports available to students on campus. Our recommendations aim to address student satisfaction within a University of Waterloo context.

Our recommendations are listed below under five categories: 1) Research 2) Training 3) Services
4) University Health Plan Coverage and 5) Culture and environment. The recommendations are informed by the work of the panel’s three working groups: i) Research ii) Survey and iii) Interview.

Our recommendations in the research section look to improve the way we collect and disseminate data that accurately captures the mental health and wellness environment on campus. It also looks to validate the experiences of students whose demographics may disproportionately and uniquely affect their mental health on campus. It is known that international student’s tuition is higher than domestic students, and until last year, was largely unpredictable year-over-year. Often times, the University validates its reasoning by expressing that there are services specifically designed to meet the needs of international students that are being funded through their tuition. This is why our panel recommends the dissemination of a climate survey on the experience and perceptions of support specifically designed to meet the needs of international students. We want to know whether these services are adequately meeting their needs, while assessing whether the additional financial burden is impacting their mental health.

In the training section, we offer recommendations around training that address service gaps of mental health supports on campus — particularly for students who are uniquely and disproportionately affected by mental illness or mental health concerns (those demographics of students are identified further down in this report). One of our recommendations is that the University of Waterloo invest and develop a multi-year plan that ensures all counsellors and health care providers in campus wellness are trained and equipped to address the mental health needs of all students, and especially those who may be disproportionately affected by mental illness. We focus specifically on trans and non-binary students, and students who have experienced sexual violence.

Under the services section, our panel addresses service gaps for students seeking mental health supports and resources —both on and off campus — while also making sure that we are addressing unmet needs for people who are disproportionately affected by mental health concerns (i.e. Counselling Services should connect with Waterloo’s Aboriginal Education Centre (WAEC) to build and provide culturally sensitive support services that address mental health concerns and needs unique to Indigenous students).

We recommend that the University of Waterloo’s Counselling Services look into partnerships and funding opportunities to improve access to mental health services during peak demand times of the term and outside the customary 8:30am-4:30pm hours of operation. One such model that we cite and the university can mirror is the Western-London model. The Project in London is a collaboration between the Canadian Mental Health Association (CMHA), Middlesex and Western University (Student Health Services, University Students’ Council and the Society of Graduate Students), King’s University College and Fanshawe College. All these stakeholders came together and were granted nearly a quarter of a million dollars to fund a project that ensures undergraduate, graduate and college students have access to CMHA crisis counsellors with peer-support volunteers. This year, in its first year, it operated Tuesday, Wednesday and Thursday evenings during the end of the term when campus services can see an increased demand (Nov. 21 -Dec.14). This example illustrates what a community approach could achieve.

Our university health plan coverage section addresses some financial and geographical barriers students have in accessing mental health supports while on campus, off-campus or on a co-op term. Our recommendations are geared toward solutions that can be implemented through the University’s Health Insurance Plan. Similar to our recommendation above, one of our recommendations in this section acknowledges that mental health concerns and mental illness do not adhere to the standard 8:30am-4:30pm hours of operation. Following the lead of the University of British Columbia and its student association (UBC-AMS), we recommend that the University of Waterloo work with the Federation of Students (Feds) and the Graduate Student Association (GSA) to implement a system similar to UBC’s Empower Me. The service would allow for 24/7 mental health service offering counselling by telephone, video counselling or e-counselling.

Finally, our culture and environment section looks at mental health and wellness on the University of Waterloo campus and in the post-secondary sector. Beyond recommending the University to endorse and advocate for the 26 recommendations in the In It Together report to the provincial government, our panel offers solutions that will help restore student trust in the institution and communicate to students the institutions’ responsibility in delivering services related to mental and physical health. For example, with increased internationalization being one of the three I’s in the upcoming strategic plan cycle, the University of Waterloo should communicate to students the extent of the institution’s responsibility to connect students to mental health support services while out of the country.

Full Panel Report

Read the full Student Experience Report (PDF) .

Panel Participants

• Donna Rheams, Athletics Recreation (Co-Chair)
• Jeanette Gascho, Campus Wellness (Co-Chair)
• Saad Ahmad, Undergraduate Student, AHS, Health Studies
• Yuna Chen, Alumni, AHS, Health Studies
• Emma Collington, Undergraduate Student, Science, Biomedical
• Randy Dauphin, Staff, UW Bookstore
• Awn Duqoum, Undergraduate Student, Engineering, Mechatronics
• Jenna Hampshire, Staff, Student Success Office
• Rev. Ed Janzen, Staff, Mennonite Chaplain
• Madeline Keltie, Undergraduate Student, Arts, Psychology/SMF
• Joyce Lu, Undergraduate Student, Arts, Accounting and Finance
• Kate McCrae Bristol, Staff, Student Success Office
• Annette McNicol, Staff, Health Services
• Melinda Meng, Staff, Dean of Science Office
• Alice Raynard, Staff, Secretariat Office
• Krista Soble, Staff, Student Awards and Financial Aid
• Seneca Jackson Velling, Undergraduate Student, Science, Materials Nanosciences
• Mark Womack, Staff, Mathematics

Executive Summary

Following the initial introduction to the President’s Advisory Council, the student services panel reconvened to determine its approach to the mandated questions. Working groups were assigned to address each question, and an analysis was conducted to identify: a) what peer services/programs currently exist on campus; b) what digital resources were promoted; and c) what literature exists on this topic and what work other institutions are doing to improve student mental health.

An online survey was distributed to student-focused services to understand what additional supports were being requested by staff, and to better understand what level of training the peer volunteers should receive on mental health. Informational interviews were conducted with Student Services representatives to identify their level of understanding with the mandated questions. A focus group was held with undergraduate students to learn if and how they feel supported by Student Services regarding their mental health.

The participants in the student focus group identified reasons they believed mental health services were used on campus (i.e. transition, intensity of program, identity, etc.) and what services they viewed as contributing to their well-being. They also shared their experiences with formal and informal mental health services around campus and in the community. Students suggested many preferences regarding how mental health messages are shared with them.

An increased need for training was a common theme that emerged during staff conversations. A challenge they frequently face is knowing what training and resources are available to them and to students. Staff indicated that there should be mandated training relevant to their specific roles and that there should be one point of contact mediating the referrals to students. Although Counselling Services does offer mental health training to staff, it is primarily funded for student programming and its offerings for staff are limited. In terms of student training, the Peer Mentorship Coordinator provides support to the variety of peer-to-peer groups on campus. Their role manages and supports the Peer Mentorship Training program.

Specific mental health training is not included in these modules but there are related topics that help support the well-being of a student e.g. students are directed to Counselling Services for further resources, if required). Additionally, peers are referred to SafeTalk or More Feet on the Ground for further mental health training. Since Peer Mentorship Training is not mandatory, the level of specific mental health training varies across peer groups, often depending on their target audience.

The University of Waterloo has not always clearly communicated its commitment to care and compassion. A community development model is recommended to encourage a more upstream approach. Student mental health should be considered in future decision making, policy creation and process development. Moreover, it has been determined that having a common definition of what “resiliency” and “failure” means to the university as a whole would help provide a framework for how students services function. Through analysis of space on campus, it is evident that there is a continued demand to consider combining locations with the needs of the students, particularly making sure there is space for each student in areas of academic study, social support and fitness.

Overall, Student Services collaborates well but there is room for further integration, particularly in the need for a single point of contact, as can be seen throughout the recommendations of the panel. Four main recommendations are offered by this panel for the PAC-SMH’s consideration.

Significantly, in reviewing other panels’ recommendations, it is our understanding that common themes with the student services panel include: clearer processes and accountability; multiple accesses to mental health support services (every door is the right door); enhanced coordination amongst services; a culture of competition vs. compassion; enhanced training for staff and faculty; review of academic programming; enhanced awareness/education and communication on mental health.

Full Panel Report

Read the full Student Services Panel Report (PDF) .