The mental health of students at post-secondary institutions has become a prominent topic of discussion inside the University of Waterloo and in the general community. Observers are alarmed to discover the high rates of psychological distress among students reported in surveys such as the National College Health Assessment (NCHA-II).
A comprehensive review involving many campus constituents was conducted in 2011-12. The review led to some significant revisions in the organization of mental health services on campus. Counselling Services and Health Services now plan and deliver mental health services in a more integrated manner under the umbrella of Campus Wellness.
The review resulted in greater attention to health promotion and prevention. There were increases to mental health staff resources, including new positions created for counsellors and psychologists, and funding for enhanced psychiatric services. In addition, improvements were made in how students access mental health services, ensuring that the most urgent concerns are addressed in a timely matter.
The changes emanating from the 2012 review helped the University to ensure that mental health services were keeping up with the steady growth and demand of the student population. Currently, a wide range of responses exists for students who arrive on campus with a history of mental illness, and for those who develop symptoms or concerns while attending the University. These responses include formal services as well as a network of peer-led support services.
The President’s Advisory Committee on Student Mental Health (PAC-SMH)
Despite the attention to students’ mental health and the development of a robust service system, a series of events in winter 2017 alarmed the campus community. In response to community expression of concern about two student deaths by suicide, the University President signalled the need for an in-depth conversation regarding student mental health.
The PAC-SMH was formed with a Terms of Reference that called for the collection of information considering “…the UW student body and the larger societal context.” The committee was further tasked with advising “…on the status of the progress of mental health initiatives across the campus.”
The PAC-SMH met regularly through summer and fall of 2017, gathering information from a variety of sources, both on-campus and from the general post-secondary environment.
Analysis was generated by five supporting panels, each covering a dimension of mental health, including academic, community partners, mental health experts, student experience, and student services panels. Reports were provided by each.
The PAC-SMH Report and Key Theme Areas
The final report, which includes a synthesis of independent submissions to the committee and the panel reports, is organized along the lines of a model of the post-secondary mental health response offered by the Canadian Association of College and University Student Services (CACUSS).
The CACUSS model recognizes different levels of required response ranging from the creation or adjustment of university policies, availability of less intrusive options for individuals who are starting to experience psychological distress, and development of an appropriate mental health service system for individuals with clear mental health concerns.
Campus Policies and Practices
The PAC-SMH report recognizes that there is an opportunity to look at all of University of Waterloo’s policies and policy development through the lens of student wellness. Some highlighted areas include the impact of the current process of obtaining academic accommodations, noting inconsistencies across faculties and services. The report also identifies that some academic policies may lead to undue and unnecessary stress. A series of recommendations suggests a path forward.
The report on social support at the University of Waterloo highlights the role of positive interpersonal relationships in preventing psychological distress. This analysis, on one hand, recognizes the importance of friends and family but also notes the emerging importance of on-campus relationships with peers, staff and faculty.
There are some groups on campus that experience more isolation than others due to their identification as international, racialized or LGBTQ students. The report speaks to opportunities to build on various mentoring initiatives to ensure that as many students as possible will benefit from being part of a social support network.
The report further addresses instances of negative interactions that occur in the academic environment, providing some recommendations for instructional approaches that mitigate these experiences.
Mental Health Awareness
Increasing the awareness about mental health and mental illness was highlighted as a theme during the PAC-SMH process. The report notes some of the current approaches for mental health promotion, including efforts to educate students about services.
Although these efforts have increased, corresponding with the increase of awareness of mental health in Canadian society, there are potential areas of improvement.
In particular, there may be opportunities to provide important information about mental health and services as part of the normal interactions between students, faculty, and staff.
Faculty and staff may need additional training and support to be equipped to provide the most helpful information to students. Some of this training already exists on campus, but in a limited capacity.
The corresponding recommendation regarding this gap is for growth in the capacity for training and improved coordination of training efforts.
Early Intervention and Skills Building
The CACUSS model identifies that there are times when students experience psychological distress and
a mental illness has not yet developed. During these periods of discomfort, students can benefit from early intervention strategies, many of which can be introduced in educational workshops or with
The report addresses the need for a strong emphasis on developing resilience as a skill area for our students.
Service Levels and Duty of Care
The current mental health service delivery system is reviewed with some detail in the PAC-SMH report. A fundamental question that this report asks is, “How far can or should the post-secondary institution go in providing treatment for mental illness?” This question is considered in the context of the capacity of the local service system in the community.
The report notes that the local system may not have capacity to provide the range of services required by university students and, as such, on-campus services need to be prepared for the spectrum of mental health concerns represented by the student population.
At the same time, the report identifies opportunities for improved partnerships with community agencies, with an emphasis on ensuring that accurate information is available to students about services and providing improved referral processes.
With respect to campus services, the report identified some areas of student dissatisfaction. Most significantly, students were concerned about the availability of services when needed.
Despite the growth in mental health resources in the past five years, there were instances in which people were not able to access appointments in a timely way. The mental health/counselling staff-to-student ratio is addressed in this report, with a recommendation that this ratio be increased to one staff member for each 1,000 students.
Growth in clinical staff also needs to take into account the expected outcomes of plans to improve mental health promotion and prevention. That is, the PAC-SMH hopes to detect a decrease in the
need for formal services as more upstream approaches are introduced.
In addition to questions of capacity, the recommendations regarding services also touch on the readiness of mental health staff to address diverse needs of the student population including transgender, indigenous, and racialized students.
Recommendations are also provided regarding emerging models of clinical care including the stepped-care approach and therapist-assisted online therapy.
The final set of summary recommendations are provided to direct attention to some of the broader implications of the PAC-SMH report.
First, it will be important to create a mechanism of accountability for implementation of the report’s recommendations. The concept of an ongoing student mental health and wellness committee is proposed. Related to this, a recommendation is made for the University to adopt the Okanagan Charter as a framework for the implementation of the recommendations.
The report invites consideration of a collaborative research program, as a way for our campus to develop knowledge about the topics addressed in this report, and provide leadership among Canadian post-secondary institutions.
The report concludes with a recommendation that University of Waterloo join provincial advocacy efforts regarding the growing concern about student mental health.
University of Waterloo has an opportunity to attend to an important campus and societal issue: mental health. The PAC-SMH report offers a cross-sectional analysis of aspects of the University that influence the mental health and wellness of students as well as a summary of the current response.
The report represents a foundation for building a campus community where our students can flourish in all areas of their lives.