Recommendation 32 Literature Review Summary

Key Points

  • Service delivery frameworks are needed that account for increasing mental health needs of students but limited campus resources.
  • Integrated care models, which combine medical and psychological services, can help improve accessibility and efficiency of mental health services. However, there are some limitations and ongoing research is needed.
  • Stepped Care is an emerging model that pairs severity of mental health needs with the least intense treatment option that is still effective. Early results are promising but further studies are required to test effectiveness.
  • While research on service delivery frameworks for post-secondary institutions is limited overall, there are many common considerations that are recommended for any model of care. 

Literature Review Findings

The number of post-secondary students presenting with mental health concerns is increasing and as a result, there is a growing demand for mental health services on campus. However, despite that relatively few students with mental health needs seek out treatment, many counseling centres are already functioning beyond capacity. The imbalance between mental health needs and resources available has prompted many post-secondary institutions to review service delivery models, especially those that improve efficiency without diminishing quality of care.

The most well-researched care delivery model is integrated care, which combines medical and psychiatric services into a unified department with shared electronic health records, physical space, and interdisciplinary teams. Original research has demonstrated that integrated care models are associated with more efficient use of primary care services and are viewed positively by care practitioners. Other benefits include improved accessibility and continuity of care. Possible disadvantages include a biomedical disease perspective of mental health, lack of ongoing mental health promotion strategies, and disagreements surrounding patient confidentiality of electronic health records. Overall, evidence of integrated care is mixed, largely due to lack of rigorous empirical research and standardization of implementation.

An emerging care model for post-secondary institutions is stepped care, where the severity of mental health symptoms is paired with the treatment option that is least restrictive but still of maximal benefit. Early evidence suggests that clinicians and other staff members perceive stepped care favourably after receiving training, and that it can maintain good treatment outcomes while improving efficient access of services. However, ongoing empirical testing is needed.

Overall, research evidence of service delivery frameworks for post-secondary schools is limited. Common topics that need to be addressed within any framework include plans for complex mental health needs, at-risk populations, social determinants of health and health promotion, substance use strategies, cost effectiveness and feasibility of service structures, client confidentiality, integration with the wider campus community, and evidence-based research.

Implications for Practice

Current service delivery practices should be reviewed (especially for complex mental health needs), as well as the availability of funding and personnel support across campus. Based on existing gaps and resources, care models can be selected that fulfill an institution’s unique needs. Integrated care and stepped care models are promising service delivery frameworks that have been tailored to suit the environment of post-secondary schools. In Ontario, implementation of Stepped Care 2.0 is underway at several post-secondary institutions, and toolkits will be made available to help guide the process. Whichever framework is selected, it is important that institutions consider the breadth of mental health needs experienced by students, as well as cost effectiveness, quality of care, and opportunities for research.