Click to EnlargePost-secondary students face high levels of mental health and addiction issues in Ontario. A 2016 study found:

  • 65 per cent of students reported experiencing overwhelming anxiety in the previous year (up from 57 per cent in 2013);
  • 46 per cent reported feeling so depressed in the previous year it was difficult to function (up from 40 per cent in 2013);
  • 13 per cent had seriously considered suicide in the previous year (up from 10 per cent in 2013);
  • And 2.2 per cent reported attempting suicide in the last year (up from 1.5 per cent in 2013) and nine per cent reported attempting suicide sometime in the past.                                                    

 

This has resulted in mounting pressure on Colleges and Universities, who are working hard to meet the needs of their students. One survey of 15 post-secondary institutions (conducted by the Toronto Star and the Ryerson School of Journalism) found that mental-health budgets have increased - on average - by 35 per cent over the past 5 years, indicating a rapid increase in students seeking support. Yet while students look to Colleges and Universities to provide support for mental health concerns, post-secondary institutions should not be tasked with providing ongoing therapy or intensive treatment services for more significant mental health concerns when expertise already exists in the community. Data is clear that as many as one in four post-secondary students will have mental health concerns with the majority considered a “mild” issue.

For students in post-secondary school – and indeed for all children and youth - we need to adopt a stepped care approach to respond to the increase in need for mental health supports. In this system, the level of intensity of care is matched to the complexity of the student’s mental health needs. This ensures that the most effective, yet least expensive treatment is delivered first. We know that many students experiencing mild mental health concerns do not require the supports provided by a therapist, psychologist or psychiatrist. Instead, they may be better supported through walk in clinics, on-campus counselling services, online self-help programs (for example, CMHA’s BounceBack program), online CBT programs,  psychoeducational programs or peer support groups.  Those youth with more serious issues need mental healthcare services including intensive therapy, psychological assessments, and intensive treatment provided by community mental healthcare agencies. Adopting the stepped care approach, which tailors the appropriate level of care to the student’s needs, will result in reduced costs to the system. And while we know what works and that the stepped care approach is efficient, demand for these services well exceeds supply particularly for those in the college/university age bracket.  Often on-campus services are swamped by those students with intensive needs who are waiting for intensive services in the community.  That means that youth with mild mental health issues wait too long and too often their health deteriorates while waiting.

For instance, a college student who we will call Max, has for many years struggled with depression. He has had mental health services from the time he was 13.  Depression is episodic, and now that he is in college, he is struggling again.  He requires treatment, however, there are long wait times for the intensive community treatment he needs. As a result, he goes back repeatedly to the Emergency Department and to on-campus services - both of which cannot meet his needs. This is both costly to the healthcare system and not generating the right outcomes for Max. 

A few years ago, students on one campus in Ontario voted to increase their student fees to improve access to psychological and psychiatric care on campus. It is an unfortunate story highlighting the incredible need on campuses across the province. As amazing as it is that students would agree to spend their own money to improve access to care, this is not the right solution. Rising tuition costs are already a significant source of stress for many postsecondary students, and a system which further burdens students to shoulder the costs of providing necessary mental health care on campus sets an unacceptable precedent. Costs to serve youth should be borne by the healthcare system as mental health is health. As discussed, most post-secondary students experiencing mild mental health issues don’t require the care provided by a psychiatrist. Instead - in alignment with a stepped care model – resources should be directed to a range of other services, building capacity across a continuum of care. Community agencies are well- positioned to meet the needs of students facing more severe mental health needs.

To improve care for post-secondary students, we need to ensure that each player in the mental health system is taking on the appropriate role based on their expertise and appropriate capacity must be built into each part of the system of care.