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Outsourcing mental health counselling

The practice remains a topic of debate among student affairs professionals.

By NATALIE SAMSON | NOV 05 2014

Mental health counselling gets outsourced

The University of Prince Edward Island announced this fall it would begin offering students access to 24-hour mobile counselling. This student support program comes as part of a two-year contract with Morneau Shepell, a Canadian outsourcing agency specializing in employee health and wellness programs, more commonly known as an employee assistance program, or EAP. The deal entitles UPEI students access to the company’s phone and online mental health counsellors and to its nationwide network of nutritionists, dieticians, financial and legal counsellors.

For student affairs manager Treena Smith, the outsourced counselling complements the two full-time, in-house mental health counsellors the university employs (it will soon add a part-time counsellor to that roster) and other on-campus resources like the medical clinic, the disability services office and the career centre. “We actually have great services,” Ms. Smith said. “But we all go home at five o’clock. We don’t have on-call staff, we’re too small.”

UPEI will pay $60,000 over two years for this service – a rate that was negotiated based on an approximate student population of 4,500. That works out to about $6.67 per student, though the program comes at no extra cost to them. The university expects, citing industry experience, that about two percent of the population, or 90 UPEI students, will use the service.

Outsourcing is a hot topic of debate among student affairs professionals in Canada. That much was clear at the annual conference of the Canadian Association of College and University Student Services (CACUSS) in June, where a session called “Outsourcing health and counselling services: How do they stack up?” was standing room only. The session was hosted by a joint working group of the Canadian Organization of University College Health (COUCH) and the Canadian University and College Counselling Association (CUCCA). According to Su-Ting Teo, former COUCH president and director of student health and wellness at Ryerson University, the issue is coming to a head on many campuses because demand for student mental health services is as high as ever, counselling services are expensive, and universities in general are labouring under a culture of belt-tightening.

There’s also a slightly more insidious reason behind the current interest, says Rice Fuller, senior director of health and wellness in the student services unit at the University of New Brunswick. He says many EAP providers are ramping up their efforts in the higher education market – not by talking to the university’s counselling services but by courting student unions, generally around late spring when the new student union is coming in. “Never have I heard of the [EAP] proposals being presented to the current counselling centre,” says Mr. Fuller, who finds the timing suspect. “Maybe there is stuff that they’re offering that we would like, but that’s never how it’s pitched.” Now, Mr. Fuller contacts the incoming student union right away to request he be kept informed if and when a pitch is made.

As with most ancillary campus services, the outsourcing of counselling services isn’t exactly a new issue. In 2000, Brock University hired Lidkea Stob, and Associates, a Niagara-based family counselling agency and EAP provider, to hire and supervise counsellors on-site at Brock. From the student’s perspective the setup at the university is seamless, said Les McCurdy-Myers, Brock’s director of counselling services. In general, Lidkea Stob dedicates the same four counsellors to staff the counselling office at the heart of campus, though staffing numbers change depending on demand. To make an appointment for counselling sessions, students call a Brock extension that patches through to Lidkea Stob.

Mr. McCurdy-Myers said he negotiated with his “community partner” for institutional oversight to the program that EAP agencies don’t usually provide, including access to student-client records and input on hiring. “I think part of the success of what we’ve done here is we’ve worked with someone local who has helped us tailor this exactly the way we want it and handed over to us a great deal of control,” Mr. McCurdy-Myers said. “I think it’s important to have somebody at the university who understands counselling services and what they need, who can oversee the service provided and can ensure you’re getting the service you’re supposed to.”

Though he wouldn’t go into specifics, Mr. McCurdy-Myers said outsourcing works out to “significantly less” than it would cost Brock to hire those counsellors directly. This model isn’t for everyone, but “for me, it’s preferable to dealing with a national or multinational firm,” he said.

Despite being tried for a decade or more at some campuses like Brock, EAPs are still a rare phenomenon in student mental health practice in Canada. At UPEI, the biggest concern in moving to this model was continuation of care, said Ms. Smith.

“We could have a suicidal student on campus and not know about it.” On the other hand, there could be a suicidal student on campus that no one knows about and that student could be receiving no care whatsoever. “We’re outsourcing these services because we can’t afford not to,” she said.

An advantage of using Sheppell, she added, is that the company employs counsellors fluent in multiple languages; UPEI hopes this feature will appeal to students for whom English and French are foreign languages.

Meanwhile, COUCH and CUCCA are working on a white paper to help establish best practices for outsourcing. The paper will be presented at next year’s CACUSS meeting in Vancouver. Already, this research has led to a series of parameters to help administrators clarify their thinking on whether to outsource counselling services. Ryerson’s Dr. Teo recommends administrators ask themselves the following questions: What does the institution need from the practitioner? What resources exist in your local community? Is there enough of a return on your investment? What is the quality of service and the level of student-staff satisfaction?

It’s a hot topic of debate – even the term “outsourcing” has been contested for its negative connotations. What everyone can seem to agree on is that outsourcing is a complicated issue and, due to increased attention on student mental health, strong demand from students, and a heightened awareness of budgetary restrictions at most universities, outsourcing will stay on the front burner for some time yet.

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