Demand for mental health support is rapidly growing on Canadian campuses. In response, we have poured more and more resources into clinical support services. Despite the additional investment, both waiting times and student distress are increasing. In a further bid to improve services, many universities have adopted some form of triage or stepped care model that allows them to identify the most serious and complex cases of distress and provide them urgent services in a timely manner. Even that has failed to make a dent in the problem. For every critical case we manage to address, many nearly-as-critical cases have to wait.
In some ways, these short-term strategies to address a growing crisis appear to be making things worse. And students are not the only ones bearing the cost. The inadequacy of our current system puts significant pressure on professors, families, student peers and university staff, such as advisers and clinicians who must increasingly improvise and accept additional responsibility for filling the gaps. This emerging crisis threatens to spiral out of control if we don’t make some significant changes in our approach.
Triage of cases into categories of severity is certainly part of the solution, but we have been going about it the wrong way. Under pressure to meet the immediate needs of severely mentally ill and sometimes actively suicidal students, we have understandably prioritized resources in their direction. Not surprisingly, helping these students mobilizes a very significant proportion of our resources. The problem is that we are not helping them as students. Let me explain.
Our students are people first, and we and they should take care of their well-being as people first. But, as universities, our role is to support them as students when they are ready to be students. In the long-term, we are not doing students a favour if we help them stay in university when they are not functioning as students. The goal of triage in a student services environment should be to identify the people whom we can support as students and those whom we must temporarily refer to external resources because we can’t effectively support them. The criteria for “functioning as a student” must of course take fully into account our duty to accommodate. This is a discussion we largely haven’t had in the academy. It is a necessary one.
Students in crisis often want to stay in university. It can be very difficult, and sometimes impossible, to convince them that they need to prioritize their well-being and that they need to take care of themselves as people and get better before they can return to fulfill their academic potential. University and society don’t make it easy for students to accept that. There are administrative barriers to temporarily leaving a program of study, and there are even more significant barriers to rejoining it later. There may be substantial financial consequences for an abandoned semester, and it can do long-term damage to a student’s record. Universities have to address those as part of the factors that directly affect the wellness and mental health of our students.
Society in general, and employers in particular, put pressure on students to have an unbroken chain of success leading to a career. We need to hear from people outside the university that taking care of yourself is OK and that it is better to take time to get well in order to do well later. Universities and the broader community need to let students know that taking a break instead of having a catastrophic semester is a sign of responsibility, resilience and diligence, not a failure in itself. We need to reform our policies to make it easier for students to make that decision. We especially need to work on making it easier for students to return to university without penalties after a necessary absence.
Beyond addressing the barriers to leaving and rejoining programs of study, we must examine our policies and procedures and address the ones that create unnecessary unwellness for our students. Universities are in some ways necessarily stressful places. They are competitive environments in which we expect people to grow and tackle new challenges. Some of the ways in which we do this, however, impose unnecessary stress and needlessly worsen mental health. We need to keep the good, productive stress, and get rid of the unnecessary, destructive stress.
As we reduce some of the barriers to convincing students in crisis to take time off, and as we address unnecessary sources of unwellness in our environment, we need to identify the external resources to which we can refer our students in full confidence that they will receive appropriate care. This is made difficult by the fact that the public mental health system is also challenged and overburdened. In many jurisdictions, waiting times for care in the public system are months longer than they already are in the university system. International students, whom we recruit actively, sometimes have very limited access to any health resources at all outside the university.
Unfortunately, universities are often not equipped to deal with the most complex and urgent cases that need the attention of the public system. We need to work hard as institutions to build the networks and partnerships that will allow us to get our students the extra resources they need. This requires a serious policy conversation with governments at all levels, and strenuous advocacy efforts on the part of university administrations for increased resources in the public system. Resources must be invested in public health systems to help persons in deep crisis who happen to be university students.
If all these things are required of universities, governments and private-sector employers to address the problem, one might ask: what does it require of students? It requires that they increasingly take responsibility for their own well-being by choosing to invest in their wellness, by taking breaks from studying when they need to, and by being in university when they are ready and not before. Exams and papers are not designed to see how well students can do when they are not well. Too many students hurt themselves in the long-term by being students when they shouldn’t be. Let’s all work to create conditions under which they can make the healthy choice.
Andre Costopoulos is vice-provost and dean of students at the University of Alberta.
My colleague, Andre Costopoulous, is correct. Readiness is a key factor. The Stepped Care 2.0 © model that we have developed at Memorial University attends to readiness. But it is not a triage model. It is a community of practice model that aligns supports (and limits of supports) within the context of a rigorous academic mission. It also includes constantly evolving networking with external agencies. It is an empowerment model that focuses on the multiple determinants of health and well-being and shifts the responsibility for well being to the student, foremost, but also extends it to the entire community in setting conditions for success. For more information on our model please check out: http://steppedcaretwopoint0.ca/
Glad to see the model constantly evolving. We need to keep this conversation going.
I agree with this perspective. Universities are not equipped to be a provider of health care. We however should not be the cause of unnecessary stress. Exams, assignments, class schedules, and grades are all sources of stress. We often consider the demand on the student in isolation of our own individual course without the broader impact of a student’s full course load.
Life is stressful! People must learn how to manage and adapt instead of expecting their university, employers etc.to accomodate them every time they feel stress coming on. Attending university is a choice and not everyone is meant to pursue the academic route.
I worry what the next generaiton is going to be like after being coddled and shielded from anything stressful or offensive.
I agree that life certainly is stressful, and we invest resources into helping students develop the skills they need to face life. This article addresses the cases of students with very severe mental health episodes, and not merely stressful situations.
It is refreshing to hear this perspective, so thank you. I’m surprised I don’t hear more about the societal pressures underlying students’ mental health struggles (especially anxiety). I’ve heard countless stories from students about the pressure to choose a career path in high school, or about parental/social pressure to succeed, and the resulting stubborn belief that every choice, every grade, every failure or achievement is going to make or break the rest of their lives. Not to mention that they are juggling jobs and school and social media (which feels like a necessity). The suffering is not insignificant. We need to address these broader issues, not just focus on accommodations. I heartily agree that some students should not stay in university when they are struggling with severe circumstances. I suspect they are too afraid to leave – led to believe their lives will be ruined if they do. Thanks, again for writing this.
As an Advisor who meets with many students in crisis I highly identify with many points in this article. I firmly believe more students would take breaks to focus on their personal wellbeing if they were guaranteed a spot to return to their studies once they were well. While I understand the reasons why universities have policies around time limits and repeating classes, these polices do not encourage students to they take the time needed to deal with personal struggles.
One of the saddest things I witness is students throwing their hard earned cash, and easy earned loans, into one class after another while they attempt to maintain minimum enrollment standards and deal with a crisis simultaneously. It often ends in academic penalties and a university record they cannot overcome. In future years once their personal situation has stabilized they are often locked out of their desired area of studies.
Continuing conversation around this topic must be on the agendas not only for universities but in wider society as well. All of us have times of personal difficulty where time away from school and work is necessary. We need to create an environment where this is not seen as weak, but as an expected and valued way of maintaining a healthy society.
This is an excellent argument in support of addressing systemic challenges that students with mental health concerns often face. The CBC recently published an article about international students in British Columbia fearing reprisals if they seek help for mental health problems. The article shows that international students are disproportionately affected by systemic and bureaucratic barriers to mental wellness supports. While it’s already difficult to convince some international students to seek help — often because of social, family, or cultural stigmas — it’s almost impossible if they are also worried that their future immigration status may be in jeopardy.