Mental Health on University Campuses

1. Mental Health on University Campuses Everybody has a Role to Play: Do you have the conceptual map to show the way?

2. Universities – A Critical Population • Our student population falls into the highest risk age group for mental illnesses and substance dependencies – youth (15-24) are the most likely to suffer from selected mental disorders (Statistics Canada; Canada Campus Survey) and 19.8% of youth in this age bracket report symptoms of substance abuse and mood and anxiety disorders (Canada 2006) • Students are more likely to suffer from psychological distress/report mental illness symptoms than the general youth demographic (Canada Campus Survey) and contributing factors associated with onset of mental health problems are customary in a college or university setting (Andres and Wilding, 2004) • Youth (15-24) are more likely to report suicidal behaviour (Statistics Canada) • Prevalence data from six Ontario post-secondary institutions (ACHA-NCHA II student survey, 2009): • approximately 4% of students have a psychiatric condition • approximately 15% of students have been treated by a professional for one or more mental health problems • the three more common factors identified by students as affecting their academic performance were: stress (38%); sleep difficulties (26%); and anxiety (26%) • with respect to common mental health problems, approximately 53% of students indicated they felt overwhelmed by anxiety and 36% felt so depressed it’s difficult to function

3. Why does student mental health matter? • Eisenberg et al(2009): depression is a significant predictor of lower GPA and higher probability of dropping out. • Hysenbegasi et al (2005): a significant, negative association between GPA and untreated depression (whereas treated depression is not associated with a significant difference in GPA). • Andrews & Wilding (2004): depression (but not anxiety) measured midway through the second year is negatively related to exam scores at the end of the second year. • Ratner et al(In press): students’ perceived ability to manage their stress could significantly reduce depressive symptoms.

4. Mental Health is Foundational for Learning • Universities need to focus on Mental Health deeply, structurally, and broadly - the ability of students to learn and participate in campus life depends on it. • Opportunity to make mental health about the core priority of Universities – teaching and learning. It is pre-conditional for teaching and learning. Key assumptions: • the interrelatedness of health, learning and campus structure/culture; • interdependence of social, emotional, physical, spiritual health and learning; • and the importance of collective responsibility and campus-wide involvement in creating a campus environment that is conducive to student mental health and academic success. • Move to a systemic model. Goal must be shared by more than the health and counseling services and championed by Student Affairs and Academic Leadership. • This is a cultural change for the institution; making this a strategic priority allows you to make budget allocations to follow the commitment

5. Build an Institution Strategy and Work Plan to Create and Sustain the Focus on Mental Health • A strong framework will target multiple levels of intervention • individual to institutional • addresses the broad spectrum of prevention through to intervention • Goal is to create a campus community that is deeply conducive to positive mental health by focusing on • environment factors that impact student mental health • building students’ awareness and self-management capacity • early identification programs • timely and appropriate access to resources and services as needed.

6. Are you focused appropriately on each level of intervention?

7. Cases • Jasmine: history of mild depression and anxiety. Has been taking anti-depressive medication but has decided to discontinue. Symptoms are returning. Can’t concentrate, disturbed sleep patterns, depressive thoughts, and lack of appetite. Academically she is declining. Requesting extensions, deferrals, late drops, and is failing or just passing. She has roommate problems. Asking for housing support. Parental involvement. Mom says she needs our support to succeed academically, and personally? She is resistant to counselling. • John is a first year international student, who has been becoming increasingly agitated as the midterms approach. Has two back to back midterms. After first, appears to attempt suicide in a highly visible way. He is taken to hospital and released 24 hours later without any communication to the university. He just shows up back in residence. He says he is fine – was just a little depressed and wants to stay in residence.

8. Small Group Discussion • Who could be involved? • How do you ensure an integrated approach to roles and responsibilities? • What role do faculty have to play? • What role do Deans play? • Considerations: • Impact • Supportive Campus ENVIRONMENTS • Mental Health Awareness • Faculty and Staff Training and Tools • Support Programs • Policies

9. Impact on Campuses • Disability Services: 320% increase in number of students using Access/Disability Services vs. 32% increase in general student population between 1992 and 2007 (Ministry of Training, Colleges and Universities). Fasting growing groups are those with Mental Health Accommodation needs. • Counselling Services:92% of counsellingcentre directors reported increase in the number of students presenting with severe psychological issues; 89% reported severity of issues has increased; 97% reported increase in clients taking medications (Canadian Counselling Centre Survey, 2004/05; increases over the past 5 years). • Heath Services: Similar complaints about increases in students presenting with mental health concerns. • At McMaster, visits to their health clinic increased from 31,352 to 35,312 in 3 years (13% increase) and mental health visits rose from 4.7% of those visits to 7.4% of the visits in the same time period. • Residences: Monitoring student behaviour, addressing rights of the individual versus the others in residence. Remember, residence life staff are usually students themselves. • Faculty: Increased concerns regarding student behaviour and requests for accommodation. • Behaviour Impacts: Judicial Offices, Program Counsellors, Campus Police, Crisis Management Teams, Legal counsel. • But most significantly, on an individual and community’s ability to learn and succeed academically.

10. Building a Supportive Campus Environment Issue: • Universities need to engage in a full review of its environments to determine ways to reduce anxiety and stresses • Need to find ways to incorporate a full system response • Need to look to things like how we schedule examinations, how we deal with requests for accommodation, how we deal with requirements for medical documentation, how we train student staff, supports for commuter students Best Practise: • Cornell – Mental Health Framework • Carlton – Mental Health Framework

11. Mental Health Awareness Issue: • Prevention is the best strategy • We need to educate our campus community about mental health issues • We need to find ways to collectively leverage resources to make this a system-wide campaign Best Practice: • A number of initiatives underway. • The Jack Project • Cornell Handbook • Involve student governments, student press, and student clubs.

12. Training and Support for Faculty and Staff Issue: • All faculty and staff need to see their role in supporting and referring students. • The need for professional development and training tools has been identified Best Practice: • Queens is endeavouring to have all its faculty and staff do the Mental Health First Aid training. • Waterloo uses QPR (suicide referral) training for its faculty and staff • Guelph has developed its own modules that range from 1 hour to 4 hours depending upon group being trained and placed on-line. • COU, in partnership with, the University of Toronto, the University of Guelph, and York University will be developing an on-line program that could be used by any university.

13. Support Programs Issue: • Universities in the past had been funded assuming support systems were for short-term personal issues. Seeing expectations for long-term sustained support. Funding has not followed. • Increases in class sizes make it harder to notice somone in trouble • Increased demand for staffing funding support from areas most impacted: Counselling Offices, Disability Offices, Housing Offices, Health Services, Campus Police. Best Practise: • Creation of Health and Counselling Centres with a triage function • Effective depression screening • Peer support programs • Cross functional teams to integrate services across unit boundaries • On-line resources such as Feeling Better Now, Student Health 101 • UBC Early Alert Identification and Intervention

14. Policies Issue: • Institutions need clear policies that outline a university’s responsibility on issues related to mental health, such as Involuntary Withdrawal policies, back to school policies. • Not just about mental health policies but about reviewing all policies with consideration of the impact on students • Institutions need clear policies regarding the sharing of information with others on campus, and need to make such policies clear to the community. Best Practice: • MTCU and COU retained legal counsel to develop a document on policy issues. It includes a number of helpful tools including: • Best practices for involuntary withdrawal • Templates for behavioural contracts, return to school letters, withdrawal letters. • Opinions on divulging information, restricting access to campus, parental involvement, requesting medical documentation, parental involvement.

15. Taking a Cross Functional Approach • Involving staff, faculty and students in the discussion • This is a long term re-orientation of people, services, policies, practices, training, and systems • Evidence based: National College Health Assessment • Key considerations to build a campus specific framework include: • Approach to student advising • Specific services and access to those services • Space development • Practices for academic concession policy • First year experience programs • Policy review; new policy development • Orientation/transition programs for students; orientation of staff and faculty • Mental health awareness programs and services • Communication planning

16. Here’s an example of where we began, our strategies: • Building Awareness and Self-Management Skills • www.students.ubc.ca/livewelllearnwell • Rapid Access to Mental Health Services • Early Alert System and Care Team (2 year implementation) • Case Management Approach to Complex Student Concerns • Creating a Supportive Campus Environment; specifically a strategy for peer leadership programs; supporting campus clubs • Training Faculty & Staff: Identifying/Referring Distressed Students • Development of Collegiums • Integration of mental health awareness in faculty-based communications to students (eg. course syllabus) • Review of policy to determine its impact on student mental health and revision where indicated • Creating a supportive campus environment, more broadly - Philosophy and Standards for student advising • Strengthening resources for building self-management skills capacity • Core priority for budget realignment: across all student services • Senate, Board, Committee of Deans, student press and Student Government Ontario Commmitte on Student Affairs

19. Inescapable focus on student wellbeing: Share the priority • International Students • Insurance • Community support/communication with family • Mental health and wellbeing is important for academic success including student engagement in: • Study abroad • Community service learning • Coop education • Research opportunities • Residence living Ontario Commmitte on Student Affairs

20. Additional References • Patterson, P. and Kline,T. (2008). Report on Post-Secondary Institutions as Healthy Settings. The Pivotal Role of Student Services, Health and Learning Knowledge Centre: Victoria, B.C., Canada • National Association of Student Personnel Administrators (NASPA) Health Education and Leadership Program. (2004). Leadership for a healthy campus: An ecological approach for student success. • Dooris, M. (2001). Health promoting universities: Policy and practice – A UK perspective. Community-Campus Partnerships for Health.