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ABSTRACT
The focus of this article is the growing gap between demands for campus mental health services and the ability of Canadian universities to play a significant and positive role in student mental health promotion. This article is grounded in in-depth interviews with young people collected as part of a participatory institutional ethnographic research project. We trace from young people’s descriptions of their work to monitor and attend to their own wellbeing, navigate the university mental health “triage” process, including their work to demonstrate eligibility for on-campus psychiatric/psychological services, into the discursive and institutional relations that influence the outcomes of their efforts. We show how the university’s Stepped Care model rationalizes and obscures the ways that structural inadequacies condition young people’s health work. Our process of discovery begins with students’ proactive and largely unsatisfying attempts to access mental health services on campus and in the larger mental healthcare system. It ends with an examination of the university’s implementation of a Stepped Care model, highlighting the difficulties it poses for students seeking to quickly address acute and/or rapidly evolving mental health needs, self-advocate for the first time, or appreciate the severity of their own symptoms.
Notes
1 The pricing of urgent clinic visits for students with out-of-province and international student insurance was taken from the university in question’s website on “Off-Campus Care.” Please note that these numbers reflect the price of the first visit, differing from the price for subsequent visits and not including the cost of blood tests, vaccinations or other materials.
2 For the street interviews, teams of youth researchers and graduate students invited young people to respond to a single interview question (e.g. where do you feel healthiest; where do you feel safest; where do you learn best; where do you feel at-home; or how do you like to get around the city) in recorded anonymous street interviews. For these interviews consent was provided orally.
3 Of the 12 young people whose interviews comprise the starting place for this article, Katya, Sam and Pamela grew up in Montreal and had some familiarity of the (mental) healthcare system here. Ahmed was born in Sri Lanka, but immigrated to Canada during early adolescence. All of the other women grew up outside of Canada, even though two had dual citizenship (Nadine and Carrie). Sam, Pamela, Nadine, Emily, Morgan, Katya, and Carly were undergraduate students at the time of this research. Carrie, Breanna, Ahmed and Minerva were graduate students. Within this sample, only Emily, Ahmed and Minerva identified as people of colour. Emily identifies as having Asian ethnicity, Ahmed is Sri Lankan and Minerva is LatinX. Most of the group identified as cis-gender straight women; Breanna is a queer woman; Sam is a “trans-boy;” and Ahmed is a cis-gender straight man. None of these young people were recruited because they had mental health issues.
4 Starting September 2019, Counselling Services began offering 30-minute drop-in consultations from Monday-Friday, with registration beginning each day at 10am. These services are reserved for students who have not previously accessed Counselling Services and were not available at the time of this study (2016–2018).
5 An FTE is the calculation used to represent the number of fulltime students.
6 As of September 2019, students could sign up for first-come-first serve 30-minute drop-in appointments from Monday to Friday, where registration begins at 10am. There is no indication on the website how many of these appointments are available per day (Drop-in appointments at counselling services Citation2019).
7 Noting a recent and significant expansion of drop-in services on campus in the 2018/19 academic school year, future research may explore how this service delivery mechanism improves timely access (University Counselling Services Citationn.d. retrieved April 1, 2019 from https://www.mcgill.ca/counselling/urgent-care).
8 Of the young people we interviewed, only Ahmed did not seek access to university mental health services and only Nadine described a positive experience seeking access to counselling. She saw her own experience as relatively positive because she was able to get access to the services she desired when she needed them and experienced no further symptoms of distress. Because we used a combination of posters and snowball sampling for recruiting in-depth interviewees, it is possible that students reached out to the project with the intention of sharing their concerns about particular campus services, including but not limited to (mental) health services.