White Paper on Postsecondary Student Mental Health

In recent years, Ontario colleges have experienced a significant increase in the demand to provide services to its students related to mental health and wellbeing. Colleges have responded by augmenting services and examining new models of delivery. The Ontario Government has provided some additional funding to assist these efforts as part of its Comprehensive Mental Health and Addictions Strategy. Nonetheless, there is general agreement at both the Heads of Student Affairs (HOSA) and the Coordinating Committee of Vice Presidents Students (CCVPS) that:

1. Current models are not sustainable
2. There is a need for a more integrated strategy and approach among stakeholders to guide funding and service delivery
3. Colleges need to better collaborate with community agencies to maximize efficiency and minimize gaps

With these issues in mind, the CCVPS has prepared this white paper. It identifies key issues and opportunities based on a review of current relevant literature and interviews with key stakeholders. It concludes with twenty-six key considerations and nine recommendations intended to provide the basis for shared strategic planning, advocacy and ongoing consultation by CCVPS.

Interviews with key institutional and government informants in mental health strategy and delivery as well as a review of current documentation revealed the following issues and challenges for Ontario colleges:

• Demand for student mental health services is outstripping capacity under many of the current delivery models.
• The complexity of student mental health needs has grown as the student population diversifies and students who, in prior years may not have contemplated postsecondary education access the system.
• There is a wide range of people and roles involved in mental health delivery and funding decisions at both at the campus/community level and across the system, but no system-wide shared understanding of their mandate, responsibility or scope of service.
• Colleges are using and adapting a variety of mental health delivery models, ranging from limited or capped counselling to outsourcing some or all services, to the development of comprehensive mental health strategies. There is a need for the continued development and testing of new models, and accommodations for students with mental health needs and robust mental health awareness programs need to be built into any model.
• There are significant policy gaps that must be addressed with respect to college-wide policies, academic policies and policies governing confidentiality and privacy. These are essential to creating a framework for new service delivery models and shared responsibility for student mental health.
• As new approaches to student mental health needs are introduced, and institutions move increasingly to a “circle of care’ approach , there is a concomittant evolution in the role of counsellors and the development of a shared understanding of their role both at the system and the institutional level. This understanding needs to take into account the involvement of support staff and other staff in health service delivery, private-sector agreements and new legislation regarding counsellor accreditation.
• Canadian research on student mental health issues and robust data are lacking, making it difficult to support evidence-based evaluation and planning. Priority areas include:
  • Improved capacity in individual colleges to measure volume, trends and impact of particular supports and interventions;
  • Better longitudinal data using standard tools such as KPI and aggregated reports from member colleges (e.g. CCDI reports);
  • Greater participation by Ontario colleges in tools such as the National College Health Assessment Survey (NCHA);
  • Improved capacity for accessing external data sources such as the information tracked by student insurance plans or usage trends of new services such as Good2Talk/Allo J’écoute.
• Resources dedicated to mental health are unequally distributed across Ontario campuses and sometimes between campuses within the same institution, particularly affecting college students studying in French and those in small or remote communities.
• There is a need for stronger mechanisms for identifying and supporting students at risk who are transitioning from secondary to postsecondary insititutions.
• Few colleges have formal structures in place to respond to the need to balance accommodating students and ensuring community safety in the context of an evolving legal framework.
• There is a significant opportunity for increased collaboration between colleges and universities that would leverage resources more effectively, strengthen capacity for data collection and create a much stronger advocacy lobby.
  Increased external collaboration is also critical. In particular the paper identifies opportunities to create or improve:
  • Agreements to provide direct community-based mental health services on campus;
  • More connections and seamless transitions between college and offcampus services (including crisis centres, hospitals, medical practitioners, help lines, etc.)
  • Coordination of the involvement of various government ministries.

The white paper highlights the multiplicity, complexity and frequently un-coordinated nature of relationships between the various stakeholders in the area of student mental health, noting in particular the need for the following:

Government Ministries.

Colleges need to work closely with universities and lead government ministries to clarify respective roles and responsibilities and to develop a funding model that is clear, efficient and fair. There is an urgent need to address the gap in student support at the point of transition from secondary to postsecondary education. Similarly, there is a need to ensure more seamless transitions between the institutions and off campus services and strong collaboration between colleges and the community agencies in their jurisdiction.

Individual Colleges.

Colleges need to define clearly what services they should and should not be providing, including possible limits on service provision. They need to identify what specialized expertise they need/are capable of providing on campus, and develop more fluid and seamless relationships with community agencies and services. As colleges begin to reconsider the current shift to a crisis interventional model, there has to be greater investment in mental health awareness and prevention strategies across the campus, including in residences, where on-campus housing exists. There are significant opportunities to use technology to expand service delivery and offer new types of service.

Province-wide Bodies.

There is a strong role for Colleges Ontario in advocacy, particularly on specific issues, such as the funding of more Family Health Teams on campuses and in supporting and sustaining the new Centre for Innovation in Campus Mental Health as a hub for sharing information on best practice and a forum for collective engagement.

Post-secondary Health-related Committees.

Colleges have a range of committees working on aspects of student mental health including the Heads of Student Affairs (HOSA), the College Committee on Disability Issues (CCDI) and the Ontario College Counsellors (OCC). Colleges are less active in system-wide organizations such as the Canadian Association of University College Health (COUCH). COUCH, which is a division of the Canadian Association of College and University Student Services (CACUSS), supports various system-wide mental health initiatives such as the National College Health Assessment (NCHA) survey. Similarly, colleges do not have a strong role in the Ontario University and College Health Association (OUCHA). More active participation in these bodies would increase possibilities for college/university dialogue and shared advocacy.

Community Agencies/Partners. Greater collaboration and integration is required between colleges and community partners, recognizing that the nature of that collaboration will always be dependent on the size and location of the institution and the available resources in the community.

The following recommendations were distilled from the 26 key considerations that form the basis for the nine recommendations covering policy, the development of new models, collaboration, transitions, data, advocacy, and funding as well as a series of considerations related to each area of recommendations.

Vision

1. Establish a clear vision and approach to develop healthy campus communities that are inclusive, foster a sense of belonging and assist students to develop coping mechanisms and resiliency both while at the postsecondary environment and when the student transitions into the workforce.

Transitions

2. Recommend that all colleges develop formal transition and entrance strategies related to mental health with a focus on seamless transition, prevention and early warning mechanisms.

Collaboration

3. Recommend increased collaboration between: a. student groups b. colleges, universities c. CICMH, MCYS, MTCU and MOHLTC and d. Key community agencies within mental health services within the community.
4. Recommend utilizing the CICMH as a vehicle to promote research, sharing of best practices, assessment and evaluation of model experimentation, leveraging existing resources, advocacy and development of shared services.

Models

5. Recommend that each college consider local and regional factors when designing models to support students and consider the following:a. Acknowledge and endorse the diversity of possible approaches and models. Recognize and respect that each college will develop/adapt the model and framework that is best suited to its context and to the needs of its student body.b. Encourage ongoing experimentation with new models with thoughtful evaluation practices and develop specific opportunities for sharing best practice through the Centre for Innovation and other appropriate vehicles.

Policy

6. Recommend that all Ontario colleges conduct a review and renewal of college policies with a lens on how the policies provide appropriate support for students with mental illness as part of the normal policy review cycle.

Data

7. Advocate for improved institutional and systemic data collection and analysis in order to strengthen evidence-based decision-making.

Advocacy

8. Advocate for a joint PSE working group on mental health with representation from Colleges Ontario, the Council of Ontario Universities, student groups, MOHLTC and MTCU with the goal of developing a plan for greater integration of programs and services.
9. Continue to promote the student mental health issues in the overall Colleges Ontario advocacy agenda.

Funding

10. Collaborate with college and university partners to develop a proposal for a funding model that is coherent and fair across the sector and that rationalizes the respective roles of government, postsecondary institutions, student governments and community agencies.