Evolving the mental health e-world: Integrating services in cyberspace to meet student needs

Every year, one in 10 McGill students will visit McGill’s Mental Health Service (MMHS). While this means the majority of students may never set foot in the quiet offices of the Brown Building’s fifth floor, MMHS actually ends up playing a role more crucial than ever for many individuals.

Mental Illness Awareness Week kicked off at McGill on Oct. 4 with the annual Students in Mind conference. During the conference, MMHS presented its new website and online resource for students: McGill Mental Health Hub, also previously known as the McGill Wellness Portal. Emily Yung, McGill’s Mental Health Education coordinator, is one of the brains behind this new tool.

Originally from Markham, Ontario, Yung completed her undergraduate degree in Health Sciences at Western University. She proceeded to pursue a two-year masters in Psychiatry from McGill, graduating in 2014. Yung was inspired to venture into the field of mental health in her first year of undergraduate studies while volunteering with a family doctor who also practiced psychotherapy. Yung would sit in on his psychotherapy sessions and observe how the doctor induced change in patients on a daily basis.

Through this, Yung saw how various sessions would help foster transformations even within a one-hour period. While changes within an hour may be minimal, there was enough positive impact for the individual to carry out their week through learning how to cope with what was going on, until the next session. This inspired her to pursue a career in the mental health field, and led her to her current position at McGill.

While many McGill students may not experience mental health issues themselves, the likelihood of having a friend or family member who has experienced one is large.

“Often times, we do see [students] bringing in friends of concern or they come to the clinic asking what do I do with a friend,” said Yung. “We don’t necessarily provide appointments for friends or family that are concerned about McGill students but […] if they have any questions we encourage them to bring […] their friend to come seek help.”

In 2012, under the direction of Dr. Robert Franck, MMHS submitted grant proposals to Bell Let’s Talk—a program designed to promote conversation on mental illness in Canada—for a plan to create an online mental health hub for students. The new website would offer information and resources for mental health at McGill in an attempt to reach those who may not necessarily know they needed help, or those who weren’t inclined to seek out help in the traditional sense. It received $500,000 from Bell Let’s Talk funds.

Over the past five years, MMHS has experienced over a 30 per cent increase in the use of its services. For the coming year, it anticipates an approximate 10 per cent increase from last year. MMHS expects a further increase in use as a result of the hub, and will use a portion of the Bell Let’s Talk grant to equip the office for heightened demand.

Seventy-five per cent of mental illnesses occur before the age of 25; thus, university students are a particularly vulnerable population.

In university, there are a lot of different stressors that may occur, such as moving away from home, trying to balance academics, workload, and relationships, and figuring out what to do after graduation.

“Transitioning to university is an inherently stressful event, no matter when it happens or what else is going on in our lives at the same time,” said Tori Conconi, U3 Nursing. “While there is a healthy level of stress that our body and mind can cope with and benefit from, we can very quickly find ourselves beyond that threshold […] an important determinant in how we deal with this stress is what resources we have at our disposal that can help us cope.”

One of the biggest issues that required addressing, and one of the largest reasons for the creation of the website, is the fact that less than half of young adults aged 18 to 25 who experience a mental health problem will seek help.

“[Students] just don’t recognize that what they’re experiencing may warrant seeking help,” Yung said. “They may think [stress] is a normal part of life, but there is a point where it really impairs the functioning of a person, [so that] they’re not able to enjoy life anymore, do things that are meaningful to them, or be successful in the way that they see success.”

Yung’s position was created as a result of the Bell Let’s Talk grant, to fill the need of a project manager for the website.

“The first step was honing on what were the biggest needs of students and how can we put that onto a website,” said Yung. “We did a lot of literature review and research on e-mental health and online tools for university students.”

One of the most prominent features of the website, and the largest component of the grant proposal, is a self-screening tool for students to fill out a questionnaire on their current state of mental health. Students are then provided with a list of resources that fit with their responses and needs at the time. The screening tool uses evidence-based screenings, like the Patient Health Questionnaire, to tap into different domains of mental well-being including depression, anxiety, panic attacks, substance abuse, and eating disorders.

While screening is currently an important part of the website, it was not initially received well by everyone involved in the creation process.

“There was a little bit of pushback on whether or not to include a screening tool on the website because some thought that it was medicalizing the model of mental well-being,” said Yung. “But at the same time there is value to helping a student get a gauge on how they’re feeling.”

In the end the website kept the screening tool due to evidence from other academic institutions where similar screenings that were offered proved to be useful. A study of the e-mental health website at the University of Washington showed that over 50 per cent of students who took the self-screening proceeded to the referral section of the system. Of 829 positive screening test results, 42.1 per cent led to subsequent referral requests.

The study also claimed that time constraints are a large barrier to students who wish to seek help during regular daytime office hours. The site’s peak hours are between 6:00 p.m. and 7:00 p.m.—accounting for almost 30 per cent of the website’s use—indicating that having an accessible resource allowed students to assess their mental health and seek help with convenience.

Following the release of the site, the University of Washington Mental Health Center experienced a 13 per cent increase in student patient volume, in contrast to the three per cent to four per cent of the previous year.

The creation of the McGill Mental Health Hub also involved a lengthy process of gathering qualitative and quantitative feedback from staff and students through surveys, focus groups, synthesizing information, and making appropriate changes to the site to fit student needs.

“We created an online survey to evaluate the website and this was sent randomly to 3,000 McGill students,” said Yung. “Of those students, about 350 responded to the survey with their experience using the beta website.Through that survey we gathered the information and synthesized it to make changes for the second rendition website so that it better meets students’ needs based off their stats.”

The majority of changes involved including more content on different subjects that staff and students felt were important, and making layout changes such as having fewer clicks to get to the information they wanted at a more efficient pace.

While Yung said the collaborative aspect of her work on the site is the most rewarding part of her job, she admits that it can be rather challenging to blend everyone’s perspective to create one cohesive site.

“A lot of different people have opinions and they want to have their say, both staff and students,” she said. “The challenge was taking the time to listen to everyone’s opinion, […] respecting their opinion, but also advancing the project in a way that will respect the original grant proposal that was written, and respecting our timeline as well.”

While the website launched last week after approximately three years of development, it is far from completed. After a long process of putting it together, Yung is hopeful that having an e-mental health resource, as opposed to only offering in-person information, will allow students to not only learn more about mental well-being and mental illness, but also help to reduce the stigma around it and help students to take care of themselves.

“This is the age of technology coming in and everyone is often on their computers, phones, or always connected online,” she said. “By having a resource online, this makes the information of psycho-education much more accessible.”

According to Yung, one of the largest obstacles of working in mental health at McGill is the lack of resources to meet the high demand for mental health service.

“I see it every day at work,” she said. “There is just such a great need and sometimes it can be frustrating working within this field where we can’t necessarily meet the need immediately for students.”

Kaelan Forgues, U2 Management, said that the creation of the mental health hub will fill in the service gap that occurs during periods of high demand.

“[MMHS] turns away a lot of students, especially during high volume periods of stress, like during exams,” she said. “A website to either help students answer questions, or direct them to other possible outlets to deal with their stress would be good.”

The McGill Mental Health Office anticipates a further increase in student patient volume, similar to that seen at the University of Washington. However, according to Yung, a portion of the grant has been used to better equip the office to deal with the higher demand.

The new Mental Health Hub also provides information to concerned individuals by outlining ways to listen supportively, giving warning signs for suicide, and listing information on how to refer a friend to MMHS, something that the Mental Health Office does not necessarily offer.

However, MMHS can never force a student to seek help. Students have to go at their own will, and if there is a strong expression of concern, MMHS tells the Office of the Dean of Students who have the reach to contact students who may be of concern.

Perhaps the online Mental Health Hub will reach students who may have otherwise not sought out help, or even recognized that they needed it; however, the exact ramifications on McGill’s Mental Health Office is something that remains to be seen. Nonetheless, access to mental health services will only serve to improve resource availability for students, and the emergence of an e-mental health hub in the millenia cyber generation will undeniably increase the reach across campus.

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