Social Policy in Ontario

“We have lineups out the door and down the hall,” said McMaster University psychiatrist Dr. Catharine Munn. “Despite hiring more counsellors, we’re drowning.”

Data collected from across the country by the investigation shows dramatic increases in the number of young people seeking mental health services as well as increases in the associated costs of meeting that demand.

Among the findings:

• A Star/Ryerson survey of 15 universities and colleges across Canada found all but one have increased their mental health budgets over the past five years. The average increase has been 35 per cent.

• Academic “accommodations” (special arrangements for students with mental health issues allowing for added time to complete assignments and exams) have also been rising — 143 per cent at the University of Toronto, for example, since 2009.

• There has been a 344-per-cent increase in calls to the Mental Health Helpline run by ConnexOntario (a toll-free mental health services information line) since 2010 by people 25 or younger.

• A major survey of 25,164 Ontario university students by the American College Health Association showed that between 2013 and 2016, there was a 50-per-cent increase in anxiety, a 47-per-cent increase in depression and an 86-per-cent increase in substance abuse. Suicide attempts also rose 47 per cent during that period.

• A growing number of major Canadian corporations that employ young people, including Starbucks and Manulife, have dramatically increased mental health benefits in response to growing demand.

Those findings are backed up by a growing body of data that points to the same conclusions.

This month, data from the Canadian Institute for Health Information reported emergency department visits by children and youth from 5 to 24 seeking mental health or substance abuse treatment rose 63 per cent and hospitalizations jumped 67 per cent between 2006 and 2016.

The reasons behind the surge in mental health demand remain a matter of debate within the medical community.

“No one knows exactly what’s going on,” said Dr. Glenda MacQueen, a professor of psychiatry and vice-dean of the University of Calgary’s medical school. “Youth today are under more pressure than ever before.”

Experts agree the problem is becoming overwhelming.

A lack of mental health services for younger Canadians leaves serious problems undetected for years. As students arrive on campus, they suddenly have access to counselling and psychiatry services not previously available in high school.

“(We have had) 40 years of gross, chronic underfunding of child mental health,” Munn said.

With decreased mental health stigma and increased awareness of the services available on campus, “people are coming out of the woodwork who are no longer ashamed,” said Jan Young, director of student health and wellness at McMaster University.

From resident advisers to professors to psychiatrists, those working with students all point to a significant increase in mental health concerns, she said.

“You can’t pin down the reason to one factor,” Young said.

But in interviews with a dozen leading experts across the country, several issues were identified.

The competitive job market means that a university degree is no guarantee of a career, leading increasingly stressed students to seek out second or third degrees to set themselves apart.

Changes in parenting styles, where parents tend to do more for their children than generations past, can leave youth ill-prepared to navigate the world as they set out on their own and less capable of accepting small failures.

Societal changes in how we communicate — via social media in the world of 24/7 Internet — can also lead to new pressures not faced by previous generations, say experts.

“This generation of children and youth live in two universes,” said Patricia Marra-Stapleton, the mental health leader for the Toronto Catholic District School Board. “One is real life. They also live in a digital social world. What we’re seeing emerging is that kids as young as 8 years old have an overdependence on social media and digital connectivity.”

Dr. Katy Kamkar, clinical psychologist at the Centre for Addiction and Mental Health, says that although social media has positives in terms of opening up communication and dialogue, there are also psychologically scarring influences.

“There is concern around cyberbullying, spending a lot of time on the computer, and limiting the actual social support from person-to-person contact.”

Whatever the cause, the effect is proving dramatic.

Budget strains

The increase in cases has triggered dramatic spending across the private, public and educational sectors.

Algoma University had the most significant change, jumping about 133 per cent in three years. Its budget for counselling services was $22,776 in 2013-2014, which increased to $53,113 in 2015-2016 despite a decline in enrolment of more than 230 students.

“Students have higher anxiety, more stress and often lack the coping skills or nearby peer support necessary to help,” said Tom Mauro, director of student services.

The University of British Columbia saw an 86-per-cent increase, from just over $1 million in 2010 to $1.9 million last year.

“The number of staff we had was completely inadequate for the size and complexity of our student population, and we really needed to be able to bolster that,” said Cheryl Washburn, director of counselling services.

Ryerson University had a 23-per-centincrease in budget in the last three years, from $1.4 million in 2014-2015 to $1.7 million in 2016-2017.

The additional money funded two new counsellor positions, a community service provider and mobile mental health options for students, said Ryerson clinical co-ordinator Sarah Thompson.

A Star/Ryerson survey of counselling appointments at 13 post-secondary institutions found widespread increases in recent years.

On average, the number of counselling appointments increased by 35 per cent.

The biggest increase was at Georgian College: a 211-per-cent jump to 3,928 in 2016-2017 from 1,260 in 2013-2014.

While the University of Ottawa’s total student enrolment decreased by 833 between 2013 and 2016, the number of counselling appointments rose by 1,195.

At Sheridan College, there have been more than 100 high-risk assessments that involved a call to emergency medical services (EMS) from April 2016 to this February.

“Post-secondary is often when some of our mental health diagnoses come to light,” said Marissa Amoroso, senior manager of health and counselling at Sheridan College. “When they’re overwhelmed, they don’t know what to do or how to reach out for help.”

Accommodating students

Another measure of mental strain on young people is accommodations granted by universities to students with disabilities that hamper their academic performance.

The number of students listed for “psychiatric” conditions who received accommodations at the U of T’s downtown campus alone jumped from 628 in 2009 to 1,526 last year — a 143-per-cent increase.

Psychiatric conditions (including ADHD) now account for 56 per cent of all academic accommodations at the country’s largest university.

Olivia Nicoloff is a 22-year-old U of T student who suffers with anxiety, panic attacks and depression.

“Twenty-two years is a long time to be fighting with yourself,” she said. “My illness really manifested in my ability to focus and my ability to do schoolwork.”

Nicoloff began seeking counselling at the university in her first year in 2013 — but didn’t get in until this year.

“It’s a good thing that I was not a serious risk to myself or others because I might not be here,” she said. “These wait lists are long, there are not enough doctors. There never probably will be to meet the demand of students.”

She received academic accommodations for assignments and tests this past year.

“All of my life being so strong academically I’ve had these expectations put on me that I’m going to do such great things … if I put my mind towards it. And there was a lot of judgment on myself because I couldn’t do that anymore.”

At the University of Winnipeg, student accommodations for mental health reasons spiked 80 per cent — from 142 in 2011- 2012 to 255 this year so far.

Last year at Georgian College, there were 684 accommodations, an increase of nearly 70 per cent since 2011.

Trent University’s accommodations jumped 108 per cent since 2010 to 604.

And since 2014 alone, Brock University’s mental health accommodations have nearly doubled to 422.

Privatizing help

Some schools and student unions, including those at Durham College, Dalhousie University, George Brown College and McMaster University, are responding to the spike in mental health demands by farming out the support services to private contractors like Aspiria Corp.

Aspiria provides Student Assistant Program (SAP) and Employee Assistance Program (EAP) services for mental health issues and life coaching to businesses and schools across the country.

In 2010, Aspiria had no SAPs. Today, it has 23, with the number expecting to grow larger by September.

“We’re finding that the on-campus counselling centres need to be supplemented by other services, external to the campuses, for mental health counselling,” said Eric Rubel, vice-president of clinical experience.

Some experts say privatizing mental health care — especially complex care for university students — is a high-stakes gamble.

“Contracting out will be a disaster,” said McMaster’s Dr. Munn. “You need to be able to work with the university to accommodate the student and modify their stressors.”

Kimberly Moran, CEO of Children’s Mental Health Ontario, says it should not be the responsibility of post-secondary institutions to provide mental health services. It is their job is to provide education. Moran’s own daughter suffered through depression and was suicidal at the age of 11.

“My advice would be for the government to fund the health-care system to provide those mental health treatment programs so universities and colleges don’t have to,” she said.

Nancy Reynolds, who is on the advisory council for the Mental Health Commission of Canada, said insufficient investment in mental health services means “there is still a large number of people who are unable to access the services they need when they require them.”

The province this month announced $6 million in additional annual funding to support mental health services at Ontario’s colleges and universities — bringing the total investment to $45 million over the next three years.

But with 44 post-secondary institutions vying for their share, many experts say it’s not enough.

One-time funding for interventions isn’t a long-term fix, says a report by the Ontario University and College Health Association this month.

“If suicide is the number one killer of our youth, of our teenagers, why are we not up in arms trying to deal with that?” said Ontario Undergraduate Student Alliance research and policy analyst Danielle Pierre. “I think it’s a serious disregard for severity of the impact of mental illness.”

Responsibility for youth mental health is shared among three Ontario ministries: health; children and youth; and advanced education and skills development.

“We can’t work in silos anymore,” said Janine Robb, the association’s president. “There is a perception that this age group is healthy, but they’re not.

“We have to help them at this pivotal time in their lives.”

Big changes are needed fast, Munn said, “because the system is being held together with Scotch Tape.”

The business world

Corporate Canada’s increasing investment in the youth mental health spike includes financial service providers, insurance companies, retailers, food industry firms and media companies.

Last October, Starbucks Coffee Canada increased its annual mental health benefits to $5,000 from $400 — a leap of more than 10 times.

“Mental health was a common theme when we held open forums across the country with our partners aged 18 to 24 last year, and again during a recent store manager survey,” said Sara Presutto, vice-president of human resources.

“We do not believe the current level of support for mental health benefits is sufficient to provide treatment and we encourage all companies in Canada to step up and join this important effort.”

Manulife boosted its mental health benefit plan to $10,000 from $1,000 in January.

“We see a high prevalence of mental health concerns,” said Kathy McIlwham, the company’s vice-president of wellness, disability and life. “It’s quite difficult at times to get access to mental health treatment in Canada.”

A plea for help

Last fall, Kimberly switched to part-time studies as her health anxiety worsened after developing gastritis.

“I couldn’t get myself to study because my brain wouldn’t let me,” she said.

She is now more than a year behind in her studies.

On bad days, her mind does sink into suicidal thoughts. But she’s better, thanks to counselling.

Her own theories on why so many young people like her are facing mental issues overlap with what experts believe: “Addiction, abuse, dysfunctional, missing parents, drugs, alcohol. And social media is a big one because we see things that make us feel like we aren’t enough when we are.”

Whatever it is, young people need help, she says.

“Schools should offer more available and free support, hospitals shouldn’t have wait lists for people who need it,” Kimberly said. “It might be the only thing that saves them. Without counselling, I would be dead right now.”

With files from Alexandria Lee.