The mental health crisis on campus

By Kate Lunau | September 5th, 2012 | 2:54 pm

Canadian students feel hopeless, depressed, even suicidal

Stephanie Duchon at Kings College, (Sándor Fizli)

This week’s issue of Maclean’s took an in-depth look at the mental health crisis on university campuses. Read the story, check out our tips for dealing with stress and join the conversation on Twitter: #brokengeneration

In late August, as the first leaves changed from green to red and gold, university ghost towns were coming back to life. Residences were dusted out. Classrooms were readied. Textbooks were purchased—and new outfits, new computers, new posters to decorate dorm room walls. Amid this bustle, construction workers at Cornell University began installing steel mesh nets under seven bridges around campus. They overlook the scenic gorges for which Ithaca, N.Y., is known; in early 2010, they were the sites of three Cornell student suicides of a total of six that year. Students cross the bridges daily on their way to class.

Cornell’s bridge nets are the latest and most visible sign that the best and brightest are struggling. In an editorial in the Cornell Daily Sun following the 2010 suicides, president David J. Skorton acknowledged these deaths are just “the tip of the iceberg, indicative of a much larger spectrum of mental health challenges faced by many on our campus and on campuses everywhere.”

Last year, Ryerson University’s centre for student development and counselling in Toronto saw a 200 per cent increase in demand from students in crisis situations: “homeless, suicidal, really sick,” says Dr. Su-Ting Teo, director of student health and wellness. Colleagues at other schools noticed the same. “I’ve met with different key people. They’re saying last year was the worst they’ve ever seen,” says psychologist Gail Hutchinson, director of Western University’s student development centre in London. “The past few years, it’s been growing exponentially.” Fully a quarter of university-age Canadians will experience a mental health problem, most often stress, anxiety or depression.

One need only to look at the results of a 2011 survey of 1,600 University of Alberta students to know something is very wrong. About 51 per cent reported that, within the past 12 months, they’d “felt things were hopeless.” Over half felt “overwhelming anxiety.” A shocking seven per cent admitted they’d “seriously considered suicide,” and about one per cent had attempted it. These problems aren’t unique to U of A. “It’s across all of North America,” says Robin Everall, provost fellow for student mental health.

In March 2010, first-year Queen’s University student Jack Windeler died by suicide. “He did well in school, was active in sports, and we thought he was ultimately prepared to go to university,” his father, Eric Windeler, says. But Jack, who seems to have been suffering from depression, had begun withdrawing from friends. “It seemed to go amiss,” Windeler says, “and go amiss very fast.”

In the 14 months that followed, five more Queen’s students (all male) died suddenly, three by suicide. “It was a very difficult period,” says Queen’s principal Daniel Woolf. In the wake of these deaths, he established a commission on mental health to see what could be done. Its panel of five members—two administrators, the head of the school of nursing, one student, and chair Dr. David Walker, former health sciences dean—met once a week for eight months, and heard from students, parents and others.

The Queen’s commission was, in some ways, influenced by Cornell’s experience. That university has grappled with the label of “suicide school,” a reputation Tim Marchell, director of mental health initiatives, acknowledges, but insists is a misperception. Cornell’s student suicide rate resembles that of other universities and colleges across the U.S. What’s different is that at Cornell, nearly half of suicides occurred at the city’s public gorges. The fact is Cornell’s mental health initiatives have been a model to other schools. Cornell’s bridge nets are just a small, if highly visible, part of its overall mental health strategy—an effort aimed at restricting access in case of impulsive suicides, not unlike keeping firearms locked inside a cabinet.

At Queen’s, a final report from the commission is due in October. A discussion paper, delivered in June, offered a range of reasons students are grappling with mental health problems: everything from the stress of moving away from home, to academic demands, social pressures, parents’ expectations, and a looming recognition of the tough job market awaiting them. More students than ever are entering university with a pre-existing diagnosis of mental illness, and there’s less stigma attached to getting help. This partly explains the flood that counsellors are seeing. But there’s something else going on, too. Some wonder if today’s students are having difficulty coping with the rapidly changing world around them, a world where they can’t unplug, can’t relax, and believe they must stay at the top of their class, no matter what.

The stress of it all is a huge burden to bear. In preliminary findings from an unpublished study involving several U.S. schools, Cornell psychologist Janis Whitlock found 7.5 per cent of students who started university with no history of mental illness developed some symptoms. About five per cent who did have a previous history of mental illness saw symptoms increase while at university. She says, “there’s probably never been a more complicated time to be growing up than right now.”

The truth is, it’s never been easy to be young. People in their late teens and early twenties are at the highest risk for mental illness; in these years, first episodes of psychiatric disorders like major depression are most likely to appear. After motor vehicle accidents, suicide is the leading cause of death in Canadians aged 10 to 24, the Queen’s report notes. In this delicate life period, people move out on their own, strike up new relationships, experiment with drugs and alcohol, and assume new responsibilities. At college or university, they could be away from friends and family who know them best—people who might better recognize the warning signs of mental illness, like social withdrawal, increasing anxiety, a growing inability to cope, or other changes in behaviour.

If some pressures are age-old, others are brand new. Students are competing more fiercely to win a spot in top universities: the average grade of incoming students at Queen’s in 2011 was 88.1 per cent, up from 87.4 in 2007. At the University of Virginia, 90 per cent of students are from the top 10 per cent of their high school classes, according to Joseph Davis, associate professor of sociology. But only 10 per cent of those high achievers can leave UVA with the same distinction. “Students experience it as a kind of downward mobility,” he says. “Maybe you were in your high school gifted program, and suddenly you’re no longer the brightest student in the room. You might not even be close.”

Davis’s student Katherine Moriarty surveyed UVA undergrads about the illegal use of prescription stimulants, like Adderall and Ritalin, to get an academic edge. Of 525 respondents, 20 per cent said they’d used stimulants non-medically at least once in their lifetimes, most commonly to “improve academic performance,” “study more efficiently” and “increase wakefulness.” Other motives—recreational use at parties, or weight loss—were deemed less important than academic ones.

Students might feel they have little choice but to compete as hard as they can. Tuition costs are rising, and the job market looks grim. In July, the unemployment rate for Canadians aged 15 to 29 was nearly 12 per cent; having an undergraduate degree doesn’t make job candidates stand out like it once did. After graduation, often weighed down by student debt, many will have to string together short-term contracts with unpaid internships—and even those can be hard to get. “Students say, ‘I need to know what I’m doing now,’ ” Hutchinson says. “ ‘I need to get into this or that program, because the world is scary and I see people out of work.’ ”

The postings to Kids Help Phone’s Ask Us Online counselling service give a hint of how dire the future can seem. “Im a 2nd year University student and the #1 thing that has been on my mind is marks!” one writes. “im worried that im not going to be able to get into teachers college and if I dont get into teachers college I really dont know what to do! In High School I was an overachiever but now in the real world it is more of a challenge! Things just seem so hopeless right now and I can barely sleep because of the stress.”

Another says, “My parents want me to become a doctor. My mom puts a lot of pressure on me. I have chemistry which I dislike, although I loved it in high school. I’m not sure why that is, maybe it’s because it has become much harder, and im so use to just ‘getting it’ that i dont feel like putting the extra effort, even though i know i should.” Students seem to be under more pressure than ever from home. Part of it could be due to the fact that families are smaller, Hutchinson suggests, so students carry a bigger piece of their parents’ expectations. Failing a class, or an exam, can seem disastrous.

Miranda struggled with depression most of her life. When she moved to Toronto to attend Ryerson, the 22-year-old (who asked not to use her last name for fear it could jeopardize her chances with future employers) found her symptoms worsening. By her second year, she was suffering from more frequent panic attacks. “I realized I was struggling, and tried to reach out for help, but [Ryerson’s is] a very widely utilized program,” she says. “There was a very, very long wait list. They do their best to find you help, but in the rest of the city, wait lists are just as long.”

Miranda was eventually referred to a counsellor at St. Joseph’s Health Centre in Toronto, but didn’t feel she was improving. Halfway through her third year, Miranda—who’d been living with a roommate—moved into her own place. “My mental health issues peaked the first summer I lived by myself,” she says. “I got bedbugs, and that was it.” She packed up and moved in with her grandparents. Finally, afraid she might hurt herself, she went to the ER and was held in a psychiatric intensive-care unit for eight days. “The resources at Ryerson weren’t helping,” she says. “That seemed like the best option.”

Ryerson has three full-time equivalent (FTE) family physicians and half an FTE psychiatrist, Teo says, as well as 14 counsellors, three of them psychologists. (After last year’s demand, two more counsellors were added.) With such a small staff, and a student body of 28,300, it’s no wonder on-campus mental health care resources can feel stretched to the limit. (Cornell has 30.6 FTE mental health professionals to serve 22,000 students.) At Ryerson, those in crisis can usually see somebody the same day “or the next at the latest,” Teo says. “If you’re not as urgent, that’s when the wait comes in.” The goal is to get each student an appointment within two weeks, says Teo, “but last year, because of the level of severity, the wait became much longer. Maybe three or four times as long.”

After Miranda got out of the hospital, and as she adjusted to new medication, her family helped her get back on her feet. She graduated from Ryerson in the spring. She’s now working an unpaid internship, hoping to land a job in communications. “It’s as promising as it is terrifying. There’s so much unknown,” she says. “Not knowing where your next paycheque is going to come from; working 60 hours a week. A lot of people I know, whether they have mental health issues or not, have trouble balancing it all.” She sometimes sits outside her building, chatting with older women who live on her street. “They say, ‘We wouldn’t trade with you to be young again.’ ”

Some problems are the natural ups and downs of life, like a bad mark or a sloppy roommate. There’s a question of whether today’s young adults are somehow less equipped to cope. “Not all pressures can be removed,” says Woolf, principal of Queen’s. “There is pressure just by going to university, or doing anything in life.” When he was in university in the 1970s, he recalls, students didn’t fret so much about their marks, or employment prospects after graduation.

“If we got a bad mark, it was ‘Too bad, on to the next one,’ ” Woolf says. “There’s a generation of students now—and I’m not saying it’s every student—but a tendency to want to be a winner in all that they do. They all get a trophy at field day; they all get a treat bag at the party; and then they get to university and suddenly find they’re now playing in a different league, and no longer necessarily the smartest in their class.” Woolf is quick to note that serious, long-term mental health struggles are a different matter.

The ability to cope is an acquired skill, and one that takes time to learn. “I speak to parents who insist their children not take summer jobs so they can go to summer school, to get the best marks,” says Trent University psychology professor James Parker, who holds the Canada Research Chair in Emotion and Health. “I say, ‘I’m not sure that’s the best strategy.’ ” It’s often at those summer jobs that kids learn resiliency: serving coffee, waiting on tables and dealing with demanding bosses and crabby customers. Overprotective parents may think they’re helping their kids, but once these kids arrive on campus, small problems can seem overwhelming.

Getting over the hurdles of life takes time for introspection, and that’s also in short supply. Students aren’t left alone with their thoughts on the bus to school or the walk across campus. They’re texting, listening to music, checking Facebook or Twitter, often all at once. There’s no time to mull over difficult, complicated emotions, and no immediate reason to do it, either.

In a 2011 study of eight U.S. universities, Whitlock, who is director of the Cornell Research Program on Self-Injurious Behaviors, found that 15 per cent of students had cut, burned or otherwise injured themselves. This behaviour is most common at the end of the day, when they’re supposed to be winding down into sleep. “It’s terrifying for them,” Whitlock says. “They can’t make that transition. They don’t have experience with it.”

Mariette Lee couldn’t wait to become a student at McMaster University in Hamilton. Toward the end of her second year, she began to feel overwhelmed. “I was trying to do too much simultaneously, to be the perfect student,” says Lee, 22. She began skipping class, and she wasn’t eating right; she became increasingly withdrawn, gripped by sadness or anxiety for reasons she couldn’t understand. “I remember sitting in class, and a whole hour would go by without me realizing it.” It wasn’t until a friend reached out to her—one who said he himself had a mental illness—that Lee understood she needed to talk to someone.

Lee got help, first at the campus health clinic, and then at St. Joseph’s Healthcare in Hamilton. She was diagnosed with depression. At first, Lee was shy about sharing her diagnosis, but once she saw others were supportive, she opened up. “If people don’t talk about it, they won’t recognize the signs,” she says. Lee, who’s beginning her fourth year, is now president of COPE McMaster, a student club. This fall, they’re holding their first-ever “Move for Mental Health” five-kilometre run, with the purpose of speaking openly about depression and other mood disorders.

Student-run mental health programs are an increasingly important resource. At the University of King’s College in Halifax, Stephanie Duchon, 23, appears on posters that say, “I am not my mental illness.” Duchon, an organizer with the King’s Mental Health Awareness Collective, came up with the idea. “I’ve suffered from depression for 12 years,” she says. “By coming out to the community, I’m hoping others will do the same.”

Alongside students’ own efforts, university administrators are introducing an ever-growing number of programs. Queen’s, Cornell and others instruct faculty and staff on how to look for warning signs that could signal a student in crisis, making it a campus-wide effort. The Queen’s report mentions initiatives at other institutions as possible models, like Bounce Back, at Carleton University, which sets up undergrads who receive less than a 60 per cent average in their first semester with an upper-year mentor. Teo, of Ryerson, sits on the board of the Canadian Association of College and University Student Services, which has a mental health working group, partnered with the Canadian Mental Health Association, to study best practices in Canada and abroad. And Everall, at the University of Alberta, is producing a report on campus mental health services and best practices elsewhere, due in 2013.

Universities are still trying to define their exact role when it comes to students’ mental health. “We are not a treatment facility,” Woolf says. “Our role is education and research, and to some degree, community service. That said, we do have a care and nurturing role over the young people that come to us.” Eric Windeler believes that mental health and well-being of students should rank alongside academics. “If students are healthy and happy, it will help them succeed academically and socially,” he says.

Following Jack’s death, Windeler and his family made a decision: to be open about what happened and to encourage others to seek help. They partnered with Kids Help Phone to launch the Jack Project, aimed at supporting young people through the transition period from high school to college. Over 20 high schools and 12 post-secondary institutions in Ontario joined in the Jack Project’s year-long pilot, involving a series of workshops and presentations, which wrapped up in June. Windeler is a full-time volunteer.

As he and others, like Lee and Duchon, come forward, the stigma around mental health issues can only diminish. In her work with COPE McMaster, Lee has been surprised to learn just how many people have struggled, but didn’t admit it, or couldn’t. “When we run events, people say, ‘Thank you, I never would have felt comfortable before talking about this,’ ” Lee says. “It does feel good.”

http://oncampus.macleans.ca/education/2012/09/05/the-mental-health-crisis-on-campus/