Every January, around 11 p.m. on the eve of Bell Let’s Talk, an annual international mental health wellness campaign, Zoe Slusar and her crew of six other students from Mount Royal University invade the main building with backpacks stuffed with hundreds of Post-it notes. They move locker by locker, sticking a colourful note to the front of each of the university’s 4,000 lockers. When undergraduates arrive for class the next day, the messages are clear as a bell. “One in five people have a mental illness. Five in five people have mental health.”
The notes encourage students to tweet about mental health and remind them that the university’s wellness services offer free support to students. “We want people to understand this is real for so many, many people,” says Slusar, a student success peer at Mount Royal’s Office of Student Success and the former vice-president of Student Life for the students’ association.
Slusar’s Post-it campaign is one of many efforts underway at high schools and post-secondary institutions to get students talking about mental health – “really talking about mental health,” stresses Slusar. They’re not waiting for crises to happen or advocating a purely medicalized approach delivered behind closed doors. Instead, they’re focused on sharing personal stories, offering one-to-one student support and implementing programs that boost mental well-being to the same priority status as physical health and academic performance. Among the tools that schools in Calgary are using – meditation, yoga, service dogs, community helpers – all have been shown to help students flourish in a life stage known as an extremely high-risk period for poor mental health.
“We want schools to be a safe place for youth to normalize mental health challenges and to realize it’s okay to ask for help and, even better, to get the help they need,” says V. Joy Pavelich, community engagement leader for the Calgary chapter of the Canadian Mental Health Association.
Experts emphasize there’s a difference between mental health and mental illness. All humans have mental health, just like we all have physical health. Sometimes, we achieve great mental health; other times, when we’re stressed or overwhelmed, it can be terrible. Mental health is a continuum. Mental illness, in contrast, is medically diagnosable disease that results from biological or environmental factors. Students with mental illness can excel if they’re in good mental health just as students without a mental illness can be forced to leave their studies if they don’t look after their mental health.
Now a third-year student in anthropology, Slusar struggled her first year at university, feeling alienated by winter depression and loneliness as the realities of university life set in. “Movies tell you this is going to be the best time of your life. There’s going to be so many people and so many parties. But I found it very isolating,” she says. “That’s one of the chief things that causes mental health issues – people just feeling lonely in the world when there are so many bodies.”
Around the same time, on the other side of the Bow River, Nancy Regular, a women’s studies student at the University of Calgary, was waging her own mental health battle. She arrived at university in the fall of 2012 after graduating as the top student at her small high school in Elkford, B.C. Her first year started happily enough; she lived in residence and enjoyed the camaraderie and opportunity of university. But as the year went on, anxiety and depression took hold. She went to the university’s wellness centre for help. There, the doctor attributed her mood problems to hormones and recommended birth control pills. When the situation still failed to improve, the doctor changed her to a different birth control pill.
“After my first year, I went home for the summer and I wasn’t taking any antidepressants or the birth control pills,” Regular says. “I credited feeling better [to] being at home and having the support of friends and my boyfriend at the time.” But when she returned for her second year, she spiralled downward. That winter, Regular experienced a traumatic event. From then on, depression and hopelessness chewed at her relentlessly. She started isolating from friends, her marks plummeted. For the first time in her life, she failed exams and dropped classes. There were many stretches of time when getting out of bed seemed “beyond impossible.”
Regular went to see a doctor, saying she was suicidal. The doctor set her up with counselling services and started her on an antidepressant. That doctor saved her life, she says. Still, the last few years have been difficult, says Regular, now president of the university’s Consent Awareness and Sexual Education Club and an advocate for mental health. She has been on and off antidepressants for the last three years as she and her doctor searched for a medication that controlled her depression without major side effects. She has experienced rapid weight gain, exhaustion and hypomania as they cycled through medications for the now fourth-year student. The medication that worked best for Regular wasn’t covered by the university’s student health plan. Regular paid out of pocket until she could no longer afford the $200 monthly cost. She was pitched into withdrawal as she came off the medication, a three-day nightmare of insomnia and loss of appetite. She has since found another medication that works, sees a counsellor regularly and has a support team of friends who join her on runs and come over to get her through tough nights.
“If love could heal pain, trauma and sadness, I would be the healthiest and happiest person in the world,” Regular says. “But sometimes it’s not that simple. Sometimes you need therapy or medication and that’s okay.”
As Regular’s story shows, the state of mental health for Canadian students is not well. Major gaps exist in services, both on and off campus. Campus clinics close as early as 4:30 p.m. and remain shut on the weekend. Teens and young adults are a notoriously difficult population to treat – prescription drugs may be unhelpful, risky or financially inaccessible. What works well for one student might not work for another. Students who appear to be flourishing academically may be suffering invisibly; the same traits that make them strong scholars mean they often underprioritize their mental health to put study time first. Meanwhile, students who languish academically at post-secondary institutions can lose their student status, cutting them off from counsellors and physicians they were seeing at university clinics.
Keith Dobson, professor of psychology at the University of Calgary, says access to mental health services is inadequate across the board in Canada, but students face unique challenges. Universities have ramped up their mental health services substantially since he moved to Alberta in 1989. The University of Calgary has reduced the course load that students need to maintain full-time status, which helps alleviate some stress for students trying to manage academics and employment. Formal policies have been
instituted to accommodate students with mental health illness; in the past, it was managed on a student-by-student basis. But gaps persist, says Dobson. For instance, when a student has a formal mental health diagnosis or a crisis after-hours, they’re referred off campus and into the general health system. There, access to traditional services can be held up by wait lists, while private services can be costly.
A report by the province in December 2015 described the mental health system as overwhelmed, fragmented and reacting mostly to those in crisis. “We know there are gaps and delays in getting access to service, and quality of services, in my opinion, is not adequate for the population,” Dobson says.
This is happening across a backdrop of an increasing burden of mental health disorders among university and high school students. In a national survey of university students conducted in 2013, more than half said they had felt hopeless. Eight per cent reported they’d seriously considered suicide at some point during the previous 12 months. Nearly 40 per cent said stress had affected their academic performance, while 17.4 per cent said depression has taken a toll on their studies. Substance abuse, long an issue at post-secondary institutions, was rampant. More than 40 per cent of males and 33.8 per cent of females reported binge drinking multiple times in a two-week period. More than 10 per cent said they had used prescription drugs without a prescription in the last year.
Student mental health problems have grown progressively worse in the 16 years since Canadian universities first enrolled in the U.S.-initiated National College Health Assessment survey. In that time, there has been a “modest” increase in students reporting a number of conditions such as anxiety, depression, stress and eating disorders, says Dobson. Many factors likely contribute to the rise, including an increased public awareness of mental health issues and decreased stigmatization around acknowledging them. Even so, he says, the numbers reflect a growing prevalence of mental health disorders.
Among high school students, too, poor mental health is endemic. According to a British Columbia study of 15,000 Grade 7 to 12 students, 16 per cent had seriously contemplated suicide and seven per cent had attempted suicide. The Canadian Mental Health Association reports approximately five per cent of males and 12 per cent of females aged 12 to 19 have experienced a major depressive episode. It’s hard to get a precise read on how anxiety levels are changing for high school students in Alberta and Calgary, but in a study that looked at worldwide anxiety levels, North American students were found to be a population experiencing one of the steepest rises. According to the Canadian Mental Health Association, mental health disorders in youth are ranked as the second-highest hospital care expenditure in Canada, surpassed only by injuries.
Those numbers have led schools and universities to revise their approach to mental health. Gabrielle Wilcox, an assistant professor in child psychology at the University of Calgary, started her career as a school psychologist working with kids with severe emotional and behavioural problems. In that time, she’s witnessed a shift in the way schools approach mental well-being. A paradigm shift is underway, with discussions about mental health moving out of doctors’ offices and into hallways, dorm rooms and classrooms. It’s a system-wide approach that widens the focus from the treatment of a single person suffering from a mental illness to promoting positive mental health across the board. “Schools are starting to have more systematic, comprehensive programs in place to support mental health. They see it has a big impact on academics and functioning in life. We are making steps to support our kids,” Wilcox says.
Take the University of Calgary: in late 2014, it set up a task force to develop a comprehensive strategy on mental health, a decision motivated in part by a survey in which 20 per cent of U of C students reported that they had been treated for or diagnosed with mental illness, and by the tragic stabbing deaths of five students at a party earlier that year, three of whom were U of C students. Matthew de Grood admitted to the mass killing but was found not criminally responsible for his actions. The task force called for better mental health literacy programs, more anti-stigma initiatives, programs to help students develop personal resilience and strategies to promote responsible alcohol use and develop personal resilience. The strategy was launched in December 2015.
At Mount Royal University, where a task force on mental health has been underway since 2012, students and staff are involved
in a range of initiatives from Slusar’s Post-it campaign to hallway info booths that encourage students to talk about what stresses them. SAIT has an annual Make Some Noise for Mental Health campaign, which is led by student athletes talking about how challenges to mental health have affected them. Across the city, organizations for youth offer programs to help teens deal with stress and other problems through new and innovative ways. Hull Services, a registered charity for kids with mental health issues, opened a recreation centre designed to help troubled kids through sport and offers a mix of programs like behaviour therapy derived from Buddhist meditative practices. Dr. E. P. Scarlett High School uses service dogs to reduce students’ distress. At Mountain View Academy, students learn art and yoga to minimize stress.
The Calgary branch of the Canadian Mental Health Association (CMHA) is working with schools to develop programs that target the mental health of students. Therapies like yoga, sport and dance can help reduce stress and anxiousness for students, says Cindy Negrello, director of client services at the CMHA Calgary. They train “community helpers” – other students, bus drivers, teachers – to help students who might be in trouble. “We know that a student who is feeling depressed and possibly suicidal will seek out a friend or peer before going to an adult. Having more youth peers trained to mentor, support and help others is a key prevention strategy,” says Negrello.
All experts in mental illness interviewed for this story emphasize that medication holds a critical place in treatment of mental illness. Pediatric antidepressant prescription use has risen significantly over the past 25 years. No published studies have looked specifically at Alberta, but a 2014 study from researchers at the University of Saskatchewan showed that the rate of pediatric use of antidepressants was 5.9 per 1,000 in 1983 and nearly tripled to 15.3 per 1,000 in 2007, similar to trends reported in Quebec, Taiwan and the U.S. The increased use was most pronounced in adolescents aged 15 to 19.
Wilcox says medication should never be the sole form of treatment but should be used in conjunction with behavioural therapy and counselling. “Thinking about my experience with kids and medicine, sometimes, looking at overmedication leads to demonizing medicine and people going, oh, it’s bad. I don’t think it’s bad.
“If you stop [prescribing] medicine, people are not developing the skills they need so that you can take them off medicines,” says Wilcox. The problem lies with a “lack of intentionality in prescribing medicine.”
“Instead of thinking about all the medications and whether medication is the right choice, I think sometimes it’s just an automatic choice and that’s a problem,” says Wilcox. “Parents and teens need to know the risks and the benefits so that they can make an informed choice.”
That’s a message that hits home with Julia Caddy, a 17-year-old Grade 12 student at Bishop Carroll High School who has been hospitalized twice in the last three years for treatment for anxiety, depression and anorexia. Caddy kept her illness secret at first, but things changed when she read a letter to her class describing what she had been through. Since then, she has stayed vocal about the difficulties of being a teen with mental health issues. When she started high school in Grade 10, she joined the school’s mental wellness committee. She has attended national mental health meetings and has gone on Twitter to raise awareness of mental health.
Caddy says she finds it unnerving that she requires several pills a day, but, the medications do help. So do art therapy, her therapist and her advocacy work. Caddy relies on all four. She encourages people to be open to taking medication but to make sure they’re learning other good mental health practices as well.
“As much as I’d like to believe that I can do everything on my own, I need help from people,” she says. “Help comes in different forms for everybody. Accepting help does a lot of help itself.”