The Diversity of Approach

University students seeking help for their mental well-being are often met with a lack of resources that prevent them

from getting the immediate care they want. 

In comparison to some universities McMaster has shorter wait times from drop-in to appointment.

Some students say current mental health support on campus isn’t enough. Why are appointments so hard to get, and

what can be done to change that?

The availability of mental health supports on campus is not always well known among the student population. Anecdotal accounts of long wait times paint a dire picture, discouraging students from seeking the help they need. On the other hand, the Wellness Centre is open from 8:30 a.m. to 7:45 p.m. Monday to Thursday and from 8:30 a.m. to 4:30 p.m. on Friday. The office only closes for lunch on Fridays, further increasing hours of operation.

Peer supports provide an alternative to tide students over between Wellness appointments, but these do not completely replace a student’s need for a counsellor.

Other students are calling for greater diversity among the services offered by the Wellness Centre, finding that the current help isn’t always applicable to those coming from immigrant backgrounds. Perfect or not, it is most important that students reach out.

Debbie Nifakis, Associate Director of the Student Wellness Centre, sustains that any help is good help, whether it is through the wellness centre or elsewhere. When dealing with an issue as important but sensitive as mental health, it is a matter of meeting needs.

The First Meeting

For those struggling with mental health problems who are just recognizing the need to reach out, it can be a daunting task to walk down the steps to the basement of the student centre and wait in line at the Student Wellness Centre.

The SWC accepts students using a consultation approach, where students going to the SWC in person should be able to get a consultation appointment on the same day. However, the system works on a first come first serve basis, and the limited number of spots per day fill up quickly during peak times of the semester.

One student, who wished to remain anonymous, started going in February last year.

“I was at a point where I felt like I couldn’t handle my problems on my own any more… It was one of the scariest decisions ever, to stand in line at the Wellness Centre and wait my turn. I was turned away twice during the drop-in sessions because, in my experience, they filled up quickly. But after I got in with a counsellor it was a very transformative experience.”

Another student was similarly turned away during the first drop in session she sought to attend, and she did not try again until a month later.

We have counsellors and therapists with a wide variety of experiences... We have counsellors who specialize in relationships and emotion focused approaches.
Debbie Nifakis
Associate Director of the SWC 

It is imperative that students recognize that after being turned away twice, they will be booked for a meeting on the third time they come in. The SWC is cautious about adopting a pre-booking structure for all consultation appointments, fearing that possible missed appointments will take time away from another student who needs it.

Cathy Jager, Education/Nurse Manager at the SWC, says she hates turning people away. Both she and Nifakis recognize what an intimidating feat asking for initial help can be, and they are constantly worried about people slipping through their fingers.

For those in obvious distress, an exception is made. “If somebody comes in in a crisis, we have a crisis mental health spot open every day with a physician and a counsellor,” said Jager. “That has been super helpful, whereas before we were trying to see where we can squeeze them in. We also have a mental health nurse. If the staff at the front are worried, they will come and get us and even if it is full for the day we will get someone to see them.”.

For those who are turned away, the SWC staff would love nothing more than to see you the following day.

Not Always Wellness

Once students are able to secure a consultation appointment, they are assessed based on their need, but that need is not always met by the SWC. The SWC provides individual counselling, group counselling focused on skill building and physician consultations if medication is an option.

“Sometimes they might be better off somewhere else, such as student accessibility services or in the community,” said Nifakis. The SWC will help facilitate the transition best suited to the student."

Wait times can be a problem at this point as well, though those who express a need are usually given priority. “The wait time from the consultation to where they are going will depend on where they are going. If they are going to see a counsellor, the wait could be two, three weeks, sometimes maybe even four weeks,” Nifakis explained. “However, depending on the intensity of the need that the student presents with, some students may be able to see their counsellor more frequently like maybe every second week, where someone else might wait every third or fourth week.”

In the past, discouraged students have stopped seeking help. Kay is a student who has continued to seek help but has questioned its value  in the past. “With my mental illness, post-traumatic stress disorder is something that you have to deal with [through] a lot of therapy, so it is not enough for me to see a counsellor every 3 weeks. I have had a good experience with a counsellor that I have seen, but I have also had an experience where I gave up, almost, because if it is going to take me a month almost to get in, I am not even going to try.”

For students requiring more intense support than can be offered by resources on campus, the SWC will facilitate a referral for a private clinician who is more frequent, albeit expensive. Alternate supports are hospital or community programs, although the wait time for those lasts months. The SWC commits to seeing students until they get into those more specialized programs.

In between SWC sessions, peer supports can be of great help. Kay attributes much of her progress to the Women’s and Gender Equity Network on campus, which tided her over between counsellor sessions. However, she hopes to see a day where the school relies less on peer support, as it can be a draining experience for the students.

If somebody comes in in a crisis, we have a crisis mental health spot open every day with a physician and counsellor."
Cathy Jager
 Education/Nurse Manager Student Wellness Centre

“One of the concerns that we have [about peer support] is that it is up to the person to [reach] out to a peer, which some people aren’t necessarily comfortable with,” said Lainey Stirling, WGEN coordinator. “It is also particularly draining for a volunteer… if we are consistently required to essentially pick up the slack in some cases.”

Day One Counsellor

Ell Veinot is another student frustrated with the wait times, wondering how she can get a doctor’s appointment the same day but a counsellors appointment the next month.

“When I asked if I could maybe get a closer appointment with a different therapist the receptionist said ‘they prefer you to stay with the same therapist’,” Veinot said. She does not care which counsellor she sees. “A counsellor is a counsellor and by the time I will get in to see her the urgency will be gone.”

While the SWC does make changes, it is usually if there is not a good fit between the counsellor and the student. “[Other times] the student and counsellor have worked together for a while and they have reached a plateau and the person doesn’t feel like they are progressing further,” said Nifakis. Some students enjoy seeing a regular counsellor with whom they can build a rapport, but Veinot would sacrifice that relationship for shorter wait times.

Not Just Us

Other prominent universities have come under fire for long wait times to see a counsellor. The Ubyssey, the University of British Columbia’s student newspaper, published a story about the outpouring of frustration on social media about the two-week wait time for an initial consultation with a counsellor. In this regard, McMaster fares much better, promising to set up an appointment within three days as long as the person continues to come in to the wellness centre asking for help. However, this process is contingent on the student’s ability to ask for help more than once, which can be a barrier for those struggling with mental health issues.

The University of Toronto’s student paper, the Varsity Magazine, published a story about the structure of the services offered through their university. The article mentions a student who was assessed in late January, called back in February and began her therapy in March, a quick case for U of T. Other students have reported wait times as long as eight months. At McMaster, two weeks to a month of waiting is the norm, significantly less than even University of Toronto’s quicker cases.

Eye to Eye

Neha Malhotra is a third-year student who was inspired to do a project on mental health services on campus after she used them herself.

“One aspect of mental health that is difficult is the way in which we define it. One definition is westernized, where medication and cognitive behaviour therapy is the main focus, whereas people from, say, an Indigenous background have a very spiritual definition where associating with nature and healers is a huge aspect of how you deal with mental health issues,” Malhotra said.

“For other people, religion is a big part of it. In my opinion, and in how I have interacted with mental health services on campus, this diversity isn’t accounted for even though McMaster is one of the most diverse student bodies in Canada” she said.

This dissonance between services offered and student response is surprising, given the variety of services offered by the SWC. Among these is evidence-based therapy, acceptance and commitment therapy, dialectical behaviour therapy, supportive counselling, short-term focused counselling, art therapy, mindfulness, yoga and sexual assault counselling.

"A counsellor is a counsellor and by the time I will get in to see her the urgency will be gone."
Ell Veinot
Student

“We have counsellors and therapists with a wide variety of experiences,” said Nifakis  “We have counsellors who specialize in relationships and emotion-focused approaches. We can match people up to what their needs are… We understand the transitional issues that students deal with, we understand all of the complexities of figuring out where you want to go, building new relationships, relationships breaking up.”

“From the perspective of Indigenous needs, we want to be respectful of the fact that they have elders and an Indigenous counsellor,” she added. “Usually if the request is related to that, we refer them to the Indigenous counsellor through the Indigenous office.”

The counsellors have all also undergone significant cultural training. “All of our counsellors have had multicultural sensitivity training and in their training have had many courses on dealing with diverse communities,” Nifakis said.

Malhotra felt like the different backgrounds between her and her counsellor made it hard for her to open up or get the help she needed.

“There have been studies showing that patients have a difficult time opening up and relating to their counsellor if they are from a different background because they believe they are from different circumstances,” she said.

Malhotra feels this leads to inefficient counselling, because the root issue is never addressed. “It is like addressing test anxiety or relationship issues, but not addressing that domestic violence is higher in South Asian families or that the pressure to succeed is a lot higher in Asian families. There are other universities like Harvard that have recognized this and have committed to diversity in their mental health services to ensure that they meet student needs.” She hopes that this change can take place at McMaster as well. “I am not saying separate the services, I am saying add the option so that people who may need different avenues for support,” said Malhotra.

Change is not out of the question. The SWC welcomes change to their programs. In the past, student demands have lead to SWC collaborating with student groups on campus, allowing them to expand to be more inclusive of diverse groups around campus with differing needs. Recent training programs have focused on sexual assault and gender identity.

New Beginnings

Jager and Nifakis are both looking to the future.

“We are fortunate to be moving into the Living Learning Centre when that is built, and that will give us extra offices for physicians and counsellors, so we are hoping it will grow us in capacity as well,” said Nifakis. “We will be right in that building with residents and alongside the child care centre… At the moment we pretty much run at capacity all the time… We never have an office free.”

With the wellness centre running at capacity but students still asking for more, it will take a change in the process or a greater commitment of money to bring about any major changes.

For now, students are stuck navigating McMaster’s maxed-out system.