Preparing students, schools for campus mental health services

Rachel Cooper was diagnosed with depression at age 11. She managed her depression throughout high school, and went on to the University of Waterloo.

But things changed when she left home. University was overwhelming for her, and campus became a big, lonely place. She asked for help, but didn't get what she needed because of the policies and procedures at the university around documentation.

Roula Markoulakis has heard many stories like this. She’s a PhD candidate at the University of Toronto. She's been researching whether post-secondary students are getting what they need from the mental health policies at their schools.

Feeling overwhelmed and isolated after leaving home for university is a new experience for many students, says Markoulakis. "The biggest thing is they don't know what's going on. They don't know who to talk to or where to go until someone reaches out to them. They think this is normal and they internalize it."

Markoulakis says students exhibit very few outward signs of problems until they themselves reveal their issues to someone. That's where university services for student mental health comes in.

"But once students find the right services, going through the diagnosis process — on top of classes and everything else — is so difficult," she says.

"If they are moving a ways away, they've coped for years at home with their supports. When they move to a new town or city, they don't have those supports. They have to learn to cope in a totally different way."

For students like Rachel Cooper, with an existing diagnosis, the problem is often exacerbated.

But she explains, Cooper asked for help but couldn’t get it.

"When the student requests accommodation, they have to identify themselves as having a mental health issue. Students have to self-disclose because that's their entry point into the system, but that's a huge barrier for people."

Markoulakis identifies several feelings that may affect students coming forward with a mental illness:

• They feel like they’re pestering someone.
• There's imposter syndrome, where a student doesn't feel like they deserve services even if they qualify for them, and that deters them from using their accommodation.
• An internalization of a mental health stigma.
• The whole process of getting a diagnosis is delaying the process of getting accommodation.

There are ways to improve campuses for students with mental health issues, though. Markoulakis's suggestions have to do with the access and spread of information regarding mental health services. Even once students are registered in a school's services, they might not access all the accommodations they qualify for because they don't have enough information about them. She says:

• A lot of times students get pamphlets and just lose them. Schools need to give students information in a way that is easy and intuitive.
• Schools also must work on creating a health culture on campus, where students feel comfortable talking about mental health, and can reach out to professors and peers.

Markoulakis is researching how university policies and practices influence service access and use by students with mental health concerns. She is conducting an institutional ethnography — a method of inquiry that explores how activities within an organization are co-ordinated and socially driven — and serves on the National Post-Secondary Student Mental Health Working Group, an organization struck by the Canadian Association of College and University Student Services to develop a post-secondary student mental health strategy.