Correction appended on October 16.
McGill Mental Health Service (MMHS), formed fifty years ago, treated over 3,500 student patients last year. According to a 2005 review of MMHS, its primary mandate is “to provide easily accessible, high quality clinical services to the McGill student body.” But in recent years, spikes in student use of MMHS and stagnating numbers of staff have posed a challenge to MMHS in terms of both accessibility and quality.
In August 2014, Nancy Low, a psychiatrist at MMHS, became the clinical director, working alongside associate director Giuseppe Alfonsi, a clinical psychologist.
Low and Alfonsi are moving MMHS toward an “autonomy-based” model of mental health services provision. “In practice that means that the majority of the choices with regards to students should remain with the student […] and the psychologist or psychotherapist is only there really as a facilitator, as a guide,” explained Low in an interview with The Daily.
Each year, more students are accessing MMHS in greater numbers. “If our demand has seen an increase of 30 per cent in the last five years, definitely our staff and resources haven’t increased as a result of that,” Low explained.
“If our demand has seen an increase of 30 per cent in the last five years, definitely our staff and resources haven’t increased as a result of that.”
“Even when we have funding we don’t have the space,” added Alfonsi.
During the last academic year, the University decided to eliminate a $112,000 transfer to the Student Services budget, which was already reduced from $443,905 in 2009-10.
In a Post-graduate Society of McGill University (PGSS) Council meeting on May 20, Deputy Provost (Student Life and Learning) Ollivier Dyens had expressed that the University did not want to “create unsustainable expectations.”
“There is a limit to how much healthcare services we can provide – we are not a hospital,” Dyens had said.
Notwithstanding the apparent funding and resource problems, however, students have criticized MMHS regarding staff-student interactions.
One student began therapy at MMHS after being sexually assaulted by a fellow student. “I ended up internalizing a lot of victim blaming ideology,” they said. “My therapist asked me what I was wearing, why I didn’t scream, why I let this person assault me.”
“I was in an intensely vulnerable position, seeking help after trauma, and not only did I not receive that help, but [MMHS] inflicted a lot of emotional harm that I am still dealing with today,” they continued.
“I was in an intensely vulnerable position, seeking help after trauma, and not only did I not receive that help, but [MMHS] inflicted a lot of emotional harm that I am still dealing with today.”
Alfonsi explained that clinical directors cannot directly fire a staff member, but rather are asked to try to mediate relations with the client or reassign the staff member to different tasks. “Cases where we would really be talking about termination would be gross negligence, [or] inappropriate behaviour with students,” Alfonsi continued.
Out of the six students to which The Daily spoke, none had filed complaints about their negative experiences with MMHS. When asked, they all expressed that they did not know how to file a complaint. This year, Alfonsi and Low have created an online feedback form to encourage students to share their complaints or praise.
Lucie Lastinger, a U2 Women’s Studies and Anthropology student, also accessed MMHS after being sexually assaulted. They explained that, because their assailant was a man, “from the get-go, this therapist was telling me that I really should not be seeing a [therapist who is a man …], which is pretty fifties kind of thinking,” Lastinger said.
Lastinger said that despite their insistence that they felt comfortable with the patient-therapist relationship, Lastiger’s therapist eventually insisted on referring them to another colleague, who is a woman.
“Some of the staff are older and so they didn’t get training more recently, so they’re not necessarily completely fluent and competent in the most modern psychotherapies,” explained Low. Under Low and Alfonsi’s new model, therapists are being trained in groups alongside students with lived experience.
“It’s interesting to have a psychiatrist sitting next to a 24-year-old psych undergrad, and have an open conversation about the nature of how to treat mental health,” Alfonsi commented.
“Some of the staff are older and so they didn’t get training more recently, so they’re not necessarily completely fluent and competent in the most modern psychotherapies.”
Another student, who wished to remain anonymous, told The Daily that she spent five months on the MMHS waiting list and contacted the office four times before receiving an appointment.
Low explained that the long waiting list leads to a catch-22. “Once [a student is] in this clinic […] they want to stay for a long time, because they feel like if they exit, that they won’t be able to be seen again,” noted Low.
Low and Alfonsi envision more peer support groups and group therapy to lessen the demand for one-on-one therapy. “If we change our model to have a breadth of what students will come in for, that will help us a lot,” said Low. “Because maybe one student needs sixty hours, and maybe one student needs ten, fifteen minutes.”
Students’ Society of McGill University (SSMU) VP University Affairs Chloe Rourke expressed her adamant support for developing a breadth of wellness projects, and argued that investing in clinical staff is an unsustainable option.
Speaking at the Students in Mind panel on October 11 Rourke commented on the University’s efforts. “It’s been a long time that students have been filling the gap that the University has provided, and in my opinion that’s a really great thing to see […] but the University simultaneously can be providing more support,” Rourke said.
Low explained that the high demand “causes [staff] to feel more hurried in their treatments of people.” As a result, students feel like their therapy is rushed, their experiences are trivialized, and their conditions are being misdiagnosed, Low explained.
Many students are shocked by the brevity and brusqueness of their initial consultation at MMHS, where a professional quickly determines the severity of their situation.
Nancy Heath, a professor in the Department of Educational and Counselling Psychology, shed light on the stresses that triage (a process by which a therapist quickly identifies the ailment of the patient) places on staff. “You’ve gone into a field in order to help students, you’re very dedicated to it, and suddenly you’re swamped,” explained Heath.
“If we change our model to have a breadth of what students will come in for, that will help us a lot.”
“The procedure that you follow at any university, hospital, community mental health service is triage. [… The professional] feels very stressed by this experience, so what happens then is that the interaction deteriorates in the sense that the student is astonished that this breakthrough for them is being responded to in such a cavalier manner.”
Alfonsi, however, insisted that “even with this demand, everybody should be getting a reasonably good quality of therapy.”
“The wait list is not acceptable to us. I don’t know if we’ll ever beat it, but we’re not ever going to say to ourselves ‘oh, it’s okay that we have a wait list,’” he continued.
With numerous criticisms of MMHS being inaccessible and providing sub-par care, Low and Alfonsi expressed that they are working to optimize their limited resources and change the face of MMHS.
“We have a culture in place of the powerful, strong psychiatrist, and the passive student,” said Alfonsi. “The whole narrative is broken. First of all, because we don’t have the resources to fulfil that narrative, but then on top of that it’s not the best way to be delivering mental health care,” he added.
The article “Students dissatisfied with McGill Mental Health Service” (October 15, News, page 3) incorrectly implied that Students’ Society of McGill University (SSMU) VP University Affairs Chloe Rourke felt that investing in clinical staff is far more important than a breadth of wellness projects. In fact, Rourke adamantly supports developing a breadth of wellness projects and believes that investing in clinical staff is not a sustainable option. The article also failed to contextualize Rourke’s quote. The Daily regrets the error.