News  Mental health services changes policy

SSMU executives worry change in medical notes process could prove detrimental

Due to recent reforms of McGill Mental Health Services (MMHS) and Counselling Services, the process by which students obtain medical notes has changed.

Previously in order to receive a medical note students experiencing mental health issues had to go to daily drop-in hours, make a brief appointment for the same day, and receive a medical note to bring to professors to justify an absence or an extension.

Now, access to same-day medical notes will be limited to two categories of students: those in imminent danger of harming themselves or others, or those who have already been assigned a Client Care Clinician (CCC).

Under the recently instituted stepped care system, students arriving at MMHS and Counselling will be matched with a CCC through a shared intake process, who will then help them figure out a plan of care best suited to their individual needs.

However, according to Students’ Society of McGill University (SSMU) VP University Affairs Erin Sobat, the current wait time for appointments with a CCC is roughly two weeks. This means that students who are not in need of emergency care and are not already being followed by a CCC will have to wait for two weeks before having access to a medical note. However, McGill professors are unable to accept medical notes that retroactively justify past absences.

In a statement emailed to campus media, including The Daily, on October 28, Sobat expressed serious concern about the impact of this change on the student body.

“This will have an immediate and detrimental effect on many of our members,” he wrote, “not least because there has been no prior warning or communication regarding the change. In particular, it disregards the need to provide services and accommodation for incidental cases of mental health issues that may not qualify as an immediate safety concern, in a system where there is not currently sufficient access to care to ensure that students are already being seen by a McGill or external clinician.”

Speaking to The Daily, Cara Piperni, Interim Senior Director of Services for Students, explained the context behind the change. She was not responsible for the decision to implement these reforms to MMHS and Counselling, as she only stepped into her role in late October, but was nonetheless able to speak to the rationale behind them.

“When we talk about ‘the change’ relating to [medical notes],” she said, “I think it’s also important [to recognize] that we didn’t actually make a decision specifically around medical notes. What’s changed is the way students access what is now a common intake for both Counselling and Mental Health, so as a consequence of some of those changes, pathways changed, and there is a subgroup of students who used to be able to use same-day urgent drop-ins strictly for the purpose of medical notes, [who can no longer do so].”

This, said Piperni, was why SSMU executives working on mental health reforms, like Sobat and VP Student Life Elaine Patterson, had not been informed about the change regarding medical notes: “This was a residual impact [of broader reforms], that I don’t think we really noted specifically.”

Piperni also explained the logic of limiting same-day emergency appointments to those immediately at risk.

“We created this notion of ‘safety appointments,’ because students that are in situations where someone or they themselves are concerned about harm to self or harm to others, because of the bottleneck that used to exist, […] couldn’t get access,” she said. “So we carved out a very particular space […] for […] ‘safety appointments.’”

“Now, knowing that there are other [cases] that are non-safety but still urgent,” continued Piperni, “we are looking to see how we can adjust the model to try and accommodate. So we’re looking at adding urgent appointments that would be same-day or next-day.”

“We’re looking at maybe inserting a new resource, like a social worker or a nurse who could deal with just the documentation things that people need, but the reality is that medical notes is a systemic issue,” she added.

Piperni assured The Daily that she and the other staff members working on implementing the stepped care system of mental healthcare were fully cognizant of the urgency of this issue. Consultation with Sobat and Patterson, other student leaders, peer support providers, and people with lived experiences of interacting with the new system will be carried out in the next couple of weeks, she explained, and adjustments based on their feedback will be implemented as soon as possible.

Piperni also mentioned that during the Fall 2016 final exam season, a pilot project will be underway across most McGill faculties which will allow students to defer an exam without medical documentation, if it is the first deferral of their current degree program. This should lessen the number of people needing urgent appointments at MMHS and Counselling.