In December 2016, Nancy Low, Director of McGill’s Counselling and Mental Health Service (CMHS), was suspended from her job and escorted out of the Brown Building.
Former Director of McGill Mental Health Services Norman Hoffman told The Daily in an e-mail that he has “been told directly by various McGill Mental Health staff that Dr. Nancy Low has been suspended, apparently for insubordination,” in relation to the newly implemented stepped care model.
Stepped Care
At the beginning of the 2016/2017 academic year, McGill’s Mental Health Services and Counselling Services consolidated to become CMHS.
In a panel discussion regarding the state of mental health services at McGill, hosted by the Students’ Society of McGill University (SSMU) Mental Health Commissioners last October, Associate Director of CMHS Giuseppe Alfonsi explained to students that the McGill Health Clinic has seen “a thirty per cent increase in users over the last five years.”
In response to this increasing demand for CMHS’ services, a new approach was taken: the ‘stepped-care model.’
This model uses a “two doors, one service,” system, wherein students can enter CMHS through counselling or mental health, but are processed by a single, combined system. Students are given a variety of treatment options which act as ‘steps’ to one-on-one psychotherapy, the treatment students previously received.
CMHS now also offers different types of treatment, such as online therapy, group therapy, and referrals to other organizations such as the Peer Support Centre, in order to reduce the strain on CMHS.
Growing concerns
However, many students have voiced concerns despite a reorganization of McGill’s counselling and mental health services. For example, trans students continue to face barriers in mental health treatment, with many such students reporting being uncomfortable discussing queerness, transness, and racialization.
Students’ concerns only grew when the process through which students obtain medical notes suddenly changed in October 2016.
Students now only receive same-day notes if they are in imminent danger of harming themselves or others, or they have already been assigned a Client Care Clinician (CCC).
On October 28, 2016, in a statement emailed to campus media, VP University Affairs Erin Sobat said that this new medical notes policy “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.”
He further noted that as the current wait time for seeing a CCC is two weeks, students who do not meet the above mentioned criteria must wait two weeks before receiving a medical note if they are sick and thereby have to miss class. This poses many difficulties for students as McGill professors cannot accept medical notes that justify past absences.
Interim Senior Director of Services for Students, Cara Piperni, told The Daily at the time that the change in medical notes was a “residual impact” of the move to a stepped care model.
“[This medical notes policy] 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.”
In an email to The Daily late December, Sobat noted that “until now, there has been little room for serious input from students or Student Services staff [with regards to the stepped care model], and we’re concerned that if people do not feel included in the decision-making process then ultimately the changes will be less successful (this is particularly true for the clinicians who are responsible for actually providing this care to students).”
“We’re actively trying to improve the situation from our side (particularly in pushing for actual communication and consultation plans going forward),” Sobat continued, “but unfortunately, I think that negative internal management styles or HR [Human Resources] struggles will only hurt students in the end.”
Low’s Suspension
Hoffman told The Daily that he has “been told directly from Mental Health and Counselling staff that the stepped care system is not working well.”
“I’ve been told directly from staff that they were told that they are not allowed to object to the stepped care system,” he added.
“We’re actively trying to improve the situation from our side (particularly in pushing for actual communication and consultation plans going forward), but unfortunately, I think that negative internal management styles or HR [Human Resources] struggles will only hurt students in the end.”
With regards to the stepped care model, Hoffman said: “It is my opinion that a stepped care system for a Mental Health Service makes no clinical sense.”
“Firstly, it is not possible to make an accurate assessment of a student’s needs in a one time triage session, especially if the student has little reason to trust that their concerns will be properly heard,” he elaborated. “Secondly, the type of modalities, apart from one-to-one therapy, that are being offered to students, may have some value as adjuncts to proper treatment, but are unlikely to be highly valuable on their own.”
“I’ve been told directly from staff that they were told that they are not allowed to object to the stepped care system.”
Sobat also voiced displeasure with regards to the stepped care model’s implementation, writing that the SSMU executive team is “disappointed that the transition to a stepped care model, which we support for many reasons, has been so rushed and poorly managed in its implementation.”
“It is my opinion that the McGill Mental Health Service has fundamentally been abolished,” Hoffman went on to say.
“In merging Mental Health with Counselling, and in relegating psychiatrists to primarily be prescribing medication, the University is fundamentally removing the role of Mental Health in being a leader in developing and implementing advanced, student oriented, psychotherapy models, and is promoting primarily symptom suppression modalities of treatment,” he concluded.
“It is my opinion that the McGill Mental Health Service has fundamentally been abolished.”
When asked for a comment regarding Low’s apparent suspension, Doug Sweet, McGill’s Director of Internal Communication, told The Daily via email that “the University cannot comment on the personnel dossiers or employment records of any of its staff members.”