Content warning: mental health, mentions of suicide
It was announced in December that Ollivier Dyens’ will not pursue a second term as McGill University’s Deputy Provost Student Life and Learning. After his now-infamous “hygiene de vie” comments, there has been renewed interest in the state of mental health care on campus, which up until now had seemingly taken a backseat to other controversies on campus.
Of note is the conversation surrounding McGill’s implementation of the “stepped care model,” a “two doors, one service” system wherein students can visit the university’s Counselling and Psychiatric Services after being “processed by a single combined system” meant to appraise their needs.
Changes in McGill Mental Health
Many have criticized the reorganization of McGill’s mental health services, amongst them Norman Hoffman, a Montreal-based psychiatrist and former Director of McGill Mental Health Services from 1992 to 2007. In an interview with the Daily, Hoffman talked about recent changes in McGill Mental Health, comparing the “stepped care model” reforms to the way the service was previously organized when he was the Director.
While the stepped care system was created with the aim of eliminating waitlist times, Hoffman says the older system demonstrated a steady and sustained increase in the number of students treated, and the new triage-based system of the stepped care model can fail to do so by referring students to non-clinical resources, such as counselling and online support programmes.
“Between the years of 1998 to 99, and 2006 to 2007, McGill Mental Health had a 300 per cent increase in the number of students seen,” Hoffman explained. “We went from 800 students a year to 2,400 students a year over a nine-year period, and during that period […] everybody was seen one to one [and] expert level psychotherapy was the primary treatment. Medication was used only when necessary.”
Hoffman emphasized that 85 per cent of the time, the first psychiatrist a student saw continued the student’s treatment.
“We did not have a triage system, it was direct to care services. You called up, you got an appointment with a psychiatrist. When our waiting list built [to] more than two weeks […] when we had usually more than 25 people on the waiting list, we had a [weekly] team meeting […] where we discussed clinical care, [so] when our waiting list built up to more than 20 to 25 people […] we would cancel our team meeting and have what I called a flying triage. […] If we had 18 people working on staff, we would book in 18 people.”
“When our waiting list built up to more than 20 to 25 people […] we would cancel our team meeting and have what I called a flying triage. […] If we had 18 people working on staff, we would book in 18 people.”
The stepped-care model, as seen by a student
However, not everyone feels the same way Hoffman does. The University has stood by the stepped-care model to this day, believing it to present students with a more straightforward approach to mental health, in which they don’t have to worry about where specifically they have to go to receive treatment.
The Daily spoke with Susan*, one student who has experienced both the stepped care model at McGill and the previous organizational scheme, and asked how she felt about the reorganization.
“My personal experience [with the stepped care model] has been relatively positive and I have found that since having the stepped care program, it’s been easier to get appointments. There’s less of a wait,” she continued, although she admitted that her being in the system prior to the transition might have helped her.
Susan has explained how prior to the stepped care model, the process of booking appointments was rigorous and required students to immediately book an appointment in the same month they had reached out.
“Recently [with the stepped care model, students] didn’t have to book an appointment in a certain month, and then everybody has to kind of quickly call in that first month,” she elaborated. “That actually made me stop calling in and I became very unwell because I would miss an appointment, and I wouldn’t be able to make another one, and there was such a huge waiting list that if I was in crisis, waiting three weeks to a month if not longer, that was just simply too long.”
Susan also praised the supplemental tools that the stepped care model have instituted, including Therapist Assisted Online (TAO) and the Wellness Recovery Action Plan (WRAP) program, which consists of group sessions led by a staff member of McGill’s CHMS and a student, with eight to ten students in each group. However, she agrees with concerns though that such supplemental resources should be accompanied by more concrete access to counselling.
“I think it’s more effective as a supplemental tool,” she began. “I think if you need to wait for a clinician, as least the TAO can be useful because it goes into why you experience the symptoms the way you do and it allows your clinician to read the responses, and have a really good idea of where you’re coming from, so you’re not starting from base.”
“Definitely individually, it’s not going to solve your crisis,” she clarified, “but pairing that with action-based programs like WRAP or a therapist, I see it as a very useful tool.”
Raised concerns over the role of the administration
However, the implementation of the stepped-care model still raises question about the extent to which the administration has its hand in access to treatment. “With the creation of the office of the Deputy Provost Student Life and Learning,” said Hoffman, “McGill took away administrative and financial responsibilities from the director of Mental Health.”
“With the creation of the office of the Deputy Provost Student Life and Learning, […] McGill took away administrative and financial responsibilities from the director of Mental Health.”
Touching on how the work environment at McGill Mental Health Services has changed since the reforms, Hoffman mentioned the palpable effects such an atmosphere could have on the quality of treatment: according to Hoffman, a tense working environment at McGill Mental Health promotes a stressful working culture, which undermines the quality of the treatment.
“One person who still works at Mental Health now calls the atmosphere within student services ‘paranoid.’ Everybody is […] frightened to talk,” said Hoffman. “People were told after they fired Nancy Low last year, […] ‘Nobody has the right to object to anything that we do. You object to anything, you’re out.’”
“One person who still works at Mental Health now calls the atmosphere within student services ‘paranoid.’ Everybody is […] frightened to talk,”
Last year, Nancy Low, the former Director of McGill’s CHMS was suspended, apparently for insubordination. A representative for the administration told The Daily then that “the University cannot comment on the personnel dossiers of employment records of any of its staff members,” so much remains unclear about how the reorganization of CHMS has impacted access to treatment.
According to Hoffman, the administration’s involvement in Mental Health services is the initial cause of apparent tension in the department.
McGill however still touts ever-increasing numbers of students seen each year of the program’s effectiveness. Many have pointed to the difference between students seen and students treated as reason for this not being conclusive however.
Many questions remain unanswered regarding the implementation of the stepped care model; Susan feels that the implementation meets the needs of students requiring immediate attention, but might overlook those with ‘less-serious’ need for treatment.
“If you’re having a severe crisis, [the stepped care model] is getting the help that you need quicker, but I think for milder cases, it’s maybe more difficult,” she explained, “especially during crunch times [midterms or finals]. They should remind students who are likely to experience it to get into the system quicker so you don’t have to wait so long.”
“If you’re having a severe crisis, [the stepped care model] is getting the help that you need quicker, but I think for milder cases, it’s maybe more difficult, […] especially during crunch times [midterms or finals]. They should remind students who are likely to experience it to get into the system quicker so you don’t have to wait so long.”
*Name changed to preserve anonymity