Opinion: U of T’s My Student Support Program app is a positive step toward improving student wellbeing

The app allows students with smartphones to access health care anywhere, anytime

Opinion: U of T’s My Student Support Program app is a positive step toward improving student wellbeing

The My Student Support Program (SSP) app is a 24-hour instant messaging service for students, for assistance with personal or academic concerns. It allows users to call or text a student support adviser from a smartphone, and is available in a variety of languages — including English, French, Korean, Chinese, Spanish, and Arabic — at no cost to the student.

Initially exclusive to international students last year, U of T recently expanded access to students at all three campuses, given its benefits.

The SSP app is, without a doubt, a massive leap toward improving the accessibility of student resources. Moreover, it is not a replacement for other on-campus resources, but rather a welcome addition to student health services at the University of Toronto.

Smartphones are a rapidly-growing part of student life, and many classrooms are currently embracing technology across the world — be it for extra-curricular activities or for in-class participation.

By providing students with support just a few clicks away, the university has alleviated stress for students who may be too anxious to reach out for help in-person. Furthermore, the app also provides students with helpful articles that can provide necessary advice for coping with the stresses of university life, as well as directing them toward the correct resources when necessary. For those who do not require immediate support, the curated articles will provide a much-needed voice to guide students toward success.

However, students who do not own a smartphone are excluded from the convenience of the SSP app, and while U of T does have many other in-person resources for student wellbeing, some students may find themselves unable to seek in-person help due to logistical or personal reasons.

Not every student has access to a smartphone or tablet, and the app being smartphone-exclusive is a concern that has not yet been addressed or resolved. The next step for the university to take in their roll out of the SSP app would be the release of a website component so that students can take advantage of the service at home or by using on-campus computer resources.

The launch of the SSP app should be celebrated. It is a major step toward improving the accessibility of student resources by a university that has faced criticism in the past for this very issue.

However, in the future, U of T should work on improving access of the resource beyond just smartphones, linking other on-campus resources to the app, and increasing its advertisement. By doing so, the university would greatly improve the quality of student life on and off campus, and foster a positive environment for coming years.

Angad Deol is a first-year Life Sciences student at St. Michael’s College.

Opinion: Missed appointment fees are a barrier to student health

The Health and Wellness Centre’s cancellation policy disadvantages students, reinforces stigma of health care access

Opinion: Missed appointment fees are a barrier to student health

It is evident that U of T’s current health and wellness services need to be revitalized in order to increase availability and accessibility for students. One prominent example of the barriers students face when accessing health care is the existence of missed appointment fees.

Missed appointment fees presumably act as a deterrent for ‘no-show’ patients. This is something the university seemingly justifies on both an economic and humanitarian basis. Firstly, medical practitioners lose potential income if an appointment gets cancelled last minute, as they would be unlikely to serve another patient with such short notice. Secondly, an hour that remains unfilled is an hour that another student could have used to access scarce health care resources.

In an email to The Varsity, a U of T spokesperson wrote, “For every missed appointment or no-show, there is another student waiting for care who is not seen. Missed appointments increase wait times and demand for services – the cost is the loss of resources for other students.”

Nevertheless, missed appointment fees often deter students from seeking health care in the first place. The risk of having to pay a fee is too high, particularly because students have dynamic schedules that change with less than 48 hours notice. Additionally, the fees disadvantage students with financial barriers who may face inflexible work hours, or lack the funds to pay off these fees.

The Health and Wellness Centre’s cancellation policy states that a student or faculty member may be subject to a fee if they fail to give adequate notice — usually 48 hours — that they will miss their appointment for any reason. 15-minute appointments are subject to a $40 fine, while 30–60 minute appointments charge a $60 fine. Astonishingly, missed psychiatric appointments come with a hefty fee of $100.

Failing to pay the fee within 30 days results in a hold on a student’s ACORN or ROSI account, preventing them from accessing their transcripts.

Ontario health care facilities have begun to switch to a capitation model — the process of paying medical practitioners a set amount for each individual in their care, regardless of treatment — calling into question the university’s first point of justification.

Instead of receiving income based on the number of billable hours, some family doctors in Ontario’s health care system have started charging flat fees, regardless of whether they see a patient once or 10 times a year.

The question must be asked: where are missed appointment fees going? And who do they actually benefit?

The U of T spokesperson wrote, “Charges for students who do not show up for their appointment are used to partially compensate physicians who have held that spot for an individual and are not otherwise being paid for their time (nor are able to provide care to other students).”

What is especially infuriating about missed appointment fees is that they impact students who are already physically or mentally vulnerable. In the case of psychiatry, these may include students whose mental health challenges have prevented them from walking 25 minutes across campus in a blizzard to reach their 9:00 am appointment, or who are in the midst of a panic attack because they are backed up on all their other appointments and deadlines.

Additionally, putting a 30 day time-limit on paying off the fees is inequitable. Students often live paycheck to paycheck because of their debt burden — or rely on their dwindling Ontario Student Assistance Plan funds to stretch until the end of the school year. Being unable to scrounge up an extra $100 within a month may require an unwell student to go without a few meals or miss an event they were saving up for. Furthermore, this will likely exacerbate the feelings of unwellness that the student originally faced.

Missed appointment fees are simply an extra punishment for students who already suffer concurrent consequences. Missing an appointment means having to rebook the appointment, which, in my experience, means having to wait another several weeks to seek health care. This is punishment in itself, and almost no student would willfully subject themselves to enduring those long wait times again. Thus, if a student misses an appointment, it is potentially for a reason outside of their control.

U of T must rethink its cancellation policy, and either subsidize or completely eliminate missed appointment fees. This would reduce the cost, as well as the stigma, of seeking proper health care as a student. In part, the accessibility of U of T’s health services acts to exacerbate the mental health crisis on campus — U of T needs to do better.

Haya Sardar is a third-year Economics student at Victoria College.

Opinion: It’s not enough to simply link to resources, mental health care must begin in classrooms

We must re-orient academics to include mental health education

Opinion: It’s not enough to simply link to resources, mental health care must begin in classrooms

There is more behind U of T’s high rankings than meets the eye.

Despite the university’s rising reputation of high academic excellence, student well-being is plummeting. The university is drastically failing to take effective steps toward combatting the urgent mental health crisis. We need a critical re-evaluation, re-calculation, and reformation of U of T’s mental health policy and the administration’s approaches to student well-being.

Following the fourth death of a student on the grounds of UTSG in less than two years, students continue to tirelessly ask the question, “How do you sleep at night?”  to administration, an admonition and a plea to raise alarms that should have sounded off far sooner.

Which resources are currently available to students in crisis?

The Health & Wellness website lists resources such as workshops, emergency hotlines, and information on counselling appointments. This digital space is one of the main places where mental health resources at U of T are accessibly described.

However, the website’s vision to improve mental health resources, exemplified by its comment that, “We all have a role to play in mental wellness on campus,” comes off as blank statements lacking proactive steps to back them up.

Without an effective path to actually move toward improving mental wellness, circulating a website link of resources for the sake of claiming that there are resources doesn’t do much for making a change. 

Simply noting that ‘the resources are there’ is not enough. Making resources available on an online or physical platform only begins to take on meaning when students who require help begin to feel like they can engage and reach out to the resources in front of them.

Access to mental health resources and tools is something that every academic institution should have, but many are lacking. Mental health resources are, in theory, present on campus grounds, but they are not actively and visibly accessible to students.

The reality is that U of T’s administration is a reactive, rather than proactive, administration.

It’s playing a game of catch-up with its students when it comes to opening up the conversation on mental health. The third phase of the Mental Health Task Force makes this clear. It consists of a summary of what students have long tried to communicate to administration.

Discussions of mental health must be integrated into the various structures that affect the daily lives of students — such as classrooms — instead of separate structures outside of the academic scope of the university. They need to become a part of the university instead of something separate from it.

In a large institution like U of T, resources must trickle down into program and classroom-oriented designs, instead of waiting for students to reach out of their own volition.

While it is recognized that our professors and teaching assistants are not our therapists or counsellors, there is nothing wrong with ensuring that educators are able to identify signs and symptoms of student distress as a part of the internal structure and design of specific academic programs. In the kaleidoscopic maze that is U of T, mental health awareness and discussion must migrate from the closed doors of administration into the classrooms where students are present.   

In a university where students have familiarized themselves with a toxic mindset that equates stress to success, the harmful academic culture must be remoulded.

Students can no longer stand as just a number that either stays or gets excluded from the system based on a calculated grade. As expressed by Guelph University’s approaches to mental health and commitment toward taking proactive steps to supporting the mental well-being of students, we must adopt a whole-person view of students when addressing the mental health crisis. This is especially true at a university like U of T, whose large population makes it easy to feel like just another number.

Living behind the shadow of academic success that solely focuses on U of T’s well-renowned ranking amongst other universities blatantly ignores the personal needs of students that live beyond the headlines of “top [university] in Canada.” Moreover, it sends a message of sheer ignorance that silences the voices of students who are making powerful pleas for change in the way the university externalizes mental health resources.

The personal concerns that are impacting students’ day-to-day lives as members of an academic institution must become an essential institutional priority instead of a side issue that is discussed every time a student dies.

The mental health issue on campus is obvious. U of T can send around links to resources such as Good2Talk, Health & Wellness counselling, and different phone numbers to call. But the administration needs to realize that this is not about resources and a long list of phone numbers. This is about structures that have allowed mental health problems to persist on campus, and how they must be re-evaluated and rebuilt.

Mélina Lévesque is a fourth-year Anthropology and Political Science student at Victoria College.

“We’ve been leaving patients behind this whole time”: caring for CPR providers

How experts in Peel Region have provided mental health support to lay-responders

“We’ve been leaving patients behind this whole time”: caring for CPR providers

Over 400,000 people in North America experience a sudden cardiac arrest outside of a hospital each year. Nearly half of these patients receive cardiopulmonary resuscitation (CPR) from a bystander providing first aid.

Whether a bystander is waving the ambulance down or physically performing CPR, involvement in any capacity can be traumatizing.

However, bystanders, also known as lay-responders in this capacity, are largely ignored by emergency services following the incident. “We call them the forgotten victims,” said Dr. Katie Dainty, a professor at U of T’s Institute of Health Policy, Management and Evaluation, in an interview with The Varsity.

“We’ve been leaving patients behind this whole time.”

Current research shows that lay-responders face a heightened risk of suffering from post-traumatic stress disorder (PTSD), as well as lasting stress, anxiety, and sleeplessness.

A promising approach to provide better care

Dainty co-authored a recent paper with Paul Snobelen, a community resuscitation specialist at Peel Region Paramedic Services, on the implementation of the Lay Responder Support Model in Ontario’s Peel region, approved in 2014. The system’s aim is to screen lay-responders for risk of mental health concerns, and offer them support proactively.

The model has helped address acute stress reactions by lay-responders, and aims to mitigate the risk for lay-responders in experiencing PTSD. The system has three stages.

First, the program’s operators identify and engage with everyone involved in a medical incident — from witnesses to CPR providers. When a cardiac arrest occurs in a public place in Peel region, Snobelen receives information by paramedics involved.

He then collects information and makes initial contact with those involved. “I try to… touch base with everyone involved in the incident, thank them for their response, [and] tell them to note down any questions that come up in the course of the day,” said Snobelen to The Varsity.

In the second stage, the lay-responders are invited to participate in a debrief within a couple days of the event. “Almost every single individual I’ve offered this to has said yes,” he said. “Very few have declined.”

The debriefing allows lay-responders to process the event, ask questions, and discuss their experiences. “I build a timeline with people together. What we do is a more collaborative approach,” said Snobelen.

“This gives an opportunity for everyone to hear [each] other’s involvement and… highlight how everybody’s role was critical to helping that person.”

Another key aspect of the debriefing is answering the lay-responders’ technical questions. Snobelen, recalling a major lesson from the model’s implementation, said that lay-responders often experience cognitive distortion.

These distortions are negative biases in thinking, whereby people convince themselves of untrue beliefs. For example, lay-responders may believe themselves to be responsible for a patient’s death, especially when they break ribs while performing CPR.

He added, “A big element of these debriefings is addressing the cause of cognitive distortions through discussing the technical aspects of CPR performance.”

The final stage of the model is to follow up with lay-responders in three steps. This involves discussing self-care strategies, encouraging them to reach out for non-professional help, and facilitating referrals to professional counsellors if necessary.

The impact of the program

“We have yet to do a longitudinal study, but the initial feedback has been great,” said Dainty. “[The model] is so important because it gives people [a] safe space and is crucial in normalizing their reactions to such a critical incident.”

Reflecting on his experiences with the model, Snobelen recalled interacting with a mall security guard in two separate incidents. The guard went from feeling hesitant about performing CPR to becoming confident in his abilities.

Snobelen has further observed behavioural changes in individuals, before and after attending the debriefing, which has instilled confidence in him about the positive impact of the model.

Potential expansion

However, according to the authors, institutionalizing and implementing the model at a large scale is difficult due to limited resources.

To expand the program outside of Peel region, Snobelen proposed multiple solutions involving different community partners. Extending Ontario paramedics’ peer support teams to the community, he said, could be a potential solution.

He also noted that of lay-responders often reach out to their first-aid instructors with questions. He remarked that the Canadian Red Cross might be able to collaborate in developing a training program, which could train first-aid instructors to facilitate debriefings.

“I’d [also] like to see a [Continuing Education Model] for therapists and counsellors,” Snobelen said, “so they are able to help their clients better in their own practice.”

Opinion: Ford burst our bubble — university health care coverage suffers under new policy changes

The UTSU can only do so much to mitigate Ford’s damage

Opinion: Ford burst our bubble — university health care coverage suffers under new policy changes

The Ford government’s changes to OHIP and introduction of the Student Choice Initiative (SCI) have brought a number of pressing issues, including access to health care for university students. The University of Toronto Students’ Union’s (UTSU) health care plan is bearing the brunt of the damage.

The UTSU health care plan is meant to fill gaps in other coverage students may have, including OHIP. However, Ford’s cuts to OHIP have made covering all gaps unfeasible, prompting major shifts in the UTSU Health and Dental Plan.

The UTSU’s coverage for prescription drug costs has been reduced from 90 per cent to 80 per cent of the cost of each prescription, up to $5,000. This applies not only to drug prescriptions, but also to vaccines — which have been fully covered to a maximum of $200 in past years.

Mental health services have also been affected: as opposed to providing $125 per visit for up to 20 visits, the new health care plan only covers $100 per visit for up to 15 visits. It’s important to note is that unlike prescription drug care coverage, mental health funding is being capped by both cost and number of visits.

In an attempt to offset these cuts, the UTSU has implemented coverage for visits to registered psychotherapists, in addition to visits to standard psychologists, clinical counsellors, and licensed social workers. This change may seem minute, but it will go a long way to help students.

What is most worrisome about the UTSU’s changes is not its immediate effects but rather its implications for U of T students. In the statement that the UTSU released regarding changes to the health and dental plan, the union acknowledges that there is a mental health crisis at the university.

Mental health is a high priority for the UTSU: in a statement following a student’s death in September, it committed to continue to place its “resources behind addressing the mental health crisis.” Even though it must contend with Ford’s difficult cuts, it should put all its efforts into tackling this crisis. In terms of policy, this means collecting as many resources as possible.

At the UTSU Board of Directors Meeting in late August, Studentcare, the health and dental care provider of the UTSU, sent a message noting that “a lower claims trend was had for mental health coverage in comparison to other parts of the plan.”

In response to this, the UTSU decided to concentrate more on other areas of health coverage, as mental health seemed to be of lesser concern. This projection was also based on the fact that the UTSU would no longer be covering students at UTM, meaning that fewer resources would be needed. However, these predictions do not necessarily translate as facts, meaning that the students at UTSG may be left without sufficient access to resources.

The UTSU is cognizant of this and is taking active measures to improve health care coverage for the following school year. UTSU President Joshua Bowman explained that the executive team is working on restructuring the Student Aid program to “bridge the financial gap in coverage.”

The UTSU hopes to establish a referendum which would allow for students to re-appraise the cost of the plan and possibly charge students more in certain areas and less in others, depending on their needs. These changes would aim to both meet the individual needs of the student while accommodating for financial barriers.

Of course, the UTSU is only a student governing body, and as such, some changes are beyond its reach. The greatest barriers to equitable access to health care are Ford’s changes to OHIP and implementation of the SCI. The true arbiters of change are the members of the Legislative Assembly of Ontario.

Just as they were the ones who created these barriers, they are the ones who can break them down. And in light of the mental health crisis, these policies are only driving us further away from the help we need and straight into the arms of physical, emotional, and financial instability.

The Ford government must recognize the harm that is already stemming from these dangerous policies and do everything it can to mitigate this harm and reverse it. Otherwise, it will only be a matter of time until Ford bursts our bubble.

Yana Sadeghi is a first-year Social Sciences student at New College.

Opinion: Mental health services for youth don’t need to be inaccessible

A growing body of research sheds light on solutions to unique obstacles faced by youth

Opinion: Mental health services for youth don’t need to be inaccessible

This past year alone marks the deaths by suicide of three students at the University of Toronto. Their aftermath opened a barrage of criticisms toward the administration for their lax services for at-risk youth. While alarm bells have been rung for increased mental health and substance use services across campus, systemic change has been slow to come.

Indeed, the issue of mental health accessibility for youth — on and off campus, throughout the province, and across the country — remains a pressing policy and health care concern affecting millions of Canadians.

Among the sobering statistics that shroud youth mental health are the following: some 12.6 per cent of people under 18 years of age in Canada experience mental health and substance use disorders, while Statistics Canada cites suicide as the second most common cause of death, after accidents, among youth aged 15 and over. Importantly, Indigenous youth are disproportionately affected by suicide and addiction, and little research thus far has focused on this issue.

Many youth facing mental health challenges avoid treatment

Who are ‘youth,’ anyway? The McCain Centre for Child, Youth & Family Mental Health at the Centre for Addiction and Mental Health (CAMH) roughly categorizes those ages 12–25 within this demographic, though CAMH more broadly includes those up to 29 years old in their definition.

Unquestioningly, this demographic is particularly susceptible to various mental health challenges as they pass through the hoops of development: commencing and finishing a university or college degree or vocational program, navigating the ebbs and flows of intimate relationships, and searching for employment.

Despite numerous treatment options available for youth, many still go untreated. Why is this? The reasons are plentiful: youth’s preference for self-managing, societal stigma, lack of assessments and screening, and even system fragmentation. With these barriers in mind, how can Canada’s health care system improve and cater diligently and efficaciously to youth across the country? 

The solutions, too, are plentiful

When I asked Dr. Joanna Henderson, Director of the Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health at CAMH, and Associate Professor of Psychiatry at U of T, if mental health services for youth are adequate, or even optimal, her answer was a hard no.

Henderson has worked with many teams and professionals to increase mental health and substance use services for youth. She explained that good services involve “creating spaces for young people who can walk in without an appointment or referral, and access high quality mental health and substance use services as an entry point.”

Long wait times, however, are a ubiquitously understood concern across the health care continuum, leaving young people with few, and often inadequate, options to choose from. The trope of “service delayed, service denied” captures this concern. 

“When young people have to wait for service, several things happen,” Henderson said. “One, the symptoms they were originally presenting for become exacerbated, so they get worse. Two, the impact on their functioning can have significant long-term consequences. And three, the overall [health] outcomes are poorer.”

“From a system perspective, that means our delays have increased the cost of providing care to young people.”

In Canada alone, the economic burden of mental illness is high, with an estimated 51 billion dollars spent per year. This includes “health care costs, lost productivity, and a reduction of various quality-of-life health indicators.”

To be clear, this also means that young people requiring mental health and substance use support resort to emergency rooms where they may be hastily ushered in and out, without receiving thorough long-term care. 

So what do youth-friendly mental health and substance use services look like? Among the many salient features, they are inclusive, safe, confidential, bright, and comfortable. Equally as critical, however, is that they involve consulting with youth for their input. 

“How is it that the whole commercial for-profit industry figures out how to sell their product or their service?” Henderson asked. “You engage with and learn from consumers. We fail to do that in mental health and in health largely.” 

Solutions to increase accessibility of mental health services for youth

The research on this is clear. A cardinal rule for youth-friendly services involves youth actively engaging with the system — from policy development to the implementation of strategies and programs. 

We know that youth-friendly services can benefit immeasurably by having youth co-design these spaces, but we also know that to do so, current systems that feature the old-fashioned clinical model of care, whereby one presents a set of symptoms and is discreetly greeted, treated, and discharged, ought to be neatly folded and set aside for more modern and progressive models. 

An optimal system, therefore, requires a flexible model of care. For starters, it’s making programs visible to youth so that they know where they can go when they need help, and one they can choose to enter and leave as they wish, without the rigidity of a treatment timeline and discharge date.

This includes drop-in visits and telephone conversations, where hours of operation are accessible, such as during weekends and evenings when youth would not need to worry about missing school or work. Artistic and innovative approaches to treatment, emphasizing non-verbal methods of communication such as music and drama therapy, could also be more accessible to youth. 

Additionally, youth-friendly mental health and substance use services ought to be accessible in communities where public transit exists. Costs, too, must be fair and inexpensive, as Hawke and colleagues note in their recently published paper on this topic: “Youth who cannot afford services will not likely access them.” 

Inclusivity mandates changing outreach platforms and engaging with technology to relate to and connect with youth. Social media platforms are pertinent sites of connection, as are websites that are colourful, up-to-date, and practical.

Steering clear from “disease language,” Henderson remarks, can shift the conversation away from pathologizing and lead youth to feel genuinely heard and understood.

Given also the wide range of development during this period of one’s life, youth services ought to be comprehensive and individualistic. There is no one-size-fits-all model, and clumping youth together under a monolithic category fails to address the transient and not-so-transient challenges children and adults experience.   

The solutions to providing youth-friendly services are exhaustive, albeit refreshingly so. It’s good to know that we matter, but it’s perhaps more important to know that the system, warts and all, is gradually shifting to welcome youth input.

This can be achieved by hiring caregivers whom young people can bond and relate to, and expanding our very conceptions of mental health and the unique pins and needles experienced by every young person.

If you or someone you know is in distress, you can call:

  • Canada Suicide Prevention Service phone available 24/7 at 1-833-456-4566
  • Good 2 Talk Student Helpline at 1-866-925-5454
  • Ontario Mental Health Helpline at 1-866-531-2600
  • Gerstein Centre Crisis Line at 416-929-5200
  • U of T Health & Wellness Centre at 416-978-8030.

Warning signs of suicide include:

  • Talking about wanting to die
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Acting anxious, agitated, or recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more of these signs a person shows, the greater the risk. If you suspect someone you know may be contemplating suicide, you should talk to them, according to the Canadian Association for Suicide Prevention.

“If you’re not studying women at all, you’re biased”

Rehabilitation Science Graduate Students’ Union hosts panel discussion on brain health in women

“If you’re not studying women at all, you’re biased”

The Rehabilitation Science Graduate Students’ Union hosted its inaugural Speaker Series event to discuss women and brain health on March 25. The panel was held at the Rehabilitation Sciences Building.

Kyla Alsbury, PhD student in Rehabilitation Science, explained that the Speaker Series is a reincarnation of what was previously a monthly awareness project.

Mary Boulos, master’s student in Rehabilitation Science, hopes that these events will bridge the gap between research and the community.

“We’re doing research on these different diseases and disorders, but those findings aren’t being shared with the people who are most affected,” said Boulos. 

The goal of the event was to share research and engage with members of the community who are affected and ultimately better their health.

The speakers included Professor Gillian Einstein from the Department of Psychology and adjunct scientist at Women’s College Hospital, who discussed the relationship between sex, gender, and women’s brain health; Reema Shafi, a PhD candidate at the Rehabilitation Sciences Institute, who explained the vulnerability of women’s brain after concussions; and Melissa Biscardi, who recently completed her master’s degree and spoke about the endocrine reproductive health outcomes of women after brain injury.

Mental rotation differences between the sexes

Einstein explained that women’s brain health is important, simply put, because “thinking about… organisms [with XX chromosomes] brings new ideas.” Taking sex into account, Einstein said, “ensures that we can develop effective and safe treatments for  [people with XX chromosomes].”

There are differences in biology, such as phenotypic expression, gene expression and epigenetic signatures, and life experience, when comparing to organisms who possess XY chromosomes to those with XX.

Members of Einstein’s lab created an experiment to determine whether sex plays a role in mental rotation tasks and when transcognition is formed.

Different groups of people were asked to complete a Vandenberg and Kuse mental rotation task. People with XX chromosomes in the follicular and luteal stage of their menstrual cycle, female-to-male transgender people on testosterone hormone therapy, and people with XY chromosomes were asked to complete the task, which shows a 3D representation of an object. The subjects then had to match that impression to another one of the same object from a different angle. 

It was found that people with XX chromosomes at low estrogen states did as well as people with XY chromosomes and people with XX chromosomes on hormone therapy. Therefore, a sex-based difference in performance is seen in the luteal phase. They also discovered that the hormone therapy that female-to-male transgender subjects receive allows them to test as cisgender males.

Concussions and menopause

Biscardi discussed the state of menopause in women who suffered a traumatic brain injury.

She explained that “most women experience new onset of changes in menstruation despite being at least one year post-injury.”

Furthermore, in the tested sample, Biscardi found that menopause symptoms were more intense when compared to the general population.

As the symptoms of menopause and post-concussion are similar, Biscardi noted that investigation is needed to determine which symptoms are due to menopause and which are due to concussive effects.

Shafi explained that there is evidence of females experiencing vulnerability after a concussion due to a combination of factors such as structural disadvantages, which can affect cognitive processing after a concussion.

Following the speakers, there was a short panel discussion with questions from the audience.

Einstein explained that in terms of research funding, she finds a lack of understanding, saying that “if you’re only doing research in females, they really don’t know why you’re doing that.”

“Fifty per cent of the population is women,” said Shafi. “So if you’re not studying women at all, you’re biased [against] women. You have to have a reason to not study sex and gender.”

Moving toward trans-inclusive health care in Canada

U of T researchers advocate for affirming and personalized health care practice for LGBTQ+ individuals

Moving toward trans-inclusive health care in Canada

Canada’s transgender population continues to face challenges from transphobia and discrimination, which, among other factors, influences their health and development.

Recent efforts by the Canadian government and affiliated agencies address issues that LGBTQ+ communities face.

In 2016, the Canadian federal government passed Bill C-16, which amended the Canadian Human Rights Act to include gender identity and expression as one of the prohibited grounds of discrimination.

In the health care setting, LGBTQ+ individuals face multiple barriers that contribute to the disparities in the management and care of these individuals.

Alex Abramovich, Assistant Professor at the Dalla Lana School of Public Health and Independent Scientist at the Centre for Addiction and Mental Health (CAMH), has been studying the health care needs of LGBTQ+ youth for more than a decade.

From his experience working with young trans people, Abramovich wrote to The Varsity that this population has an unmet need for mental and physical care.

Many transgender individuals are “unable to come out and speak honestly about their identity and health care needs because they may not know whether or not it will be safe to do so,” wrote Abramovich, explaining how gender identity affects access to health care.

He added that some trans youth do not even have a family physician due to “previous experiences where their gender identity and sexual orientation were pathologized.”

To address the urgency for improved health care accessibility by trans populations, Abramovich recently co-authored an article in the Canadian Medical Association Journal (CMAJ) that provides comprehensive steps for physicians to follow to become more trans-inclusive and trans-competent.

One of the recommendations listed in the article was to privately ask all patients what name and pronoun they go by, instead of making assumptions based on perceptions of their voice, appearance, or name and sex listed on their health card.

Another key recommendation made in the article was to ensure that patients are addressed with a gender-affirming approach that does not view gender variance as pathological.

“These are just some of the things that health care professionals can implement immediately,” wrote Abramovich, expanding on the purpose of publishing such health care recommendations.

Staff Physician and Adolescent Medicine Specialist at St. Michael’s Hospital, Joey Bonifacio, argues in a review article recently published in CMAJ that adolescents’ mental health improves when they receive gender-affirming care.

Bonifacio mentions that primary care providers are equipped with some published medical guidelines on providing care for the transgender population. However, practice is hampered by a lack of experience and training in trans health issues.

He suggests that primary care providers support trans adolescents with gender dysphoria by facilitating discussions about the “timing of social transitioning, reviewing and overseeing the potential use of medical management, and connecting them with local community resources and supports.”

Besides improving the management and care of trans individuals, U of T-affiliated researchers suggest that routine data collection can “contribute to evolving norms in Canadian society regarding sexual orientation and gender identity.”

Currently, there is a lack of national and territorial data on trans populations, mainly because there is no standardized way of collecting and analyzing data about gender identity.

Andrew Pinto, Assistant Professor in the Department of Family and Community Medicine at U of T and Staff Physician at St. Michael’s Hospital, tackled this challenge with his research group by examining how Canadian patients react to being asked routinely about sexual orientation and gender identity.

By administering a sociodemographic survey of all patients in the waiting rooms of St. Michael’s Hospital on a regular basis and later conducting semi-structured interviews with 27 patients, Pinto and his research group found that the majority of patients appreciated the variety of options available for both the sexual orientation and gender identity questions.

However, some patients felt discomfort in answering such questions, and some felt that their identities were not reflected in the options despite efforts to provide diversity in survey responses.

Based on these research findings, the authors suggest that an open-ended option such as Identity not listed (please specify) could be included in addition to prespecified options. They also suggest that health care organizations should set the stage for asking these questions by explaining how the data will be used and ensuring that clinics are LGBTQ+-positive spaces.

Pinto and his colleagues hope that further research will be done in a variety of Canadian and international settings in consultation with LGBTQ+ communities, as such data can help organizations identify health inequities and build a framework with improved and inclusive care.