The inaugural Faculty of Arts & Science Minds Redefined Mental Health & Wellness Conference will bring together students, faculty and staff to foster dialogue about mental health within the Faculty. Attendees will hear from mental health experts and advocates, develop skills to promote well-being, explore campus and community resources, and engage in rich discussions that showcase research, lived experiences and diverse voices.

The event — which is free to the U of T community — takes place on Tuesday, September 17, 2019 at the U of T Chestnut Conference Centre. Attendees are welcome to attend the conference in full or in part. For more information and to register visit the conference webpage.

Keynote speakers are celebrated Canadian and mental health advocate Margaret Trudeau and Michael Landsberg, one of the best-known personalities in Canadian broadcasting and founder of #SickNotWeak 

Full details are available at https://www.artsci.utoronto.ca/mindsredefined.

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.

Content warning: this article contains mentions of suicide.

The Presidential & Provostial Task Force on Student Mental Health is in the first phase of its operational plans. The task force was formed in late March in response to two reported student deaths by suicide on campus in the past year. Following its start in the summer, the task force will continue to meet with various student groups, university staff, and administration, and other relevant groups over the fall. 

In total, the task force consists of 13 people: the Chair, Dean of Medicine Trevor Young; four student representatives; three faculty members; three administrative staff members; and two senior assessors. 

The central goal of the task force is to review both student mental health services and co-ordination between support systems across U of T’s three campuses, in addition to evaluating the physical spaces where mental health services are provided. Proceeding evaluation, the task force then plans to make recommendations to President Meric Gertler and the Vice-President & Provost Cheryl Regehr by December 2019.

The task force’s Outreach and Engagement plan, published online, details the groups and individuals that the task force will meet with as it gathers information, operates pop-up booths, and hosts in-person consultations at all three campuses. The final stage of the task force will be to present its draft themes and recommendations for a public response via an online form before giving its findings and recommendations to the administration.

“Nothing About Us Without Us”

In an open letter published in The Varsity, 15 students characterized the task force as an insufficient response to a “ongoing mental health crisis” on campus and asked for the task force’s dissolution on the grounds of “a lack of transparency, diversity, and accountability mechanisms.” The students also criticized the administration for being unresponsive to their requests for meetings and consultations on the university’s mental health infrastructure.

“Nothing About Us Without Us”  is a 40-page report written by student activists that outlined numerous demands, among them that any university initiatives regarding mental health be comprised of a student majority, including in leadership positions. The report details specific criticisms that students have lodged since 2014, and also cites student experiences with the university’s mental health support system. 

University of Toronto Students’ Union (UTSU) President Joshua Bowman, while remaining “cautiously optimistic,” echoed concerns of student activists, noting that the task force lacks sufficient student representation. 

“[The four students on the task force] are charged with representing 71,930 undergraduate and 19,356 graduate students, respectively, according to 2017-2018 enrolment,” wrote Bowman in an email to The Varsity. He also noted that “members were selected without regard to lived experiences of mental illness or diverse identities, but based on professional and scholarly experience.”

“U of T has, for too long, ignored the voices of students in mental health policy. This Task Force was an opportunity to center the voices of students that U of T has failed to realize,” wrote Bowman.

Egag Egag, one of the two graduate representatives on the task force, acknowledged the challenges of having four students on a task force set to address the mental health of around 90,000 students across three campuses. In an email to The Varsity, Egag wrote, “it is my hope that all students will take an opportunity to participate, so that we have feedback that is authentic and representational of UofT’s students.”

Action and accountability

Currently, the task force’s sole purpose is to make recommendations, and although the Outreach and Engagement plan states that the task force will be meeting with various student unions, Bowman reports that the UTSU has not heard from the task force. 

Similarly, Chemi Lhamo, President of the Scarborough Students’ Union, wrote to The Varsity that “[the administration] also need to acknowledge that U of T students are different because of the overwhelming pressure to do well in one of the best institutions in the world.”

While Lhamo hopes that the task force will produce results, she is skeptical that the it will be able to properly represent marginalized students, and address the unique challenges faced by U of T’s satellite campuses.

 “We are looking forward to seeing actions being taken and not just the talk,” wrote Lhamo. 

Social and behavioural health sciences PhD student Corey McAuliffe is one of the members of the newly formed task force. In an email to The Varsity, McAuliffe described the role of the task force as “one way in which to address student mental health at U of T.” 

Echoing sentiments made by President Meric Gertler in an interview with The Varsity in late July, McAuliffe called on the participation of all stakeholders in the university — including the government and students — to create a “healthy environment.”

The task force is currently running an online consultation form, as part of its first phase, which will close on October 15.

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.

Dementia is taking a serious toll on Canada’s aging population: roughly 76,000 people are diagnosed with the condition every year. It is estimated that the number of Canadians living with dementia may even double over the next 20 years due to our growing senior demographic. 

Diagnosing, treating, and managing dementia brings many challenges for both those affected by it and their caregivers. Fortunately, the rapid growth of technology in recent years has sparked innovation which help tackle these issues. But lacklustre awareness and slow implementation of these technologies have limited their outreach.

Time is of the essence in dementia research. The surge in innovation, coupled with our aging population, means that we need to quickly change the way we treat dementia. 

What is dementia? 

Dementia is a medical term that covers a variety of syndromes affecting the brain. It can be caused by conditions such as Alzheimer’s, Parkinson’s, and head trauma. Patients affected by dementia experience memory loss, difficulties with problem solving and, in some cases, severe changes in mood.

Treating dementia can come with many challenges. However, technology can play a huge role in mitigating some of these obstacles.

Dr. Arlene Astell, an Ontario Shores Research Chair in Community Management of Dementia at U of T’s Medical Sciences Department, recently co-authored a paper summarizing developments on the diagnosis, treatment, and management of dementia.

The paper highlighted the multifaceted uses of technology in treating a syndrome like dementia.  

“Direct healthcare has very little to offer people once they have been diagnosed,” wrote Astell to The Varsity. While a range of medical interventions and services to support lifestyle management can be offered to patients with conditions such as diabetes and cancer, such is not the case with dementia.

“There are no disease-modifying therapies available,” continued Astell. Patients may only receive some medication for symptom management, which is not available for all types of dementia.

Most treatment plans for dementia largely rely on sending the patients “home to live as well as they can with support from family or friends.”

Improve treatment plans for dementia

Limitations of the current approach for treating dementia, according to Astell, lie in the way we treat the syndromes. Dementia has vast implications on a patient’s everyday life, which cannot be easily treated through traditional health care approaches. 

“Individuals with dementia need practical interventions and supports to compensate for their cognitive challenges,” she wrote. “By leveraging their retained abilities and enabling them to maintain independence for as long as possible.” 

Improving the ways in which we treat dementia can induce widespread benefits throughout the health care sector. Current methods for treating dementia are putting unnecessary strain on our hospital systems.

“We are seeing, for example, growing numbers of people with dementia filling acute hospital beds, which is leading to cancellation of planned surgeries due to [a] lack of recovery beds,” Astell noted.

Changing dementia treatment methods could also better ensure that patients with different conditions than dementia get the help they need more quickly. 

The role of technology in dementia treatment

Fortunately, many novel innovations for treating dementia are becoming more accessible with the rising use of smart home devices and wearable technology.

Prototypes, such as the Gloucester Smart House, have been developed to help dementia patients in their everyday lives. It comes programmed with bathing and cooking monitors, an automatic night light, and prompts that remind users when to take their medication. 

Since its introduction, smart home technology has grown rapidly. Newer systems use artificial intelligence, machine learning, and sensor technology to reduce reliance on caregiving and help patients with tasks such as dressing and cooking.

Researchers are hoping to use the easily-installed technology to run wide-scale clinical trials to understand its potential benefits on those with dementia. 

Developments in Global Positioning System (GPS) applications on smartphones and motion-enabled gaming can also be used to help maintain patients’ social and active lifestyles. Many GPS applications on smartphones can now detect whether the user is lost.

Such a feature is especially useful for dementia patients, who may rely heavily on the app to navigate. Helping users walk safely makes it easier for them to maintain an active lifestyle.

Many motion-based games have also been tested to improve cognitive and physical stimulation in those with dementia. These games, which can be used on tablets and consoles like the Kinect or Nintendo Wii, also enable patients to spend their leisure time with others without having to leave their homes.

The upshot is that technology can help dementia patients manage their symptoms daily. According to Astell, accessible technology has the potential to play a huge role in this stage.

“Providing technology to assist individuals to monitor how they are doing would empower them to self-manage their condition,” she wrote. “This could be in the form of an app or device that they interact with throughout the day as their companion for living with dementia.”

“We need to develop new kinds of services to provide this support, with digitally-enabled staff.” 

Moving forward 

Improving accessibility to these technologies remains a major challenge. “We currently do not have one place that people can access to find out what is available and what other people are using,” wrote Astell.

To address this issue, her research team has launched their AcTo Dementia website, which provides dementia-friendly gaming apps that have been reviewed for their suitability for patients affected by the syndrome. 

Astell is currently working on a new online resource to guide users on how to use smart home and motion-based technology to manage dementia. 

Yet another issue in the implementation of these technologies lies in research. Unlike traditional big pharma research, most dementia studies do not involve dementia patients. 

“It has focused either on families of people with dementia (as proxies) or care providers to address their needs in relation to dementia,” wrote Astell. Putting more focus on understanding dementia patients directly could broaden the care that is available for them. 

Technology-based dementia treatments are rapidly evolving. But its limited accessibility and slow implementation are preventing them from reaching patients who need it. Our traditional approach to treating dementia must keep up with the pace of innovation.

Unfortunately, dementia patients do not have the luxury of time. “We have accessible, affordable technologies at our fingertips that can revolutionise how we approach dementia,” wrote Astell.

“[We can] improve the lives of people who receive a diagnosis… and provide something useful and beneficial in the face of no effective medical treatments [for dementia patients].”

Content warning: this article contains discussions of suicide.

In the wake of a death by suicide at Bahen Centre for Information Technology on March 17, U of T President Meric Gertler issued a letter to students, staff, and faculty announcing the formation of the Presidential & Provostial Task Force on Student Mental Health. This letter followed a large public outcry concerning the university’s inaction over the mental health crisis.

The task force was created to work toward the priorities identified in the university’s Student Mental Health Framework report. The mandate of the task force includes a review of mental health service delivery, coordination of tri-campus student mental health support, and partnerships with community-based mental health organizations. 

While the task force aims to strengthen pre-existing policies and improve mental health facilities, its mandate does not effectively tackle one major cause of stress: the administration’s academic and admission policies.  

University is a huge stepping stone from secondary education; many students find themselves in a completely new and strange environment. This can take a huge toll on a student’s academic performance.

And yet, it is a huge task to reserve an appointment with a health and wellness counsellor if the wait time for these services is too long. There is a lack of adequate safe counselling spaces and counsellors amongst the three campuses. Regardless of what the administrative policies might be, every student should have access to these services. 

Students are hoping to see more effective communication with faculty and staff to improve on these services. They hope to see tangible change. 

Earlier this year, President Gertler issued a statement clarifying that students’ mental health and physical well-being are the university’s utmost priority. 

However, “if that really was the case, then that needs to be embodied in the academic culture on all three campuses,” remarked Lina Maragha, a representative of the University of Toronto Students’ Union’s ad hoc mental health committee. 

Academic culture has become toxic over the years, as represented by the mandated leave of absence policy. The policy not only potentially forces student facing mental illnesses to take leave from school, but also restricts them from accessing numerous services, including those provided by the Health & Wellness Centre. 

To restrict access to not just education, but also to essential services such as fitness centres, forces students to conceal their mental illnesses and prioritize academic achievement over mental well-being. Indeed, students may feel pressured or ashamed by their circumstances. 

Students want to see President Gertler’s message incorporated in the way that student life is structured and envisioned, including increasing academic forgiveness policies, having lenient timelines for credit/no credit options, and late withdrawal for any courses. 

As the task force’s mandate fails to address the GPA admission requirements to enter specific programs of study, there are steps that the administration can take toward creating a less stressful academic system. Other than lowering cutoff grades, U of T should make the program selection system abundantly clear to all prospective students. 

In conjunction, the university should discuss directly admitting students into their programs in their first year, as is the case in numerous prestigious universities around the world. Moreover, a more holistic application process may be a better reflection of students’ abilities, and the admissions committee may be able to grasp a better understanding of who the student really is.

Earlier this summer, U of T revealed the 13  members of the task force, with four students representing the diverse student population at three campuses. 

Maragha further commented that, “the current composition of the task force may not truly reflect the lived experiences of mental health by the community.” To tackle this, members of the community believe that it is important for the task force to have continuous discussions and consultations with students of all levels and status, and for the task force to integrate these consultations into its recommendations. 

Furthermore, there have also been instances where professors do not take mental health illnesses seriously or act in a manner which might cause stress to some students. For instance, in a 2016 article reported by City News, a professor dismissed a student because they did not “look sick.” 

Computer science students should be a particular focal point of the task force. Two deaths by suicide occured at the Bahen Centre this past year, which is the hub of computer science classes. These students are under intense pressure not only to get into their program, but also to succeed in highly competitive classes. 

“Even with the minimal changes previously made for U of T mental health services, students are still hopeful about changes in the near future,” said Maragha. 

The task force was formed as a result of increasing public pressure. The university administration failed to publicly recognize protesters for nearly two weeks, and mental health activists were shut down at Governing Council meetings. The announcement of the task force came after vast media coverage, and seems largely performative thus far.

Only one task force was made for three campuses that are in different geographical areas and whose student demographics differ drastically. This is not enough to review and address the entire community’s concerns. Only if and when the task force considers recommendations by students, and is willing to communicate effectively, will we begin to see a change in the happiness and health of the student population.

Vinayak Tuteja is a second-year Neuroscience and Bioinformatics student at University College.

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.

The University of Toronto can be a challenging place to be. It’s worthwhile to know where you can get help when you need it.

Academic support

Academic accommodations: The university offers services to accommodate students with learning and physical disabilities. For physical accommodations, adaptable furniture is available, as are many textbooks that are available in braille and DAISY recordings. You can also request calculators or dictionaries for use during exams as long as they do not compromise core learning objectives. Accessibility Services also provides lecture notes from volunteer notetakers. All of the above can be accessed by providing documentation for your disability and completing an online form with Accessibility Services, which will then put you in touch with an Accessibility Advisor to discuss your accommodations.

Writing Centres: All three campuses have writing centres. UTM and UTSC each have one, as well as all of the major UTSG colleges. These centres have trained instructors to provide you with guidance on your writing assignments. Find the website for your specific campus or college and book an appointment online with your UTORid. Group workshops are usually available to all students, whereas individual sessions should be booked further in advance at your college or campus’ website.

Aid centres: Many departments, like mathematics and statistics, also have a department-specific centre to help with coursework, especially for first-year students. These aid centres offer drop-in tutorials where students can ask questions and discuss problems they have been struggling with. The Department of Economics also offers a peer mentorship program for first- and second-year students, who are paired up with an upper-year undergraduate student for tutoring. Look into your program to see which specific options are available to you.

Physical wellness

Health & Wellness Centres: Each campus has a Health & Wellness Centre or a Health & Counselling Centre. These centres offer physical care, such as general health check-ups, birth control, STI and pregnancy testing, vaccinations, and addiction treatment. If you are travelling anywhere, it is also worth booking a travel appointment to properly organize your vaccinations and medication well in advance.

Drop-in and Fitness Classes: Gyms at all U of T campuses provide classes in a wide variety of activities and levels, from beginner yoga to master-class boot camps. Among these activities are swimming, martial arts, and dance classes. If you’re at UTSG, take a look at the activities offered at Hart House, the Athletic Centre, and the Goldring Centre for High Performance Sport. The Recreation, Athletics and Wellness Centre and the Toronto Pan Am Sports Centre have similar options, for those at UTM and UTSC, respectively. 

Union health and dental plans: Each of the major U of T student unions, including the University of Toronto Students’ Union (UTSU), the Association of Part-time Undergraduate Students, the University of Toronto Graduate Students’ Union and the Scarborough Campus Students’ Union, provides coverage to its students. The University of Toronto Mississauga Students’ Union will begin its own health care plan on September 1 as part of its separation from the UTSU. These plans can provide services such as psychologist appointments, massage therapy, dental check-ups, and eye care, and are supplementary to other basic health care programs. Check your union’s website to view your coverage!

Mental wellness

Health & Wellness Centres: In addition to general physical care, the centres also offer counselling services, group therapy sessions, and online therapy, all free of charge. Health & Wellness is also where a student can book an appointment with their doctor to determine if they need prescription medication for their mental health. Since these services can sometimes be overburdened, it is best to get in contact early.

Indigenous Student Services: Indigenous Student Services provides support for Indigenous students across all three campuses. This includes academic support like tutoring, financial assistance in the form of scholarships and grants, and community support. The First Nations House is a great place to get in touch with members of the community and access these services.

The Centre for Women and Trans People: The Centre for Women and Trans People offers peer support programs and advocacy for women and transgender people. The centre also offers a community cupboard stocked with food for those who need it, contraceptives, workshops, and social events throughout the year.

University can be a difficult adjustment, but the best way to help yourself is to get help from others when you need it. Make this year as enjoyable as possible by taking full advantage of the services at your disposal.

Content warning: this article contains mentions of suicide

Five months ago, approximately 100 students stood outside Simcoe Hall, the seat of the university’s power, to protest what they perceived to be the administration’s inaction in the face of a growing mental health crisis on campus. Only one day earlier, U of T confirmed that a student died in the Bahen Centre for Information Technology, the site of another suicide the previous summer.

Although protestors gathered in silence, their message to administration officials was clear: despite having at least three known suicides in campus buildings in the past year, U of T has failed to take concrete action on the mental health crisis on campus.

An aspect of the students’ frustration with the administration is the highly controversial university-mandated leave of absence policy, which allows U of T to unilaterally place students on leave if their mental health either poses a dangerous physical risk to themselves or others, or if it negatively impacts their studies. It’s a hallmark of the university’s mental health framework. 

Despite heavy public opposition, Governing Council — the university’s highest decision-making body — passed the policy almost unanimously in June 2018, with only three out of over 40 governors voting against.

According to Sandy Welsh, U of T’s Vice-Provost, Students, the policy has been used eight times in the past year. Six of those cases “involved urgent situations such as death threats with plans including acquiring a weapon, physical attacks and persistent and concerning communications.”

While the other two cases also involved threats, “other systems and supports were in place such that the urgent situations clause did not need to be invoked,” Welsh wrote in an email to The Varsity in late July.

Welsh also noted that a medical professional was involved in all eight cases due to serious mental health issues among the students. When the policy debuted, many within the community took issue with the fact that nowhere in the policy were medical professionals required to be involved.

As it currently stands, the policy notes that medical professionals “may” be involved but does not explicitly make it a requirement.

According to Welsh, two of the eight students placed on leave returned to their studies within six weeks, with accommodations made. The university is working with three others so they can return in the fall. One student is still away, and the remaining two cases are “relatively recent,” she noted.

Welsh also wrote to The Varsity that feedback from the families and students involved in the policy has been positive, citing one family who was pleased with its application. “The family had thought that due to the student’s behaviour, their student would have been expelled,” she said. 

Upon its introduction to the public sphere in the fall of 2017, the policy drew condemnation from student groups who criticized what they saw as a lack of consultation with students. 

Renu Mandhane, Chief Commissioner of the Ontario Human Rights Commission, noted that the initial draft of the policy raised several human rights concerns and fell “short of meeting the duty to accommodate.”

The University of Toronto Students’ Union (UTSU), under then-president Mathias Memmel, initially backed the policy, noting that they were “impressed” by it. However, the UTSU later withdrew its support due to concerns over the apparent lack of consultations.

Speaking to Governing Council on June 25, a year after the policy was approved, U of T’s Vice-President & Provost Cheryl Regehr noted that due to the generally good feedback on the policy, senior administration has no plans to modify the document. 

Regehr is scheduled to conduct a formal review of the policy in the 2020–2021 academic year.

However, student leaders continue to criticize the policy. Lucinda Qu and Kristen Zimmer, both prominent student activists, strongly rebuked the university’s existing mental health structures at a March Business Board meeting, the first governance meeting sinceafter the Bahen suicide.

Qu, one of the few students in the room, said that “the university is ignoring the needs of students in a blatant attempt to take the onus off of its administration for our mental health, safety, and well-being.”

“We see this policy, we see it in print, we see it in writing, and we are afraid. The consequences of this fear, the consequences of being silenced is life-threatening,” Zimmer said at the same meeting.

Joshua Bowman, President of the UTSU and the organization’s third chief executive since the policy was first introduced, wrote to The Varsity, expressing that the document gives the administration “too much discretionary power” to place students on leave.

Bowman also noted that the policy “is a reflection of the administration’s desire to remedy the mental health crisis from their perspective of the situation,” and that it was not “born out of consultation with students.”

“The reality is that we are experiencing a mental health crisis on campus,” he wrote.

Despite repeated calls from the student body to stop using the policy, even amid the formation of a dedicated mental health task force last spring, U of T is remaining steadfast in keeping it. 

“What we can do and will continue to do is work with our community partners to provide every opportunity for our students to seek the kinds of service and supports they require,” Welsh wrote.

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.

The growth in mental health awareness and advocacy around the globe has exposed the psychological limits that individuals can reach in academic- and career-based paths. Terms like “burnout” — the intense emotional, physical, and mental exhaustion connected to excessive stress — are often linked to depression and anxiety.

In sensationalized careers like medicine, it might come as a surprise that burnout plagues the medical world to a staggering extent. A 2018 national survey by the Canadian Medical Association indicates that one in four physicians experience elevated levels of burnout, while one in three screen positive for depression.

In a recent editorial published in the Canadian Urological Association Journal, Dr. Martin Koyle, the Head of the Division of Urology at The Hospital for Sick Kids, recounted his personal experiences grappling with burnout and depression as a physician.

The Varsity sat down with Koyle to discuss his challenges with depression and burnout in his lifelong career in medicine. He contended that his experiences stem less from the practice of medicine itself and more from the bureaucracy and social dynamics entangled within the Canadian health care system.

Koyle’s experience in the medical system

Koyle’s recollections began in 1976, when, as a fresh medical school graduate, he moved from Canada to the United States to begin his long and accomplished career. He’s practiced medicine in Los Angeles, Texas, San Francisco, Denver, and Seattle. He was employed in positions varying from academic faculty to Chief of Pediatric Urology and Renal Transplantation.

While practicing in the United States, Dr. Koyle spoke highly of the Canadian universal single-payer health care system, placing it on an esteemed pedestal which he hoped the US could one day emulate. 

However, the intense public scrutiny that came along with his position as Division Chief at the Seattle Children’s Hospital, coupled with a personal family tragedy and a physical injury, led him to return to Canada in 2011. In Toronto, he began his practice as the Head of the Division of Urology at The Hospital for Sick Kids.

Upon returning to Canada, Koyle promptly realized that the Canadian health system was quite different than the romanticized version he had been promoting during his time in the US.

“I realized from day one that all that I was, was a number,” he said. The system, although advertised as universal, lacked strongly in quality of patient care and career gratification. In the US, Koyle discussed his feeling of belonging to a “community” and being “part of a family.” He personally knew other physicians, and trusted them with his patients when referring them to other specialists. He also felt a general feeling of gratification and mutual appreciation within this supportive network.

In Canada, however, this community aspect was lacking for Koyle. He especially felt uncertain of who would assess his patients in the future. “I didn’t know any of my patients. They didn’t know me. I didn’t know who would see them in follow up,” he said. These factors were further discouragement which added to the climate of emotional hardship.

Koyle also mentioned that the sense of entitlement to health care in Canada contrasts to that of the US, where patients failing to respect wait lines and no-shows are more common, causing other patients to wait longer in order to receive the care they need. To top it all off, recent intense hospital budgeting in Ontario has undercut the quality of patient care available, in ways such as limiting operation times for patients during surgery.

As Koyle summed up his contrasting experience practicing in Canada: “My support from the institution is very different, my control in my environment is very different, my relationship with my patients and with their families and with their providers is very different, and the outcomes are very different in that in the States where my primary physician… was the quarterback in the system in that patient’s care.”

“Here, the buck stops at me… I’m not providing the healthcare that I want to provide to people [due to these social dynamics of the Canadian health care system].”

Koyle’s experiences in a wider context

Although Koyle emphasizes that these experiences are his own, and that some aspects of his burnout and depression are connected to personal challenges faced in his life, he is most certainly not alone in his experiences with mental health challenges in medical careers.

A recent review underscores the factors contributing to Koyle’s burnout: most cases of physician burnout in Canada are neither related to patient care, nor to the practice of medicine itself. Factors such as bureaucracy in the health care system, as well as negative social dynamics with other health care professionals and coworkers, play a more prominent role. 

Notably, with physicians expected to constantly project a “healthy” image, it’s not surprising that studies show that only eight per cent of urologists suffering from burnout seek professional help. This strikes a chord for Koyle, who recalled his own hesitation and fear in initiating regular appointments with his now-psychiatrist.

“You’re afraid that somebody will find out, that you’ll go in and somebody will say, ‘he’s crazy.’” But Koyle, who is now open to discussing his appointments, has found that his psychiatrist has helped him to a great extent, in addition to his yoga and practice of meditation. Today, he is a strong mental health advocate, and encourages those battling with burnout and depression to seek the help that they need.

When asked about his thoughts on hope for the future, Koyle is cautiously optimistic. Having recently finished a Master’s degree in Quality Improvement Patient Safety, with another Master’s connected to international health policy and leadership underway, he aims to develop a skillset to change the climate of the system he works in — both for the benefit of patients under the system’s care, as well as for physicians who impart treatment.