Guided by students and experts, U of T rolls out new approach to mental health services delivery

Students in Highland Hall
U of T is making sweeping changes to improve the delivery of mental-health care services (Photo by Ken Jones)

Geoffrey Vendeville

No wait times for mental health appointments at Health & Wellness. Redesigned health and wellness spaces, both virtual and physical, that make it easier for students to receive help when and where they need it. And, beyond campus, access to staff who can help students navigate mental health resources in the community.

These are among the many steps the University of Toronto has taken, or that are underway, to improve the delivery of mental-health services across its three campuses in line with the sweeping recommendations made by Presidential and Provostial Task Force on Student Mental Health, which was composed of students, faculty and staff.

“You don't have to wait a month to see a counsellor,” said Joe Desloges, the provostial adviser on process redesign of mental health services, of the new “stepped care” model. “For those in need, you don't have to wait months to see a psychiatrist.”

The majority of the task force’s action items have already been completed or are in progress – with students continuing to play a key role in the systems’ redesign. They include Vishar Yaghoubian, a two-term undergraduate student representative on U of T’s Governing Council who canvassed student groups over eight months and synthesized their points of view in a report spanning more than 100 pages. Yaghoubian, a Woodsworth College student, called it a “long process,” but said the fact that university leaders have dedicated many months to hearing students’ concerns and soliciting recommendations are signs that U of T is truly listening.

Cheryl Regehr, U of T’s vice-president and provost, lauded the U of T community for its commitment to improving mental health service delivery on the three campuses.

“Across the university, our faculty, students, staff and librarians have been remarkably generous in sharing insights, ideas, experiences and recommendations that show how deeply they care about this issue,” Regehr said. “We’re especially grateful to our students for their contributions and their commitment to fostering compassion and community.

“Now, we are seeing the results of all that consultation and work come together as the University of Toronto continues to roll out a new approach to mental health services delivery – one that will support students’ well-being and success at every turn.”

In a recent meeting of U of T’s senior leaders, Desloges and Andrea Levinson, director, psychiatric care at U of T’s Health & Wellness, provided an update on the university’s progress toward enacting all 21 of the task force’s recommendations.

A top priority of the task force, as well as all the campus Health & Wellness Centres, was to build an “easy access system” by implementing a “stepped care’ model of mental-health service delivery – a system where a range of resources and services are available to students, and where decisions about care are made based on students’ preference, need and the types of programming with which they are prepared to engage.

The U of T team engaged Stepped Care Solutions, a not-for-profit mental health consultancy group founded by Peter Cornish, now director of counselling and psychological services at the University of California, Berkeley, to help U of T transition to a more flexible and client-centric mental health-care model. Stepped Care’s 2.0 framework has been used by the Government of Canada in its COVID-19 response, as well as well as by jurisdictions such as Newfoundland and Labrador, Nova Scotia and the Northwest Territories.

“This system really supports a very diverse student body with wide-ranging needs and preferences,” said Levinson, an assistant professor of psychiatry in the Temerty Faculty of Medicine. “One key piece is that it’s strength-focused. We often see service delivery as trying to fix a problem, but this is about meeting students where they’re at and building on their inherent strengths and capacities.”

The model offers increased access to care at various degrees of intensity, with patients accessing different steps, in a flexible way, based on readiness, engagement and strengths. “The steps are based on choice and readiness rather than looking at traditional symptoms and functioning,” Levinson explained.

Crucially, the stepped care model emphasizes treatment over lengthy assessments, so that individuals can begin to receive the help they need sooner. In a presentation to U of T leadership, Cornish and Alexia Jaouich, vice-president program development and implementation at Stepped Care Solutions, said the framework helped reduce wait lists in provinces by more than 60 per cent.

While there may still be wait times for certain specialized services such as group psychotherapy under the new model, students don’t have to wait long for an initial appointment, said Desloges, a professor in the departments of geography and Earth sciences in the Faculty of Arts & Science.

In cases with more complex and urgent care needs, students on the St. George Campus will have access to mental-health navigators – in partnership with the Centre for Addiction and Mental Health (CAMH) – to guide them to and from acute care services in the hospital system.

“The navigators will be embedded within CAMH to support our students specifically in a setting that is often described as very overwhelming, confusing and hard to navigate,” Levinson said, adding that it’s the first time the system is being applied to a post-secondary context.

The university is also taking a phased approach toward recruiting navigators who would serve U of T Scarborough and U of T Mississauga in partnership with local hospital networks. And U of T has begun a search for an executive director, student mental health systems, policy and strategy – a new role overseeing mental health services across the three campuses. “Think of it as quality assurance across the whole institution to ensure consistency of information, accessibility, communications, branding and to lead outreach,” Desloges said.

As part of the redesign, service providers across the three campuses have completed cultural sensitivity and literacy training, and many have shared their biographies and specializations online so students can find a counsellor who is the right fit.

Jodie Glean, U of T’s executive director, equity, diversity and inclusion, said such initiatives are inextricably linked with the goal of creating a “culture of caring” across the university, a priority frequently mentioned in the task force’s report.

“The EDI landscape is continuously giving us tools, policies, initiatives to help mitigate the experience of -isms, discrimination and harassment on our communities,” Glean said. “But as well, it supports the notion of creating a culture of care because it gives us spaces to listen, learn and then develop our services and programs in a way that accounts for the fullness of who people are.”

The improvements to mental health services haven’t just been concerned with personnel but also spaces – both virtual and in-person.

Prior to the task force’s report, faculties, divisions and campuses listed their mental health resources separately, but they can now all be found at mentalhealth.utoronto.ca. The online mental health wayfinder, Navi (short for navigator), helps students discover available resources at the university and make personal decisions about appropriate supports. The tool is accessible 24/7 and communication is anonymous.

At the same time, Desloges noted that mental health service areas on all three campuses are undergoing renovation. On the St. George campus, the Koffler Student Services Centre, on the northwest corner of College and St. George Streets, is undergoing a planned modernization that begins this fall. The project will consolidate health and wellness services on a single floor and will add levels, ramps and an elevator to improve accessibility. During the expansion – expected to take two and a half years – health and wellness services on St. George will move to 700 Bay Street, a site chosen for its proximity to campus.

At U of T Scarborough, a new, five-storey hub on the north side of the campus, the Instructional Centre 2, will have a floor dedicated to health and wellness, along with airy lounges, glass facades and a green roof. The new Health & Wellness Centre will be equipped with areas designed for exercise, meditation, decompression, baby feeding and relaxation. “The presence of a highly visible student service centre will create an inclusive and accessible hub for student supports,” said Sheila John, acting dean, student experience and wellbeing at U of T Scarborough. 

At U of T Mississauga, the Health & Counselling Centre (HCC), on the first level of the William G. Davis Building, is in the midst of a renovation of its counselling and medical suites. Once the project is finished, the suites will be facing each other and share a lounge to better integrate care. The counselling suite, which was completed first, is due to reopen this summer, while renovations at the medical clinic are slated to begin this fall.

“This has allowed us to expand the number of counselling staff and mental health navigation and triage staff,” said Erin Kraftcheck, medical director of the HCC. “It has also allowed our counselling rooms to be remodeled so that they are bright and spacious, to assist with setting a tone of wellness for student clients.”

Students’ input may shape, indirectly, the future of mental health services at U of T and beyond another way: through research.

Lexi Ewing, a fourth-year PhD student in developmental psychology and education at the Ontario Institute for Studies in Education, was among the students who lent their expertise and experience as advisers to a student and youth mental health research initiative called Inlight, which is led by Kristin Cleverley, an assistant professor in the Lawrence S. Bloomberg Faculty of Nursing.

Ewing provided feedback on the stepped care model, mental health website and on the role of special constables when responding to mental health calls.

“What makes this research so important is there is so much work that needs to be done – a lot of nuanced contexts need to be investigated further and more in depth,” she said.

“I tend to think of post-secondary student mental health as an emerging field of literature.”

For her dissertation, Ewing is looking at how stressors associated with a stage in life researchers call “emerging adulthood” sometimes overlap with the transition to university to produce unique challenges. “We don’t really know how those things interact and create kind of unique risks for the development of mental health concerns,” she said.

U of T’s new stepped model of care, along with other changes like the mental health navigators and streamlined website, are all positive developments, according to Ewing.

“With the redesign, one of the big things was ensuring timely access to care and appropriate care,” she said.

“I do think the stepped care model that is being implemented will help to really address that. I think it’s really structured so that it can meet students where they are at the right time.”