Post-secondary students say virtual therapy misses the mark

Online mental health supports provided by Canadian universities lack privacy and close connections.

This article discusses mental illness, with a brief reference to suicide. It may be triggering to some readers. If you require support, resources will be listed at the bottom of this article. Additionally, some individuals have been referred to by fake names to preserve their anonymity.


 

On the first day of the school year, Lucy*, a student at the University of Toronto (U of T), answered her phone to find out one of her friends was now a missing person.

She was sent into a whirlwind of emotion, spending her time communicating with the police and looking for her friend. The situation had a ripple effect on her mental health.

“Eventually we found her, but I was already struggling with anxiety and [this] was just a tipping point for me. I think being in a nerve-wracking situation like that made me realize just how bad [my] anxiety had gotten, and I realized that I needed help [to] work through that,” said Lucy.

Her former residence assistant was able to help Lucy get in contact with a counsellor, who then referred her to a psychologist from U of T Health and Wellness. From there, through the U of T platform Medeo, Lucy booked her counselling appointment.

With that, she was also given numerous resources for further help. She registered with the university accessibility services and had a special learning plan created, giving her extra time for tests, access to peer notes, and other accommodations to excel academically.

“I felt a bit ashamed for needing to seek mental health services and also a little awkward,” said Lucy. “It seems odd to tell a complete stranger intimate details of your life. I was just apprehensive.”

Due to COVID-19, many like Lucy have been attending therapy virtually. For Lucy, talking to her therapist in an apartment where her roommate is in the next room is hard.

“To get the most out of therapy [you have] to be raw, vulnerable, and open. As much as you are friends with someone or you’re close to someone, it’s a different kind of closeness than what you have with a therapist.”

Lucy isn’t alone. The transition from in-person to virtual mental health services, compounded by the stresses of a global pandemic, has made seeking counselling especially difficult for Canadians—especially post-secondary students.


 

Nine months ago, the world was sucked into virtual reality. Everything suddenly became accessible online, from grocery shopping to therapy. The pandemic eliminated the need to commute, allowing people to wrap themselves in blankets and stare at their screens all day—but this convenience has had its own impact on mental wellness.

According to Statistics Canada, even prior to COVID-19, mental health was an increasing issue for young Canadians. Suicide has been one of the leading causes of death among youth aged 15 to 24 in the country.

Now, with the pandemic, this issue has only grown. In a report by CAMH from July, 50 per cent of Canadians surveyed reported that their mental health has worsened due to COVID-19. A similar survey among Ontario post-secondary students in April revealed that many “perceived their mental health to have deteriorated” because of the pandemic.

After a long summer of isolation, September finally came, bringing with it the start of a new school year. Many post-secondary students were nervous and anxious about returning to school in the middle of a pandemic.


 

Universities across Canada usually offer various forms of mental health care to their full-time students. U of T’s St. George campus, located in downtown Toronto, Ont., provides several mental health services such as wellness workshops, group therapy, same-day single-session counselling, pharmacotherapy, psychiatric care, and short-term intensive counselling or psychotherapy.

Student fees also cover a certain number of care visits. The 2020-2021 University of Toronto Students’ Union Health & Dental Plan offers coverage for visits to a psychologist, master of social work, clinical counsellor, or psychotherapist for up to fifteen visits per year, one hundred dollars per visit. U of T also covers up to 80 per cent of the cost of prescription medications.

Unfortunately, studies show that many students find these services don’t meet their needs or provide the mental health support they are looking for.

A common reason is that the counselling sessions are limited with follow-ups being rare. This could be a barrier for many full-time students who only get around 4 to 12 weeks of free one-hour sessions at U of T.

Lucy’s 12-week sessions are winding down with the semester’s end. She and her therapist are working on finding another service Lucy can go to once her campus-based sessions are over—but she’ll have to start seeing someone new.

“It feels odd. I put myself out there, and now it’s just over. I guess it’s a little bit like a breakup,” Lucy said. “One minute you’re super close, and the next minute you don’t say hi when you pass each other on the street.”

“Do I want to go through this again? Is it really worth it?” said Lucy.


 

A spokesperson from U of T told The Pigeon in an email that mental health supports are available for students through the phone, video call, or text on both desktops and mobile devices, allowing some flexibility if speaking isn’t an option.

Colleges and universities across Canada have recommended students seeking mental health support use an app called My Student Support Program (My SSP). The app is a free 24/7 support service for post-secondary students and can be used via phone, video, or chat. This service was around before the pandemic, and is for both one-time use and ongoing counselling.

Similarly, McGill University offers students KeepMeSafe, a similar service to My SSP. Use of this counselling site has increased since last year.

While these web-based services can be useful when in-person appointments are impossible to access, many post-secondary students have expressed discomfort with virtual counselling, whether it’s due to the lack of privacy or emotional connection.

Julia Caddy, the mental health commissioner at McGill University, mentioned that on KeepMeSafe, students have shown a preference for the chat format.

“There are questions about whether that’s [due to] convenience or fear of having to talk in a place where your family might be. There’s a lot of different reasons that can contribute to that,” Caddy said. “But it has been quite a trend we’ve seen in terms of a preference for the chat support when it’s available.”

In light of COVID-19, Caddy admitted maintaining privacy has been a challenge for people accessing and giving mental health services online.

“[However], if you look at it a certain way, a very meaningful connection [is made]; we’re all in this together,” she said.

Even with these supports in place, some students are reluctant to use virtual services.

Seren Emiroglu, a student at the University of Toronto Mississauga (UTM), has been dealing with pre-existing mental health challenges. Since the pandemic started, she hasn’t wanted online counselling.

Last year, Emiroglu found herself in the Health & Counselling Centre (HCC) at UTM. For quite some time, she had a gut feeling that something wasn’t right mentally. After she attempted suicide in Oct. 2019, she decided to seek treatment.

“I knew I couldn’t do this anymore. I couldn’t put my loved ones in that situation at all. I couldn’t forgive myself for that.”

After her second appointment with her doctor at the HCC, Emiroglu was diagnosed with mental illnesses. From there, two options were brought up: therapy and medication. Emiroglu made the personal choice not to seek medication, and opted to try the five free counselling sessions offered to full-time UTM students.

After her sessions ended, Emiroglu didn’t feel like she had benefited much. However, she was open to trying new options outside of UTM.

Emiroglu still felt as if there was more to her illnesses than anxiety and depression. When voicing this to her doctor during her follow-up appointment, she was referred to a psychiatrist who worked through the school.

“I was kind of hesitant at first. [I thought,] ‘I can’t be that mentally ill,’” Emiroglu said.

After an hour and a half session with the psychiatrist, she learned she showed symptoms of borderline personality disorder (BPD). This was her last in-person appointment before COVID-19 hit.

By then, Emiroglu had agreed to start medication, but had some difficulties using Prozac and had to switch to a new medication. That, too, didn’t help.

Throughout this process, Emiroglu kept her diagnoses a secret from her parents, but eventually decided to disclose her experiences to them. Initially, her parents were confused, but Emiroglu told The Pigeon her mom has started to better understand.

Recently, Emiroglu searched for accessible therapy outside of the university. Fortunately, she was able to find a psychotherapist who is offering in-person counselling, and with whom she felt a connection.

“I think there is a more emotional component to in-person counselling sessions because over the phone [or a screen] there is a little emotional barrier present,” Emiroglu said.


 

In Calgary, Alta., Maya Smith, a student attending Mount Royal University, used to commute half an hour to meet her therapist even before the pandemic. With COVID-19, her commute is non-existent.

Instead of driving from the south end of her city to the northwest, Smith just opens her laptop and connects with the therapist she has been seeing for three years now with her parents’ support.

In Smith’s first year of university, she moved closer to campus and found it increasingly difficult to take care of herself.

“I started experiencing super severe anxiety and depression symptoms. I couldn’t get out of bed. I was crying all the time. I needed to be on the phone with my mom, and she’d be like, ‘Okay, I need you to put your feet on the ground and stand up out of bed, go to your dresser, pick out something to wear,’” she said.

“[I’d] never functioned like that before until I [moved out].”

After trying and failing to find meaningful mental health care on campus, Smith decided to drop out of school and move home. Both her parents supported her decision, but made her agree that she would talk to someone.

Now that COVID-19 restrictions are in place, Smith speaks to her therapist online. Even with family support, she said she still fears them overhearing her conversation. This makes it challenging to feel free and open, which is one of the goals of therapy.

“It’s a little too close quarters. I feel like I’m talking and everyone in the house can hear me even though I’m in my bedroom with the door closed. It’s a little awkward,” Smith said.


 

In Jack.org’s 2020 Youth Voice Report, the Canadian mental health charity reported that since the pandemic began, 37 per cent of students have accessed digital mental health services.

This shows a decrease of 20 per cent compared to the number of people who accessed any mental health services pre-pandemic.

Only 44 per cent of the report’s respondents thought digital services met their mental health needs.

With the semester coming to an end, many students have been overwhelmed with coursework. According to Jack.org, “94 per cent of post-secondary survey respondents reported that academic stress creates mental health struggles for them and their peers.”

This was the case for another student from the University of Toronto Mississauga, Misaki*.

“[My mental health] was affecting my ability to perform at a level that accurately represents [what] I learned,” she told The Pigeon in an interview.

Misaki began this year struggling. One or two all-nighters turned into a constant habit. She found herself staying up until 2 a.m. finishing homework and then waking up again at 6 a.m. to start studying again. Soon, she hit a breaking point.

“I literally wasn’t able to function.”

From there, Misaki reached out to her professors and told them a five-class course load was too much for her. Her professors helped connect her to a curriculum support officer who then told her about the HCC. In no time, Misaki was booked in for an appointment with a counsellor.

This was only the beginning of her search to improve her mental health. At the end of Misaki’s first session, she was told to book an appointment with a doctor who could help her receive accommodations from the accessibility centre.

“I feel like the [long] process is unnecessarily complicated,” Misaki said. “I hit a breaking point too late in the semester [and it’s] starting to throw me off now. If I had reached out maybe in September, I wouldn’t be in this position.”

Academics haven’t been Misaki’s only obstacle. She said her family has become a barrier to her mental health care and they’ve opposed her seeking professional help.

This lack of support can come from the fact that mental illnesses continue to carry a stigma in Canada. Both of Misaki’s parents don’t fully understand the concept of mental health and closely monitor their daughter’s activities.

“I’m living with my parents and they stalk everything. I don’t like having conversations over the phone. It isn’t beneficial to me because there are certain things I can’t say,” Misaki said.

“The first reaction when I told [my father] that I was getting mental health help was: ‘Why did you get that? It will be on your health record.’”

Instead of attending therapy sessions in the comfort of her own home, Misaki chose to have them on the phone while walking outside.

Jacqueline Anderson, an associate director of health and counselling at Humber College, told The Pigeon leaving the house is one option for students.

“Our sessions are offered via video and phone. Students have called from a space away from their home to connect with services,” Anderson said.

However, with provinces across Canada tightening COVID-19 restrictions and the winter months making outside calls uncomfortable, being able to leave home for digital counselling is becoming less accessible to post-secondary students.

While online options have helped post-secondary students transition away from in-person mental health services, the past few months have shown that not every student can benefit as deeply from digital care.



Sabra Ismath is a Toronto-based journalist. Her work has appeared in Streeter, Toronto Observer, and MY Voice Canada. When she’s not writing, Sabra’s cooped up inside watching Netflix or cooking some sort of pasta dish. 



If you require resources or assistance surrounding mental illnesses, please visit
the Mental Health Commission of Canada’s website to learn more. Crisis lines and 24/7 help options can be found at The LifeLine Canada

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