Pushing a community solution to mental health

There is no question in Gitta Kulczycki’s mind about what comes first.

“Safety trumps confidentiality,” Western University’s vice-president (resources & operations) said. “When we see there is a risk to the safety of an individual or to the safety of others around them, safety will always trump confidentiality.”

Following the suicide of a first-year Carleton University student in 2008, Ontario Information and Privacy Commissioner Ann Cavoukian wrote to universities, stressing their ability to disclose much-needed information in urgent situations involving significant risk of serious bodily harm.

“Privacy laws are often faulted with preventing the disclosure of a student’s health information to parents or others who could perhaps offer some assistance in urgent situations. I want you to know they do not,” she stated in the letter. “The decision to disclose is yours to make, and must be made very carefully and guardedly, but it is yours to make.

“Privacy laws do not stand in your way.”

That call to action dovetails perfectly into Western’s recent efforts to ramp up mental health awareness and support on campus. Next week, the university will continue that push by launching a new one-stop, mental health website. It all plays into the institution’s goal of making its concern for mental health on campus as visible as possible.

According to the Canadian Mental Health Association, mental disorders in youth are ranked as the second highest hospital care expenditure in Canada, surpassed only by injuries. With 4,000 deaths annually, suicide is among the leading causes of death in university-age Canadians (15-24), second only to accidents.

After the shooting and subsequent suicide at Virginia Tech University in 2007 that left 33 dead, there was clearly a significant amount of confusion about privacy and whether or not information could have, and would have, been shared in the case.

“A lot of dialogue happened because of that incident,” Kulczycki said. “Confidentiality is important, but important to take in the context of the need for safety. Your intervention needs to be right away. It’s just a question of what the intervention is.”

She assures while such information is not shared indiscriminately, sharing within the university – particularly with Campus Community Police Service (CCPS), Student Development Centre or Student Health Services – is appropriate and necessary in some rare cases.

It’s all part of a broader effort to involve the community.

At Western, training has been in place in all residences to help staff and students identify situations requiring immediate referral. For example, with direct or indirect reference to suicide, regardless of the circumstances or context, any reference is to be taken seriously. Training stresses observing for indications such as expressed feelings of worthlessness or hopelessness; feelings the world, family or friends would be better off without them; or unreasonable feelings of guilt.

Kulczycki added residence staffers wear buttons reading ‘How are you? No, how are you, really?’ as a visual attempt to reach out before a situation hits a crisis point.

“We train staff and those in residence as to how to have those conversations, which is more broadly addressed in the mental health first aid program that we offer,” said Kulczycki, who took the program herself last fall. “It’s part of the training that if you work for me and I see things are off, I need to say ‘Have you ever thought of killing yourself or harming yourself?’ It’s not something to avoid.”

The easiest, and most recommended, method to start the process of getting help is simply notifying campus police; they are on duty 24/7.

CCPS director Elgin Austen agrees with the adage ‘safety trumps confidentiality.’ While the police generally don’t assess mental health cases, they do conduct assessments and address behavior often based in mental health issues. And those numbers are going up.

Occurrences directly linked to mental health for the past three years has grown from six in 2009 to 15 in 2010 to 27 cases in 2011.

“Campus police conduct in-depth investigations relating to such matters followed by an assessment of facts, but where personal safety is involved, whether it is to ones-self or others, safety always trumps,” Austen said. “Early identification and support reflects more positively on outcomes. Escalated situations are more reactive and challenging.”

Parents are among of the more important players in these situations. But at what point should the university involve parents?

“We will get parents involved, but we can’t just do it willy-nilly,” said Kulczycki, noting police and the university residence system know how and when to engage them. “In working with the student you want to ask them ‘You want us to contact your parents, don’t you?’ You have to be careful in finding out because sometimes that could be the cause. So you just can’t categorically say ‘all parents’ because that may be precisely what the driver is.”

In Canada, only 1 out of 5 youth who need mental health services receives them. John Doerksen, vice-provost (academic programs and students), said Western is taking the issue of mental illness very seriously.

For that to happen, students, along with staff and faculty, need to know should they require psychological services, for example, they are seeking it in confidence.

“Our psychologists are obligated under their professional code to keep things confidential. They’re no different than any other clinical health worker,” Doerksen said, adding at times students are concerned if they use a service such as this on campus it’s part of their academic record. Not true.

“There’s a firewall between what happens there, in confidence, and their academic programs,” Doerksen said. “A professor is not going to be told; it’s not on their record. But there are those rare cases where it’s going to be necessary to inform people who could help with their safety, if that is imminent. In that sense, they would be compelled to share.”

On Feb. 9, Western launches Mental Health @ Western, uwo.ca/uwocom/mentalhealth, a new website with specific links for students, family, staff/faculty assisting students and staff/faculty in difficulty, as well as direct links to campus police, Student Health Services (SHS) and Student Development Centre.

Shelagh Hodson, SHS director, said two student surveys (conducted by Nursing and the Richard Ivey School of Business) as well as anecdotal comments from students showed they didn’t know where to get help if they needed it.
“We feel we have good resources for counseling and assisting students and staff, but folks did not know about them,” said Hodson, adding student surveys identified stress and anxiety as top concerns. “This is our attempt to reach out and share what we have on campus, videos, web links, e-magazines and community resources all at their finger tips.”
Kulczycki stressed Western has an “obligation to take the steps” in order to keep campus safe. “Doing nothing is not an option,” she said.

Kulczycki has taken it upon herself to see the necessary steps are taken.

“I’ve personally done this, in dealing with students I truly believed needed some help,” she said. “I’ve called the Student Development Centre and walked them over myself so they can be seen. If it’s your child, do you want the university to take some action? Absolutely. Would I want someone to reach out to my children and offer help? Absolutey. Nobody wants to get, or have to make, ‘that call.’

“This is about being pro-active. We are learning all the time and we need to continue to lead. You know that expression it takes a village to raise a child? It’s true. It takes every person watching.”