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One year into Dalhousie’s new “stepped-care” counselling system

At this time last year, Dalhousie University’s counselling services were overburdened. 

Stressed-out students were trying to book appointments through the centre to help them handle the anxiety-inducing workload of exam season, but they were met with wait times of a month or more – if they were even able to book an appointment, that is. 

Prior to the change, students had to go through consultation before they could even be put on the waitlist for further services. Appointments for those consultations had to be made by calling in on the same day, and the slots ran out quickly; some students would try for days to make an appointment without luck, only to get discouraged and give up. 

At this time this year, Dalhousie’s counselling services are still overburdened.  

There’s still an uptick in students seeking help at the end of the semester, and that’s compounded by a recent shortage of psychologists due to a mix of retirements, maternity leave, private practice and issues with the changes and internal politics (the university is seeking to hire three more as soon as possible, and an additional two in the near future). 

But what’s different is the way Dalhousie’s counselling services are handling the demand. At the beginning of this academic year, they implemented a stepped-care model of counselling with same-day walk-in consultations. 

“The old system we weren’t serving the students well. Plus, what I’m saying was even worse, is that we weren’t serving students who needed us most well,” said David Mensink, a psychologist who has been working at Dalhousie for the last 30 years. “We [were] not doing as well as we’re doing now. We did a good job, we saw a lot of students – thousands of students – in terms of that old system, but now we’re doing it better.” 

With the new triage system, students can walk in and be assessed the same day. After the initial meeting, the counselling centre will decide how to handle their case based on their level of need. 

Not every student will get the help they feel they need with this stepped-care model – its greatest strength is that those students in the most dire of situations won’t slip through the cracks while waiting six weeks or more for their first appointment. 

“Whenever you provide a service – like say you went into my private practice, probably I’m going to have to make decisions in terms of who I’m going to see and how frequently I’m going to see them. And there may be some of my clientele that aren’t happy with some of those decisions,” said Mensink. “ It doesn’t mean there’s anything wrong with the service. And there’s nothing wrong with the person that’s complaining about it either. It’s just a normal thing.” 

Cory Larsen, Vice-President (Student Life) of the DSU, echoed Mensink’s points. 

“Dal decided to move forward with moving to a triage system, which has since seen a strong decrease in the wait time that students need in order to see a counsellor,” he said. “Students do seem to be favourably impressed with the ease of access that they now have to get into a drop-in counselling session,” he said. “So far, nothing negative at least has come forward.” 

That could be true. This new model has been working well for some students. But not as well for others, and if those students aren’t receiving the services they need from Dal, they still need to find those services elsewhere.  

Mathew Kahansky greatly appreciates the help he got through Dal Counselling. He was struggling over this past summer, when he ended up stuck in the wrong course because the King’s journalism school dropped his original course with little notice. Kahansky ended up dropping out of King’s because of it, but not before anguishing over his predicament. 

“Ultimately the experience I would say was positive overall. I got the immediate help that I needed, I got some coping strategies I could deal with afterwards,” he said. 

There weren’t enough resources over the summer for Kahansky to schedule a regular appointment, but he was told to come back for another drop-in session if he felt like he needed it. That’s the reason the counsellor taught him coping strategies, in case they weren’t able to see him on the same day. 

Kaila Jefferd-Moore had a similar experience to Kahansky – at least the first part. She was stressed out from the pressures of school and work, so she went in for a walk-in consultation. She too was given some coping mechanisms – ones that she was already familiar with, she says – and told to use a website called Welltrack, a free online self-help program. The website prompted her to answer a list of questions similar to the questions she had answered prior to her appointment. 

“I got a pop-up warning sign after I took the quiz that said ‘warning, you are experiencing symptoms of severe anxiety and severe depression, you need to go talk to a therapist as soon as possible.’ And I honestly can’t explain how defeated I felt reading that pop-up, because I had just come from trying to ask for that help from a therapist, and was sent back with this program that’s like now telling me I needed to go back,” she said. 

Jefferd-Moore ignored the warning and tried going ahead with Welltrack. Welltrack tried to instruct her in something called progressive muscle relaxation, which involves flexing a muscle group for a few seconds and then unflexing them, to teach the body what relaxed muscles feel like. 

“And so my first time trying it, I actually experienced a panic attack or anxiety attack because of it […] I tried sitting down and I tried my hamstrings and my quads, and when I tried flexing my muscles I could not un-tense my muscles – like I could not unflex them. I was just so wound up; so anxious and tense. And when that happened, I immediately panicked,” she said. 

Unfortunately for Jefferd-Moore and other students in similar situations, Dal Counselling doesn’t have the resources to provide full service to every Dalhousie student – only the resources to assess them all. To determine the ones with the most need and recommend alternative solutions for the others.  

“See, here’s the difference. This is the key here, with this new approach,” said Mensink. “Jim’s a little disappointed that he didn’t get to see [me]. But I saw Sarah, and if I didn’t see Sarah, she might be six feet under. And that’s the point that really needs to be stressed.” 

Vicky Levack is one of those students who’s truly benefited from Dalhousie’s counselling services. 

“I’d probably be dead without it. And that’s not hyperbole. I would be dead without them,” she said. “Because I need help because I have depression. And if I can’t get that help, then I’d be dead.” 

Levack is obviously more than satisfied with her experience, and she says her counsellor has literally been a lifesaver. But she does have one gripe. 

“I think it would be better if they had more funding because they would be able to help me more as well as other people. But considering what they have they’re doing a really fucking good job. Like a really good job.” 

Considering it’s their first year using the new system and there’s been a lack of counsellors in the winter semester, Dal Counselling has done a pretty good job.  

Mensink and Larsen both say the new system has drastically cut waitlist times by ensuring prompt assessments for everyone and determining who most requires the services.  

It’s true that not everybody will get all the help they need through Dalhousie, but that was true in the old system too. Now, at least, Dalhousie can prioritize who receives their help – and no one is left waiting for six weeks or more as they feel like they’re drowning in life. 

But that doesn’t mean there isn’t room for improvement. There are still ways Dalhousie could improve its service for students.  

The first is the most obvious: more funding.  

More funding would mean more counsellors, and more counsellors would mean more students could be seen. The University of Waterloo recently announced it would be spending $1.2 million to increase its number of counsellors to 37, or one counsellor for every thousand students. Dalhousie will never be able to treat every single one of its students, but the more money it spends the more it could help. 

Additionally, the DSU could try to get more coverage for mental health in its health plan. The current plan includes $1,000 a year for psychologists and social work, as well as 80 to 100 per cent coverage of medications.  

And as the demand for psychologists increase so do their rates, and $1,000 a year might not cover more than five or six sessions. For the many students whom Dalhousie recommends go seek outside services, that $1,000 isn’t enough. An increase in coverage from the health plan could mean the difference between an extra appointment or two, which could be the difference between passing and failing a class. And the plan doesn’t cover a registered general counsellor or therapist – only psychologists – which many of those students who aren’t in desperate need are looking for.  

“That is definitely a possibility. In the next year I’m hoping to create a health plan panel of students to do better outreach on if their needs are being met with the health plan,” said Chantal Khoury, Vice-President (Finance and Operations) for the DSU. “We could see what’s feasible with what we have, and […] how far a small increase in the health plan could go.” 

One last thing that Dalhousie could do to help its students acclimate to the new system is let them know ahead of time how it works.  

If students go in expecting their problems to be solved, or at least expecting to schedule regular appointments, they may very well leave disappointed, feeling like they’ve been dismissed as Jefferd-Moore did. Many students aren’t aware of how the counselling system operates and don’t realize why they’re being turned away. 

If they knew going in how the procedure worked, that the first appointment was an initial assessment and that those students with the greatest need would be bumped to the top of the waitlist, it’s reasonable to think they wouldn’t feel so personally rejected.  

Marlena Szpunar worked at Dal’s counselling services for three years before leaving in January. 

“It was a combination of a lot of things, but at the end of the day I am now in private practice full time and I continue to enjoy working with students in that capacity,” she says. “At the time that I left Dalhousie, there was a huge amount of change and some relatively novel initiatives. I believe student feedback about their experiences is extremely important in assessing how the new system is meeting their needs and I think it would be helpful if this article serves as a springboard for further discussion.” 

The psychologists who still work at Dalhousie don’t want anything to inhibit people who might potentially use their services, but if those people don’t understand the process that they’re being put through, they may think twice the next time they consider going through Dalhousie for therapy. 

“Students do seem to be favourably impressed with the ease of access that they now have to get into a drop-in counselling session, which is great,” said Larsen. “Aside from that, a lot of this year has been educating students about how they now access health and wellness services, cause that was a big changeover.” 

Editor’s disclosure: Jefferd-Moore is the current EditorinChief of the Dalhousie Gazette, and was interviewed for this article by a journalist from The Watch.  


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