Wait times persistent barrier to student health

Amidst many changes, delayed appointments remain primary concern for students seeking care at Queen’s

The outside of the Queen's Physical Education Centre (PEC).
The PEC has been identified as a new site for the creation of a student wellness centre that would house SWS.

Over the last half-decade, Queen’s has dramatically changed the way it provides student health services, but it has yet to make lengthy waiting times a thing of the past.

What once had a long history as Health, Counselling and Disability Services (HCDS), has been renamed the “Student Wellness Services” (SWS) by the University. 

Since the Principal’s Commission on Mental Health was established in 2011, the University has created faculty-specific counsellors, pledged to add an accommodated exams centre and established programs such as QSuccess and Bounce Back to assist students as they progress through university life. 

But the most pressing problem — lengthy weight times for appointments — has proven to be remarkably resilient.

Counselling Services, one of the SWS services, is used by around 10 per cent of students each year. It provides one-on-one crisis counselling, short-term counselling interventions and other services to students, staff and faculty.

In a 2008 article, The Journal reported that HCDS had asked for a $10 increase to its student fee in response to concerns about wait times for booked appointments, which the service’s then-Director Mike Condra said “could take weeks” to obtain.

According a 2015 report released by the Provost’s Advisory Committee on Mental Health (PACMH), “most requests” for non-urgent appointments are still scheduled with a two-week wait. 

In addition, two evening clinics — which require appointments — have been in operation since 2011. These clinics are consistently fully booked, according to the 2015 PACMH report.

Despite high demand for clinics and appointments, the total number of visits in 2014-15 decreased significantly from previous years. From April 1, 2014 to March 31, 2015, 22,885 students were reported to have used the service, down from 26,583 in 2013-14. 

According to the PACMH, the decrease in total visits may be due to a decrease in the number of “physician clinics” offered each week. Another factor could be an increase in length of appointments, which would mean that fewer students are seen each day. 

The theory couldn’t be verified, though, as SWS doesn’t track the length of appointments. 

Despite a decrease in physician visits, increased counselling appointments have led to more overall visits to SWS. (Graphic by Ashley Quan.)

In either case, although there are fewer appointments, the decrease is due to a change in capacity, rather than a drop in student demand for services. 

According to an external review of HCDS undertaken in 2015, “the demand for individual counselling resources may always exceed capacity.” 

That being said, most students appear to want more than one counselling appointment. 

PACMH data reveals that the average number of visits per student each year to Counselling Services has remained constant — at three per student — since 2012-13.  

There’s no hard limit to the number of appointments students can book in a year, but Counselling Services operates as a short-term solution. 

Although students book more than one appointment on average, there’s no capacity for longer-term care. Students seeking care and support in the long-term are instead referred to services within the greater Kingston community. 

Although capacity may remain constrained, data from the PACMH also reveals that since 2011-2012, when a new intake protocol was applied, waiting times for first appointments were reduced to less than five weeks. Counsellors currently see 95 per cent of students seeking an appointment for an “immediate issue” within one working day.

A significant change affecting the improved wait times for Counselling Services could be the addition of embedded counsellors across campus.

In 2011-12, Queen’s established the “embedded counsellor program”. Embedded counsellors allow the University to adopt a “hub and spoke” model of care, whereby students have access to general support through SWS in addition to faculty- or situation-specific professionals. 

Last year, an embedded counsellor was introduced at the School of Medicine, bringing the number of outreach counsellors to eight. When the program was established, only three counsellors existed. 

In a 2014 interview with the Centre for Innovation in Campus Mental Health, embedded counsellor Joanne Roston — who works in the Faculty of Engineering & Applied Science — spoke about the program. 

According to her, “a definite strength [of an embedded counsellor] is being able to understand the culture around a specific faculty or discipline … essentially all therapeutic interventions can be tailored and met where they are more directly.” 

For example, as the embedded counsellor working with students studying Engineering and Applied Science, Roston applies the principles of engineering education to her programming. 

“Engineers seem to really like looking at issues and ways to solve problems that have a middle, beginning and an end,” Roston said.

“Understanding how students think is very helpful for me to direct programming using their (faculty and students) strengths,” she added.

Mike Young, ArtSci ’16, B.Ed ’17 and Queen’s Rector, told The Journal via email that despite the provision for urgent appointments, his quality of care was affected by lengthy wait times. 

“As a student who was struggling considerably with personal issues, I had a choice between an appointment 2 weeks away or to claim one of the emergency next-day appointments.” 

Young recalled the pressure not to take a spot from a student experiencing similar hardship. 

“I wasn't willing to take the emergency spot from someone who might be in more of a crisis than I was experiencing”, he said adding that, “… this wasn’t a comfortable position to be in.”

At the end of the day, he took the later appointment. But after a two-week wait, the appointment was of much less use than it could have been.

“I had to deal with a lot of my issues myself.” 

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