For students rushing along the snow-covered winding roads between McGill University's aged greystones, this should be the time of their lives. School is where the future begins, the last outpost of youthful freedom and non-conformity, rebellion and curiosity.
DAVID SHERMAN, Special to The Gazette
Published: 11 hours ago
But many slogging through the snow are burdened by more than backpacks, papers and exams. Here, as in other universities and colleges across North America, students are being stalked by depression, anxiety, aggression, dependence, bipolar disorder, suicide and self-injury in unprecedented numbers.
Worse, many are showing up with what health professionals call multiple psychopathologies: They are plagued not by one demon but several.
One in six under 18 are said to be suffering from some disorder that impairs their ability to function. Some say as many as 20 per cent of our young people under 25 are mentally ill.
No place is the impact being felt harder than in colleges and universities. And the darkest fear of many health professionals, especially on campuses across the continent, is that the problem is getting worse. Our kids, many say, are getting sicker.
Norman Hoffman, a psychiatrist who heads up McGill's Mental Health Service, summarizes the condition of many students as "angry, anxious, fragile."
In 1983, the service received 300 visits. Last year, 2,300. In the last 10 years, Hoffman says, there's been a 300-per-cent increase in the number of students seeking help. One in 10, says Hoffman, have purposely cut themselves with razor blades or glass, usually choosing to slice open their arms or legs. Some do it secretly. Others, he says, take part in cutting parties, getting together to mutilate themselves, comparing scars, bragging about the depth of their cuts. Some slice then shower to ramp up the sting.
"Some describe that they are feeling numb or dead," says Hoffman, a soft-spoken, gentle man who arrives for a late autumn coffee in bicycle pants, helmet in one hand, bike seat in the other.
When Marie-France Desautels draws a thin red line across her belly with a razor blade, she feels neither numb nor dead. She likes the pain, she says. Desautels, 22, is a petite nursing student at CEGEP du Vieux Montréal, and with the help of a psychologist she sees once a week, a psychiatrist she sees once a month, and a daily regimen of two antidepressants, an antipsychotic and Ativan, a sedative, she has reduced her cutting habit to three times a week. Now she wounds only her stomach, what she describes as "small cuts ... instead of taking pills."
"It calms me but just for the time I'm doing it," she says, tugging on a white scarf she wraps around her neck.
Desautels used to go to school with a blade in her pillbox and lock herself in a toilet stall to cut herself "all over her arms and legs," every day. Now she'll adjourn to her dining room in front of her computer in her one-bedroom apartment in Point aux Trembles and mutilate only her stomach every second day or so.
She suffers from sadness, depression and anxiety and says she confides in no one, not even a friend who waits for her a few tables over and is also a self-mutilator.
While no one doubts mental illness among those under 25 is an elephant in the room, there are no Canadian studies to tell us whether the elephant is growing. What is certain is that post-secondary schools are fast becoming the frontline of defence against mental illness.
"They (disturbed kids) waited to get to Dawson to talk to someone," says Susan Wileman, a counsellor at Dawson College. "They hadn't been seen by anyone."
School counselling and mental health services are strained, the amount of time they can spend with students limited by budget constraints and the grim reality that schools are not psychiatric facilities and can only do so much.
"We're not meant to be clinicians, we're supposed to do counselling for education and career guidance," says Wileman. "It gets pretty heavy."
Janice Martin, accessibility office manager at the giant University of Toronto's downtown St. George campus, says they've hired a second caseload adviser to handle psychiatric cases.
"The number with psychiatric disabilities grows every year," she says, highlighting depression, anxiety, schizophrenia and eating disorders as the main afflictions.
Charlotte Waddell is a psychiatrist and director of the Children's Health Policy Centre at Simon Fraser University in British Columbia. Waddell studies 4- 17-year-olds and her numbers are cited in the Quebec government's 2005 Plan d'action en santé mentale paper that warns 15 per cent of Quebec children are suffering some degree of mental illness, which, by some accounts, might be an optimistic appraisal.
Some of these fragile 17-year-olds will soon be booking appointments at counselling or mental-health centres at college and university, environments many say have become increasingly stressful and alienating, a kind of mental-illness incubator.
"Is there real increases?" asks Waddell. "We don't know. We need to keep a careful eye. There are some surveys going on."
But those results are a few years away and without the epidemiological studies, the debate continues. No one disputes that campus counselling and mental-health services are seeing more students than ever, but there is no definitive answer as to whether that's due to an increase in the rate of mental illness or an increase in the rate of reporting mental illness.
"It's the topic of conversation at all the conferences. Everyone will tell you anxiety and depression are going up," says Caroline Rabbatt, in charge of the Critical Incident and Student Conduct office at the Scarborough campus of the University of Toronto. But, Paula Stewart, director of the Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, will only say it's possible.
"I absolutely agree that we have a serious problem," says Stewart in a phone interview from Ottawa. "But I can't say it's increasing."
Latest studies into the state of mental health of Canada's young show that 18.6 per cent of 15-24 year olds "meet the criteria for mood disorder, anxiety disorder and substance abuse" among other illnesses, she says. That compares with about 10 per cent of the population age 25-64, according to StatsCan.
Stewart says mental illness is so common among young people now "that it's hard to imagine it wasn't a problem before."
The Canadian Psychiatric Association has no position on whether mental illness in young people is on the rise, writes spokesperson Hélène Côté, in an email. She arranges an interview with psychiatrist Stanley Kutcher, an associate dean at Dalhousie University in Halifax and the Sun Life Financial Chair in adolescent Mental Health. But Côté stipulates Kutcher does not speak for the psychiatric association.
If rates of mental illness are on the rise, "it's not increasing super hugely," says Kutcher. Without the studies to prove it, it's all hypothesis and he's skeptical.
"Show me the data," he says.
Kutcher attributes the growing demand for mental-health services on campus to increased awareness of illness among caregivers, decreasing stigma among students, so that they are less shy about seeking help, greater awareness of mental illness in general and improved accommodation on campuses.
Much the way schools have built ramps for the wheelchair bound, they have tried to make it easier for those suffering from mental illnesses. Schools may adjust exam schedules for those with excess anxiety, or those whose medication makes them groggy at certain times of the day.
"In previous years, you didn't identify if students had mental-health difficulties," Kutcher says. "In the old days, you closed your eyes and the problem would go away and the kid would drop out."
The run on counselling and mental-health services is a challenge schools have to meet, Kutcher says. He suggests educational institutions are not set up to deal with it and he's working with counsellors to improve their skill set.
"There is a big problem when dealing with young people that have mental-health difficulties," he says, and warns that creating a "bogeyman" of accelerating illness doesn't help the situation.
Kutcher's assertions that mental illness among young people is not on the rise and that university people are not properly trained rankle psychiatrist Hoffman, who has been at McGill for 25 years. Even taking into account the small percentage of students who can now go to school because of a panoply of pharmaceuticals, including antidepressives, antipsychotics and sedatives, Hoffman says he believes students are in crisis.
In an email reply to Kutcher's assertions, Hoffman writes: "There is evidence of significant increases in emotional distress, with self-injury, drug abuse and relationship difficulties rising sharply. Despite the decrease in stigma, increase in diagnosis and modern medications, there has been a 400- 500-per-cent rise over the past 15 years in students requesting mental-health intervention. That is a fact."
Iris Erdile would concur. She's a 20-year-old from Albany, N.Y., in her third year at McGill. She suffers from an obsessive-compulsive disorder and started a campus organization called Headspace (safe.minds.mha@gmail.com) for students with mental-health difficulties. It had its first meetings in January.
Erdile is not alone in wanting student backup in the battle for mental health. Active Minds is a Washington-based student-run mental illness resource with 110 chapters across the U.S., including one in Canada. It was founded by 26-year-old Alison Malmon four years ago, after her brother, on leave from Columbia University, killed himself.
"He was depressed and suffered from psychosis," she says. "He felt ashamed and stigmatized."
Active Minds began with three students at the University of Pennsylvania. It now has a membership Malmon estimates at 1,500.
"My goal is to prevent other students from being ashamed and to (encourage them to) seek help."
The only Canadian chapter is at the University of Windsor in Ontario on the Detroit River. Though the U.S. college experience is different than ours - traditionally students go away to school in far greater numbers than they do here, a rite of passage that paves the way to adulthood in some but can also exacerbate fragility and despair - studies in the United States indicate illness is climbing.
A 2006 study of Cornell and Princeton University students found almost 20 per cent had practised some form of self-injury or abuse, usually self-inflicted cuts or burns.
Researchers at the University of Kansas examined changes over 13 years, from 1988 to 2001, and concluded: "Students who were seen in counselling services in more recent times have more complex problems that include the more normal college student problems ... as well as the more severe problems such as anxiety, depression, suicidal ideation, sexual assault and personality disorders. Some of these increases were dramatic." Depression doubled, suicidal students tripled, students seen after sexual assault quadrupled, the report says.
"There is more pathology, more severity, not just more reporting. Perception is reality," says Maggie Olona, a director of students counselling services at Texas A&M University and a spokesperson for the Association of University and College Counselling Centre Directors, in a report last fall. "There is more pathology coming over our doorstep. These are not students who are homesick. These are students in real psychological distress."
Canadian studies might be non-existent, but the anecdotal evidence is striking.
"Anybody here would tell you there's an increase," says Concordia University's Melanie Drew, director of the school's health services. "The acuity issue is what we're quite shocked about. There's a much greater level of distress; anxiety disorders, panic attacks, students are feeling some stress and stressors that I didn't deal with."
Demand for counselling services has been climbing five to 10 per cent over the last few years, says Dawson's Wileman, with a sharp increase in the last year, which may or may not be connected to the September 2006 shooting rampage by a young man that injured 20 and killed one.
"It's never gone down," she says. "And we don't go beating the drums for business."
It's difficult to imagine a more bucolic academic setting than John Abbott College. A few football field lengths from Lac St. Louis, it's a campus of groomed lawns, ancient trees and low-rise red brick buildings. In the Students Services department in the Hertzberg Building, the centrepiece of a long curving driveway off Lakeshore Rd., three longtime counsellors seem to long for the old days when students concerns were mainly about career counselling, sexuality and autonomy.
"(Students) had age-appropriate issues: autonomy, sexuality, relationships. The majority (of students I see) are now disturbed," says Su Baker, who started at John Abbott 30 years ago. "More and more of our work involves general anxiety and depression, suicidality, students identifying themselves as being abused."
Klarer, another 30-year veteran at the Ste. Anne de Bellevue CEGEP, says "there's been a significant increase over the last 10-15 years."
The same can be said at the Université de Montreal where psychologist Daniel Moissan heads up the Service de consultation psychologique.
"I have the feeling that psychopathology is more prevalent than in the past," he says.
Moissan says there's no spike in the number of visits to his office but says his budget dictates the number of students the office can accommodate and that hasn't changed.
But what about those not not driven or privileged enough to go to college and university? Jean-Remy Provost is executive director of Revivre, a Montreal organization offering support and assistance to Quebecers with mental illness. It's been around since 1983 and Provost says the membership has been pretty steady at 1,000, about half of whom he estimates are under 25.
In the emergency room of the Montreal Children's Hospital, a destination of last resort for those under 18 who find the torment intolerable, psychiatrist Brian Greenfield has a finger in the dike of an increasing volume of cases that now averages 600 a year.
Greenfield doesn't mind taking a break and sitting back in a fifth-floor conference room, trying to assess what's going on.
Originally from New York, Greenfield has been in Montreal for 25 years, practising at the Children's since 1990. He doubts the incidence of mental illness is rising. But after a brief discussion, he says, "Maybe I'm not seeing it."
In this environment, kind of a peacetime mental-health MASH unit, it would be easy to miss. He spends typically 30 to 45 minutes with each troubled child before he has to send them onto the next instalment, maybe a referral, maybe a prescription, maybe some soothing advice. Ask him whether 30 to 45 minutes is enough for a diagnosis and he says "no." Ask him whether he follows up to find out how just ill these young people are after their initial foray into the emergency room and he admits he doesn't have the time.
"I can give it a ballpark," he says. "Maybe that's all I can do. But I can't really say how sick they are."
Waddell says she knows how sick our kids are in general but she doesn't use the word epidemic.
"What we have is an epidemic of lack of service," she says. Only 25 per cent of ill kids are being treated, she says.
Society would not tolerate ignoring 75 per cent of youngsters if they suffered from diabetes or cancer, she says, yet mental illness will plague them all their life if left untreated, and it often is.
