Hannah Derue | The Avro Post

In Canada, 75 per cent of all mental illness is clinically diagnosed by the age of 25, says a research study, and the state of post-secondary mental healthcare can be improved by politicians acting on evidence-based research through policy change, according to research and healthcare professionals. 

The Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication cited that in 75 per cent of cases, the onset of mental health disorders occurs before the age of 25.

The same study showed that in Ontario colleges and universities, the number of individuals with a mental health concern has more than doubled in the last five years.

These statistics hold obvious implications for post secondary students, which frequently fall under this demographic.

The Spring 2016 National College Health Assessment, a national online survey that gathers student health behaviours and attitudes, found the following statistics about the post-secondary population.

The NCHA found that 46 per cent of students felt so depressed within the previous year that it impaired their function, an increase from 40 per cent in 2013.

Furthermore, 65 per cent of students reported feelings of overwhelming anxiety within the previous year up from 58 per cent in 2013.

In terms of suicide in the post secondary student population, 14 per cent of the participant pool had seriously considered suicide in the previous year, up from 14 per cent in 2013, and 2.2 per cent reported a suicide attempt within the prior year, up from 1.5 per cent in 2013.

According to the In It Together: Taking Action on Student Mental Health report (published by the College Student Alliance, The Spring 2016 National College Health Assessment (NCHA), a national online survey that gathers student health behaviours and attitudes, cited that:

  • 46 per cent of students reported feeling so depressed in the previous year it was difficult to function, increased from 40% in 2013;
  • 65 per cent of students reported experiencing overwhelming anxiety in the previous year, up from 58% in 2013;
  • 14 per cent had seriously considered suicide in the previous year, up from 11 per cent in 2013;
  • 2.2 per cent of students reported a suicide attempt within the previous year, up from 1.5 per cent in 2013.

Furthermore, the shift in mental health trends for the age demographic encapsulating most post secondary students can be explained through population research.


Variables in students’ mental health

There are a multitude of variables which may be attributable to post secondary students’ mental health outcomes.

The In It Together: Taking Action on Student Mental Health report, published by the CSA, notes that many students are living on their own for the first time in their lives.

This holds some obvious social and financial implications; these stressors, without adequate supports at post secondary institutions, can be dangerous to the wellbeing of students.


State of on-campus mental health supports

Many Canadian post secondary institutions recommend the destigmatization of mental health concerns and for students to seek help for a variety of conditions from addictions to anxiety disorders.

However, mental health services on campus outside of short-term counselling are often not provided, or are limited to a certain number of sessions per student.

The Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication states that there is “unstustainable demand” for mental health services provided on campus.

Often, when physicians or short-term counsellors on campus refer to outside sources, the necessary services are not covered by OHIP+.

It goes without explanation that the vast majority of post secondary students are often financially unstable or ill-equipped to pay the out of pocket costs associated with long-term therapy provided by a psychologist, psychotherapist, or other allied health professional.


It’s complicated

Trends in research show that older demographics tend to have higher incidences of physical illness, and younger demographics show much higher incidences of mental illness.

However, this may be more complicated than a unidirectional relationship, where age is the sole determinant of public health concerns for individuals.

Evidence shows that so-called “non-medical determinants of health” blur the line on where physical illness and mental health intersect, considering the social contexts that human beings exist in.

According to the final edition of The Health of Canadians – The Federal Role, written by the Kirby Commission, non-medical determinants of health are said to include: “biology and genetic endowment; income and social support; education and literacy; employment and working conditions; physical environment; personal health practices and skills; early childhood development; gender; and culture.”

The Kirby Commission goes as far as to assert that “…75% of the health of the Canadian population is determined by a multiplicity of factors outside the health care system.”

The Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication found that women had significantly higher risk than men of anxiety and mood disorders, whereas, men had significantly higher risks of developing impulse-control and substance abuse disorders.

This example demonstrates that not only are there possible biological and social/cultural variables at play, but that they may be the result of interaction effects.

As a result, it is clear that a reform in Canadian healthcare that would reflect the best interests of Canadian post secondary students would have to take an integrated whole-systems view of the sociological variables contributing to the diminished health outcomes in this demographic.

Furthermore, this assertion of complicated relationships between variables in mental health outcomes is supported by a statement from In It Together: Taking Action on Student Mental Health, that students with mental illness often also encounter physical health issues, like sleep difficulties and exhaustion.


Implications to the Canada Health Act, 1984

It is worth noting that the mental well-being of residents of Canada is protected under the Canada Health Act, 1984, (c. 6, s.3), which outlines that:

“It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”


A promising future for Canada

A promising future for healthcare in Canada is just around the corner if politicians follow evidence-based research, say professionals in healthcare fields.

Although there is currently limited research in this area, a recent 2018 study Evaluation of an mHealth App (DeStressify) on University Students’ Mental Health: Pilot Trial, suggests that the mindfulness-based mobile health app applied in the study was a discrete and accessible form of alternative health that shows promise in future post secondary applications.

Data showed that the mental health app “DeStressify” had a statistically significant effect on trait anxiety, overall health, emotional well-being, and school and work productivity in the experimental group of student participants.


Healthcare policy organization in government

A major barrier to effective public health policy described by the final report of the Kirby Commission is disjointed implementation. All provinces and territories have separate legislation, which is part of the lack of accountability and leadership, and the “less than optimal coordinated activity”, described by the Kirby Commission final report.

The Kirby Commission stresses that experts support increased federal leadership efforts in order to remediate the disorganized state of healthcare in Canada.

According to the Kirby Commission final report: “…there is an immediate need for strong federal leadership to rectify this unhappy and less-than-productive situation.”


Political considerations in healthcare policy reform

It is worth noting that the Kirby Commission points out the ways that the Canadian political system may impede the systematic, long-term change that is suggested by years of established research in public policy.

The non-medical determinants of health are inconspicuous, but are shown to have substantially greater impacts on the health of the population than healthcare itself. The positive outcomes of promotion, prevention, protection, and population health activities are typically only visible over the longer term.

As a result, investments in long-term systematic changes that improve the quality of life of individuals is less newsworthy than hasty investments into short-term developments. The Kirby Commission outlines it in simple terms, “Because they are less likely to capture the attention of the general public, they are less attractive politically.”


This is part one of a series on healthcare by Hannah Derue. Image of the Parliament of Canada from Maine University. Edited by Eli Ridder.

 

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