Background
In response to the Presidential and Provostial Student Mental Health Task Force Report released in 2019, the University of Toronto (U of T) is re-envisioning how mental health services are delivered to students across all three campuses. With over 90% of the recommendations now launched, work continues to ensure the university is working toward full completion of these recommendations which were heavily informed by our students.
One critical step in the re-design process was implementing a Stepped Care Model of care, which organizes services from low to high intensity to meet student needs. Within Stepped Care, a key service commitment is the same-day, single-session appointment known as One-at-a-Time (OAAT) counselling which is offered across all three campuses. Students can make appointments the same or the next day for a single session and can come back for more sessions when needed.
In 2022, student perception of campus-based mental health care was selected as the inaugural tri-campus evaluation activity, to ensure that student voices are being included in mental health service changes. The Tri-Campus Student Mental Health Team, a new unit within the Office of the Vice Provost Students, provided strategic support to this collaborative effort between the three health centres of U of T.
Measuring Perception of Mental Health Care
Perception of mental health care services is considered a key indicator of the quality of care and the degree to which the unique needs of a population are being met (Centre for Addiction and Mental Health, 2022). The health centres selected the Youth (mental health) Service Satisfaction Scale (YSSS), developed by headspace in Australia, as a measure of perception of care, because it was developed specifically for youth.
The scale has 14 items that fall into 4 subscales:
- Centre (e.g., “It was easy for me to get to the health centre, or access services virtually.”)
- Staff (e.g., “I felt that my views and worries were taken seriously.”)
- Perceived benefit (e.g., “I got help with the things I wanted to get help with.”)
- General satisfaction (e.g., “If a friend needed this sort of help, I would suggest the health centre.”)
For each item, the survey-taker is asked to use a 5-point scale ranging from “Strongly Agree” to “Strongly Disagree” (with an n/a option) to rate the extent to which they agree with the statement.
How were students involved?
Not all youth are post-secondary students and not all post-secondary students are youth. Researchers took the YSSS to students to make sure the scale would be appropriate for use at U of T. A consultation with U of T students from multiple campuses who had lived experience accessing on-campus mental health care provided feedback on the survey. Students were asked to review the survey and provide recommendations for adaptation.
Examples of student recommendations are:
- Provide definitions to help interpret words or phrases used in the survey.
- Adapt the questions to incorporate virtual care.
- Use the term “service” instead of “contact with.”
- Add open text boxes for comments after each section of questions.
- Provide the context for and the purpose of the survey up front.
Who participated in the survey?
In November 2022, students who had used the health centres for mental health purposes in the previous 12 months were emailed a link to the survey. Access to the survey was also provided via QR codes presented on posters in the health centre waiting rooms. Responses were analyzed from 512 students who had answered at least one of the YSSS questions.
- Most students who participated in the survey were 22 years old
- 2 in 3 were cis women
- 1 in 2 were 2SLGBTQAI+
- 2 in 5 were Asian and 2 in 5 were white; the remaining students identified as Black, Indigenous, Middle Eastern, Latin American, or had mixed or other racial backgrounds
- 1 in 3 were graduate students
- 1 in 4 were international students
- 3 in 4 were from St. George campus
What were the findings?
Overall level of satisfaction is positive
- Most students rated most questions 4 out of 5, with 5 indicating the highest levels of satisfaction (i.e., the median for most items was 4).
Perception of care was highest for in-person visits
- Even though most students had last experienced a virtual visit (2 in 3), perception of care was higher, on average, for those who had in-person visits than phone visits (on all four domains: centre, staff, perceived benefit, and general satisfaction).
- General satisfaction was higher for those who had experienced an in-person visit compared to a video visit.
Perception of benefit was higher for those who returned for care more than once.
- One in 3 students were first-time users of the health centres.
- Perceived benefit was higher, on average, for repeat users, compared to first-time users.
- One-time use may be ideal for some students, but returning for further sessions is also open to all students as part of the Stepped Care model.
Some communities of students feel more comfortable at the health centres than others.
- Perception of the centre and general satisfaction were lower, on average, for 2SLGBTQIA+ students than other folks.
More than 500 comments were provided by students, some positive, others with suggestions for improvement.
- Analysis of comments identified themes related to wait times on phones. Additionally, some students reported a lack of availability of staff and certain appointments.
Five Impacts from the Survey Results
Inform improvements to virtual care. Virtual care increases access to care – and all staff want to ensure all care is high-quality.
- Staff training in virtual care is recommended across all three health centres, including training staff to regularly address how care is provided to students to ensure they’ve raised the opportunity to experience accessible in-person care.
Learn more about student experience with single sessions.
- A targeted evaluation of single sessions, also known as “OAAT” (One-at-a-Time) sessions, is planned for 2024.
Enhance our inclusive spaces & engage diverse student groups.
- Health centres will work—and hire—to provide more diverse and representative counsellors to meet the specific needs of students.
- The Tri-Campus Student Mental Health Team will meet with Student Advisory Groups to determine the best methods for engaging students to better understand why some communities feel less comfortable at the health centres and what can be done to improve their experience.
Reduce phone wait times and increase quick access to services
- Health centres will ensure a full complement of front desk staff at clinics are available to take calls and book appointments.
- Health centres will streamline the registration process.
- The Tri-Campus Student Mental Health Team will improve communication about the availability of different services.
Co-design the next version of the Perception of Mental Health Care Survey with students
- Researchers will determine how to ensure the voices of equity-deserving groups are strongly represented in survey findings.
- Researchers will engage with students to design an easier-to-use survey that reaches a larger group of students.
How can you get involved?
Sign up to be involved in future consultations on the survey.
Sign up to be included in the next survey administration.
Contact smh.evaluations@utoronto.ca for more information.
