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 important 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. The model prioritizes reducing wait times by offering same or next day counselling when requested. This new counselling model was a major initiative across the Health Centres of the university. 

To ensure that student voices are included in mental health service changes, in 2022, student perception of campus-based mental health service was selected as the inaugural tri-campus evaluation activity. The three Health Centres collaborated to launch the survey.

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 specifically developed 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 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 2SLGBTQIA+
• 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

Five specific findings and our response to this feedback

1. The overall level of satisfaction was 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).  

2. Perception of care was highest for in-person visits. Even though most students had last experienced a virtual appointment (2 in 3), perception of care was higher, on average, for those who had in-person rather than phone appointments. General satisfaction was also higher for those who had in-person compared to video visits. 

These results suggest that satisfaction with in-person care is highest, followed by video visits, and lowest for phone appointments. While there are benefits to both virtual and in-person care, virtual care increases access for many students. In response to this, the Health Centres will advise students who are requesting phone or video appointments that in-person may be preferable. Maintaining flexible options for access remains important and Health Centres will continue to work on improving use of technology to ensure virtual and phone appointments are a high-quality experience. How best to deliver care through a virtual model will also be part of staff annual training to improve student experience. 

3. Perception of benefit was higher for students who had more than one session of care.  Perceived benefit was higher, on average, for repeat users compared to those who used the Health Centre once. This is consistent with research outside of U of T showing more engagement with service increases perception of helpfulness. The new same day, single session model includes the option for students to return for follow-up sessions if they wish or if recommended by the counsellor. This option has been misunderstood often and students may feel they can only access one session. To respond to this, the Health Centres will improve communication regarding the counselling model to ensure students are aware of the option to return for additional sessions when needed. 

4. There is an opportunity to improve the experience of 2SLGBTQIA+ students. Better serving our 2SLGBTQIA+ student population is an important priority of the Health Centres. This survey was the first to look specifically at the experience of this group. While overall satisfaction reported by all students, including those who self-identify as 2SLGBTQIA+, was positive, the latter reported a lower level of satisfaction on two of the four subscales (see section above Measuring Perception of Mental Health Care for information on the subscales). This is an important finding requiring further exploration. Health Centres are already working to ensure they are hiring using staffing approaches that aim to reflect the diversity of our university communities and address the needs of all students. As a follow up to the survey, further consultation will be undertaken with students to better understand their experience and how best to respond to their needs. 

5. Additional input. A thematic analysis of both positive comments, as well as those with ideas for improvement, was conducted. Positive comments reflected an appreciation for the counsellors, while constructive comments included the need to address wait times to reach staff at the front desk. The Health Centres have already begun to address this issue, ensuring there is a full complement of front desk staff to take calls and book appointments. The campuses are working collaboratively to streamline the intake process and improve communications about the different services offered.  

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.