by Jesmen Mendoza, this article was originally published June 26, 2017 as part of the Truths & Aspirations: RyersonSA’s Critical Reflection on Past Failures and Future Growth series. This series tasked RyersonSA members to reflect on a way they may have let students down, what they learned, and how they plan to address the issue.
Waiting. It’s seems almost inescapable, especially in our city where we wait in line-ups for food, a place on public transit, and a space on a highway to get home. Student Health and Wellness (SHaW, Ryerson University) is all too familiar with wait times and is constantly faced with rising to the challenge. Almost twenty years ago, at the Centre for Student Development and Counselling (CSDC), we would rarely have any waits times and it would be a “first come, first serve” approach to meeting the demand. This approach had its advantages: access to support was readily available and, on the face of it, the accessibility of our support was equitable. As the demand for such support increased over the years with student population growth, this “first come, first serve” approach was tested. From the time a student called to ask for support and book an appointment for help, the wait for that first appointment became longer and longer. Some solutions along the way involved overextending ourselves, increasing our team complements, hiring relief staff during high demand times, offering group programs, and increasing on-call appointments for students in crisis. Despite these measures, the wait time for a first appointment at the CSDC still remained long.
Getting at the Truth: What Worked Then Won’t Work Now
One might think that waiting is not only inescapable but a part of life – so why would shortening (and dare I say, even eliminating) wait times matter? The concerns of the multi-disciplinary teams at SHaW on wait times are twofold. First, there are students, for a variety of reasons, that minimize their concerns, issues or, problems and waiting may exacerbate or worsen their condition while they wait. Wait times challenge our old notion of “first come, first served” being a good enough approach. Adopting it today with those students that are possibly minimizing their conditions may, in the end, create “cracks,” and worse, let these students fall into them. We worry about missing the students who struggle with suicidal thoughts, and making sure we “catch” them, all the while balancing the demand for non-crisis related support. Plainly, what we didn’t want was a student struggling with suicidal thoughts waiting weeks for a first appointment. Our old system left us vulnerable to missing such students.
The second concern that the multi-disciplinary teams at SHaW have is the inherent difficulty in being able to wait while one is in pain. When SHaW contemplates the idea of shortening and eliminating wait times, we empathize and understand that it is difficult for people to wait for support when they are in deep pain. At the heart of this concern is SHaW’s understanding that when students are in pain, it becomes difficult for a student to concentrate on anything else but the suffering. If our students are in pain, they are less likely to attend to their academic responsibilities, do their course assignments well, socialize with colleagues, or generally fulfill their role as a student on campus.
Imagine if you had hunger pains. Imagine the last time you were hungry because you missed a meal. Imagine how hard it was to concentrate, to take a phone call or talk to a colleague. Having hunger pains can distract us from making good decisions or behaving well. Imagine now, if you had to wait a week before you could eat to address those hunger pains; how hard would that make the rest of your week? How well would you do your job or how well would you act? Hunger pain and trying to address this need is a relatable example of how difficult it can be to wait. Now imagine what it would be like needing to wait for support when you are in deep psychological or physical pain. For the multi-disciplinary teams at SHaW, we know that students seeking help is not only about finding support, it is also about relieving immediately one’s emotional or physical pain.
Aspirations for the Future: Pathways of Support
In an attempt to address these pains quickly, and in an equitable manner, we at the CSDC have changed the way we take in students in recent years. I think Dr. Danielle Martin, a Toronto doctor at Women’s College Hospital, who testified to a partisan U.S. Senate Committee on Health Care, said it best when she explained to Washington how taking time to organize our wait lines benefit us all.
Her testimony showed how a single-payer system, like Canada’s health care system, is something to take pride in. How we organize queues based on needs can create a system that is both responsive and fair. We now do this at the CSDC where students can meet, on the same day they book a first appointment, with one of two specialized counsellors who triage (i.e. assess the nature of the issue, level of crisis, and create an initially personalized support plan) and guide them through the myriad of support paths at the CSDC. It has taken, under Dr. Sarah Thompson’s leadership and advocacy, a few short years to move us step by step to this new system.
Moving to this same-day consultation system at the CSDC has helped reduce our concerns of having a system where students may “fall” into the cracks. This type of health care delivery (same-day consultations) is the current gold standard. Students in extreme distress are seen immediately and are given rapid support. No student in that much pain will wait. Those students that have pressing and urgent concerns are also seen immediately, and are given guidance, coaching and support, while they gain priority access to a counsellor within a number of weeks. We also see students on the same day they request an appointment, where their concerns are not urgent nor are in extreme distress, but will have to wait a few months before they start working with a counsellor to resolve their personal, academic, and career issues. In the meantime, these students can check out resources and participate in Take Care groups that were brought to their attention during the same-day consultation. Despite access to resources during the wait, these students are still left waiting. How do we shorten the wait times for those students seeking important support for non-urgent and non-distressing issues?
This summer, the team at the CSDC will be addressing this issue and examining creative ways of shortening and alleviating the wait times for those students seeking help for non-urgent issues. We’ll be taking a look at our current practices in therapy and ask ourselves the hard questions around the flow within the pathways of support within our system. In other words, could we be treating our students more effectively? Can we somehow shift the perceptions and expectations of those waiting? Can we embrace new cutting edge treatment?
These questions are difficult questions for the CSDC and SHaW because the pace of treatment and therapy is contingent on the relationship between the multi-disciplinary teams and the student seeking help. It means accepting that students work at the pace that they need to work at because each person is different and comes from varying social locations and with various types of available resources. Trying to quantify this is not an easy task. You can’t always say, “Time is ticking, we need to do your therapy faster.” Managing a student’s perceptions of wait time and why they are waiting are difficult conversations to have because trying to convey that they need to wait and, at the same time, let that student know that they are important to us is a setup for disappointment, no matter how you frame it. Finally, cutting edge treatment is sometimes hard to embrace because the multidisciplinary teams are registered health professionals who have professional standards to adhere to and such cutting edge methods don’t always meet the rigour of those standards. These are questions that the SHaW department, and the CSDC specifically, will be meditating on for the next number of months.
Despite these hard questions and hard truths to accept, I have faith in how SHaW comes to find any solution. The thought that all of the multidisciplinary teams put into finding solutions to current problems is tremendous because of the passion, knowledge, wisdom, and expertise that each member of SHaW has. And these current problems don’t also just apply to SHaW but to RyersonSA and our country as a whole. Wait times in Canadian health care are also long and there are many health professionals across our country that want to solve this problem. Whatever SHaW finds and decides upon to see students in a timely fashion where they do not wait long for their pain to be alleviated, I know that it will be a system and process that is based on being responsive and equitable for all. Being responsive and equitable are not only hallmarks of the CSDC, SHaW, or Ryerson, but they are also the cornerstone of what it means to be Canadian.