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Accessible care or adequate care: Students with eating disorders shouldn’t have to choose

Editorial/Opinion by

McGill’s Mental Health and Counselling Services face a twofold challenge: Make mental health care efficient and accessible to all students, while ensuring that care is appropriate to each student’s specific needs. Given limited resources, it is not an easy balance to strike. But it is, fundamentally, a balance—not an either-or situation. The Sept. 20 announcement that McGill has cut its dedicated Eating Disorder Program (EDP) flies in the face of this wisdom. The abrupt rollback of the program and after-the-fact informing of affected students is not just a case of sloppy communication. More alarmingly, it reflects a flawed assessment of the unique nature and risks of eating disorders, and the needs of students living with them.

When it comes to eating disorders, students are at special risk. The transitory, high-stress rollercoaster that is university life—and first year in particular—can frequently trigger or exacerbate disordered eating. Like all mental health challenges, eating disorders vary widely in severity and symptoms. More uniquely, however, they often lack the clear cognitive or functional correlates frequently used to flag prevalent mood disorders, like depression and anxiety—especially in the context of the already semi-dysfunctional norms of student life. Eating disorders can be deadly, yet too often, they go unnoticed.

McGill's EDP had been available to students since 2009, providing individual therapy, nutritional counselling, and group therapy sessions. Despite the chronic understaffing of McGill’s health services, a patient of the EDP has previously praised the program for its multidisciplinary, tailored approach to each student’s needs.

Things look different now. Even prior to last week’s announcement, staffing had been continuously reduced: A coordinator position was already cut previously, and the program’s single nurse resigned this year, and hasn’t been replaced. The EDP’s psychotherapist is being moved elsewhere in mental health services, and the dedicated nutritionist will now be servicing all students—not just those with eating disorders. For the time being, group therapy sessions have been cut altogether. Diagnosed students seeking treatment will now be funneled through the school’s general Psychiatric Services, with the possibility of being referred to off-campus, specialized clinics.

 

[Cutting the EDP] raises problems that extend beyond a shoddy messenger—problems that are perhaps reflective of broader flaws in McGill’s approach to mental health services.

McGill’s decision to cut these resources without adequately warning the students who rely upon them, nor offering support in transitioning them to alternatives, is egregious. The message it sends to students struggling with eating disorders—diagnosed or not—is that their school isn’t there for them. That is unacceptable. Martine Gauthier, the executive director of McGill Student Services, has herself acknowledged the poor communication of the circumstances. In a written statement to The McGill Tribune, the administration explicitly apologized to affected students.

However, this drastic step raises problems that extend beyond a shoddy messenger—problems that are perhaps reflective of broader flaws in McGill’s approach to mental health services. Explaining the situation, the administration’s statement cites a necessary redistribution of resources, in order to more efficiently address the full range of mental health needs of all students on campus. In strikingly utilitarian fashion, the statement notes that, according to a 2014 McGill Student Psychological Wellbeing survey, only one to three per cent of students on campus struggle with eating disorders. Last fall, McGill Student Services gave similar reasons for streamlining Counselling and Mental Health into a single service: The transition was meant to decrease wait-times, and to deliver the least intensive and most accessible treatment for all students, regardless of severity.

These are legitimate goals; however, in the trade-off between accessibility and quality of service, the former cannot eclipse the latter—especially when the service in question is as crucial as supporting and treating students with eating disorders. Following last fall’s merging of services, an open letter from the McGill Students’ Mental Health Working Group raised concerns about the new model’s capacity for tailored care, particularly for students in crisis situations requiring a specialist. The individual needs of a student living with an eating disorder are a case in point.

One of the EDP’s clear strengths was its multi-pronged, holistic approach to each student’s unique situation. To the university’s credit, moves towards a more collaborative model of mental health care match that spirit, particularly in their focus on preventative care. Yet at a more fundamental level, McGill’s approach to its mental health services must be rooted in a commitment to both accessibility and to student-specific care. Steps to optimize these services must be taken accordingly. When it comes to mental health—and especially, the unique, potentially lethal nature of eating disorders—students shouldn’t have to choose between getting an appointment and getting the right appointment.

 

 

 

 

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