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Streamlining of McGill Counselling and Mental Health Services leaves gaps in medical notes procedures

Editorial/Opinion by

As part of the integration of McGill Mental Health and Counselling Services (MHCMS), medical notes are no longer available for students who use drop-in appointments unless their case falls under the criteria for the newly designated “Safety Appointment.”

Although the change prioritizes support for students who urgently need it in order to be safe, questions remain as to what students are supposed to do if they do not qualify for a Safety Appointment, but need a medical note due to mental health reasons. While such growing pains are no doubt a side effect of the ongoing integration process, measures must be put in place to resolve this gap in services that adversely affects students now. Going forward, McGill must better disseminate information on what this change means, what support is still available to students, and how it will accommodate those who do not fall under urgent cases, but nevertheless require medical notes.

The new Safety Appointments are reserved for urgent cases, such as if a student is at risk of harming themselves, has recently overdosed or been hospitalized in a psychiatric ward, or has recently been physically assaulted. Medical notes still remain available to those who already have an assigned mental health professional.

Although the change prioritizes support for students who urgently need it in order to be safe, questions remain as to what students are supposed to do if they do not qualify for a Safety Appointment, but need a medical note due to mental health reasons.

MCMHS is overburdened and understaffed relative to demand. Serving a student population of over 39,000 while grappling with budget constraints is no easy task. The integration of services is a positive step that improves efficiency and streamlines the care model, as students no longer need to determine in advance whether they need psychiatric care or counselling. The single point of entry will reduce confusion in this sense; however, the effect of the integration on medical notes shows that gaps remain.

Any policy change—no matter how temporary—must recognize that mental health experiences vary between individual situations and that the criteria for a safety appointment are not the only criteria by which a student would require a medical note. Mental health and wellness cannot be predictably planned for, making it imperative that MCMHS develops a procedure whereby those in need, but not in such need as specified by the Safety Appointment criteria, may receive a medical note. This is not to say that all students who attend drop-in sessions unconditionally require a deferral or extension; that decision ultimately rests with the clinician. But, restricting access to medical notes to a certain category of students leaves those who do not fit the category unsure of their options. At the moment, students must wait two weeks for an appointment if they are not mentally well enough to take an exam or complete a project, and cannot acquire a medical note in time.

It is essential the MCMHS is able to provide medical notes to any student in need on a timely basis, as students may have no other options off campus. For instance, private physicians can be expensive, as visits are not fully covered by SSMU’s Health Coverage plan.

In the interim, students may resort to methods outside MCMHS in order to get more immediate support. Student-run services—such as the Peer Support Centre, the Sexual Assault Centre of the McGill Students’ Society (SACOMSS), and the McGill Students’ Nightline—all provide support for both mental health and physical safety concerns. These services can also advise students on how to best approach their professors if they need an exam deferral. Additionally, as part of a transition towards a university environment that is more accommodating of mental health, the Students’ Society of McGill University’s (SSMU) newly-implemented Mental Health 101 training may help raise the necessary awareness and understanding among professors about the diverse range of mental health situations students may find themselves in. All of these student-led initiatives are essential to filling the gaps and to helping reduce the strain on MCMHS; however, crucially, these services do not have the power to provide medical notes. Going forward, McGill should consider whether academic advising should play a greater role in helping students prepare for their course load and informing them of how best to acquire a deferral or extension.

MCMHS is looking into solutions to provide more equal access to medical notes, such as creating a case manager role; however, the immediate implementation of the integration without informing students of what it entails, and without having a contingency plan to avoid such gaps, seems short-sighted. As yet, students have not been formally notified of this particular effect of the integration, and many may not be aware that drop-in appointments with an intake clinician are still available to all students. While this may have been a necessary change in the care model, this oversight is disruptive and detrimental to students—especially with the Fall 2016 final exam period looming—who find themselves with mental health concerns and unable to get a medical note from MCMHS in time to have an exam deferred. 

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