A student waits two month for an appointment at the McGill Mental Health Service. When eventually seen, he is given a diagnosis of “bipolar 2” after just six minutes and then handed a prescription for an antipsychotic. When seen outside of McGill fro a proper assessment, it is clear that both the diagnosis and prescription are entirely inappropriate.  

   There are so many aspects disturbing about numerous stories like this coming out of students’ experiences at the Mental Health Service, which are evidence of poor management and negative attitudes towards students.  Clearly the service has been feeling so overwhelmed that it is resorting to short cut evaluations and treatments, but the realities of what is occurring inside the service goes deeper.

    Rather than understanding and promoting expert models of treatment, the service is turning to bureaucratic regulations to limit services.  There is apparently a twenty page document of rules for staff to follow, none of which is about clinical excellence. Now, in order for students to be treated at the service, they will have to be given a diagnosis of a mental illness.  This may not sound unreasonable to bureaucrats, but the reality in student mental health is that diagnoses are usually irrelevant and often dangerous. There is considerable controversy over the DSM diagnostic system, but the most important point in the limitations of the system is that the diagnoses are not aetiologically based. In other words, the diagnoses say nothing about the underlying causes of emotional distress, so are a poor guide to treatment.  Yet often these days in psychiatry, giving a diagnosis leads quickly to the prescribing of medication.  While medication can at times be helpful, it has never been the best or primary modality of treatment in student mental health. In a student population, it can also cause serious side effects, including excessive sedation and impaired cognitive abilities.  The inappropriate use of medication can also interfere with the resolving of crucial underlying emotional issues and can turn an acute and easily treatable problem into a chronic condition.

   The McGill Mental Health Service has abandoned any sense of clinical excellence and promoting proper treatment.  For decades, when the service had an excellent reputation, the weekly team meeting was considered a highlight by most clinical staff because of the high quality of the clinical case discussions. Now these discussions have been stopped. This means that there is no real top level teaching or development of expert modalities of treatment, and no way for the people supposedly in charge to have any sense of what the clinical staff is doing.  I have never heard of any psychiatric service anywhere that doesn’t have in-service clinical case discussions and supervision as an integral aspect of the service.  It is incomprehensible that McGill Mental Health would stop these case discussion, though given the lack of any real expertise by those in charge, perhaps it is understandable why these discussions were no longer seen as valuable.

  In its present state of dysfunction, the McGill Mental Health Service can not really be seen as a true service team. It appears to be focusing primarily on symptom control modalities rather than on expert models of psychotherapy, and has no cohesive team spirit.  It has become a bureaucratic student processing unit, with no real leadership, and clearly no one in charge, either within the service or in McGill administration who have a clue about how a proper service should be managed. It is using standard hospital type approaches rather than treatment orientations developed specifically for a university population. It is a “mental illness” service and not a mental health service.  The type of approaches used, and the regulations being imposed, will tend to limit proper responses to treatment, and lead to students having poor results and chronic symptoms. A significant part of the turnover of student seeking help will come from the artificial limitation placed on treatment by regulations or by students leaving the service due to frustration or poor treatment.  There certainly are some good people working at the service, but basically the situation now is that one just has a group of independent, unsupervised clinicians each doing their own thing, yet having to adhere to nonsensical regulations and being forced to label students. This makes no sense, and will lead to devastating results for many students.