Mental Wellness

How do students cope when homesickness turns to isolation and course overload leads to anxiety? The answer can define a young person’s success long after university.

By Amie Filkow on August 14, 2015

Mental Wellness Banner

Photo by John Ulan

For David Manuntag, ’14 BCom, the daily bus ride from North Campus to his parents’ home in southwest Edmonton was normally quick and uneventful. But stepping onto the bus one cloudy May afternoon in 2010, Manuntag was carrying a massive burden. One week earlier, the first-year student had received an official notice of academic probation.

The first one in his family to attend university, Manuntag chose economics as a major without really knowing why. He soon found himself adrift. He was overwhelmed by class sizes and underwhelmed by the subject matter. He started skipping classes. Now his grades had slipped below a 2.0 average, and the kid who had graduated from high school with an above-80 per cent average didn’t know how to tell his family he was in danger of being kicked out.

“I really had no clue what I was doing or what I wanted to do. The transition from high school was difficult and I wasn’t really talking to many people. I just went to school, went to lectures and went back home. I didn’t really have a support network.”

On the bus that day, he ran into a friend from high school. They hadn’t seen each other in a while, but Manuntag was feeling in over his head and just needed to talk to someone. He sat down and told his friend what he hadn’t yet said out loud to anybody: he was thinking about quitting university. “I just wanted to get it out. I just wanted to share,” he says, recalling that day.

His friend listened carefully and then encouraged him not to give up. “Just try,” he said. “Try it for one more year. You don’t want to look back and say you didn’t try.”

That one conversation made all the difference for Manuntag. It helped him get back on track and, eventually, it would lead him to create a way to help other University of Alberta students in need of someone to listen.

David Manuntag on the bus

Photo by John Ulan

One in Five

“We take illness far more seriously than health,” social psychologist Corey Keyes says as he shows slide after slide demonstrating how mental health is waning among university students.

With his silver moustache, hipster glasses, rolled-up shirtsleeves and jeans, Keyes looks more like an honorary member of the Grateful Dead than a leading mental health researcher. On this poetically gloomy day in Calgary, the professor from Emory University in Atlanta, Ga., is delivering the keynote speech at the 2015 Wellness Summit: a meeting of students, faculty and staff from 26 colleges and universities across Alberta, including 32 people from the University of Alberta. Their collective goal on this day is to develop a framework for post-secondary mental health and addiction.

Mental health is a major issue for young people. It’s a problem that goes beyond universities and it’s a problem that goes beyond Alberta. In North America, mental illness has an earlier onset than anywhere else in the world — about a year earlier, according to Keyes. In Canada, three-quarters of mental health problems emerge during childhood or adolescence, according to the Canadian Mental Health Association. Only one in five young people who need mental health services get the help they require. “More and more students arrive at university already in treatment,” Keyes says. “Isn’t the point of life to start with a full tank?”

Canada spends more than $6 billion every year on uninsured mental health services and time off from work for depression and anxiety.

Keyes, who specializes in positive psychology, makes an important distinction between mental health and mental illness. People who are clinically depressed or diagnosed with bipolar disorder could actually be thriving — as long as they are living a healthy lifestyle and have support. Likewise, someone who has never been diagnosed could be languishing — living with anxiety or depression, feeling isolated and painfully lonely, feeling overwhelmed or generally unable to cope.

Mental health in young people has become an increasingly talked-about issue, and most Canadian universities are taking action.

The National College Health Assessment was completed at the U of A for the first time in 2011 and again in 2013. The U of A is on par with other North American institutions but the numbers are disconcerting. In the 2013 survey of 5,000 randomly selected U of A students, half of respondents “felt things were hopeless” in the previous 12 months. Nearly two-thirds felt very lonely. More than 54 per cent felt overwhelming anxiety. And 8.5 per cent — representing 3,400 students — had seriously considered suicide. Though more than a third of all students felt so depressed that it was difficult to function, only nine per cent reported being diagnosed or treated for depression. What happens to the rest? “If you’re free of mental illness, you’re on nobody’s radar,” says Keyes.

Students living with poor mental health are not dealing simply with a disappointing test result or a bout of homesickness. These are behaviours, thoughts or emotions that bring real suffering and can interfere with school work, jobs, how they interact with people —even students’ ability to live on their own, says the Mental Health Commission of Canada. And if these issues aren’t tackled at this stage in students’ lives, they can follow young people for decades. “If gone untreated, mental illness will follow youth into the labour market. Among 20- to 29-year-olds, including those just entering the workforce, mental illness is prevalent and problematic,” wrote the mental health commission in a 2013 report, “Making the Case for Investing in Mental Health in Canada.” Canada spends more than $6 billion every year on uninsured mental health services and time off from work for depression and anxiety. What’s more, “languishing” adults — researcher Keyes’ term for those who have poor mental health but are not clinically depressed — miss as many workdays and visit the doctor and therapist more often than depressed adults.

Steve Knish

Steve Knish says it’s important for young people to learn resiliency — how to bend but not break. Without this skill, they are at risk for a lot of problems. “It’s only a failure if you stop and don’t learn anything.” [Photo by John Ulan]

The Right Time, the Right Place

University is a unique period in a person’s life. It’s a kind of crucible: a test of strength, a time and place that challenges us, but also where our adult selves are forged. Our university experiences can push us, bend us and sometimes bring us to our knees, but by the time we cross the convocation stage, we are irreversibly transformed.

As a university community — students, faculty, staff and alumni — we could view the struggles of students as a rite of passage, a necessary requirement as young people transition to adulthood. But universities are realizing they are uniquely placed to serve as a safe space, to help provide a safety net as students cross the gulf between adolescence and adulthood. Universities can create supports that help young people gain personal insights, test their boundaries, learn how to seek guidance when they need it and begin to build the resiliency they’ll need to thrive in the world beyond graduation.

As Keyes puts it: “Imagine what we could do if we didn’t make the road so God damned hard for people.”

“Imagine what we could do if we didn’t make the road so God damned hard for people.”
– social psychologist Corey Keyes

In the past decade, the U of A has begun to place new emphasis on mental health. But it was two years ago that things really started to change, thanks to a three-year provincial grant that allowed the university to add more counsellors and become the only university in North America with a group of registered community social workers. In 2012-13, before the new funding, the campus Mental Health Centre (now Counselling and Clinical Services) treated 5,142 students and had to turn people away. In 2014-15, the centre served 7,400 students. Nobody was turned away.

That provincial funding is set to run out in 2016.

While acute care services are crucially important, the conversation on U of A campuses is increasingly centred on finding ways to intervene before students break down. The goal is to create an integrated support system that is proactive, integrated and holistic, focusing on prevention and early identification as well as building a community trained to listen and help. The idea is to make sure students are able to have the kinds of conversations that can transform a struggling young person into a flourishing adult.

Chengtao Yan was no stranger to stress. He had encountered plenty in China’s highly competitive secondary school system. Yet, like many international students, he found the transition to Edmonton overwhelming. In his second year studying at the U of A, the environmental and conservation sciences student began to feel depressed. He found some of his classes uninteresting. His GPA was slipping. He didn’t get along with his roommates. And, as his Chinese friends graduated, he became less social. As the pressure continued to build, Yan felt increasingly isolated from his classmates. “In my major there is a big age range, so it was hard to identify with the other, older students who had already done a degree and who had a different destination. I couldn’t ask them, ‘Oh, what’s your strategy to deal with this stress?’ I started to lose my focus — I was procrastinating, not sleeping and wasting a lot of time online.”

Finally, a good friend noticed that Yan was disengaging. That friend pulled Yan aside for a conversation, urging him to see a counsellor. “After talking to my friend and the counsellor, I started to step out. I realized that it takes time to follow your path, to find what you like. “Online video games often have user reviews with tips, like, ‘if you go this way, you can maximize your points.’ In video games, you have a pathway and you push yourself through that pathway. But real life doesn’t work that way.”

The transition to university can be a rude awakening. It’s often the first time young people are living on their own, working and having to be responsible for themselves. University students — many of whom were their high schools’ top achievers — struggle with the expectations of this new environment: the pace, the workload, feeling unnoticed by professors in a sea of students. In order to keep up, some lose sleep. They don’t eat well. They don’t exercise. Sometimes they turn to substance abuse or self-harm.

Steve Knish, ’94 PhD, a clinical psychologist at the U of A, calls these “welcome to the human race” problems. “They’re trying to deal in a competitive environment. Some of them are working 16 hours outside of school. There could also be family issues.”

Half of the students Knish and his colleagues see at Counselling and Clinical Services are in their first and second year — a critical time to identify issues. And counselling staff know that if first-year students get help to manage the transition to university life, they will be more likely to succeed in their programs. Research shows that if students have a positive first six weeks of university, and if problems are identified early, they are more likely to graduate within four years.

Of course, not all students are “traditional” in that they enter university right out of high school. Mature students face additional expectations and an array of complexities that can lead to mental health issues. International graduate students often arrive on campus with families in tow, unsure of where to find services and support. Students coming to the city from rural areas and Aboriginal students, too, face unique challenges. (See story, In the City, You Feel Alone)

Vivan Kwan

“You share it like a story, a memory. It doesn’t define you,” says Vivian Kwan, who talked openly about anxiety and depression as part of her Students’ Union campaign. [Photo by John Ulan]

‘Is This World Even Real?’

In the waiting room, anticipating her fourth appointment with a campus-based counselling psychologist, Vivian Kwan wasn’t alone. In front of her, another student was anxiously pacing back and forth. “She reminded me of myself, nervous about something because you really don’t know what to expect,” Kwan recalls. “So I waited for her.” When the student came out of the session, her eyes were puffy and she seemed emotionally drained. “Let’s grab a coffee,” Kwan suggested.

A few months earlier, at the start of her second year at the University of Alberta, Kwan had been diagnosed with depression and anxiety. She can point to a number of factors that contributed: a heavy academic workload during her first year in neuroscience, overtaxing herself, a difficult breakup, the fact that she’d move out of her parents’ home to live on campus. Kwan felt depressed and her anxiety mounted to the point where she was afraid to leave her dorm room. On the days she could make it to class, she would look down to find her hands shaking and cold.

Kwan’s roommate encouraged her to seek help. After a few counselling sessions, she seemed to be doing better, so when she met Lucy and Nicole (not their real names) in the waiting room, she wanted to pay that support forward. The three women bonded over their shared struggles with mental health.

“It was like being in a confession box — even though we didn’t know each other that well, it was weirdly comfortable to share our feelings,” Kwan says.

Inspired by the progress they each felt after the counselling sessions, the trio pledged that, once they were better, they would help others in the same circumstances.

It turned out that Kwan would have to fulfil that pact on her own. The worst two weeks of Kwan’s life began the winter of 2013. A month had passed since she had last seen her two friends. Kwan texted Lucy. Lucy replied that she wasn’t feeling well. She hadn’t been to counselling in a while. Kwan offered to bring her something. Lucy said no.

A few days later, Kwan learned that Lucy had taken her own life.

“It was a complete shock. I didn’t see it coming. I just thought she was sick,” Kwan says.

Unbelievably, a week later, Nicole also took her own life.

“I thought, ‘Oh my God, is this world even real?’ ” Kwan remembers through tears.

After the deaths of her friends, Kwan spiralled. She stopped going to counselling. She didn’t go to class. She wasn’t speaking to friends. She had a hard time getting out of bed. “I dived into that dark, dark place again,” she says. “I didn’t think life could get any worse.”

Kwan began hurting herself. “I just needed that little bit of reassurance that I was still feeling something, because I wasn’t feeling anything for a long time.”

It was Kwan’s roommate who eventually saw what was happening and helped convince her to move back home. Her family had known she was having a rough time, but they hadn’t known the extent of what had happened. It was the start of her road back to mental health, but the path was not an easy one.

When Kwan’s younger brother expressed his ambition to follow in his sister’s university footsteps, she couldn’t understand why: “You don’t want to experience things in my shoes.”

Bend, Not Break

“University tends to be a culture of a lot of work and not a lot of self-care,” says Steve Knish, the clinical psychologist. He has worked with students through the U of A’s Counselling and Clinical Services for 13 years.

Whether it’s the dim lamp lighting, the comfortable black leather Ikea chairs, the Persian rug or the offer of tea, Knish’s office might be the most calming room on campus. His walls are covered with reminders of the stories that have been shared in this room. Photographs and a wire guitar hang above his desk. The guitar was made by a former client, a dentistry student, who felt severely depressed. “I thought we were going to lose her.” But they didn’t. The student has since graduated and owns her own dental practice. The guitar, a token of her appreciation, is a nod to the musical hobby she and Knish share. “It’s made out of braces and dental floss,” he says.

A former hockey goalie and coach for the National Collegiate Athletic Association, Knish uses his interest in sports psychology and the trial-and-error lessons of sports to inform his yoga and group therapy programs for students. “I teach students to be mindful. When students prioritize themselves and take care of themselves, it’s so self-healing, and that tells me it’s less about mental illness and more about connecting them to their resiliency.”

Knish describes resiliency as the ability to self-regulate, to self-monitor — in other words, to bend but not break. “We’re trying to teach students how to work with setbacks, because they just have no idea what to do with a negative experience, where to go with it. But these experiences need to be normalized: you keep going, you keep trying. It’s only a failure if you stop and don’t learn anything.”

Students cannot flourish without first being resilient. Anything less puts them at high risk for a lot of problems.

Sheena Abar and Paisly Symenuk

Students turn to each other before they seek out formal supports, says Sheena Abar, (foreground) who co-ordinates the U of A’s Community Social Work Team and helps train Community Helpers, such as nursing student Paisly Symenuk (right). [Photo by John Ulan]

Sip, Chat, Connect

David Manuntag’s 20-minute conversation on the bus was a turning point. That brief connection with an old friend gave him the encouragement he needed to pursue his dream of going to business school. “My friend was one of the first people to tell me that I could do it, that it was possible.”

Manuntag found his niche in the bachelor of commerce program. For an entrepreneurship assignment, he invented a new kind of student group: Unitea, a one-to-one conversation over tea. Given his experience with isolation and anxiety — and the impact of that conversation on the bus — he wanted to make that simple connection available to all students. “I wanted it to be something that anyone could do. You didn’t have to be in business or know someone or be part of something already.”

After launching Unitea in September 2012 with his girlfriend, Maggie Tong, ’14 BScN(Hons), Manuntag was surprised at how much his little idea resonated with the student community. “When two people share an experience, like drinking tea, it’s a lot easier to get on the same page, slow down and just start talking,” he says. “Students are so often on their phones, they’re only half engaged or half there. With tea, the only thing you can have in your hand is the cup of tea, so it allows you to be engaged and listen.”

“At some point or another we’re all going to be affected by mental health. We’re all responsible for creating a healthy and well community.”
– Paisly Symenuk

Tong reflects on the strength of such a simple concept as conversation. “It can make people brave, make them passionate. If talking to them for half an hour changes someone’s trajectory, then it’s worth it.”

Manuntag now lives in Vancouver, where he works as a software developer. The Unitea program will be revived and expanded at the U of A in coming months and he hopes it will inspire other students to make a difference.

Connection and conversation can be powerful tools to support mental health. “Students turn to informal supports before they turn to formal supports: their family, their friends, their community,” says Sheena Abar, who co-ordinates the Community Social Work Team at the U of A. Abar’s team has created a series of outreach initiatives aimed at bringing students together, building community and reducing loneliness.

Community Helpers workshops train students, faculty and staff to recognize warning signs and give them the tools to help. “Our mission is to make campus a place where people feel welcome, feel comfortable, feel safe, where they want to come and connect with others,” says Abar. Community Helpers and the university’s other outreach initiatives, including suicide prevention training, reached more than 10,000 students in 2014-15 alone.

The U of A’s large population can be overwhelming for students, but it’s also an opportunity to create a robust community network of awareness and support for mental health. Listening, asking questions and connecting can be seen as a simple thing but it is difficult to do it effectively — and has a more resounding echo in the world — than we realize.

“Everyone is responsible for everyone,” says Paisly Symenuk, a nursing student who has completed the Community Helpers program and is helping bring Unitea back to campus. Symenuk, like many, struggled during her first year and thought about dropping out. She draws on that experience as she works to help support other students — a role she feels is her responsibility. “However you define your community, we all have a role to play, and at some point or another we’re all going to be affected by mental health. We’re all responsible for creating a healthy and well community.”

Maggie Tong and David Manuntag

Unitea founders David Manuntag and Maggie Tong, who now live in Vancouver, say the simple act of drinking tea allows people to actively listen. No phones. No distractions. [Photo by John Ulan]

A Rising Tide

The university community can offer support, guidance and inspiration, but, like any journey, students have to find their own path.

Resiliency has to start with the students themselves. They have to seek out connections, look for supports and share their stories in order to grow.

When Vivian Kwan began to recover from her depression, she was encouraged by organizers of the student-led Healthy Campus Unit to join their efforts. Before long, she began to find her footing. She joined several campus groups, including the Student Health Committee and the Lieutenant Governor’s Circle for Mental Health and Addiction. She is a co-creator of Positive U, an initiative to help foster resiliency among students and get people talking. Last spring, Kwan was elected to the Students’ Union executive board as vice-president of student life.

“It’s real life, and the more you talk about it the more you face it and leave it in the past. It’s really hard but you keep going.”
– Vivian Kwan

One of Kwan’s goals is to build awareness around student mental health. The resiliency she developed has given her strength to forge ahead and carve out a transformative university experience. Now she wants to develop strategies to help other students learn how to cope before a crisis hits, before they find themselves at the end of a closed road where it seems there’s no way out.

Students who seek help often become helpers themselves, and not only helpers, but leaders. The more they get involved — looking out for each other, intervening when they see someone struggling — the stronger leaders they become and the stronger the community becomes. And those campus leaders go on to become compassionate citizens who listen and build a better society.

Our university experiences change us, for better or for worse. They push us to cope, to grow, to discover. A system of support, both informal and formal, can help students find their way and make the whole experience just a little less scary. So many student mental health issues can be overcome with a listening ear, a helping hand and a calming presence.

In her Students’ Union campaign speech, Kwan shared her struggle with mental illness. “I didn’t think I’d be brave enough to give that speech. People came up to me and said, ‘I didn’t know.’ ... After the speech I wondered why I was afraid to share my story. I mean, it’s something that happened, it’s real life, and the more you talk about it the more you face it and leave it in the past. You share it like a story, a memory. It doesn’t define you.”

And if she could go back and give herself advice, what would she tell her troubled first- and second-year self? “Hang out with friends more. Enjoy the outdoors a little bit more. Build relationships, even if it’s a 10- or 15-minute conversation. Take time to talk to someone about how you feel, even if how you feel is tinged with negativity.... It’s really hard, but you keep going.”