Mental Health at Ambrose University Strategies for Change

Partial Fulfillment of the Post-Secondary Student Mental Health Grant Transition Period, Phase 1: August 1, 2017 to March 31, 2020

Presented by: Ambrose University

Presented to: Alberta Advanced Education

Contents Preamble/Introduction ...... 3 Literature Review ...... 5 Mental Illnesses and Mental Health Problems ...... 5 Mental Health as Flourishing ...... 5 A System-Wide Approach ...... 6 Summary of Findings...... 8 Ambrose Mental Health Strategy ...... 10 1. Mental Health Awareness ...... 11 2. Self-Management Competencies and Coping Skills ...... 12 3. Early Identification and Response ...... 12 4. Accessible Mental Health Services and Crisis Response ...... 13 5. Institutional Policies and Procedures ...... 14 6. Supportive and Inclusive Campus ...... 14 Sources ...... 16 Appendix A: Ambrose Values ...... 18 Appendix B: Key Findings from the 2018 Ambrose Gap Analysis and 2019 NCHA Survey ...... 19 Findings from the 2019 NCHA Survey ...... 19 Findings from the 2018 Gap Analysis ...... 20 Sample Characteristics: Demographics ...... 20 Accessing Services ...... 22 Accepting Community ...... 23 Resourcing Mental Health Services ...... 25 Staff and Faculty and Mental Health ...... 26 Environment...... 26 Antecedents ...... 26

Preamble/Introduction Ambrose is a Christian Liberal Arts University located in a large urban centre. Ambrose is a community of transformative Christian higher education with a vision for the welfare of our city and our world. By providing excellent post-secondary education we prepare men and women for wise, joyful and redemptive engagement in the church, society and the created order.

Ambrose is a small university community with around 850 undergraduate and seminary students. Ambrose cares about the holistic formation and development of students. With our guiding mission and values of service and holistic formation, (see Appendix A for Ambrose’s values) it is imperative that Ambrose comprehensively attend to the mental health of the community. While this strategy is primarily focused on students, this strategy would not be comprehensive if it did not address the entire community.

Mental Health is a growing concern for post-secondary institutions. The onset of mental health challenges are especially significant for those aged 15-24—many of whom attend post-secondary institutions. Suicide accounts for a disproportionaly high amount of deaths in Canadians of this age. Univerisities are witnessing that more students are coming to university with pre-existing mental health concerns and are seeing rising levels of stress. The institutions serving these students have noted both the complexity of the issues students face and an increase in help-seeking behaviours. (CACUSS and Canadian Mental Health Associaion, 2013).In short, we face growing need in the area of mental health, and we must provide additional supports so that students can succeed academically and be equipped to participate meaningfully and fully in all aspects of life throughout their lifespans.

In Fall 2017, in response to the mandate from the Government of Alberta for university campuses to create a mental health strategy specific to their campus, Ambrose University created a task force to develop a student mental health strategy that would implement ongoing strategies and interventions to address students’ mental health. The task force included indivduals from divisions across the university.

In Winter 2018, we conducted a gap analysis to ascertain the mental health needs of the student body. Previously, we had gathered data on student mental health through two surveys:

 The Redeemer survey (Fall 2016) measured students’ current health, both physical and mental, including their attitudes toward and experiences with self-harm and suicide.  The Thriving survey (Fall 2017) assessed students’ sense of connectedness and community.

However, we lacked deep, systematic knowledge of students’ needs. Thus, in the gap analysis, we combined a broad survey of the student population with more in-depth sessions: focus groups and interviews. The entire current student body was sent a 63-question survey consisting of demographic, qualitative and quantitative questions (see Appendix B). Subsequently, we conducted four focus groups and four individual interviews to clarify common suggestions in the survey such as “increase mental health awareness.” Paying particular attention to minority and affinity groups on campus, we considered the feedback of Indigenous students, residence students, commuter students, and students diagnosed with a learning disorder or mental illness, noting how their needs compared to the needs of the student body at large. The results highlighted broad recommendations for the whole student body as well as specific interventions for minority and affinity groups.

In Spring 2019, we participated in the National College Health Assessment (NCHA), which further increased our understanding around key health and mental health indicators. This survey was helpful in indicating what students were experiencing in terms of diagnosis as well as what issues were most significantly impacting their academics.

These sources of information about our students have served to highlight gaps and needs at Ambrose and serve as the basis for the recommendations being put forward.

Literature Review Mental Illnesses and Mental Health Concerns According to the Canadian Mental Health Association, many Canadians—1 in 5—will experience mental health problems or illnesses in their lifetimes; however, in most cases, less than half of all adults with mental health issues actually seek help for their symptoms (Canadian Mental Health Association; Eisenberg, Golberstein, & Gollust, 2007). In other words, many individuals need mental health supports, and few actually receive them. This issue disproportionately affects youth and young adults: individuals aged 18-24 years, the age of the majority of university students, are considered at the highest risk for mental illnesses and substance misuse (Reavley & Jorm, 2010). Moreover, suicide accounts for 24% of all deaths in 15-24 year olds (Canadian Mental Health Association). This trend is likely to continue; in fact, the rate of mental illness is predicted to increase with the newest generation (Han, Compton, Mojtabai, Colpe, & Hughes, 2016). Despite the growing need, especially in this age group, only 20% to 36% of students in the university setting actually receive professional help for their mental health (Eisenberg, Hunt, Speer & Zivin, 2011). In short, post-secondary institutions are facing a growing gap between students’ mental health needs and their ability to provide adequate supports.

For many students, the post-secondary environment creates social, financial, and emotional pressures that influence the development, manifestation and treatment of mental health issues. In the 2018 gap- analysis survey, many Ambrose University students reported that they felt high pressure in their finances, the amount of assigned coursework, and the amount of paid work they feel they must complete to survive. The majority of students at Ambrose University did not feel they were able to live a balanced lifestyle while attending school, and they did not feel that there were enough formal supports for them at the time of the survey. Furthermore, in the 2019 NCHA survey, 88% of Ambrose University students reported feeling very overwhelmed in the last 12 months. These various pressures leave university students at high risk for mental health issues.

To receive the help they need, students often need to overcome significant barriers—including financial stress, lack of time, privacy concerns and lack of perceived need for help (Hunt & Eisenberg, 2010). In addition, stigmatization plays an important role in preventing students from seeking help: it makes individuals less likely to disclose their concerns out of fear of consequences (Clements et al., 2015). According to the Canadian Mental Health Association, approximately 50% of Canadians report they would not tell friends or co-workers if they struggled with a mental health issue. In the Ambrose context specifically, a 2016 survey on mental wellbeing showed that 30% of Ambrose University students felt they would be seen as weak if they sought help from a mental health professional. These findings line up with research showing that those from evangelical backgrounds face more stigma around mental health and are even more unlikely to seek professional help (Wamser, Vanderberg, & Hibberd, 2001). To encourage students to seek support for their mental health, institutions need to decrease these barriers.

Mental Health as Flourishing As noted above, many students face mental illnesses and mental health challenges, and institutions need to address these specific concerns. However, as the World Health Organization (2002) notes, mental health is not merely the lack of mental illness; thus, a robust mental health strategy should not focus solely on these concerns. Rather, we should define mental health as “The capacities of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual wellbeing that respects the importance of culture, equity, social justice, interconnections, and personal dignity” (Government of Canada, 2006). Rather

than focusing only on mental illnesses and mental health challenges, we should seek excellent mental health for all. Thus, Corey Keyes (2002) describes mental health as “flourishing.” Keyes’ Dual Continuum Model of Mental Health and Mental Illness (see Figure 1) demonstrates that we need to promote mental health for individuals with and without mental illnesses. As this framework shows, individuals with no mental illness but with many life challenges may suffer from poor mental health, while individuals with mental illnesses who have effective coping skills and strategies may demonstrate optimal mental health. As post-secondary institutions, we need to ensure that both types of students—those with mental health symptoms and those without—have access to the supports they need to flourish.

Figure 1. The Dual Continuum Model of Mental Health

A System-Wide Approach To reach this goal, we must adopt a system-wide approach, one that:

 Is comprehensive: it views the whole campus as the domain to be addressed.  Creates environmental conditions for the flourishing of all students—conditions that are grounded in values of social equity and sustainability—and supports integrated development and capacity building.  Provides general support for all students while also providing specialized, targeted programs for those who are experiencing mental health issues and others who are at risk of mental health issues.  Is student-directed, grounded in the values of informed choice and inclusion; thus, it involves students—especially those who have lived experiences of mental health issues—in strategy development and decision-making.  Sees the whole campus as responsible for enhancing and maintaining the mental health of community members and involves all stakeholders in creating campus environmental conditions that support student learning and mental health.

As noted in the CACUSS Framework for Post-Secondary Student Mental Health, a truly comprehensive mental health plan should cover all aspects of campus life, including institutional structure, campus culture, student services, crisis management, and more. These seven areas of analysis promote success for all students, including those with and without mental illnesses.

Figure 2. CACUSS Framework for Post-Secondary Student Mental Health

Summary of Findings To design a mental health strategy reflective of the needs of the students and the mission of Ambrose University, we have drawn on the findings from our 2018 Gap Analysis study (including surveys, focus groups, and interviews) and the 2019 NCHA survey. Such key findings include:

 42% of Ambrose students self-identify as having a mental illness, while only 26% report being actually diagnosed by a professional with a mental illness or learning disability.  Overall, students report feeling connected and supported at Ambrose University, but students who report struggling with a mental illness report a lower sense of belonging.  When asked how Ambrose could create a healthier campus, 30% of students (n=120) identified a need for increased healthy food on campus. While students made several other suggestions, this response was the top choice.  Students’ secondary mental health need is increased mental health awareness on campus. NCHA Findings (Ambrose undergraduate students)

 81.7% of Ambrose students indicated that they are interested in their campus providing information about stress reduction.  81.3% of students indicated that they are interested in their campus providing information about how to help others in distress.  76.5% of Ambrose students want their university to provide information about depression and anxiety.  Like students from throughout Alberta and across Canada, Ambrose students reported high levels of emotional distress in the last 12 months: Reported Action or Emotion Ambrose Alberta Canada felt hopeless 52.4% 62.1% 63.6 felt overwhelmed 88% 88% 88% feelings of loneliness were 65.6% 67.6% 69.6% pervasive felt so depressed that it was 44.4% 50% 50% difficult for them to function indicated they seriously 10.4% 16.4% 16.4% considered suicide attempted suicide 1.2% 2.6% 2.4%

 Female students have a significantly higher rate of being diagnosed and treated by a professional within the last 12 months for anxiety, depression and panic attacks. Ambrose Alberta Canada Male Female Total Male Female Total Male Female Total Anxiety 10.7% 31.8% 24.9% 13.2% 28.8% 24.8% 12.6% 27.8% 23.7% Depression 8.3% 23.6% 19.2% 12.3% 22.5% 20.1% 11.4% 21.6% 19.1% Panic 2.4% 16.6% 12.0% 5.3% 15.8% 13.1% 5.3% 15.2% 12.5% attacks

Students 6.0% 19.7% 15.6% 9.0% 19.2% 16.7% 8.4% 18.3% 15.8% reporting both anxiety and depression

 Students reported that the following psychological, physical, social, and financial factors influenced their academic performance, causing them to drop a course (or face a disruption in thesis or research) or receive a lower grade on a course, project, assignment, or exam. Ambrose Alberta Canada Stress 35.2% 41.5% 41.9% Anxiety 28.5% 34.4% 34.6% Sleep Difficulties 24.8% 29.8% 29.0% Depression 19.7% 23.4% 24.2% Cold/Flu/Sore Throat 16.0% 19.4% 19.6% Internet use/Computer games 13.2% 15.0% 16.3% Work 12.9% 18.7% 17.7% Participation in extracurricular activities 10.8% 7.2% 7.6% Relationship Difficulties 9.6% 12.4% 12.2% Finances 7.2% 11.1% 11.3%

 55.8% of Ambrose students (42.9% of males and 63.7% of females) reported being diagnosed or treated by a professional with one or more of these conditions within the last 12 months:

Ambrose Alberta Canada ADHD 8.4% 9.5% 7.9% Chronic Illness 6.4% 6.8% 6.0% Learning Disability 9.3% 7.4% 6.6% Psychiatric Condition 10% 8.6% 8.9%

See Appendix B for more in-depth findings from the 2018 gap analysis and the 2019 NCHA survey.

Ambrose Mental Health Strategy Ambrose University is focused on the wellbeing of its students and is dedicated to integrating our values, including our desire for mentally healthy students, into all levels of the university. Drawing on the literature about mental health and the findings of the above studies conducted at Ambrose and considering our diverse population and the underlying values of the institution, the mental health committee has developed a comprehensive mental health strategy covering six strategic areas. The framework in Figure 3, built upon the CAUSS framework, depicts the relationship between the six strategic areas that contribute to a healthy and supported student population. In the following pages, we will discuss each area in turn.

Figure 3. The Six Strategic Areas Covered by Ambrose’s Mental Health Strategy

1. Mental Health Awareness Mental health awareness initiatives strive to improve student mental wellbeing by increasing knowledge and understanding of the determinants, nature, impact, prevention and management of mental health issues. Increased knowledge and understanding builds resilience and capacity to maintain wellbeing and promotes early help-seeking behavior. Stigma, prejudice and discrimination have a significant impact on mental health by impacting one’s sense of self-worth and commitment to self-care, as well as making it more difficult to reach out for help. A supportive campus environment requires that all community members recognize their responsibility to others as well as themselves. By raising mental health awareness, we can encourage community members to take action not only to care for themselves and their immediate connections but also to promote mental health at the campus level, especially among students.

Strategic Objective Goals and Objectives Increase anti-stigma programming to reduce the number of Reduce stigma by normalizing students who feel they cannot be open about their mental health discussions around mental or who feel they cannot access services due to fear of diagnosis health Increase the frequency of in-class conversations between faculty and students about issues related to health and wellness Increase mental health training and workshops on topics such as Provide Education and Training resilience, anxiety, and depression for the Ambrose community Increase prevention programming (e.g., self-care, mindfulness) Hire a wellness coordinator Build Capacity for Mental Health Maintain a Peer Health Education program Awareness and education Create and maintain a centralized website for information related to mental health and wellness

2. Self-Management Competencies and Coping Skills Self-management competences and coping skills strengthen students’ resilience and ability to manage the multiple demands of student life. They also decrease vulnerability to mental health issues such as depression and anxiety.

Strategic Objective Goals and Objectives Increase student participation in supportive programming Increase skill building programs to build resiliency (i.e Foster student coping skills mentorship, mindfulness practice) Enhance self management programming (i.e time management, healthy eating, sleep)

Design and Implement a peer mentorship program Develop student interpersonal coping skills Increase capacity to equip students with coping skills by offering group support programs and therapy

3. Early Identification and Response Those who interact with students in the course of their day on campus are in the best position to notice early indicators of poor mental health. Therefore, early recognition requires everyone’s participation. To build this capacity, we need to increase student, staff and faculty ability to recognize early indicators that a student may be experiencing difficulty and indicators of more serious student distress. We must also build the capacity of each community member to reach out to a student and help connect the student to appropriate resources and supports.

Strategic Objectives Goals and Objectives Increase mental health training (e.g., Mental Health First Aid and Crisis Intervention Training) to help staff and faculty to Develop the ability of the identify concerning behaviour Ambrose community to Provide suicide intervention training to student leaders, and recognize early indicators and acute distress make it available to staff and faculty Increase self-screening opportunities online and through wellness programs Increase training for staff and faculty about on-campus Increase the ability of staff and supports and resources faculty to provide appropriate support and referrals Increase training for staff and faculty on current policies and procedures for accessing accommodations to students Increase the understanding of faculty, staff and select student leaders about how and when to use Ambrose Aware (our campus-wide early alert system)

Strategic Objectives Goals and Objectives Strengthen process for case Develop a case management strategy that allows Student Life management and tracking of and Student Academic Success to coordinate their response to concern students flagged through Ambrose Aware (or any other mechanism) Implement a protocol for referring students to off-campus supports (e.g., emergency services, distress centre, family doctor), when necessary, and following up as appropriate.

4. Accessible Mental Health Services and Crisis Response Accessible mental health services are a critical part of a systemic approach to student mental health. Numerous studies have found that these services also have a positive impact on student retention (Frank & Kirk, 1975; Illovsky, 1997; Porter, 2011; Turner & Berry, 2000; Wilson et al., 1997). They are uniquely placed to contribute to a systemic approach on multiple levels. They provide a range of services to support students through mental health difficulties and the recovery process, as well as specialized programs to meet the need of specific student populations.

Post-secondary institutions also need plans to respond to mental health crises, such as acute distress and imminent risk of self-harm. These crises have a significant impact on students’ mental health and academic success; they also have an impact on others and can affect the entire campus community. Crises are also often complicated situations that require collaboration between various individuals and departments. They also require an elevated level of response in order to ensure the safety of all involved. Crisis management protocols are critical, therefore, to enable the campus community to respond effectively, and all staff and faculty must understand their roles within the institution’s crisis management plan.

Strategic Objectives Goals and Objectives Strengthen inclusive mental health supports to minority groups on Reduce the number of students campus who feel they cannot access Develop a post-vention survey for student counselling services services Implement a population-specific intake form Develop well-defined emergency response plans Develop print and online resources for handling mental health crisis Increase the ability of staff and faculty to provide appropriate Increase training for faculty and staff on protocols and procedures support and referral during a for handling crisis situations on campus crisis Implement campus training for responding to critical events Develop capacity within security services and within Student Life and Student Academic Success for assessing risk

Strategic Objectives Goals and Objectives Develop post-incident protocols to support the community after a crisis (i.e. death of a student, significant disruption) Increased and comprehensive training for security team

5. Institutional Policies and Procedures While we can improve wellness by designing strategies for specific groups of people or specific moments in their lives, we must also consider the broader organizational context. An institution’s structure and policies contribute to its culture by reinforcing certain values, beliefs and behaviours and discouraging others. A post-secondary institution’s structure, goals, policies and practices therefore impact student mental health, which, in turn, impacts student learning. To address this area, we must assess the degree to which these organizational elements support student mental health and engage the whole student in the learning process.

Strategic Objectives Goals and Objectives Implement a process that reviews campus policies with a mental Increase the institutional health lens, including an emphasis on equity, diversity and commitment to student inclusion (EDI) wellbeing, health and safety Maintain a Mental Health Working Group for implementation of the mental health strategy Enhance communication about policies and procedures for students requiring accomodations or medical extensions Examine the policy in the Office of the Registrar to clarify the Application of a mental health institution’s response to medical crises and other extenuating lens to existing and new policy circumstances. Examine and update the Community Standards through a mental health lens

6. Supportive and Inclusive Campus A supportive campus climate promotes students’ mental wellbeing and holistic development. In this environment, students can meaningfully participate in the community and experience a sense of inclusion and belonging. This kind of campus is fundamentally committed to social justice and sustainability and identifies, addresses and remedies barriers to the full participation of all students. This dimension of our strategy also considers the physical environment and how the spaces of campus can best support and promote mental health and wellbeing.

Strategic Objectives Goals and Objectives Implement opportunity for Equity, Diversity and Inclusion (EDI) training for faculty, staff and student leaders Increase inclusivity for minority Increase understanding (e.g., via a climate survey) of the barriers that groups on campus keep students from participating fully in campus life Increase training in Universal Design for faculty Increase awareness of the effect of environment on mental health and Create a physical environment optimize current surroundings on campus that increases Conduct a campus wide audit of the physical space student opportunity for a balanced and healthy lifestyle Implement food committee and increase education on campus (e.g., norming food prices, nutrition information)

Task Force Members: Wally Rude (VP Student Development), Carissa Muth (2017-2018 Wellness Coordinator), Monique Verhoef (Director of Community Life), Maureen Hickman (2017-2018 Student Council Representative), Bill McAlpine (Professor of Practical Theology), and James Cresswell (Associate Professor and Program Head of Psychology). Added members: Christina Conroy (Faculty of Theology), Melissa Kroker (2018-2020 Wellness Coordinator) and Rebecca Tunke (2018-2020 Student Council Representative).

Sources

1. Canadian Association of College & University Student Services and Canadian Mental Health Association. (2013).

Post-Secondary Student Mental Health: Guide to a Systemic Approach. Vancouver, BC: Author.

2. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ... & Thornicroft, G.

(2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological medicine, 45(1), 11-27.

3. Eisenberg, D., Golberstein, E., & Gollust, S. E. (2007). Help-seeking and access to mental health care in a university student population. Medical care, 45(7), 594-601.

4. Eisenberg, D., Hunt, J., Speer, N., & Zivin, K. (2011). Mental health service utilization among college students in the United States. The Journal of nervous and mental disease, 199(5), 301-308.

5. Han, B., Compton, W. M., Mojtabai, R., Colpe, L., & Hughes, A. (2016). Trends in receipt of mental health treatments among adults in the United States, 2008-2013. J Clin Psychiatry, 77(10), 1365-71.

6. Hunt, J., & Eisenberg, D. (2010). Mental health problems and help-seeking behavior among college students.

Journal of adolescent health, 46(1), 3-10.

7. MacKean, 2011. Adapted from: The Health Communication Unit at the Dalla Lana School of Public

Health at the University of Toronto and Canadian Mental Health Association, Ontario; based on the conceptual work of Corey Keyes

8. Reavley, N., & Jorm, A. F. (2010). Prevention and early intervention to improve mental health in higher education students: a review. Early intervention in psychiatry, 4(2), 132-142.

9.Wamser, R., Vandenberg, B., & Hibberd, R. (2011). Religious fundamentalism, religious coping, and preference for psychological and religious treatment. International Journal for the Psychology of Religion, 21(3), 228-236.

Appendix A: Ambrose Values We are committed to these enduring mission-related values:

Christian Faith • We believe that Christ is the centre of what we do. We seek to live lives devoted to serving Christ, and we pursue His will with bold confidence in His sovereign power and purposes. • We are ecumenically minded, broadly evangelical, and rooted in the holiness traditions of the Christian and Missionary Alliance of Canada and the Church of the Nazarene. • We believe that every person is created in the image of God and worthy of dignity and respect. • We integrate faith and learning and anchor our teaching and research within the Christian intellectual and spiritual tradition.

From these beliefs and practices flow the rest of our institutional values:

Pursuing Excellence • We encourage our students, faculty, and staff to be intellectually curious. • We promote conversations about difficult issues that are marked by both courage and charity. • We provide high-quality education as well as co-curricular experiences that prepare students for their future lives and vocations. • We pursue excellence in all that we do. Our efforts evidence love, wisdom, thoughtfulness, knowledge, scholarship, and skill. • We are accountable to the Government of Alberta, our accrediting bodies, and our founding denominations. We also recognize our obligation to provide students with the learning environment set forth in the Academic Calendar.

Holistic Formation • We assert that Ambrose is a place where students develop virtues, grow in character, acquire life skills, and prepare for future vocations. • We wrestle together with the hard questions of life and faith. • We create intentional, holistic, formational experiences in and out of the classroom. • We model lifelong perseverance in intellectual and spiritual formation.

Service • We strive to integrate faith and active service to the world. • We commit to shaping servant leaders who will honour Christ in their vocations. • We shape culture through our scholarship, research, and artistic expression.

Community • We believe that spiritual, personal, and academic development is best accomplished within the context of a Christian community that worships and glorifies God. • We collaborate to foster a welcoming, hospitable, generous, just, and truth-telling community that strives to fulfill the university’s mission. • We seek the welfare of students, one another, and the external community. Proposed to Board of Governors, October 3, 2019

Appendix B: Findings from the 2018 Gap Analysis and 2019 NCHA Survey Findings from the 2019 NCHA Survey The NCHA survey highlighted a high overall stress level in the Ambrose student population, noting that 43.2% of students rated their overall stress as “more than average” in the last 12 months. Within that same time period, 48.2% of students found academics (48.2%) the most traumatic or difficult thing for to deal with. The remaining students selected their primary stressor as finances (41.2%), family problems (34.5%) and sleep (30%). Of note, female respondents reported sleep difficulties at a higher rate than male respondents (38.0% female and 21.4% male).

Related to student mental health, students reported that they . . .

% Male Female Total Felt things were hopeless Any time within the last 12 months 44.0 58.6 52.4 Yes, last 2 weeks 10.7 17.2 14.8 Felt overwhelmed by all you had to do Any time within the last 12 months 83.3 93.0 88.4 Yes, last 2 weeks 31.0 59.2 47.6 Felt exhausted (not from physical activity) Any time within the last 12 months 79.8 92.4 86.8 Yes, last 2 weeks 41.7 58.6 52.4 Felt very lonely Any time within the last 12 months 58.3 70.7 65.6 Yes, last weeks 21.4 26.8 24.8 Felt very sad Any time within the last 12 months 66.7 75.2 71.6 Yes in last 2 weeks 19.0 32.5 27.6 Felt so depressed it was difficult to function Any time within the last 12 months 39.3 47.1 44.4 Yes, in last 2 weeks 8.3 14.0 12.4 Felt overwhelming anxiety Any time within the last 12 months 53.6 70.1 63.6 Yes, last 2 weeks 14.3 31.8 25.6 Felt overwhelming anger Any time within the last 12 months 29.8 20.4 22.8 Yes, last 2 weeks 9.5 14.6 13.2 Seriously considered suicide Any time within the last 12 months 6.0 12.2 10.4 Yes, last 2 weeks 0 1.9 1.6 Attempted suicide Any time within the last 12 months 1.2 2.6 2.4 Yes, last 2 weeks 0 0 0 Intentionally cut, burned, bruised or injured self

Any time within the last 12 months 3.6 12.8 10 Yes, Last 2 weeks 0 2.6 2.0

Findings from the 2018 Gap Analysis Full vs. Part Time Sample Characteristics: Demographics At Ambrose, 74% of students study full time: that is, they take 3 or more classes per semester. The sample of students in this survey roughly reflected 39 the broader population in that the majority of respondents (90%) were full- time students.

Visible Minority In the general population at Ambrose, 28% consider themselves visible 363 minorities. In this survey, 19% of respondents self-identified as visible 78 minorities. Full time Part time

Many survey respondents reported that they lived with parents, guardians, or Living Arrangement 324 relatives (33%) or on campus without roommates (32%). Only 26% indicated that they lived on campus. These 29 numbers roughly line up with the 130 Yes No 72 broader Ambrose population, where just 19% of students live on campus. 132 Among the broader Ambrose population, 56% of students are female. In this 21 survey, 61% of the respondents were women, while 37% were men; the remainder were cis-gender, two-spirit, non-binary or other. On campus, no roommates

On campus, with roommates SEXUAL IDENTITY n % With parents, guardians, or relatives Asexual 0 0 Off campus, living alone Bisexual 7 2%

.5% Off campus, living with others Gay 2 1% Lesbian 3 Pansexual 4 1% Questioning 2 .5% Same Gender Loving 2 .5% Straight/ Heterosexual 371 92%

Total 402 100%

In the survey, a large majority identified as Christian (93%), followed by ‘spiritual but not religious’ (3%) and agnostic (1%).

Of the respondents 26% (n= 103) reported being diagnosed with learning or physical disability or mental illness. In contrast, 42% (n=170) self-identified as having a mental illness.

Self-Identified Mental Illness

170

232

Yes No

Of the 103 respondents who had reported that they had been diagnosed with a disability or mental illness, the prevalence of diagnoses was as follows:

Reported Diagnoses* n % Anxiety & at least one other 26 25% Depression & at least one other 23 22% Depression alone, including suicidal ideation 14 14% ADHD/ADD alone 10 10% Anxiety, including Generalized Anxiety Disorder & Panic attacks 10 10% Physical disability 8 8% PTSD 6 6% Left Blank 6 6% ADHD + another 5 5% Unspecified learning disability 5 5% Autism spectrum 4 4% Dyslexia 3 3% OCD 3 3% Bipolar or cyclothymia 1 1% Eating Disorder - Bulimia 1 1% Mental Illness general 1 1% Visually impaired 1 1% *note that more than one category can apply to a single respondent

Accessing Services Of the 139 students who accessed campus resources, 56% accessed counselling services, 20% drew upon accessibility services, 12% accessed an academic strategist and 10% accessed the writing centre.

Respondents moderately feel like their struggles aren’t severe enough to access services (mean = 3.37). Students who have been diagnosed with a mental illness, learning disability, or physical disability are significantly less likely than those who have no diagnoses to feel like their struggles are not severe enough to access support (p<.001)

Respondents generally disagree with the idea that the fear of receiving a diagnosis prevents them from accessing services (mean = 2.22). There is no significant difference between respondents on the basis of their living arrangements.

There is a difference, however, between respondents who had received a diagnosis and those who have not. Those who had no diagnosis were significantly more likely to say that fear of receiving a diagnosis keeps them from accessing services (p = .006).

Accepting Community When asked if the community at Ambrose facilitates a sense of belonging, students responded positively, with a mean rating of 4.04. There were no significant differences on the basis of living situation.

There was a significant difference between Indigenous and non-Indigenous students, however (p = .04). Indigenous students were more likely than non-indigenous students to rank Ambrose as creating a sense of belonging (p = .04).

Respondents who have been diagnosed with a learning disability, physical disability or mental illness, however, were less likely to agree with the statement that Ambrose creates a sense of belonging (p = .02).

As expected, when considering support outside Ambrose, there were differences between students on the basis of their living situation. Students living off campus with others experienced more support than those living alone off campus and those living on campus with roommates (p= .03).

Respondents did not differ on the basis of their living situation in terms of the degree to which they felt like they could be open about their mental illness. Overall, students indicated that they could be open about their mental illness with a mean of 3.67.

There were no differences among groups of students in response to “I would appreciate more formal supports at Ambrose.” Students responded with a mean score of 3.28.

Students were also asked if they felt they could contribute to the mental health culture at Ambrose. There were no differences among students on the basis of their living situation. On average, students responded with a mean of 3.42 on this item.

There were some important differences between students who have received diagnosis of a learning disability, physical disability or mental illness.

Respondents with a diagnosis felt less strongly than those without that they could be open about their disability or mental illness (p=.005).

Not surprisingly, students with a diagnosis felt that they would appreciate more formal supports at Ambrose (p< .001).

It is important to note that those students who had received a diagnosis felt that they could contribute to the mental health culture at Ambrose more than those who had no diagnosis (p = .001).

Resourcing Mental Health Services As shown in the table below, many students agreed that they had access to adequate support services at Ambrose; however, many students also indicated that they would like more information about mental health. There were no differences across student groupings.

Mean There are enough resources at Ambrose for those struggling with mental health 3.90

I feel comfortable accessing student services 3.67

I feel that if I was in crisis, Ambrose could help 3.64

I would benefit from more information about coping and health 3.27

Many students also indicated that they knew where to seek help when struggling: for this item, 3.70 was the average student response. Those living on campus tended to agree more strongly with this statement, while students living with parents, guardians, or relatives had less confidence that they knew how to access help (p=.04).

When asked more specifically about their awareness of mental health resources on campus, students responded with a mean of 3.90 on this question. Responses did not differ by living situation. However, students with a diagnosis indicated that they were more aware of the resources that promote mental health (p = .05).

Staff and Faculty and Mental Health In general, students reported that staff and faculty were caring and responsive to their mental health needs. However, students were less likely to agree that their professors talked about mental health resources in class. Among student groupings, there were no differences on the following items:

Mean My professors are accommodating if I have a health concern 3.91

My professors talk about health and wellness related opportunities 2.90 and resources this semester

My professors care about my well being 4.15

I can approach professors with issues and concerns 3.96

I can approach student development with issues and concerns 3.65

Administration at Ambrose cares about my well being 3.63

Environment Students indicated mixed preferences for their learning environment. For the statement “I learn better in a collaborative classroom set up where group work is encouraged,” the mean response was 3.05. There were no differences across student groupings. For the statement “I learn better in a traditional classroom set up,” students scored a mean of 3.67. There were no differences across living arrangements on either measure. However, there was a difference between students who had been diagnosed and those who had not. Students who had no diagnosis felt that they learned better in a traditional classroom (p = .018).

In terms of campus space, students generally agreed that there are spaces where students can create social connection: they scored an average of 3.97 in this area. Similarly, students generally felt like there were spaces on campus where they could study effectively (mean = 3.98). Again, there were no significant differences across student groupings.

Antecedents Students reported some concerns about how financial, academic, and other pressures impacted their wellbeing. Among student groupings, there were no differences on the following items: Mean The amount I work negatively impacts my health 3.36 My financial situation negatively impacts my well being 3.37 The amount of classes I’m taking negatively impacts my health 3.00

Students responded to the item “I feel pressured to complete a full-time class load” with an overall mean of 3.41. However, differences emerged on the basis of living situation and diagnosis. Those living at home with relatives felt more pressure relative to students on campus without roommates or those living alone off campus (p=.02). Those with a diagnosis felt more pressure relative to students without (p=.03)

Participation in Ambrose activities was generally strong, but participation differed by student grouping. Students living on campus reported higher participation in campus activites (p<.001), as did Indigenous students (p=03). Students with a diagnosis were less likely to participate in campus activities (p=04).

In terms of developing a healthy lifestyle, students reported that they found it difficult to eat healthy while on campus (mean = 3.74). Students differed, however, on the basis of their living situation: those living on campus noted that it was significantly more difficult to eat healthy (p< 0.001), relative to those with different living situations.

Likewise, students on average (mean of 3.20) noted that it is difficult to live a

balanced lifestyle at Ambrose. However, those living on campus found it significantly more difficult (p<0.001).

On average, students agreed that Ambrose offers opportunities to engage in physical activities (mean 3.43). Those living on campus with roommates were more likely to agree with this statement than any of the other groups, except those on campus without roommates. Those on campus with no roommate scored higher than those living in “other” situations (p= .03).

Students offered a variety of suggestions to make Ambrose a healthier campus. The top response was to offer better food at reasonable prices.

n % What could Ambrose Do to be a Healthier Campus? (asked of all respondents, n=402)* Better food at reasonable prices 120 30% Outreach/raising awareness about mental health (e.g. speakers, seminars, information campaigns) 51 13% Improve fitness options, includes enhancing intramurals and providing more fitness classes 39 10% Improve the gym & fitness 26 6% Build community, including build community between commuters and residence students 21 5% Make services easier to access, including making the resources easier to find 17 4% Enhance the attitude of professors and staff, including being more understanding 14 3% Provide quiet rooms for study & rest 13 3% Provide lower cost or more counseling 13 3% Develop support groups, includes mental health support groups, bible studies, prayer groups 12 3% Enhance non-judgmental campus attitude, including access to condoms & pregnancy tests 11 3% Lower costs at Ambrose, including tuition, books 9 2% *note that more than one category can apply to a single respondent