Cornell’s Mental Health Review: Final Report

The Cornell University administration on October 22 released the Final Report of a nearly year-long Mental Health Review that contains 60 recommendations comprehensively calling for improvements in mental health and medical services, academic life, student well-being, and mental health awareness and proactive support.

Download Cornell University’s Mental Health Review Final Report

The administration at the same time announced the formation of a high-level Executive Accountability Committee, led by senior academic officials as well as senior administrators overseeing student affairs and Cornell Health, to evaluate and prioritize the recommendations.

The 34-page report’s recommendations include a mix of specific suggestions and identification of areas for further review. The report cited a need for upgrading psychological counseling services, but also strongly argued that fully supporting student mental health requires significant changes in academic policies and practices.

“Cornell, like its peer schools, must rethink what it means for students to strive for excellence, and design an enhanced version of excellence, which has as its foundation a healthy educational environment,” the report stated.

“While treatment offered by counseling centers can benefit students directly through symptom relief, increased levels of academic and social functioning, and increased retention and graduation rates, improving mental health requires a degree of culture change, which must be a university wide effort,” the report said.

“Students maintain a culture of competition in the curricular, co-curricular, and social spheres, which normalizes course and extra-curricular overloads that can become a detriment to physical and mental health,” the report’s authors wrote. “We have observed that the culture of competition may take on an unhealthy cycle of expectation and behavior that can reach traumatizing levels for students, faculty, and staff.”

The report expressed concern about the health and well-being of faculty and staff, and about the impact that increasing expectations has on their well-being and on their ability to support students. The report said the issue warrants continued attention but noted it was outside the scope of the review that was focused on student mental health.

The review was conducted during the 2019–20 academic year by a task force appointed in mid-2019 that included three experts from outside the university as well as faculty, staff, and students from the campus community. The task force submitted its Final Report in April just as the Covid-19 (coronavirus) pandemic was disrupting education at Cornell and on campuses across the country.

The review examined challenges affecting Cornell’s undergraduate student population as well as its graduate and professional students (numbering 14,743, 6,239, and 2,638, respectively, in Fall 2020). It included two campus surveys, 37 focus groups, five Telling Stories workshops, six World Café large-group dialogues, and meetings with undergraduate and graduate students, deans and faculty members, senior staff members, and campus healthcare providers. Additionally, the task force met with off-campus therapists and community mental health organizations. The task force also reviewed Cornell Health data, and examined mental health reviews conducted at other colleges and more than 70 student well-being programs and initiatives.

The 13-member internal Mental Health Review Committee, which included five students, was headed by Marla Love, senior associate dean of students, and Miranda Swanson, associate dean for student services in the College of Engineering. The External Review Team consisted of Michael Hogan, a former commissioner of mental health for New York State, Ohio, and Connecticut (chair); Karen Singleton, chief of Mental Health and Counseling Services at the Massachusetts Institute of Technology’s MIT Medical; and Henry Chung, senior medical director of care management organization at Montefiore Medical Center in New York.

The report highlighted one “overarching recommendation” to sustain the complex challenge of improving student mental health: “Creation of a widely representative permanent committee on mental health to ensure the implementation of immediate recommendations, and to monitor progress and conduct further review of those recommendations that will require more time and resources to enact.”

The External Review Team members stressed the importance of establishing a permanent committee on mental health “to act as a steward of this cause” in an April 15 report transmittal letter to Vice President for Student and Campus Life Ryan Lombardi. “An issue like mental health, which touches so many and is affected by every aspect of university life, requires consistent attention and a centralized effort across the university,” they wrote.

Hogan, Singleton, and Chung also cited the “distinctive role” the Cornell administration must play in implementing the recommendations. “Mental health must be championed at the highest levels of leadership in order for students, faculty, and staff to have the confidence to act,” they wrote.

The plea echoed the report’s introduction, which stated in part: “The recommendations that emerged from this process must be addressed and ongoing change led at an institutional level to ensure that mental health and wellbeing is valued and embedded in the culture of the university.”

Medical and Mental Health Services

In its assessments and recommendations, the report recognized Cornell’s history in the collegiate mental health field, and commended Cornell for providing “whole person,” or “integrated,” mental health care through Counseling and Psychological Services (CAPS) and Cornell Health’s primary care services.

The report noted “significant recent changes” to improve access to mental health services. These included the hiring of additional staff—according to the report, the number of budgeted fulltime CAPS therapists increased from about 28 in 2018 to about 38 in 2020.

The changes also included the adoption of a new service-delivery model in Fall 2019, which enabled 25-minute initial outpatient sessions virtually on demand, and offers students greater flexibility in choosing their therapists and scheduling appointments. “The approach has already led to increased utilization, significant reductions in wait times, and decreased referral to community therapists,” the report said.

With the recent changes, there is not currently a need for significant staff increases or expanded access to services, the report said. Yet, if access and quality of care cannot be sustained, the report added, future increases in CAPS clinical staff may be required.

The report said that student feedback indicated a strong preference for long-term, weekly 50-minute psychotherapy sessions at CAPS. However, the review concluded that such a practice was not justified based on research evidence about the effectiveness of specific psychotherapies as well as current practices in insurance coverage.

“This is not to say that there is no benefit to long term counseling,” the report explained. “Clinics and insurance plans encourage individuals desiring such care to seek and pay for it on their own, so that available resources are used to benefit the entire community, and can be focused especially on those with immediate and serious concerns.”

Nonetheless, the report stated that “continued improvements in the professional medical and mental health services at Cornell are necessary… [involving] a continuing, long-term quality improvement process, not a quick fix.”

The report called for continued efforts to balance increased demand for mental health services as well as medical services with “finite resources.” The report urged improvement efforts including measuring outcomes, working with data, sustaining staff quality, and measuring patient satisfaction and concerns.

The report specifically recommended that Cornell require annual professional development training for all clinical staff on topics including suicidal patients, risk management, and multicultural competency and threat assessment; create a patient advocate/ombudsman for students to register complaints and positive feedback; utilize the Zero Suicide Model self-study to determine needed improvements in suicide prevention; utilize best practices tools to provide optimal care for underserved populations such as LGBTQ+ students; develop a framework for mental health patient access and continuity of care; improve integrated mental health care; consider refocusing the “Let’s Talk” mental health outreach service on underserved students; consider consultation with the International Accreditation of Counseling Services to benchmark against other collegiate mental health services; and consider hiring a sports psychologist to address the particular needs of student athletes.

Healthy Educational Environment

Noting there is “much to celebrate” about Cornell’s educational environment, the Mental Health Review nonetheless made significant recommendations for addressing the “toxic effects” that Cornell’s academic and social culture can have on student well-being and achievement.

“Multiple measures indicate that the mental health needs of students have increased significantly in recent years,” the report stated. It cited Cornell PULSE/CUE surveys indicating that the proportion of undergraduates who reported that they were unable to function academically—missing classes, unable to study or complete homework, etc.—for at least a week in the past year due to depression, stress, or anxiety increased from 33 percent in 2015 to 42 percent in 2019. From Fall 2015 to Fall 2018, individual CAPS therapy encounters increased by 19 percent, the report added.

The report broadly pointed to pedagogical innovations that could play a role in decreasing student stress and anxiety, such as multiple and varied means of grading and evaluation, academic credit limits, and flexible timing in exam administration. The report recommended approaches to “foster community, collaboration, and autonomy” in academic and co-curricular life. The report also identified the need for increased “multicultural competency and fluency” and financial aid solutions addressing inequities to reduce stressors across Cornell’s changing racial, ethic, socioeconomic, and gender demographics. The report cited a need to address student stress over career prospects and graduate school admission.

The report specifically recommended that Cornell create a centralized mechanism for institutional oversight of academic policies and practices that negatively affect student mental health. It called for the mechanism to work closely with college/school leadership and faculty across Cornell to examine eight issues: grading on a curve; Pass/Fail grading for first-year students and certain types of classes for all students; academic work during scheduled breaks; credit limits; attendance policies, especially as related to mental health; workload outside of class; pre-enrollment syllabi availability; and mandatory meetings with advisors.

Cornell should address problems around prelim [mid-term exam] scheduling, raise the profile of advising as a critical component of student success, launch a uniform course feedback instrument, and encourage academic departments to conduct self-studies to identify key stressors for students and mitigation strategies for them, the report said.

The report called for mandatory mental health training for every faculty member and staff member at least once every two years, and said Cornell should encourage faculty to model and discuss behaviors that promote mental health in their course orientation lectures and initial meetings.

The report singled out Cornell’s graduate students, who play dual roles as students as well as teaching assistants (TAs), for requiring special attention. “Graduate students feel particularly vulnerable within Cornell’s rigorous yet loosely structured academic environment,” the report said. “Financial independence, loneliness and isolation, power differentials with faculty and mentors, work-life balance, and ambiguity and vulnerability in advisor/advisee relationships, seem to intensify stress in the graduate student experience.”

The report said that graduate students as well as professional students face special challenges related to social connectedness, work-life balance, and resilience. Classes, research, employment, and job searches limit the time they have to engage in activities that reduce stress, the report said. Moreover, it added, they tend to have few social connections outside of peers in their labs or programs, with whom they are often in competition for jobs and resources.

The report listed five proposals for addressing concerns raised by graduate students: train TAs in mental health and resilience so they can support their undergraduate students as well as self-manage their own well-being; create clear and consistent standards for PhD degree completion; develop a mechanism for reporting and acting on problematic thesis advisors; develop a template for documenting expectations when selecting an advising committee chair; and train new faculty advisors and graduate students in developing positive mentor/mentee relationships.

Social Connectedness and Resilience

Acknowledging benefits like diverse academic offerings, research opportunities, and a beautiful campus, the report nonetheless argued that “Cornell’s competitive environment, complex structure, and physical layout compound feelings of isolation… [C]ompetition and a culture of achievement at all costs pervade the academic and social environments and hinder social connections.”

The report cited factors such as a campus social life that is heavily dominated by fraternities and sororities, where hazing, sexual assault, and alcohol abuse are perennial problems; competitive application processes for club membership and leadership positions; lack of free and convenient fitness facilities; and Ithaca’s long, cold winters.

The report called for a centralized, campus-wide strategy, with substantial, personal, and sustained support from Cornell leaders, to live up to Cornell’s “Caring Community” slogan and promote messages and means for social connectedness and mutual support.

According to the report, the university has undertaken a series of substantive reforms to address hazing, sexual assault, and alcohol misuse in the Greek Letter community; the report said the review team members “strongly endorse these important and challenging steps as key aspects of supporting campus wide mental health.”

The report specifically recommended that Cornell establish a high-level task force to develop a campus-wide strategy for student well-being; foster stronger competence in new students for managing college transition; explore mental health training for campus housing Residence Assistants (RAs); expand outreach support to international students, transfer students, first generation students, veterans, and other vulnerable populations; expand opportunities for physical fitness and prioritize fundraising for fitness facilities; regulate application-based student organizations; incentivize student organizations to offer well-being programming; improve sense of belonging for students in campus housing; promote alcohol-free activities and night programming; expand campus and off-campus spaces for programming and social interaction; and establish a task force to promote Cornell pride and create new traditions.

Help-Seeking Behavior and People in Need of Care

Student demand for mental health services at Cornell exceeds expected use, according to the report. Yet, it said, students still express reluctance to seek mental health care. Among the reasons cited by students were lack of time, cultural aversion to help-seeking, negative experiences with help-seeking, confidentiality concerns, perceptions that their symptoms were “not bad enough,” and that “everyone is stressed” at Cornell.

The report said that while it is critical that all members of the university community play a part in recognizing and responding to students in distress and to those who could benefit from proactive intervention, faculty, staff, and students all expressed uncertainty about their roles and abilities to do so.

The report made 10 recommendations for promoting help-seeking behaviors. Among them: develop a single comprehensive source of information about health, mental health, and well-being; ensure all new students receive information about recognizing mental illness and support resources; use orientation materials to equip parents to recognize signs of distress, reduce stigma, and encourage help-seeking behavior; create a pre-departure guide for international students with information about arrival logistics, finances, the academic system, and mental health; implement a mental health awareness campaign; create a social media platform where faculty, staff, and students can model help-seeking behavior through sharing personal experiences; develop a comprehensive strategy for mitigating the intersection of mental health and alcohol use; and establish a protocol for students to notify faculty of health or well-being issues that affect attendance or work completion.

For identifying and supporting students in need the report made seven specific recommendations, including: improve the experience for students taking, being on, and returning from Health Leaves of Absence; increase the number of sexual victim advocates; improve the system for handling “Students of Concern”; develop a “Big Red Folder” as a quick reference guide for all faculty, staff, TAs, and RAs to assist students in distress; and increase staff resources at the Skorton Center for Health Initiatives to offer enhanced mental health training for faculty and staff.

Executive Accountability Committee

According to the Cornell Chronicle, the seven-member Executive Accountability Committee will oversee three teams focused on “implementing efforts in key areas – academic community, campus community and clinical services.” The committee is being led by Vice President Ryan Lombardi; Kathryn Boor, dean of the Cornell Graduate School and vice provost for graduate education; Lisa Nishii, vice provost for undergraduate education; and Sharon McMullen, assistant vice president of student and campus life for health and well-being.

“Moving forward to implement change will require careful reevaluation of our university priorities as well as changes within our policies and systems,” Boor said in an October 22 article in the Chronicle. “Implementing key recommendations will help to improve the well-being of our community, and more specifically, the well-being of our undergraduate, graduate and professional students.”

In September 2018, the Office of President Martha E. Pollack published a plan for a comprehensive review of student mental health services. Lombardi shared the decision in an email to students; and, in an email to the Cornell Daily Sun,said it “reflects the University’s commitment to promoting health and well-being as a foundation for academic and personal success.”

Throughout 2018, undergraduate students and graduate students separately formed task forces to lobby the university administration for improved mental health support and services.

In an April 2017 letter, Scott MacLeod and Susan Hack, who founded The Sophie Fund after their daughter Sophie, a Cornell student, died by suicide in 2016, called on the Cornell president to “establish an independent, external-led task force on student mental health without delay to review and assess the mental health challenges for Cornell students and the university’s policies, programs, and practices to address them, and to make recommendations to the Cornell president to ensure that the university is adopting and implementing current best practices.” They repeated the request in August 2018.

Responding in a letter on September 20, 2018, Pollack said that Cornell would conduct a “comprehensive review” and thanked MacLeod and Hack “for your advocacy for providing the best possible environment to support the mental health of Cornell students.”

The Sophie Fund gave a presentation with 22 recommendations last January 15 to the Mental Health Review teams.

DOWNLOAD THE CORNELL UNIVERSITY MENTAL HEALTH REVIEW FINAL REPORT RECOMMENDATIONS AT A GLANCE