The Harvard University administration on July 23, 2020 released the Report of the Task Force on Managing Student Mental Health, which found that Harvard students are experiencing “rising levels of depression and anxiety disorders, and high and widespread levels of anxiety, depression, loneliness, and other conditions.” The report made eight recommendations and 30 sub-recommendations for improving the university’s support for student mental health.
The 46-page report described a toxic campus culture characterized by stressful academic and social competition, overwhelming workloads, unhealthy faculty-student connections, lack of sleep, isolation and loneliness, fear of failure, financial pressures, worries about job prospects, stigma around mental health, and confusion about when, how, and where to seek help with mental health concerns. The report identified shortcomings in clinical support services.
“People in power should demonstrate that they care about mental health, and I think a cultural change within Harvard as a whole would be important,” said an undergraduate student focus group participant quoted in the report.
The report said that undergraduates reported high levels of stress, overwork, concern about measuring up to peers, and inability to maintain healthy coping strategies. It also found that extracurricular activities at Harvard often represented another source of competition and stress.
Graduate and professional students described high levels of isolation, uncertainty about academic and career prospects, and, among those in PhD programs, financial insecurity and concerns about their relation to advisors, the report said.
The task force was convened by Provost Alan M. Garber and co-chaired by sociology professor Mario Small, Arts and Sciences Dean Emma Dench, and psychology professor Matt Nock. It was led by a 13-member steering committee made up of 10 mostly senior Harvard administrators and faculty members, and three external experts. Eight undergraduate and graduate students served on two working groups alongside administrators and faculty members.
The task force examined data on Harvard’s mental health services, analyzed national and campus surveys, and heard from focus groups representing undergraduate, graduate students, professional students, faculty, and staff. The review was conducted from February 2019 to April 2020. As the task force had completed most of its work before the outbreak of the Covid-19 pandemic, the report does not recommend pandemic-specific response actions.
The task force’s eight main recommendations:
- Create a permanent mental health team to implement recommendations, facilitate cross-campus collaboration, produce an annual report, and distribute information on student mental health to students, faculty, and staff.
- Launch a one-year campaign focused on mental health awareness and culture change.
- Institute an annual follow-up messaging program focused on mental health awareness and culture change.
- Examine making Harvard’s Counseling and Mental Health Services (CAMHS) more accessible to students.
- Examine addressing mental health, sexual climate, inclusiveness, isolation, and sense of belonging holistically.
- Address potential service gaps between the Academic Resource Center, which provides academic support, and CAMHS, which provides mental health counseling.
- Examine how to reduce stress caused by the process of competing for entry into extracurricular activities.
- Provide clear guidance to faculty and graduate students to ease stress caused by advisor-advisee relationships.
- Encourage open discussion about mental health conditions and struggles; the report cites imposter syndrome (feelings of inadequacy despite success), duck syndrome (appearing calm despite struggling), and Sleep Olympics (glorifying hard work at the expense of healthy sleep).
- Frame mental health awareness campaigns in terms of flourishing (through healthy behaviors), not illness, toward achieving a cultural shift.
- Incorporate strong mental health messaging into course syllabi.
- Consider student well-being in setting assignment deadlines.
- Consider instituting regular faculty check-ins with students.
- Distribute a road map for navigating mental health support options.
- Organize events and discussions that allow students to discuss their challenges openly with others.
- Improve clinical wait times for initial consultations and ongoing therapy.
- Ensure counseling staff diversity.
- Improve the process for referring students to community mental health providers and assisting with related financial costs.
- Explore the use of digital clinical assessment and intervention tools.
- Examine how to address mental health, sexual climate, inclusiveness, isolation, and sense of belonging holistically.
- Explore providing a broader faculty advising support network for students.
- Encourage programs and departments to develop formal and transparent “rights and responsibilities” guidelines and workplace expectations.
- Encourage mentorship training for faculty and examine expanding incorporating mentoring into faculty evaluation.
- Improve understanding of student financial need and examine ways of signposting resources for students in acute financial need.
In assessing the state of student mental health, the report noted that rates of anxiety, depression, and other mental health conditions are rising nationally among college students and young adults as a whole. The report went on to describe an increasingly bleak outlook for today’s generation of college students:
“Students across the country are facing structural realities dramatically different from those experienced by previous cohorts. The costs of higher education and housing have soared. The planet has warmed dramatically, and the economic, environmental, and social consequences, now too numerous and too frequent to ignore, have dimmed the aspirations of many who will be forced to deal with the repercussions over their lifetimes. The academic labor market has changed, and while the number of PhD’s has risen dramatically, the number of tenure-track job openings in many fields has shrunk. The changing immigration policy landscape in the U.S. and other countries has unsettled many students and their families. And students were facing all these conditions before the world was forced to confront its worst pandemic nearly a century.”
The report said that from 2014 to 2018, Harvard undergraduates reporting that they have or think they may have depression increased from 22 percent to 31 percent; and those reporting that they have or think they may have an anxiety disorder increased from 19 percent to 30 percent.
In a survey of first year students completed in the first week of classes, 62 percent of students scored in the high range on the UCLA loneliness scale and 61 percent reported frequent or intense feelings of being an imposter, according to the task force. “These concerns do not seem to abate over the course of students’ collegiate careers and likely increase (or fail to buffer against) the negative effects of stress,” the report said.
The task force reported that students do not seem to believe they are getting a clear and consistent message about mental health from the university.
Various forms of stigma continue to prevent students from seeking help, the report said. “Students from families or cultures in which mental illness is stigmatized may find it more difficult to recognize when they are struggling, to seek help, and to get either emotional or financial support from their families while in treatment,” the report said. “And for high-achieving students more generally, it can be a challenge to admit when things are not going well.”
According to the report, students cited the possibility of being put on an involuntary leave as a reason not to seek help.
“Students reported hesitation to disclose their mental health challenges to Harvard-employed counselors and others in the administration, fearing the possibility that they would be asked to leave if they were deemed ‘unsafe’ by CAMHS,” the report said. “Students noted that they may censor what they say to a counselor, or avoid CAMHS altogether, if they think they might be placed on a leave of absence. This situation may leave some of the students most at risk fearful of being open about the depth of their problems.”
Graduate and Professional Students
The report found that Harvard graduate and professional students struggled “within a culture that does not appear to prioritize wellness.” And while graduate students across units struggled with many of the same issues, the report said, schools largely worked in isolation to address the mental health issues for their own student populations.
Approximately 23.6 percent of graduate students responding to a depression screening survey exhibited symptoms of moderate to severe depression, the report said. Similarly, approximately 23.1 percent of graduate students who responded to an anxiety screening survey exhibited symptoms of moderate to severe generalized anxiety.
Across campus, graduate students struggled to establish meaningful connections with peers and mentors, grappled with the feeling that they do not measure up to others in their programs, and worried about making ends meet and finding a job after they graduate, the report said.
Task force focus groups conducted with graduate and professional student populations revealed a strong sense of overcommitment, intense workloads, a feeling that self-worth is linked to academic output, and “that sleep and mental health must be sacrificed for academic success.”
Financial hardship is a major source of stress for many graduate and professional students, the report found. “Students who accumulated debt throughout their graduate studies—in many cases adding to existing debt from undergraduate studies—worried about being able to repay their loans and about the extent to which their loan burden could limit their career choices,” the report said.
Moreover, the task force found, graduate and professional students worried about finding a job after graduation, and many felt pressure to conform to certain expectations about the type of career they will pursue. “Recent years have seen a shrinking of tenure-track positions in many disciplines and fields, causing high levels of stress and anxiety,” the report said.
Students have concerns about displaying weakness or vulnerability in front of both peers and faculty, the task force found. “While student well-being can be bolstered by relationships with faculty that are both personally and professionally supportive, students worry about opening up to faculty who may be in a position to evaluate them either now or in the future,” the report said.
Graduate student surveys revealed a strong correlation between the relationship between a PhD student and their advisor and scores on screening tools for depression, anxiety, self-esteem, and imposter phenomenon, the report said.
In surveys and task force conversations, imposter syndrome emerged as a major factor in graduate students’ mental health, and is likely both a cause and an effect of loneliness, the report said.
Clinical Knowledge, Access and Barriers
CAMHS increased its professional staff by approximately 40 percent since 2015, and as of April 2020 employed 47 mental health clinicians. The CAMHS student to staff ratio is roughly 468 to 1, within the range report by other leading institutions of higher education, according to the report.
Nonetheless, the report said, students who participated in focus groups continued to report difficulty getting a CAMHS appointment in a timely manner, whether for an initial consultation or for ongoing therapy.
Students also cited difficulties when seeking off-campus mental health support. Some reported calling numerous providers only to find that they do not accept insurance, are not taking new patients, or in some cases just do not return the student’s call. “For a student in distress, encountering such hurdles could lead them to give up on finding help,” the report said.