Welcome to The Sophie Fund’s 2021 Cupcake Button fundraiser! Each October, we work alongside student organizations to raise monies for a local nonprofit focused on community wellbeing.
Members of The Learning Web’s Volunteer Community Service Program help the Family Reading Partnership prepare books to be given to local kids
This year the campaign is collecting funds for The Learning Web, an Ithaca agency offering experiential learning, youth employment, and independent living programs to youth and young adults in Tompkins County.
One hundred percent of monies raised will go to The Learning Web and specifically to its Supporting Strong Families project. The project helps youth with children learn new skills, acquire childcare equipment and supplies, and access needed resources.
The Learning Web strives to support local youth—from the homeless to the more fortunate—to make the transition to adulthood successfully, finish high school, develop a productive career path leading to gainful employment and self-sufficiency, and contribute in a healthy and positive way to better the greater Ithaca community.
Every year The Learning Web helps 600 youth, 200 of whom are homeless, through a variety of programs. Services are provided to ensure safe housing, assist education and training opportunities, develop career pathways through apprenticeships and employment, and help with parenting skills for young parents.
Students will raise money through in-person activities (and provide donors with Cupcake Buttons) and through online collections via GoFundMe.
The symbol of the campaign is a Cupcake Button, because the fundraising takes place in the run-up to the Annual Ithaca Cupcake Baking Contest hosted by The Sophie Fund. To enter this year’s cupcake contest, go to: https://thesophiefund.org/cupcake-contest/
2021 Cupcake Button (detail from Evolution, a painting by Sophie Hack MacLeod)
As Cornell University administrators consider the recommendations from a mental health review released last October, Cornell Health needs to cross train all of its clinicians to diagnose and treat substance abuse disorders and other mental health disorders as soon as possible.
Cross training is an important consideration in all health services, but it is especially necessary for clinicians who work with college students. For example, a female student sought help from her college’s counseling program because she was feeling anxious and depressed. She met with a counselor for several weeks but experienced no relief. Her counselor decided to seek advice and brought her case to the counseling service’s weekly clinical meeting. After a lengthy discussion, another counselor asked, “Did you ask about her drinking?” No, the counselor had not asked about her drinking because she focused on the presenting problems, anxiety and depression. In the end, the counselor diagnosed the student as having a serious alcohol use disorder and treated her successfully for both addiction and depression.
Another in an occasional series of articles about student mentaOne in an occasional series of articles about student mental health. For more information, go to The Sophie Fund’s Student Mental Health Page
Clinical services, whether in the workplace or on a college campus, have a common problem: most clinicians do not have sufficient training to diagnose and treat both substance use disorders and other mental health disorders. This occurs primarily because clinical training programs often do not provide social workers, psychologists, and psychiatrists with sufficient background and skills to diagnose and treat substance abuse disorders, particularly addiction.
At the same time, programs specializing in training counselors about substance use disorders may give short shrift to the diagnosis and treatment of other mental health disorders. Clinical services can rectify this problem by ensuring that all clinicians are cross-trained to the point of competence where they can identify, assess, and intervene on both substance abuse disorders and other mental health issues.
Cross training is especially important for college counseling services because college students drink, sometimes excessively, and use and abuse other drugs such as marijuana, prescription drugs (e.g. Adderall and Ritalin), Ecstasy, and cocaine. Since the 1990s, college health practitioners have utilized two approaches to prevent and treat substance use disorders among students.
The first is a harm reduction model. For example, it seeks to reduce the harm associated with excessive drinking by teaching students to drink responsibly. Within this framework, college health practitioners think of heavy drinking as a symptom of an underlying social problem, a dysfunctional “culture,” and they create programs such as social norming campaigns and BASICS (Brief Alcohol Screening & Intervention for College Students) to teach students moderate drinking norms with the expectation that students will change their behavior and drink moderately or not at all.
The second approach conceives of substance use as a coping mechanism that students use to relieve stress, anxiety, and depression. By treating the stress, anxiety, and depression, clinicians believe that students will be less reliant on alcohol and other drugs to cope and use alcohol and other drugs responsibly. These interventions work well with students who are not addicted and are abusing alcohol or other drugs, but they are inadequate for treating those who are addicted to alcohol and other drugs.
More recently, colleges have begun to recognize that many college students who drink excessively and abuse other drugs cannot control their consumption because they are dependent upon alcohol and other drugs and many college health services have begun to develop recovery programs to treat their addiction. One study, for example, found that 18 percent of college students have an alcohol use disorder: 12 percent met the criteria for a diagnosis for alcohol abuse and six percent met the criteria for a diagnosis of alcohol dependence.
Interview skills are essential for making an accurate diagnosis and ensuring effective treatment. Mental health clinicians and addiction specialists can learn from one another to improve their skills.
Again, the classic example is the depressed client who seeks help from a mental health practitioner for depression. A male student sees a mental health clinician who focuses the interview on his symptoms of depression and reasonably prescribes anti-depressants and talk therapy. However, the clinician misses the fact that the client is implying that his alcohol consumption is minimal but is actually consuming large quantities of a depressant (i.e. alcohol). The therapist does not consider the patient’s self-medication and prescribes antidepressants.
In the opposite scenario, the same male student sees an alcohol and drug counselor to discuss his potential abuse of alcohol. The counselor does a standard intake evaluation and determines that he does meet all the criteria for alcohol addiction but, because of the nature of the questions asked, the counselor misses the fact that this person has had all the symptoms of depression since before he ever took his first drink. In both scenarios, the most effective treatment requires the clinician to diagnose both the addiction and depression and treat them in an integrated manner. Treating only the depression will perpetuate the addiction, the pain, and dysfunction. Only treating the addiction will perpetuate the depression and likely lead to ongoing suffering and relapse.
Cross training ensures that health services deliver the most competent care in the most cost effective manner. The only thing worse than not getting the help one needs is thinking you are getting help when you are not. Clinicians owe it to their patients to be able to assess issues across the mental health spectrum. As Cornell Health responds to the mental health review, it can ensure that students receive the most effective care by guaranteeing that all of its clinicians have sufficient training to diagnose and treat both substance use disorders and other mental health disorders.
—By William J. Sonnenstuhl and G.P. Zurenda
William J. Sonnenstuhl is an emeritus professor in the School of Industrial and Labor Relations (ILR) at Cornell University. His primary research examines alcohol and drug problems in the workplace and on college campuses. He is the faculty advisor for Sober@Cornell, President of Cornell Collegiate Recovery, Inc., board member of Cayuga’s Watchers, and member of the Fraternity, Sorority, and Alumni Council.
G.P. Zurenda is a social worker and addiction specialist. He holds an MBA from the SC Johnson College of Business.
When I started my first year at Cornell University, I experienced imposter syndrome and overwhelming feelings of depression and anxiety. I questioned whether I belonged at an Ivy League school and had doubts about whether I could be successful on my own. I began having a negative view about myself and my capabilities, started self-isolating, and worked to attain a level of perfection that isn’t possible in my classes.
Memorial Room, Willard Straight Hall, Cornell University
While I was going through all this, I realized I never heard or had any information about the groups and initiatives on campus that were directed toward addressing student mental health. I believe that I could have benefited from them when I felt so alone.
It is essential that incoming students have this indispensable information if they ever need support or a community to turn to if they are struggling. Turning to someone who understands or even talking to someone while you’re dealing with a hardship makes a big difference. Getting out of your own head gives you perspective about what you’re going through and how you perceive the situation. You are never alone. Your struggles and vulnerabilities do not make you weak. Sharing makes you stronger and more connected with others.
One in an occasional series of articles about student mental health. For more information, go to The Sophie Fund’s Student Mental Health Page
My experience, and then learning about the deaths of Cornell students earlier this year, motivated me to create the Cornell Mental Health Resources Guide to empower incoming and current students to find and ask for emotional support when they need it—whether they’re going through a crisis or need someone to talk to. The transition to college is very difficult. It’s important more than ever, given the Covid-19 pandemic, that new students know that they are supported and that there are communities of students that are here to support them and have their own experiences related to dealing with mental health and negative body image.
Through this guide, I hope to inform students about where they can find support and the kinds of resources and communities that exist on campus to address their personal, mental health, academic, and/or spiritual needs. I want to further the idea that asking for help is a strength and challenge the societal belief that emotions should be pushed aside.
Mental health should be a number one priority. Many students buy into a hustle culture in college that encourages you to struggle and put yourself last, but your wellbeing should reside in the center of everything you do. Taking care of yourself allows you to feel better about yourself, put struggles into perspective and see challenges objectively, be less tired and stressed, focus and perform better in your academics, be a better friend, be present, etc. Only by taking care of yourself can you show up as who you truly are. Investing time in relationships is also important as human connection makes us happier.
Over the summer, I distributed my work to more than 800 organizations, professors, and departments on campus. It was sponsored by student organizations working to address mental health on campus including Cornell Minds Matter, EARS, Reflect at Cornell, and Body Positive Cornell. It was shared with freshmen through Cornell’s new student orientation, the Tatkon Center, Cornell residential housing, Cornell athletics sports teams, and students coming back from health leaves of absence. It has also been shared by some professors in their course syllabi.
In receiving a lot of positive responses from the Cornell community, I’ve been able to see that there are many people who care about student wellbeing at Cornell and want the best experience for every student. Together, we can work to make Cornell an even better campus and environment for students to grow and thrive.
—By Katie Gorton
Katie Gorton is a sophomore at Cornell University hoping to study Communications.
As the 2021-22 academic year begins, Cornell University reports that it continues to implement changes related to student mental health and wellbeing. In messages welcoming students back to campus, university administration leaders highlighted the virtues of kindness and self-care.
Willard Straight Hall, Cornell University
Cornell announced changes to the 49-year-old, student-led Empathy Assistance and Referral Service, known as EARS, citing recommendations made in Cornell’s 2020 Mental Health Review as well as an Office of Risk Management determination that peer counseling is not covered under the university’s general liability insurance.
Cornell unveiled a new model consisting of peer mentoring, training, and outreach in which EARS Peer Mentors, Empathy Chairs, and Liaisons will expand the organization’s outreach to Cornell undergraduate, graduate, and professional student communities.
“The final report of the Mental Health Review underscores the need for significant culture change at Cornell,” Sharon McMullen, assistant vice president of student and campus life for health and well-being, told the Cornell Chronicle. “The new EARS model aims to expand outreach and social connection to students with diverse interests, backgrounds and identities, including those with identities that have been marginalized. It also offers concrete opportunities for student organizations to support campus-based student resilience, social connection and help-seeking efforts. This kind of active engagement is exactly what our campus needs at this time.”
Cornell’s Executive Accountability Committee (EAC) charged with implementing recommendations announced the launch of a new website as a centralized platform on resources for students, staff, faculty, and families who seek guidance on supporting students and their mental health needs. The EAC said that it would work with groups and teams across campus to expand the site’s content.
The EAC also announced the launch of a new web page to provide guidance to faculty, staff, and teaching assistants about how to support student mental health.
Other notable EAC updates about the implementation of student mental health recommendations:
—An advising working group was formed to address academic advising, clarifying the role of advisors across campus, training for advisors, implementing best practices, and assessing advising needs for vulnerable populations.
—A sub working group was formed to review the Student of Concern notification tool.
—The Graduate School is spearheading a Graduate Field Handbook for each field so that departments have documented, clear, and consistent standards for degree completion.
—A task force is being formed to develop a strategy for graduate students to provide feedback to be implemented by the end of fall 2021.
—A working group will create a document outlining mutual expectations between advisors and advisees.
—Training programs are being created to develop mentoring skills.
—The Student Evaluation of Teaching Committee is working on improvements to the course evaluation tool.
—Academic policies working groups are exploring possible changes:
Eliminating forced distribution grading (grading on a curve).
Instituting pass/fail (or S/U) grading for first semester, first-year students.
Limiting the number of credits that students may take each semester.
Prohibiting evening exams and improving exam scheduling to prevent students from having exam clusters.
Requiring faculty to make available to students during pre-enrollment certain components of course syllabi most important to students and feasible for faculty, such as information about course workload and assessments.
Expecting departments to identify key stressors in the student experience and strategies to mitigate them.
—Cornell’s director of Financial Aid and Student Employment will be required to include a focus on financial wellness.
—Cornell’s associate director of Student Employment will be required to include a focus on using student employment to create a sense of wellbeing, personal growth, and campus connection for students.
—Faculty have been sent reminders and/or suggestions to consider mental health and wellbeing in the classroom, including transparency of class policies and making syllabi available during pre-enrollment.
—A committee will be charged with examining and implementing recommendations related to undergraduate orientation for August 2022.
—Cornell Health initiated a work group to review patient advocacy policies and processes with the goal of making recommendations such as: staffing and representation, standardizing engagement with concerned parties and follow up with staff/supervisors, training for those in the role, and processes for identifying opportunities for system improvement.
—Counseling and Psychological Services (CAPS) updated training for staff and streamlined risk documentation in notes to continue to advance an evidenced-based approach for managing the care of individuals experiencing suicidality.
—CAPS integrated professional development trainings into monthly staff meetings and biannual retreats that have included risk management and documentation as well as multicultural competency.
“As we begin this new year together, I ask you each to chart your course with knowledge and with kindness,” President Martha E. Pollack told students on August 26. “Measure your progress both with the skills you build and the competence you gain—and with the connections and the respect and the kindness shared between yourself and your fellow travelers.”
Ryan Lombardi, vice president for student and campus life, encouraged students to avoid comparing themselves to their peers, and to be patient and generous with others as well as themselves.
“We invite each of you to reflect and consider how your actions—as an individual or as a member of a group, department, team, college or organization—can support your own well-being and also help to advance positive culture change on campus,” the EAC said in a message to the Cornell community.
Mental health services in Tompkins County have been stretched to the limit for years. Demand for crisis support at local mental health clinics, as well as calls to Ithaca’s crisis hotline, spiked after the Covid-19 pandemic disrupted normal life in 2020. The number of people seeking non-crisis counseling in the county has also increased steadily since then.
MindWell Center Co-Founders Sarah Markowitz and Aaron Rakow
Into this breach last October stepped a new service provider promising cutting-edge approaches to mental health care: Mindwell Center LLP, located in the South Hill Business Campus.
MindWell is the brainchild of Aaron Rakow, a clinical psychiatry professor at Georgetown University who returned to his native Ithaca with a mission to upgrade the availability of services and standard of care in rural upstate New York. In short order, Rakow and co-founder Sarah Markowitz have hired 25 therapists and are adding another one-to-two a month; they plan to open a second clinic with 10 clinicians in September in Albany. MindWell is currently supporting 350 patients and counting.
“Across our society, we have more demand for mental health services than we have providers able to support that demand,” Rakow said. “In particular, within a category of the mental health field that we refer to as evidence-based care, or psychological intervention that is based on science, to be as effective as possible in treating a host of mental health challenges amongst individuals, there are even fewer practitioners that practice in that space. My hope is that through opening MindWell Center we will be able to address some of those needs.”
The Tompkins County Chamber of Commerce honored MindWell at its 2021 Annual Meeting and Celebration on May 20 with its Distinguished Business of the Year Award. Announcing the award, the Chamber said: “In response to a specific and substantial community need—access to effective, quality mental health care, and removing stigma regarding mental health concerns—MindWell founders Aaron Rakow and Sarah Markowitz have introduced a new model of treatment to our community and expanded their staff and services considerably in a short period of time.”
MindWell strives to provide the highest quality evidence-based mental health care to children, families, and adults for a spectrum of mental health conditions, including depression, anxiety, eating disorders, sleep disorders, substance use disorders, Post-Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), and Attention-Deficit/Hyperactivity Disorder (ADHD).
Besides supporting individual patients, MindWell is ramping up population-level initiatives—for example, it offers contracted services for companies where clinicians implement programs fostering healthy workplaces through leadership training, wellness seminars, stress reduction classes, support groups, and individualized care for employees. MindWell is offering similar services to schools in the region, both K-12 and colleges. Rakow believes that the Ithaca community is aware of the need to address the “mental health pandemic” many experts believe accompanied the Covid crisis.
Rakow said that another key part of MindWell’s mission is to support the training and retention of high-quality evidence-based clinicians in upstate New York. To that end, MindWell has formed partnerships with the University at Albany and Binghamton University to provide training through externships for graduate programs in clinical psychology.
WATCH: Promotional video about the MindWell Center
Evidence-Based Care (EBC) is an evolving standard of care involving a variety of treatments endorsed by leading mental health associations. According to experts, it emphasizes integrating the best available research with clinical expertise in the context of a patient’s culture, individual characteristics, and personal preferences. Nonetheless, as a 2013 New York Times article pointed out, “surprisingly few patients actually get these kinds of evidence-based treatments” despite numerous trials demonstrating their effectiveness.
MindWell clinicians are trained to provide Cognitive Behavioral Therapy (CBT) and Measurement-Based Care (MBC) to carry out its evidence-based approach. According to the American Psychological Association, CBT encourages patients to recognize distortions in their thinking that are creating problems, and learn problem-solving skills to cope with difficult situations.
Any good therapist will utilize treatment elements such as reflective listening, validation, and empathy. As Rakow describes it, evidence-based treatment adds a roadmap for the client and the therapist to most efficiently decrease the symptoms of disorders through specific strategies and techniques that have been proven through science. In treating a patient with depression, Rakow explained, the therapist will assess the factors behind the patient’s negative thinking patterns. Then the treatment will focus on teaching coping skills that can change the patient’s cognitive narrative.
“The client gets a workbook to help their guidance and help their process at home,” said Rakow. “The clinician has a workbook to help guide the sessions. That is an evidence-based intervention in practice.”
Furthermore, MBC bases clinical care on data collected from patients throughout their treatment; experts say that MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes.
“We are looking at every single session for the individual on how they are improving, if they are improving,” Rakow explained. “And if they are not, what can we be doing differently on an interventional level?”
To use an example, Rakow said that a clinician treating anxiety will have patients fill out screen tests during every therapy session to measure increases or decreases in symptoms. “So they can say, ‘It looks like you’ve had a difficult week. We’re seeing your anxiety go up. Let’s see how we can calibrate the treatment effectively to bring that level back down. Because we know you have that potential.’ If we are not practicing measurement-based care, we’re not practicing evidence-based care. Those two things must always go together,” Rakow said.
Some team members at MindWell are equipped to prescribe medications. That said, Rakow points out that many of the most evidence-based strategies involve the combination of psychotherapy and medication management, as opposed to a treatment regimen that involves medication management alone. Thus, MindWell’s team of multidisciplinary providers collaborate closely on cases to ensure that the treatments are optimally calibrated to each patient’s individual needs.
Population-level initiatives provide easier access to mental health treatment, Rakow explained. “There are far too many barriers to accessing high quality mental health care in our country,” Rakow said. “We will partner with hospitals, with school systems, with institutions of higher education, with businesses big and large, to provide integrated mental health solutions for their employees, for their pupils, for their staff, for their patients, to make the process of accessing mental health care that much easier.”
Rakow said that businesses are receptive to upstream mental health support for their employees, especially amid the Covid-19 pandemic, in part because they realize that decreased wellness can impact productivity and profits. He said that MindWell services for K-12 schools can focus on administrators, teachers, and staff as well as students and their parents.
School-integrated support helps parents avoid what can be a difficult challenge in navigating mental health services for their children on their own, Rakow said. “If you are a mom or dad, and your child needs mental health care, you have to locate a provider, wait for that provider to have an opening, take time off to drive across town and take that child to that appointment, wait while the child is seen, and follow up with the clinician,” Rakow said. “That could take weeks or months to treat, in the best-case circumstances.”
MindWell’s model for higher education similarly supports faculty and staff members while seeking to relieve the increasing burden on student counseling services.
“College student mental health is right now an extremely high need for our field,” said Rakow. “The institutions of higher ed in our region are taking this issue extremely seriously and have put an incredible amount of thought and commitment and resources towards it. But our need in our society from a mental health perspective continues to grow and the demand for it continues to increase. We need to really think innovatively about how we can provide support and access points for undergraduate and graduate populations of learners in our community to be able to effectively meet that demand.”
UPDATE: MindWell is working with regional insurance carriers to become in-network as soon as possible to increase access to its care model. In the meantime, MindWell offers a generous sliding scale for clients in need. MindWell also offers what it calls courtesy billing whereby the MindWell team submits the claim on the behalf of the client so they can focus on their care rather than dealing with paperwork.