Harvard Students: “Widespread Anxiety, Depression, and Loneliness”

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.

Harvard University

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.

Notable sub-recommendations:

  • 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.”

Undergraduate Students

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.

Read: Cornell University Mental Health Review Final Report

Download: Harvard University’s Report of the Task Force on Managing Student Mental Health

College Counseling in a Pandemic

This is not what Brian Petersen imagined when he came to Ithaca College to become director of the Center for Counseling and Psychological Services in the fall of 2019. His old boss at Pace University told him that he won’t really know a school until he’s worked there for at least an academic year. Petersen set out to experience Ithaca’s ebb and flow through the changing seasons, but then the Covid-19 coronavirus pandemic forced the school to close the campus and move to online instruction.

Brian Petersen, director of the Center for Counseling and Psychological Services at Ithaca College

Yet, Petersen stresses, Ithaca College’s counseling services have remained open for business. Not only that, he adds, due to increased staffing and reduced demand on campus, CAPS has not maintained a waiting list for appointments since fall 2019.

“I think the pandemic has forced everybody to assess how well we do in taking care of ourselves,” Petersen said. “And some students may have discovered that they’re more resilient than they thought they were.”

Due to the campus closure, everything from individual therapy sessions to drop-in groups have operated virtually through Zoom teleconference meetings.

The 12-person CAPS clinical staff will extend its telehealth services into the Spring 2021 semester even as the campus reopens to practice social distancing as a means of reducing exposure to coronavirus. A CAPS counselor will be present on campus at all times for crisis interventions.

While demand for services is expected to increase as students return to campus, during the pandemic new client intakes at CAPS have been down approximately 20 percent. Petersen said this was probably partly due to students utilizing hometown support services rather than relying on CAPS. The decreased demand, however, has enabled CAPS counselors to work with students individually for longer periods of time.

Utilization of Let’s Talk, a virtual drop-in service that offers confidential consultations with a CAPS counselor without an appointment, fell off 50 percent. The pandemic also saw a fall in demand for Toolbox support groups; utilization dropped by around 20 percent for the Anxiety Toolbox group, and a toolbox for social skills and communication was not utilized at all. Due to reduced demand CAPS scaled back the number of groups focused on body image and eating issues from two to one.

CAPS responded to the campus closure with an innovation called Connection & Health Through Text Support (CHATTS), where students connect to a counselor on Zoom but with video and audio turned off and only the chat function enabled. Each session of this group service sees an average of six to eight people.

The CAPS website also provides a self-reporting mental health screening tool call MindWise that allows students do their own check-ins and receive immediate feedback. Nancy Reynolds, director of the Health Promotion Center Program, has posted apps on the website to help students with sleep and nutritional needs.

Additionally, the CAPS website has a wealth of resources. It includes contact information so that students can reach the people of CAPS. Brandi Riker and Brittany McCown, the front desk administrators, remain available by phone to guide students through the process and explain the levels of services that CAPS offers.

CAPS experienced some difficulty reaching those students who remained outside New York State with remote counseling due to geographical restrictions imposed by counseling licensing. Initially, many states allowed services across state lines with little problem or paperwork. But starting with the fall semester, many states rescinded permissions.

CAPS holds a handful of licenses in other states, including California, Connecticut, Maine, and Massachusetts. For others, the CAPS team has kept up with databases managed by other schools such as the University of Texas at Austin to obtain temporary licenses whenever possible. CAPS will always provide crisis intervention services for Ithaca College students wherever they may be.

“If a student wants counseling from us and they’re in a state where we’re just not able to get the licensing that’s needed, then we can provide consultation services and then help them find local providers in their area,” Petersen said. “But one thing I want to be clear about is that no matter what state a student is in, we can still provide consultation services. So we can do an initial assessment. We can do the Let’s Talk and the Toolbox groups because those aren’t considered clinical groups.”

CAPS expanded its outreach efforts by building more connections than ever before across the campus community. It has created relationships with the departments of Athletics and Recreational Athletics, Housing and Residential Life, the Center of Ideas, and the five schools of Ithaca College, among others.

The CAPS team wants faculty members in every department and major to have direct access to someone in the counseling center. That enables them to bring in CAPS representatives for informational class presentations and to consult someone about students who made need CAPS services. Every CAPS counselor has been assigned two or three liaison relationships on campus, Petersen said.

Petersen noted a decrease in the number of first year students utilizing CAPS services compared to a typical semester. “A lot of first student first year students use CAPS, because they’re dealing with adjustment issues like homesickness, social anxiety, and adapting to being in college,” he said. “And because we didn’t have them on campus this year, those adjustment issues have sort of been pushed off. I anticipate [this] semester we’ll see more because they’ll be here.”

As a consequence of CAPS counseling services have been mainly utilized by upperclassmen, notably seniors experiencing anxiety about jobs and graduation.

“Covid has really impacted people’s confidence about what comes next,” said Petersen. “And so, juniors that are looking for internships for senior year and seniors that are looking to step out into a job have a higher than normal level of anxiety about what comes next, and how they’re going to negotiate it. And the other impact of all of this, besides the job anxiety, is the lack of social connectedness and the idea that you want to leave college with some good solid social connections. We’ve all been remote for so long now that it’s harder to feel that way.”

—By Nicole Brokaw

Nicole Brokaw is a senior at Ithaca College majoring in Cinematography and Photography and in Writing

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

Download: Cornell University’s Mental Health Review Final Report

Meet Ithaca College’s New Counseling Director

Brian Petersen took over as the new director of Ithaca College’s Center for Counseling and Psychological Services last September. He sat down with The Sophie Fund to discuss his position and plans.

brianpetersen

TSF: How do you describe your job?

Brian Petersen: I supervise all of our programs and interventions with students as well as work with our counselors to help them enact our model of care. I also represent the Counseling Center on campus-wide task force and committee projects related to Mental Health and Wellness on campus.

TSF: What led you to Ithaca College?

Brian Petersen: I was the associate director for the Counseling Center at Pace University in New York City. I managed the day-to-day provision of intake and outreach services and participated in our pre-doctoral internship program in Health Psychology as a clinical supervisor. I worked there for 12 years. Ithaca offers me an opportunity to continue working in a university/college counseling role. I wanted to work at a smaller school due to the focus on creating a coherent community and Ithaca College has that reputation. I am originally from Brockport, New York, so I also am happy to have the opportunity to return to central-western New York.

TSF: Do you have specific interests?

Brian Petersen: I am interested in working with performing artists on their personal relationship to/experience of their craft and how that intersects with their identity. I am committed to suicide prevention and education. I also have an interest in parapsychology. My doctoral dissertation was on interviewing people about their experiences of the paranormal in the context of grief and bereavement. I really enjoy working with young adults on the creation of existential meaning in life.

TSF: What is your favorite thing about CAPS?

Brian Petersen: We have a very talented and creative staff who are committed to helping students achieve both their personal and academic goals.  It is nice to work with colleagues who truly care about what they do.

TSF: What is your least favorite thing, or what you most want to improve? 

Brian Petersen: Our services are in high demand and not all students can be seen for long-term therapy. We offer a wide range of services and interventions including Let’s Talk, our Toolbox Skills groups, group therapy, and coping skills education, and we try to match clients with the best solution to what they want to work on. For students that want long-term therapy, that can be frustrating though we will help to find a referral off-campus to a therapist with whom they can work for the full time they are at Ithaca.

TSF: Where do you see CAPS going in the future?

Brian Petersen: We are currently in the process of integrating more with healthcare services at Ithaca College. The goal is to allow students to experience holistic care of both physical and mental health needs. I would also like to increase our visibility on campus through a year-long schedule of outreach events. We are happy to work with faculty/staff/students on specific outreach projects related to mental health and overall wellness, especially around the issue of self-care.

TSF: What is your opinion about the current mental health situation in the Ithaca College community?

Brian Petersen: I think students at Ithaca are hard-working and this can create a lot of pressure to perform. With that comes stress and anxiety, two of the main reasons that students utilize our services. We also see students who are having difficulty transitioning to college and early negative experiences can create a lot of self-doubt. We see approximately 20 percent of the student body for some form of intervention each year and this is a substantial number of students. I do find that more and more students are coming to college with a high degree of knowledge and experience with mental health treatment  and they are often very informed consumers of our services.

TSF: What is the importance of mental health?

Brian Petersen: I think our mental health is the foundation through which we create meaning and connection in life. When we feel mentally healthy, we have the courage to engage with life. When we struggle, we disengage and then isolate.

TSF: Anything you’re working on right now that you can share?

Brian Petersen: I would like to create a more sustained outreach focus on suicide prevention and education so that all members of the Ithaca College community can notice and assist others who are feeling hopeless and disconnected. Very small interventions can yield life-saving results.

TSF: What do you think Ithaca College could do to help the stigma that still exists on this campus? 

Brian Petersen: I appreciate an interview like this as it allows me to be public about what CAPS and the university are doing to prioritize mental wellness. I feel that the administration at Ithaca College is truly committed to creating a community that destigmatizes mental illness or distress. The President [Shirley M. Collado] has spoken openly about her commitment and I think that has a real impact on allowing others to openly acknowledge and talk about difficult topics. I, personally, hope to reach out to students who feel marginalized or categorized at Ithaca College and I hope to meet with student groups and leaders over the spring semester. I just started at Ithaca College in September and I feel I am steadily gaining the knowledge and connections I need to begin to be proactive with this goal.

—By Meredith Nash

Meredith Nash is a senior Writing major at Ithaca College and an intern at The Sophie Fund

Recommendations for Improved Student Mental Health at Cornell University

The Sophie Fund, briefing the Cornell University Mental Health Review teams this week, issued 22 recommendations for improving the institution’s student mental health conditions and services.

IMG_4295

Entrance to Cornell Health, Cornell University

Highlights of the recommendations include: aim for a student mental health “gold standard”; avoid excessive academic and social stress levels; upgrade clinical psychological counseling services; rationalize referrals to overburdened community mental health providers; effectively fight sexual assault and hazing; implement a student-centered health leave of absence policy; print the National Suicide Prevention Lifeline number on student ID cards; create an ombuds for student mental health; and establish a Standing Committee on Student Mental Health to regularly review Cornell’s practices.

“Cornell, in common with probably all institutions of higher education, is confronted by a student mental health crisis,” said Scott MacLeod, co-founder of The Sophie Fund, speaking in a video conference call with the heads of the Mental Health Review Committee and External Review Team. “In our increasingly complicated world, college students are dealing with immense pressures during a transitional time in their lives and at an age when they are vulnerable to the onset of mental illness.”

“Much more needs to be done by institutions of higher education—including Cornell—to address those challenges. We need to better support the legions of students who are struggling with anxiety and depression and other disorders so that their mental health experiences do not break their trajectory toward successful and fulfilling lives.”

MacLeod added that “leadership is the ultimate key to successfully addressing the crisis, especially given the complexities around mental health and the complexities of managing an extremely large institution. Leadership will make all the difference in whether Cornell achieves real progress in better supporting student mental health, or tinkers around the margins with no tangible and sustainable improvement.”

Cornell’s “comprehensive review of student mental health,” announced in 2018 by President Martha E. Pollack, is taking place throughout the 2019-2020 academic year. According to Cornell’s website, the internal Mental Health Review Committee “is tasked with examining the Cornell campus context, including issues pertaining to the academic and social environment, climate, and culture related to mental health.” The External Review Team “is charged with a comprehensive review of clinical services and campus-based strategies.”

Click here to read or download The Sophie Fund’s “Recommendations on Student Mental Health at Cornell University,” presented to the review teams on January 15.

Click here to read or download The Sophie Fund’s “Perspectives on Student Mental Health at Cornell University,” presented to the review teams on August 23, 2019.

Detailed highlights of The Sophie Fund’s recommendations:

  • Cornell leadership should humbly acknowledge the existence of the crisis and the systemic challenges that must be overcome, and commit to working vigorously and transparently with all stakeholders to address the crisis.

 

  • Cornell leadership should aim for a student mental health gold standard, sparing no effort or expense in finding ways to successfully address the student mental health crisis. The crisis demands a gold standard, not a band aid.

 

  • Cornell leadership should provide and be held accountable for student mental health resources that are commensurate with the challenges, sufficient to support best practices, and in proportion with spending on other institutional priorities.

 

  • Cornell leadership should implement a cross-campus framework for supporting student mental health and wellness, with the aim of strengthening accountability, streamlining policies, programs, and practices, and enlisting schools, faculty, staff, and students in a comprehensive, coordinated, results-oriented effort that prioritizes student mental health, healthy living, and unqualified support for every student’s academic success.

 

  • Administrators, deans, and department chairs must be fully engaged in avoiding excessive academic and social stress levels; providing reasonable accommodations for mental health and other disabilities; encouraging help-seeking behaviors; offering meaningful mentoring, advising, and tutoring; providing healthy residence life conditions; promoting resilience and coping skills; and in generally creating the “caring community” that Cornell aspires to be.

 

  • All faculty and staff should be provided with a “Gold Folder”—a one-page chart on recognizing signs of distress related to mental health or sexual assault, how to engage students in distress, and how to guide them to professional help.

 

  • Deans should be responsible for knowing the identities of Students of Concern and closely following their cases.

 

  • Administrators, deans, and department chairs must be engaged in identifying and supporting at-risk students.

 

  • Psychological clinical services must be upgraded to ensure that every student who needs help gets the best possible support, and that no student falls through the cracks of an overburdened and distracted healthcare system.

 

  • Cornell leadership should cease the practice of outsourcing student mental health treatment based on overburdened campus services. If more campus services are needed, then they should be provided.

 

  • Cornell should ensure that referrals to community providers are made solely on the basis of student preference, and are made to providers who are capable of accepting new clients and have been fully vetted.

 

  • Cornell leadership should develop and publish a comprehensive suicide prevention policy incorporating current and anticipated best practices, including the Zero Suicide Model in healthcare, and mandatory training in suicide prevention tools for gatekeepers including RAs, deans, department heads, and academic advisors.

 

  • Cornell leadership should develop new and effective strategies to combat the serious problems of sexual assault and hazing within its student body.

 

  • Cornell leadership should develop new and effective strategies for addiction prevention, intervention, treatment, and recovery support.

 

  • Cornell leadership should institute a mandatory online education module prior to freshman registration that provides students with information about mental health risk factors and warning signs, Cornell data related to student mental health, and resources for receiving support.

 

  • Cornell leadership should create and implement a leave of absence policy that prioritizes the interests of the student over those of the institution, and is designed to fully safeguard students’ health, academic, financial interests, and successful life trajectory. Cornell leadership must fully support students throughout the leave process—i.e., before, during, and after leaves are taken.

 

  • Cornell leadership should create an ombuds position to serve as an independent campus advocate for student mental health rights and to provide practical assistance to students navigating the university’s healthcare system and academic accommodations.

 

  • Cornell leadership should provide an effective factual presentation about student mental health risks and responses to parents of all incoming students before or during freshman orientation.

 

  • Psychological counselors and academic advisors should encourage struggling students to consult their parents and include them in discussions related to important decisions such as health leaves of absence.

 

  • Cornell leadership should leverage online platforms including Internet websites and social media accounts to deliver effective mental health education, effectively fight stigma and encourage help-seeking behavior, and most importantly, effectively provide resources for addressing mental health crises.

 

  • Cornell should print the telephone number for the National Suicide Prevention Lifeline on student ID cards.

 

  • Cornell leadership should establish a Standing Committee on Student Mental Health including a range of key campus stakeholders to regularly review Cornell’s policies and practices and issue annual reports on identified needs for continued quality improvement.