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.
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.
A letter of acceptance to college, which usually arrives in March or April before high school graduation, is a wonderful milestone for young people and their parents. Thus begins an exciting and sweet passage: commencement festivities, packing for life on a college campus, some goodbyes and hugs, moving into a dorm, making new friends, and beginning a promising academic journey into adulthood.
After more than a year of Covid-19 pandemic restrictions, the smiles will be wide when students arrive this fall for what is expected to be normal in-person classes at Cornell University, Ithaca College, and Tompkins Cortland Community College.
It is very easy to overlook—or even be clueless about—what for some students will become a dark side of leaving the family nest: anxiety, depression, sexual assault and hazing violence, misuse of alcohol and drugs, academic struggles, relationship problems, and more.
At Cornell, the proportion of undergraduates who reported that they were unable to function academically (missing classes, unable to study or complete homework) 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. Many reports indicate that college students are struggling even more with their mental health during the pandemic.
College orientation materials usually provide some notice about the risks and the resources for staying safe and healthy, but they may have minimal impact amid the excitement of transitioning to college.
So, a word of advice for college students, particularly for incoming first-years:
Educate yourself about the mental health challenges that you may face, and learn about the ways that you can address those challenges if and when they arise.
The same advice goes for parents. Know what your college kid is getting into.
This essential booklet was written by Forefront’s Marny Lombard, who has gained a profound understanding of the challenges that college students may experience. Lombard’s son Sam struggled for many years with depression and died by suicide in 2013. He was 22 years old and a college senior majoring in architecture. Lombard wrote the Guide to provide parents and families with the knowledge that she needed but did not find.
“Mental health problems among young adults are more common than many families realize,” the Guide says. “In fact, one in three college students experiences a mental health issue, most commonly anxiety or depression. Major life changes such as adjusting to college life and experiencing added academic stress can set the stage for the onset of mental health issues.”
According to the Guide, parents and family members sometimes struggle to understand their student’s mental health concerns—or even to recognize that their student is in distress. Learning that their student is having suicidal thoughts can create extreme stress for the family.
Forefront’s Guide provides authoritative resources and recommended reading to help parents and families of students who are struggling with their mental health. It can help them to stay in touch with their students and know when and how to seek help if needed.
The Guide asks parents to gradually change the tenor of their conversations with their students, listening more and speaking less. Using compassion, setting aside judgment.
Guide sections include: “Ways to Keep Conversation Flowing”; “Ask about how things work at your college”; Finding the Right Therapist,” “What To Do When Your Student is Struggling”; “About Medications”; and “If Your Student Is Thinking About Suicide.”
“Suicidal urges, in particular, should always be taken seriously and never dismissed as a ploy to gain attention,” the Guide says, noting that “asking someone whether they are thinking about suicide will not plant the idea in their mind.” The Guide provides valuable information about engaging with a suicidal student and helping them get professional help. Suicide is preventable. “The vast majority of young people who consider suicide will move through this difficult time,” the Guide says. “Many will begin to learn how to manage their mental health.
Finally, the Guide advises parents to check in regularly about their students’ stress levels and warns against delaying treatment when the need is clear. It cites data showing that 75 percent of the time the onset of mental illness occurs by the age of 24.
“The longer the delay between the onset of mental illness and the start of treatment, the more difficult it can to successfully treat these issues,” the Guide says. “The good news is that you can learn how to support them and help them manage the underlying stressors.”
Ten to 15 students a day would come around to the Muller Faculty Center office of Derek Adams to discuss African American literature and ask questions about assignments.Then the Covid-19 pandemic forced Ithaca College classes online and turned the professor’s office hours into Zoom calls as well. Only a couple students a week showed up after office hours went virtual.
Adams regretted the lost mentoring time, but he had an even greater concern: his students’ mental health. A professor who cares deeply about student wellbeing, Adams uses office hours to keep an eye on how his students are doing.
“I don’t think it takes a license to actively listen, or to be open minded and listen to what somebody has to share,” said Adams, an associate professor of English who came to Ithaca College in 2012. “That’s something we should all be able to do. That’s just a very human thing that we do.”
Professors can often be the first to notice if a student is struggling with their mental health. On the first day of classes, Adams addresses students with three ice-breaker questions that demonstrate how he incorporates their wellbeing as a priority in his teaching: What is something you want to take from the class? What is something you’re willing to give to it? What is something we should know about you to get to a place where we can do the work that we need to do?
From there, Adams strives to create a classroom community with strong student connections that he believes benefits their mental health. For example, he requires students to learn each other’s names and encourages them to address each other as such in classroom discussions.
“I think, the better the state [my mental health] is in, the more I retain from what my students share with me, the more I retain from what I’m reading and what I’m conveying, the better I’m able to make connections between things,” Adams said. “And so, I just imagined that if that was true for me, it would be true for students as well, so I wanted to make that a core part of my pedagogy.”
A caring community in which students are allowed to feel vulnerable facilitates a greater understanding of literature, Adams believes. “I don’t know that we will ever get to the level of instruction and transmission of knowledge and the sharing of information that we want to get to without at least acknowledging that mental health is a core part of our experience,” he said.
But after the pandemic hit, Adams’s classroom community became more difficult to build in a Zoom gathering. The casual chatter before and after class—about things in the news, or popular culture—largely disappeared. “There’s just something about being in person that I think makes students feel more free to share those things,” he said. “Without those, it was harder to establish that kind of bond with my students.”
In response, Adams tried out some new ideas to rebuild his classroom community. He asked his students to address a letter to someone they trusted and cared about, exploring current events and how they felt about them. As they shared their letters with the Zoom class, Adams felt a better connection to his students and to the state of their mental health.
“Just giving students the platform to do that helped cultivate that sense of community that I’ve been able to hit on in my in-person classes for so many years,” Adams said. “I was learning to do this for the first time online.”
Adams also made clear that he is sensitive to obstacles in online learning and has adjusted expectations accordingly. He reminds students to prioritize their well-being and gives them pep talks. “Look at what you’re doing right now,” he tells his students. “How incredible is it that, in the middle of the pandemic, you can pick yourself up?”
Adams understands that many students struggle to be open with their professors, wary to admit they are having trouble keeping up. He believes that’s why it is essential for professors to pay attention to their students’ mental health. Although he is not a clinician, he can offer an empathetic ear. And, when he sees a cause for greater concern, he refers students to other resources such as Ithaca College’s Center for Counseling and Psychological Services (CAPS).
CAPS Director Brian Petersen agreed that everyone on campus can help improve the mental health climate.
“Mental health support for students is the responsibility of the entire campus community and Ithaca College is committed to creating a campus-wide culture that is focused on mental wellness,” Petersen explained.
Petersen believes that faculty members should be formally trained to recognize warning signs for distress and even suicide. Currently they are provided with a resource guide for directing students to support services on and off campus.
“Our goal is to help faculty feel comfortable with this kind of intervention,” said Petersen. “We also talk with faculty about boundaries and how to be helpful without being too invested or psychologically or emotionally enmeshed with the student.”
Adams is looking forward to seeing students in his daily office hours again. But he doesn’t want to forget the lessons he’s learned about community building during the pandemic “Whatever happens from this point forward, I would like there to be a continued focus—a renewed focus—on mental health and well being,” he said.
—By Lorelei Horrell
Lorelei Horrell, an intern at The Sophie Fund, is a second year Ithaca College student with a Writing major and double minor in Sociology and English.
Instead of falling asleep at 10 p.m., Daniel, a junior psychology major at Ithaca College, has just woken up. He was too tired to stay awake in the afternoon, but now he won’t be able to get back to sleep until 2 or 3 a.m. Because he won’t get enough sleep at night, tomorrow he’ll be tired again in the afternoon.
The Fountains at Ithaca College
College students are notorious for their unconventional sleep schedules. The transition to online classes during the Covid-19 pandemic has merged school and personal time, meaning even more students are having difficulty getting enough sleep at night and staying awake during the day. The Ithaca College Center for Health Promotion hosts the THRIVE @ IC Wellness Coaching program, which includes one-on-one sessions and group workshops for building resiliency to help students address these sleep difficulties and other health concerns. According to Program Director Nancy Reynolds, a Health Education Specialist and National Board-certified health and wellness coach, anyone can start taking steps today to improve their sleep cycle and overall wellness.
A good night’s sleep might be hard to get for some, experts agree, but it’s easy to define. According to the Centers for Disease Control and Prevention, adults college-aged and up need seven to nine hours of sleep every night. Sleep is generally better without frequent awakenings and when you keep a consistent routine, waking up and going to bed at similar times every day.
Reynolds points out signs of a poor sleep schedule that may sound familiar to college students.
“Do you feel well-rested in the morning?” Reynolds asks. “What’s your fatigue level during the day? Because that’s another marker of if you’re not getting enough sleep or a good quality of sleep. You’re going to notice during the day that you’re feeling groggy, maybe you’re falling asleep in class, you’re having to take naps every day because you’re so tired.”
It’s a stereotype that college students choose to stay up past midnight and sleep into the afternoon, but many students like Daniel, who requested that his full name not be published, really do have difficulty getting up and staying awake.
According to Reynolds, various aspects of student culture contribute to unhealthy sleep schedules. When students spend time on phones and laptops late into the night, she noted, blue light from these devices prevents the brain from releasing sleep chemicals. Reynolds said that many students also struggle with time management, especially when they’re juggling a lot of responsibilities. That can force students to stay up late to complete all their tasks or assignments, she said. Reynolds also points to a strange element of college culture in which students “compete” to be the busiest or the most sleep deprived—which some students dub the “Sleep Olympics.”
The switch to online learning has further complicated student sleep problems, Reynolds said. Students face even more hours of screen time, and the line between schoolwork and rest of life is blurred. It’s not unusual for students to log in to a class on Zoom and see several classmates attending from their beds. Reynolds explained that taking online classes from the same room all day may be another reason students are struggling with sleep.
“We’re not getting variety in our day in terms of social connections and moving around to different environments—walking around campus, going to the library, hanging out in different students’ rooms,” she said. “We’re not getting the same amount of stimulation that our brains need to make our bodies ready for sleep at night.”
Along with lack of stimulation, Covid-19 has introduced new stressors, such as social, financial, and health-related worries, that may keep students up at night, Reynolds said. She noted that many people are coping with feelings of grief for those they have lost to Covid-19.
Reynolds said that sleep and mental health are strongly interconnected. Bad moods, low energy, and difficulty in focusing due to lack of sleep take a toll on mental health.
Reynolds explained that sleep cycles necessary to maintaining mental wellness can be interrupted for many reasons, one of which is substance use.
“Some students are self-medicating with cannabis,” she said, explaining how students use marijuana to help them fall asleep at night. “The downside is we know scientifically that THC and cannabis prevent us from going into REM sleep, which is dream sleep. If you don’t get dream sleep on a continual basis, your mood may suffer.”
Struggling with mental health can cause poor sleep, and in turn poor sleep can make it difficult to focus on one’s mental health, Reynolds said. Anxiety specifically feeds into this cycle, as racing thoughts keep people awake, and the resulting poor sleep causes them to feel like they can’t handle challenges in their lives, she added.
Daniel agreed that the two were related, saying, “When my sleep schedule is off, I’m often anxious about class work, since I don’t have time or energy to get it done.”
It can seem like an endless cycle. At Wellness Coaching, Reynolds focuses on finding a first step that can help students move forward. This may be anything from mindfulness to a new exercise routine.
“You have to go at it from both aspects—improving the sleep and reducing anxiety,” Reynolds explained.
All aspects of health are related, which Wellness Coaching illustrates through a “Resilience Pyramid” graphic. The bottom building blocks of the pyramid are eating well, “balancing substance use,” moving your body, and getting good sleep. All of these elements are essential for building up personal health and moving up to higher goals on the pyramid such as connecting with others and adopting a growth mindset.
In a first visit with Wellness Coaching, students typically assess their own strengths and challenges on the pyramid. They can then start finding solutions. Wellness Coaching is currently available virtually at no cost for all Ithaca College students. Reynolds encourages students to reach out, even if they only need assistance for one session. (Email firstname.lastname@example.org for more information.)
Reynolds said there are several first steps that a student can take today to getting their sleep cycle back on track. For example, she said, take the time to go for a walk outside, allow yourself breaks between classes, and stay connected with the important people in your life. Be mindful of activities that may be disrupting your sleep cycle, such as upsetting media, substance use, and long naps, Reynolds advised. She also recommends establishing a nightly wind-down routine, a period of 30 to 60 minutes before bed when you shut off your devices and do something quiet like stretching or listening to a podcast.
As the semester nears an end, Daniel is feeling hopeful. With three of his five classes now meeting in person, he’s having less difficulty separating work and leisure environments. He’s also monitoring his afternoon habits, trying to avoid too-long naps. Daniel’s latest report: the sleep cycle is getting back on track.
—By Lorelei Horrell
Lorelei Horrell, an intern at The Sophie Fund, is a second year Ithaca College student with a Writing major and double minor in Sociology and English.