Cornell’s Student Mental Health Review: “Disappointing”

In a letter emailed to Cornell University students on March 20, Ryan Lombardi, vice president for Student and Campus Life, announced long-awaited plans for a “comprehensive review” of student mental health.

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We support all steps to improve student mental health. We sincerely hope these plans will produce significant improvements. But it is with regret that we must express our disappointment with Vice President Lombardi’s announcement.

Nearly two years ago, after looking closely at student mental health policies and practices across the nation as well as at Cornell, we wrote to President Martha E. Pollack to respectfully seek a robust, independent, external-led review of the mental health challenges facing Cornell’s students as well as the university’s policies, programs, and practices to address them.

We wrote that we had observed systemic failure in Cornell mental health policy and practice, topped by a failure by Cornell administrators “to fully and openly recognize the magnitude of the mental health challenges facing Cornell, and to address them with best practices backed by human and financial resources commensurate to the scale.”

Our concerns are based partly on Cornell’s own data. The 2017 Cornell PULSE Survey of 5,001 undergraduates reported that 71.6 percent of respondents often or very often felt “overwhelmed,” and 42.9 percent said that they had been unable to function academically for at least a week on one or more occasions due to depression, stress, or anxiety. Nearly 10 percent of respondents reported being unable to function during a week-long period on five or more occasions. Nine percent of the respondents—about 450 students—reported “having seriously considered suicide at least once during the last year,” and about 85 students reported having actually attempted suicide at least once in the last year.

Vice President Lombardi’s announcement falls very short of what is needed to address Cornell’s mental health crisis and of what the Cornell administration promised when President Pollack announced the decision last September to conduct a review.

In brief, Vice President Lombardi’s announcement said that the review will be handled by two separate entities. One is an “external review team” to look at clinical mental health services—Cornell’s Counseling and Psychological Services (CAPS). The other is a “university committee” comprised of students, faculty and staff to examine “the ways in which the campus environment and culture contribute to mental health challenges at Cornell.” 

Lack of urgency; lack of a holistic approach; lack of independence, transparency, and accountability; lack of full mandate, scope, and goals; such aspects of the announcement highlight our concerns about the strength of the Cornell administration’s commitment to student mental health.

Lack of Urgency

Some background puts the March 20 announcement in perspective. President Pollack announced in September 2018 that Cornell would undertake a “comprehensive review” of student mental health. It was then only last week, seven months into the academic year, that the Cornell administration finally outlined plans for the review in a late-night, mid-week, out-of-the-blue email to students.

It may also be noted that after we first wrote to the Cornell President seeking a review of student mental health, it took 10 months for the administration to respond with a clear answer, and President Pollack’s answer at that time was “No.”

In that January 2018 response, President Pollack pointed instead to an “external assessment” then being conducted by The JED Foundation, JED’s on-site visit to the Cornell campus in the summer of 2017, and Cornell’s “ongoing engagement with the foundation to ensure we are providing holistic support.”

We wrote to President Pollack again in August 2018, arguing that the JED review was “plainly insufficient.” We noted that the review (or the parts of it that Cornell had chosen to make public) included no findings, and that its recommendations had not addressed 1) CAPS services; 2) Cornell’s suicide prevention policy; 3) community mental health provider services to Cornell students; 4) academic workloads; 5) or faculty and staff handling of students in distress.

Throughout 2018, two student organizations—the undergraduate Cornell Mental Health Task Force and Cornell Graduate Students United—made extraordinary efforts to seek an independent review and to advocate for specific improvements for student mental health.

With the March 20 announcement, the Cornell administration seems to have lost an entire academic year of time for a comprehensive review. Cornell’s 10-day spring break starts this week, and then only five weeks are left until the last day of spring semester classes.

Lack of a Holistic Approach

Vice President Lombardi’s announcement suggests that the Cornell administration has decided against going forward with a true comprehensive review; the announcement indicates a preference instead for a review that is modest and incremental.

The plans outlined on March 20 fragment the review into at least two compartments, rather than establishing a centralized task force to review all Cornell mental health matters in their “comprehensive” entirety. This is at odds with President Pollack’s statements that Cornell would undertake a “comprehensive” and a “holistic” review of student mental health.

We along with others have called for a task force to conduct a comprehensive review due to the interconnectedness and complexity of student mental health challenges. The challenges deal strongly with CAPS clinical services but hardly with CAPS alone; the scope of a comprehensive review must examine university policies, administration commitment, academic culture, campus climate, community mental health services—and the intersection of all these areas.

Lack of Independence, Transparency, and Accountability

The March 20 plans lack a structure or mechanism to ensure the independence of the review, such as the appointment of a recognized external expert as task force chair (or co-chair), who would oversee all elements of the review and report directly and only to the Cornell President; the Cornell administration, rather, seems intent on a review with ambiguous lines of authority and accountability that is guided and closely controlled by the administration itself.

The March 20 announcement said nothing about the charge that the review teams have been given; about who authorized the fragmented review plans; about who appointed the members of the two entities that will conduct the review; or about which university authority the review teams will report to, and by what deadline.

The announcement also failed to identify all but two members of the review teams—nothing was said about the appointment of specific external mental health experts, student leaders, or Ithaca community stakeholders. This lack of transparency (or efficiency) suggests the absence of a strong mandate.

Vice President Lombardi did announce the appointment of co-chairs for the campus environment committee—two associate deans who are both new to Cornell and to Ithaca. Typically, university officials at the vice president and vice provost levels have been assigned leadership roles on mental health task forces at peer institutions.

The March 20 announcement made no commitment to transparently releasing all reports related to the review.

Lack of Full Mandate, Scope, and Goals

The March 20 announcement said nothing about the mandate, scope, and goals given to the clinical mental health services external review team and the campus environment committee. The announcement makes no mention of mandating the two review entities to report findings or make recommendations.

Vice President Lombardi said that the clinical mental health services external review team will “evaluate our services.” With such a vague and narrow mandate, the team may not be empowered to review the many budgetary and other policies that affect the services, or the services provided to Cornell students on referral off campus by community providers.

Vice President Lombardi said that the campus environment committee “will gather information” about the environment and culture at Cornell. With such a meager mandate, the committee may not be empowered to examine the plethora of policies and practices related to mental health (suicide prevention, student disabilities, academic pressure, alcohol and other drug services, residential life, sexual assault, hazing, vulnerable population groups, education and awareness, emergency response)—and their interconnectedness—with the required rigor and vigor.

Lack of Resolve

All this leads us to worry about a lack of resolve in addressing student mental health at Cornell. We continue to have concerns about “an institutional mindset reflecting complacency and defensiveness,” as we wrote to President Pollack nearly two years ago.

We are disappointed by the President’s hesitation and delays in moving forward with a comprehensive review. We were surprised when she declined our request in 2017 to meet with us to discuss our concerns and suggestions. In December, Robert S. Harrison, chairman of the Cornell University Board of Trustees, also declined our request to address the board on student mental health at its meeting in Ithaca scheduled for March 22.

Last fall, we welcomed President Pollack’s announcement that Cornell would conduct a comprehensive review of student mental health. What we said then remains our belief—and our hope:

“There is a mounting mental health crisis facing our young people today, and the goal of the comprehensive review should be not merely to tinker with the existing system but to create a gold standard for supporting student mental health in the years to come. As one of the world’s leading research institutions, Cornell should expect no less of itself.

“We continue to stress the importance of a truly independent, robust, and transparent review, led by an external expert—a recognized public health authority with a strong background in mental health and without any current or previous ties to Cornell. This is vital, both to ensure the best possible outcome and to win the confidence of Cornell students and the wider campus and Ithaca communities that the university administration is doing its utmost to support student mental health.”

—By Scott MacLeod and Susan Hack

Scott MacLeod and Susan Hack are co-founders of The Sophie Fund, a non-profit organization supporting mental health initiatives aiding young people in the greater Ithaca community. The Sophie Fund was established in memory of their daughter, Sophie, a Cornell fine arts student who died by suicide in 2016 while on a health leave of absence.

UPDATE 4/1/19

Cornell Health posted further information about the mental health review on its website:

Cornell’s comprehensive review of mental health

In September of 2018, the Office of the President announced that the university would be conducting a comprehensive review of student mental health, stating that “Cornell Health will work with the campus community during the fall 2018 semester to determine the appropriate scope for a comprehensive review of student mental health at Cornell, anticipating that such a review could potentially begin in early 2019.”

Over the course of fall 2018, feedback was solicited from a wide range of student, staff, and faculty stakeholders, including the university-wide Coalition on Mental Health.The consensus was that the comprehensive review should include two broad themes:

Exploring how best to meet the growing clinical needs of students facing mental health problems

Identifying ways in which the campus environment / campus culture might change to better support student mental health

Cornell’s comprehensive review will be conducted by two different groups working in concert with each other:

A university Mental Health Review Committee composed of staff, students (undergraduate, graduate, and professional), and faculty
An external team of expert evaluators (members to be announced soon)

Upcoming timeline:

This spring 2019, the university is in the process of finalizing membership in the Mental Health Review Committee, and will convene the committee and refine questions to explore with key stakeholders. The committee co-chairs (Miranda Swanson, Associate Dean for Student Services in the College of Engineering and Marla Love, Senior Associate Dean for Diversity and Equity in the Dean of Students Office) will also develop a plan for gathering campus input and collaborate with external reviewers to plan site visits. Between Fall 2019 and Spring 2020, the Mental Health Review Committee will conduct a ‘Listening Tour’ of campus; the external reviewers will conduct their site visits, and submit a written report.

More details will be added to this page soon.

Cornell Health also posted information about “Upcoming changes to Cornell Health’s counseling services”:

Cornell Health is planning changes to student mental health services to provide more rapid access to care. These changes are in response to student feedback and a growing demand for services, and were first announced in a message to the student body on March 20, 2019.

We are adapting a model of care currently in place at Brown University that has proven successful in supporting seamless and rapid access to mental health services.

Beginning in Fall 2019:

Students can have access to same-day counseling appointments (or next-day appointments, if they contact us in the afternoon)
Students will have flexibility in who they see: they can select a therapist based on convenience (i.e., whomever has an opening on a given day at a specific time), or wait to see a therapist of their choosing
Students who are interested in continued counseling will be able to select half-hour or hour-long appointments (students’ counselors will partner with them in determining the frequency and length of appointments that will meet their needs)
Students will have increased access to psychotropic medication management services

How we plan to accommodate these changes:

Beginning fall 2019, every therapist’s day will include time slots for same-day appointments. These same-day appointments will be focused on addressing immediate needs and problem-solving. We will gain much of this time in the schedule by converting the “brief assessment” telephone screenings and the traditional “CAPS intake” appointments into times that can be scheduled to directly address the student’s concern.

Additionally, we will offer half-hour counseling appointments along with the traditional hour-long appointments to increase the number of appointments available each day. We anticipate the rapid access and the flexibility built into this new model will be a welcome change for students.

More details will be added to this page soon.

Report Card: D- for Cornell’s Mental Health Leave of Absence Policy

In a scathing critique of student mental health at Ivy League schools, a new report gives Cornell University a grade of D- for its mental health leave of absence policy. No Ivy scored higher than a D, and Yale and Dartmouth were assigned F grades.

“The leave of absence policies do not reflect institutional commitment to supporting students with mental health disabilities,” the report said. “When it comes to inclusion of students with mental health disabilities, the Ivy League schools do not provide the leadership that the landscape of higher education desperately needs…The findings demonstrate that the Ivy League schools, the most elite institutions in our nation, are failing to lead the sector of higher education in supporting students with mental health disabilities.”

The Ruderman Family Foundation, a Boston-based organization advocating for and advancing the inclusion of people with disabilities in our society, issued the report in December. The report, “The Ruderman White Paper on Mental Health in the Ivy League,” was authored by Miriam Heyman, a foundation program officer responsible for the development and oversight of disability inclusion programs.

While generally critical of how universities are meeting student mental health challenges, the report focuses on the aspect of leave of absence policies. Noting that a health leave is a potentially useful mechanism enabling a student to focus on well being and recovery, “schools may also use the leave of absence as a tool for discrimination, pushing students out of school who are entitled by law to receive accommodations and supports which would enable them to stay.”

The report claims that college campuses are facing a unique crisis, arguing that the prevalence rates of mental illness among college students are far larger than prevalence rates for age-matched non-college individuals.

The Ruderman report says:

“Meanwhile, college resources provide woefully inadequate support to students. … The scope of the problem, combined with the lack of resources available to address the problem, is exerting a horrible toll. Suicide is among the most tragic consequences of untreated mental illness and it is the second leading cause of death of college students…”

“Clearly, colleges need to invest in increasing the availability of mental health professionals on campus. One clinician for every one thousand students is not enough, and this ratio represents the availability of clinicians on the campuses with the most resources.”

The report speculates that college administrators are wary of bad press coverage about campus suicides, and that their fear of a lawsuit if a student takes their own life motivates them to remove students from campus.

In the study, Ruderman cited “problematic” issues in seven of 15 categories related to Cornell’s leave of absence policy. It said there was “room for improvement” in two other issues, and that the university followed “best practice” in six others.

Here are the 15 categories and Cornell’s scores in them:

PUTTING A STUDENT ON LEAVE

1. Does the involuntary leave policy include “threat to self” language (with the premise that the inclusion of this language is facially discriminatory)?

The policy states, “…whether the student’s behavior is disruptive of the university’s learning environment and whether the behavior poses a direct threat to the safety of others…”

Grade: Best Practice

 
2. Do leave policies specify that the student is entitled to reasonable accommodations which would enable them to stay at school?

The policy states, “Consideration will also be given to accommodations that may reasonably be provided that will mitigate the need for the involuntary leave.” There is no mention of individualized assessment.

Grade: Ambiguous / Room for improvement

 
3. Do leave policies include language against generalization, fear, or stereotype?

There is no language against generalization, fear, or stereotype.

Grade: Problematic

 
4. Is there language about community disruption?

The policy states, “When there is an actual or the threat of a community disruption, Cornell University may place a student on an involuntary leave of absence.”

Grade: Problematic

 
5. Does the policy empower students to work with mental health professionals of their choice?

The student must get approval to take a leave and return from leave from Cornell Health (it can’t be an outside treatment provider). Also, a Cornell Health clinician or counselor will provide “…specific treatment recommendations as part of the HLOA agreement. Compliance with the treatment expectations is a primary factor in approving a student’s return to Cornell.”

Grade: Problematic

 
6. Can the student initiate the process at any time?

There are no health leaves of absence after the last day of classes.

Grade: Problematic

 
7. Are policies and procedures transparent?

All decisions regarding return from an HLOA are made by an interdisciplinary committee of Cornell Health clinicians. Student requests to return are denied only when the committee is unanimous in its opinion that a return is not advisable at this time. The return process checklist also provides transparency. Also, the involuntary leave policy states that involuntary leaves are imposed only “in extraordinary circumstances.”

Grade: Best practice

 
THE LEAVE ITSELF

8. Is there a minimum length of time for the leave?

The policy states, “The duration of the leave is to be determined by the vice president for student and campus life based on the facts and circumstances leading up to the imposition of the involuntary leave…For health leave, amount of time will depend on the circumstances.” The mental health provider report requests information, including “Once achieved, has the substantial reduction [in behaviors such as suicidal behaviors, self injury, food purging] been maintained stably for 3 consecutive months?” This may suggest that three months is the minimum duration.

Grade: Ambiguous / Room for improvement

 
9. Does the school specify a maximum duration or maximum number of leaves?

There is no language about maximum number or duration.

Grade: Best Practice

 
10. Does the policy identify a liaison or contact person at the school?

The policy does not identify a liaison or a contact person.

Grade: Problematic

 
11. Are students on leave prohibited from visiting campus?

The policy states, “The student may visit campus only as authorized in writing by the vice president for student and campus life.” The policy states, “Where appropriate, impose a persona non grata order on a student who has been placed on involuntary leave.”

Grade: Problematic

 
12. Are there work or school requirements?

The policy states, “It is expected that the student uses the time away from the University for treatment and recovery.” The policy states, “Until the student complies with the pre-requisites to enrollment mandated by the vice president for student and campus life. An individualized assessment will be made for the student to determine if the pre-requisites have been satisfied.”

Grade: Best practice

 
RETURNING FROM LEAVE

13. What is the deadline to apply for return?

The student must notify Cornell Health in writing of their wish to return by June 1 for a Fall return and November 1 for a Spring return. Submit documentation by July 1 for fall semester return, by December 1 for spring semester return. The score is based on the documentation deadlines.

Grade: Best Practice

 
14. Does the policy mention confidentiality, and facilitate confidentiality by specifying that medical records should be submitted to health services, not school administration?

Voluntary leave policy states – “December 22, 2017: Added note at end of procedures indicating that requests for health-care related leaves should be referred to Cornell Health to initiate the HLOA [Health Leave of Absence] process, and that academic units should not request health information or medical records directly from a student.” There is no explicit mention of confidentiality.

Grade: Ambiguous / Room for improvement

 
15. Does the policy facilitate student participation in university housing?

The policy does not mention housing.

Grade: Problematic

 
The rating system allotted a score of 1 if problematic, 2 if there was room for improvement, and 3 for best practice.

The Ivy League ratings:

Brown University: 29/45 D

Columbia University: 29/45 D

Cornell University: 28/45 D-

Dartmouth: 23/45 F

Harvard University: 28/45 D-

Princeton University: 29/45 D

University of Pennsylvania: 31/35 D+

Yale University: 24/45 F

A report on Cornell student mental health by the JED Campus program published in April included recommendations on health leave of absences:

“Develop/refine a written medical leave of absence policy that is consistent with JED Campus recommendations.”

“Ensure that all leave policies are transparent and easily accessible to the campus community.”

Cornell responded saying:

“Cornell Health continues to work with all of the academic units at Cornell to make the health leave process as straight forward as possible.

“The university’s Voluntary Leave policy was recently revised in December 2017 to address identified issues.”

In 2017, The Sophie Fund, an Ithaca nonprofit organization advocating for youth mental heath, released a proposal aimed at supporting students taking leaves of absence for mental health reasons from Cornell University, Ithaca College, and Tompkins Cortland Community College.

The proposal calls for an Ithaca community-based program featuring a “leave of absence coach,” a community outreach worker providing practical guidance and moral support for students in transition. It also proposes a website hosting useful information about college leave policies, strategies for fruitful time off from school, local housing options, and employment opportunities. To date, no tangible progress has been made in funding or implementing the proposal.

“Leaves of absence entail an often unexpected, abrupt, and painful loss of a structured environment that includes a support network of friends, professors, university staff, roommates and other fellow students, campus organizations, cultural and athletic facilities, and school medical providers,” the proposal says. “Testimonies from students on mental health leaves of absence relate how it can be a confidence-crushing experience that induces shame and guilt.”

Click here to download a copy of the proposal.

In April 2017 and again in August 2018, The Sophie Fund’s founders, Scott MacLeod and Susan Hack, called on Cornell University President Martha E. Pollack to launch an independent external-led review of student mental health. They said the review should include “Cornell’s policies, programs, and practices for students taking HLOA for mental health reasons.”

In a September 18 email to Cornell students reported by the Cornell Daily Sun, Vice President Ryan Lombardi announced plans for “a comprehensive review of student mental health” that will bring together “internal and external partners.”

In a September 18 email to the Sun, Lombardi said: “While for many years the university has engaged in regular assessment of student mental health needs and evaluation of services and programs, the decision to pursue an additional comprehensive review of student mental health reflects the University’s commitment to promoting health and well-being as a foundation for academic and personal success.”

Cornell Task Force Demands “Gold Standard” for Student Mental Health

The student-run Cornell Mental Health Task Force has issued a set of recommendations for immediate steps to improve the campus climate and services for mental health, and called on the university administration to ensure that an upcoming comprehensive review of student mental health is “independent, thorough, and transparent,” and involves “full student participation.”

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Statue of Ezra Cornell in the Arts Quad

The recommendations addressed to the Cornell administration proposed three immediate initiatives to be carried out in two phases, covering improvements in student mental health services, mental health education and collaboration within the Cornell community, and academic policies and practices that impact student mental health.

The task force also called for the creation of “an official Standing Committee on Mental Health,” comprised of task force members and other students, “tasked with overseeing ongoing implementation of best practices for student mental health, reviews, and serving as a liaison between students and their needs and the administration.”

The task force, co-chaired by Matthew Jirsa ’19 and Joanna Hua ’20 and consisting of more than 20 students, issued the recommendations earlier this week after a six-month study and following an October 19 public forum where draft recommendations were presented and discussed.

Specific recommendations of the task force included:

Hiring more psychological counselors to accommodate rising numbers of students seeking services; reducing wait times for counseling appointments; requiring counselors to undergo diversity training; improving access to off-campus psychological services; requiring mandatory suicide prevention training for Resident Advisors; requiring mandatory mental health training and an accountability system for faculty; introducing a standardized grading system to reduce academic stress; creating a student mental health advocate; providing support to students at every stage of the process for taking a leave of absence for mental health reasons.

In its letter, the task force said it sought to collaborate with the administration “to mutually work towards profound change, with the ultimate end of making Cornell a standout institution where mental health is holistically and completely championed, academically, clinically, and culturally.”

The task force applauded recent announcements by President Martha E. Pollack and Vice President Ryan Lombardi that the administration intends to launch a “comprehensive” review of student mental health. The task force added: “We call on the administration to ensure that this review is independent, thorough, and transparent, includes full student participation, and strives to become a ‘gold standard’ for addressing mental health on the college level to which other universities can look for guidance.”

The task force commended many aspects of Cornell’s current mental health efforts, noting the hiring of additional Counseling and Psychological Services (CAPS) counselors, the recent formation of a broad-based campus Coalition on Mental Health, and ongoing support for peer-to-peer programs aimed at reducing stress. “These measures are a fantastic start, but with high wait times [for CAPS appointments] and recent incidents of suicide attempts, we are far from where we need to be,” the task force said.

The task force said that Cornell’s “Ivy-League culture of hyper-competition and ‘stress Olympics’ is centered in the middle of a rural health system—a situation that creates a high demand for mental health services despite rural issues of lower mental health professional supply.” It cited Cornell Pulse data indicating that four of 10 undergraduates surveyed were “unable to function academically for at least a week in the past year due to depression, stress, or anxiety” and that 12 percent of surveyed Cornell students had seriously considered suicide within the past year.

A summary of the Cornell Mental Health Task Force key recommendations:

Mental Health Services

—Develop a system of intaking students that is more efficient, shortening wait times and improving access while also ensuring quality of care.

—Pledge to hire new counselors in the event that the number of students seeking CAPS services continues to rise in the coming semesters/years.

—Seek input from the student body concerning whether or not the current counselors are diverse and adequately understand a broad range of mental health concerns.

—Require all counselors to obtain a baseline of diversity training in order to accommodate for the diversity and intersectionality of mental health concerns.

—Share estimated wait times for appointments with counselors on the Cornell Health website for transparency.

—Create a mechanism for anonymous referrals of persons in distress to mental health resources before extreme actions such as calling the police.

—Establish a clear and straightforward method for switching counselors within Cornell Health if requested.

—Create of a page on the Cornell Health website that addresses considerations that are made when matching patients with counselors, clearly outlines the process for switching to a new counselor, and lists resources for students who are unhappy with their care (i.e. patient advocates).

—Allow students to state their counselor preferences (demographic, personality type, etc.) during the 15-minute phone screening and accommodate their requests.

—Create an anonymous outlet for students to voice complaints about their counselor to be utilized in counselor training.

—Enable students to change counselors by speaking with a receptionist or patient advocate, or by sending an email to their counselor.

—Create an Off-Campus Therapy Referral Network to sustain relationships with therapists in the Ithaca community.

—Provide an easily accessible list of off-campus therapists accepting Cornell students and accepting the Student Health Plan including those willing to offer prorated/discounted prices.

 

Mental Health Education and Collaboration

—Create a mental health program for Residential Advisors covering mental illnesses and substance abuse and including mandatory QPR suicide prevention training.

—Provide basic mental health information and learning to incoming freshmen while underscoring support from various communities at Cornell.

—Create a Standing Committee on Mental Health that helps implement initiatives and objectives, and serves as a liaison between students and administrators about mental health services and concerns.

—Establish mental health training for all faculty and staff members, and advisors/administrators, including concise mandatory manuals and training programs.

—Establish a system of accountability for professors to be more cognizant and understanding of mental health issues among students.

 

Academic Policies and Mental Health

—Appointment of a Mental Health Advocate who can represent students in academic settings where mental health is a factor in academic success or stress.

—Present students with their rights and when necessary have the Mental Health Advocate serve as a facilitator between students and professors.

—Ensure that professors understand mental health complexities and accommodate students as needed.

—Implement a standardized and transparent grading scheme as a method of course stress reduction.

—Provide housing aid to students taking a leave of absence for mental health reasons who don’t have supportive households to return to.

—Provide a system of support and contact for students at every stage of the leave of absence process.

Cornell President Promises Holistic Review of Student Mental Health

Cornell University President Martha E. Pollack says that Cornell will be conducting a “comprehensive review” of student mental health, possibly beginning in early 2019. She says the “team” at Cornell Health had advocated for the review “to provide an opportunity to look holistically at mental health on our campus.”

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Cornell University campus

Pollack’s statement came in a letter dated September 20 to Scott MacLeod and Susan Hack, the co-founders of The Sophie Fund. In a letter dated August 23, they had called on Pollack to “appoint without further delay an independent, external-led task force to review and assess the mental health challenges for Cornell students, and the university’s policies, practices, and programs to address them; and to make recommendations to the Cornell President to ensure that the university is implementing current best practices.”

MacLeod and Hack published their letter to Pollack in a blog post on September 8 headlined, “Time for a Mental Health Task Force at Cornell.”

In her reply to the MacLeod/Hack letter, Pollack said: “We will be conducting a comprehensive review of student mental health at Cornell… The team at Cornell Health—those in both clinical and educational roles—have advocated for this review to provide an opportunity to look holistically at mental health on our campus.”

Pollack said that Cornell Health “will work with the campus community” beginning this semester “to determine the appropriate scope for this review, which could potentially begin in early 2019.”

Pollack thanked MacLeod and Hack “for your advocacy for providing the best possible environment to support the mental health of Cornell students.”

Pollack’s letter did not respond directly to MacLeod/Hack’s request for an “independent, external-led” review. In their letter, they wrote: “The independent task force should be led by a recognized public health expert with a strong background in mental health and without any current or previous ties to Cornell or to organizations and professional associations focused on collegiate mental health.”

In a September 18 email to Cornell students reported by the Cornell Daily Sun, Vice President Ryan Lombardi announced plans for “a comprehensive review of student mental health” that will bring together “internal and external partners.”

In a September 18 email to the Sun, Lombardi said: “While for many years the university has engaged in regular assessment of student mental health needs and evaluation of services and programs, the decision to pursue an additional comprehensive review of student mental health reflects the University’s commitment to promoting health and well-being as a foundation for academic and personal success.”

In a statement to the Graduate and Professional Student Assembly (GPSA) on September 24 reported by the Sun, Lombardi said he “can’t speak … to exactly who” will be conducting the review but that the administration does “envision it being external audiences.”

“I think part of the first step is to understand what we want to look at, and then I think that will really inform that broader question about who’s best to come in,” he said. “Obviously I think we’re going to want people to have expertise in mental health. I don’t want that just to be Cornell folks.”

In her letter to MacLeod and Hack, Pollack noted that the intention to conduct a comprehensive review was cited in an update about “diversity and inclusion” initiatives posted on the Office of the President’s website, apparently in early September, and announced in Lombardi’s email to students on September 18. The reference read as follows:

Conduct a comprehensive review of student mental health.

Cornell Health will work with the campus community during the fall 2018 semester to determine the appropriate scope for a comprehensive review of student mental health at Cornell, anticipating that such a review could potentially begin in early 2019.

MacLeod and Hack, whose daughter Sophie (’14) died by suicide while on a health leave of absence in 2016, initially wrote to Pollack on April 19, 2017 detailing their concerns about “systemic failure” in Cornell’s institutional handling of mental health matters, and calling on her to launch an independent task force review. However, in a letter to MacLeod and Hack on January 11, 2018, Pollack declined their request, citing an “external assessment” conducted by The JED Foundation, JED’s on-site visit to the Cornell campus in the summer of 2017, and Cornell’s “ongoing engagement with the foundation to ensure we are providing holistic support.”

MacLeod and Hack said that they wrote to Pollack in August asking her to reverse her decision after studying the JED review and finding it “plainly insufficient.” They said a glaring omission was the lack of any reference in findings or recommendations regarding the capacity of the Counseling and Psychological Services staff to meet the demands of students for services. Another omission, they said, was the lack of any reference to the capacity of community mental health providers to address the needs of Cornell students referred to those off-campus services by CAPS. They said that the JED-review documents reported no findings and recommendations in areas such as academic workloads and faculty and academic staff handling of students in distress, and appeared to lack a comprehensive assessment of Cornell’s suicide prevention policies and practices.

MacLeod and Hack also questioned the independence of the review, pointing out that institutions of higher education pay The JED Foundation a fee to become what JED calls “partners” in the JED Campus program. They also said that the JED review entailed only one on-site campus visit by a JED External Contributor, one that lasted merely three hours and did not include meetings with any of the community providers who receive many CAPS referrals. They also said it appeared that Cornell had not released all relevant documents pertaining to the JED review.

In response to Pollack’s September 20 letter, MacLeod and Hack said in a statement:

“We welcome President Pollack’s personal engagement and specifically her commitment to conducting a comprehensive review of student mental health at Cornell. We commend Cornell Health for advocating for this review “to provide an opportunity to look holistically at mental health on our campus,” as President Pollack said. Lastly, we are encouraged to know that the Cornell administration will consult with students and other members of the community as the review proceeds.

“There is a mounting mental health crisis facing our young people today, and the goal of the comprehensive review should be not merely to tinker with the existing system but to create a gold standard for supporting student mental health in the years to come. As one of the world’s leading research institutions, Cornell should expect no less of itself.

“We continue to stress the importance of a truly independent, robust, and transparent review, led by an external expert—a recognized public health authority with a strong background in mental health and without any current or previous ties to Cornell. This is vital, both to ensure the best possible outcome and to win the confidence of Cornell students and the wider campus and Ithaca communities that the university administration is doing its utmost to support student mental health.”

The full September 20, 2018 letter from President Pollack:

Dear Ms. Hack and Mr. MacLeod,

Thank you for your letter dated august 23, 2018, and for your care and concern for the mental health and well-being of Cornell students.

As you may have seen in our recently announced diversity and inclusion initiatives (https://president.cornell.edu/diversity-and-inclusion-initiatives/), we will be conducting a comprehensive review of student mental health at Cornell. Beginning this semester, Cornell Health will work with the campus community to determine the appropriate scope for this review, which could potentially begin in early 2019. Vice president Lombardi also shared this news with our students in a message sent on September 18, along with other updates and investments in mental health support services.

The team at Cornell Health—those in both clinical and educational roles—have advocated for this review to provide an opportunity to look holistically at mental health on our campus. We also continue to engage with and support mental health resources in the larger community.

Thank you again for reaching out to me and for your advocacy for providing the best possible environment to support the mental health of Cornell students.

Sincerely,

Martha E. Pollack

Time for a Mental Health Task Force at Cornell

We have written a letter to President Martha E. Pollack stating that the recent review of Cornell University’s mental health practices by The Jed Foundation is “plainly insufficient” and calling on her to appoint an external-led task force to perform an “independent, transparent, and robust review.”

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Statue of Andrew Dickson White, Cornell’s first president, in the Arts Quad

Our daughter, Sophie Hack MacLeod ’14, died by suicide at age 23 in Ithaca while on a Health Leave of Absence from Cornell, where she was enrolled in the College of Architecture, Art, and Planning. In setting up The Sophie Fund in her memory to advocate for mental health initiatives aiding young people in the greater Ithaca community, we became very concerned about the mental health policies, programs, and practices for supporting Cornell students.

We initially wrote to President Pollack on April 19, 2017, just after she assumed office as Cornell’s 14th president, detailing our concerns about “systemic failure” in Cornell’s institutional handling of mental health matters, and called on her to establish an independent task force to report on Cornell’s mental health policies, practices, and programs and to make recommendations on needed improvements.

In a January 11, 2018 email to us, President Pollack declined our request. She cited an “external assessment” conducted by The JED Foundation, JED’s on-site visit to the Cornell campus in the summer of 2017, and Cornell’s “ongoing engagement with the foundation to ensure we are providing holistic support.” She also cited the JED review in subsequent remarks to Cornell’s Graduate and Professional Student Assembly (GPSA) and the Cornell Daily Sun.

In a letter last month, dated August 23, we informed President Pollack that we have examined what Cornell has made public about JED’s “external assessment” and concluded that it is plainly insufficient. It is not the independent, transparent, and robust review that we sought and that we believe Cornell’s students deserve. And it does not adequately address many of the concerns we raised in our original 2017 letter—about practical issues such as campus and off-campus mental health services and the high incidence of sexual assault and hazing misconduct, as well as policy concerns such as a defensive mindset that appears to prioritize Cornell’s public image over the welfare of students struggling with mental disorders.

We pointed out that, despite her promise to release the JED report, to date Cornell has chosen to publish—on the Cornell Health website—only two documents related to the review.

A glaring and troubling omission in the two posted documents is any reference in findings or recommendations regarding the capacity of the Counseling and Psychological Services staff to meet the demands of students for services. Another omission is any reference to the capacity of community mental health providers to address the needs of Cornell students referred to those off-campus services by CAPS. The documents report no findings and make no recommendations in areas such as academic workloads and faculty and academic staff handling of students in distress.

We explained to President Pollack that it does not appear that the JED review included a comprehensive assessment of Cornell’s suicide prevention policies and practices. However, we commended Cornell Health Executive Director Kent Bullis for recently announcing provisional support for the Zero Suicide Model initiative within the framework of the Tompkins County Suicide Prevention Coalition.

As we wrote in our letter to President Pollack, we do not believe that the JED review can be considered an independent external assessment because institutions of higher education pay The JED Foundation a $22,000 fee to become what JED calls “partners” in the JED Campus program. Furthermore, the director of Cornell’s Counseling and Psychological Services has a longstanding professional relationship with JED and is a member of its Advisory Board. The JED External Contributor who conducted JED’s on-site visit to the Cornell campus is a professional colleague of the CAPS director.

Neither of the two posted documents contain any JED findings; rather, in the first document JED merely makes brief comments on Cornell’s self-reported survey responses, and in the second document JED makes recommendations without reference to any findings they are presumably based on.

We understand that the review entailed only one on-site campus visit by a JED External Contributor, and the visit lasted merely three hours. We also understand that the External Contributor’s visit did not include meetings with any of the community providers who receive many CAPS referrals.

According to the JED Campus program, its partnerships with participating colleges’ mental health programs include the following five elements, which Cornell has not released: a Strategic Plan “complete with detailed objectives and action steps for implementation”; a Fourth-Year Post-Assessment “evaluating systems change”; a Healthy Minds Study, which JED describes as “an in-depth assessment of students’ attitudes, behaviors and awareness of mental health issues”; a Feedback Report on the JED Campus and Healthy Minds Study findings; and a Summary Report containing data analysis for the JED Campus assessment and the Healthy Minds Study. JED declined to release its Cornell report to us, citing a confidentiality agreement with Cornell.

We believe that the JED review is clearly inadequate for a comprehensive assessment of the serious mental health challenges faced by a large university campus today, especially one located in a small upstate community. As we reminded President Pollack, the 2017 Cornell PULSE Survey of 5,001 undergraduates reported that 71.6 percent of respondents often or very often felt “overwhelmed,” and 42.9 percent said that they had been unable to function academically for at least a week on one or more occasions due to depression, stress, or anxiety. Nearly 10 percent of respondents reported being unable to function during a week-long period on five or more occasions. Nine percent of the respondents—about 450 students—reported “having seriously considered suicide at least once during the last year,” and about 85 students reported having actually attempted suicide at least once in the last year.

We have often heard the view that Cornell’s mental health policies are better than those of many universities, and that Cornell’s mental health statistics are no worse. We find such a complacent view to be surprising and disappointing, especially coming from a world-renowned research institution. In fact, these escalating mental health challenges require a relentless approach in response from everyone in a position to act. We truly hope that President Pollack—and Cornell—will lead the way.

—By Scott MacLeod and Susan Hack

Scott MacLeod and Susan Hack are the co-founders of The Sophie Fund, a nonprofit organization advocating mental health initiatives aiding young people in the greater Ithaca community. The organization is named in memory of their daughter Sophie Hack MacLeod, a Cornell fine arts student who took her own life in Ithaca in 2016.

UPDATE 9/7/18:

Lee Swain, director of JED Campus, sent the following comment to The Sophie Fund:

I do see one inaccuracy I’d like to correct related to this paragraph:

“According to the JED Campus program, its partnerships with participating colleges’ mental health programs include the following five elements, which Cornell has not released: a Strategic Plan “complete with detailed objectives and action steps for implementation”; a Fourth-Year Post-Assessment “evaluating systems change”; a Healthy Minds Study, which JED describes as “an in-depth assessment of students’ attitudes, behaviors and awareness of mental health issues”; a Feedback Report on the JED Campus and Healthy Minds Study findings; and a Summary Report containing data analysis for the JED Campus assessment and the Healthy Minds Study. JED declined to release its Cornell report to us, citing a confidentiality agreement with Cornell.”

The elements you describe are part of our current program. I believe Erica explained to you how the program has changed. When Cornell joined, the program was designed slightly differently than is currently described on our website. For instance, we did not have a partnership with or include the Healthy Minds Study at that time. So, Cornell did not participate in that data collection. Also, Cornell is not completely through the four year program yet, which is why they have not posted or shared the “fourth year post assessment” as it has not yet been completed. It should also be noted that because Cornell joined an earlier version of the program than what is described on the website, they also only paid $1,950, the cost of the program at that time, not the $22,000 that schools currently pay which includes the Healthy Minds Study, a day long visit (sometimes a bit more) and policy and protocol review (both at the beginning of the program and throughout as policies are changed/adapted). We also collect more data on counseling center utilization, crisis incidents, and staffing patterns in the current version of the program than in the original version.