Welcome to our new section, Thrive on Campus, devoted to covering the urgent issue of mental health among college and university students from all angles. If you are a college student, we invite you to apply to be an Editor-at-Large, or to simply contribute (please tag your pieces ThriveOnCampus.) We welcome faculty, clinicians and graduates to contribute as well. Read more here.
In August, the New York Times reported on a lawsuit brought against Stanford University by the Disability Rights Advocates, a non-profit organization representing a group of Stanford students who felt they had been discriminated against by the university. They claimed that the University had effectively forced them to take a leave of absence when they were feeling suicidal, and had been brought to the hospital against their will, often in handcuffs. Although the story shocked the national audience, many Stanford students thought it was about time the University’s mental health practices were brought under the spotlight. As a Stanford student myself and an intern at Thrive, which focuses on improving mental well-being, I thought it would be a good idea to shine a light on how Stanford approaches the mental health of its students on a day to day basis.
Stanford, We Have a Problem
Based on this lawsuit, and the opinions of students, Stanford University has a serious problem. As students on campus try to overcome the anxiety and stress that come from being at one of the top universities in the country, many report struggles to get the help they need on campus. While Stanford itself does not release figures for the number of students making use of mental health resources on campus, it’s clear from recent statistics that students everywhere are struggling. A recent report published in the Journal of Abnormal Psychology found that more than one-third of first-year university students around the world report symptoms consistent with a diagnosable mental health disorder. Another September report published in the journal Depression and Anxiety found that 1 in 5 college students in the U.S. has contemplated suicide. (Read Thrive’s investigation into the root causes of today’s student mental health crisis here.)
One of the most common phrases heard on campus is ‘The Stanford Duck Syndrome.’ This refers to the appearance of a swimming duck: above the water, it is calm and steady, but underneath its legs are paddling frantically. This allegory has been adopted by students to illustrate their stress: while outwardly they often look collected, beneath the surface they are extremely stressed and anxious. “So many students say things like, ‘I was studying all night,’ or ‘I was writing essays all night,’” says Cole Holderman, a senior Human Biology major at Stanford who has struggled with mental health issues for many years, including two diagnoses of manic depressive disorder (the loss of Holderman’s younger brother to cancer during his sophomore year at Stanford culminated in a suicide attempt). “How much you degrade yourself becomes a badge of honor,” Holderman says. Ashwin Agarwal, a senior Computer Science major who has dealt depression for years, says when he first came to Stanford, “the culture of not being okay was normalized to the extent that trying to express that you’re really not doing well got lost in the sea of people complaining about classes and workload.”
Ostensibly, Stanford has a number of resources on campus for dealing with mental health issues. The primary resource is the center for Counseling And Psychological Services (CAPS). But there is also the Bridge Peer Counseling Center, the TItle IX Office, and the Confidential Support Team. Other than CAPS, each of these resources deals with specific issues. The Confidential Support Team focuses on sexual violence and relationship violence, Title IX acts in instances of sexual assault, and the Bridge Peer Counseling Center offers walk-in support for students, billing itself as a short-term, one-off resource that refers students who need longer-term care to CAPS. Finally, there is the Department of Psychiatry, which operates out of the Stanford Hospital. Sophomore Jennalei Louie, a new co-director of Mental Health and Wellness — a student government role that serves as a liaison between all the mental health resources across the campus, helping them communicate with each other — has words of praise for the Department of Psychiatry, based on her first-hand experience with the mental health resources on campus. “They’re a lot more motivated to help, [and] a lot more understanding.” than the other facilities, she says.
Francis Aguisanda, a PhD student in BioScience, says he also received excellent care while he was there. Six days after he voluntarily entered the hospital for suicidal ideation, he was released to a group therapy session in Palo Alto, while also being assigned a social worker to help him navigate through the transition period. Similarly, the Confidential Support Team is well-regarded on campus. Louie says when CST advocated for her, she was able to get a therapist at the Department of Psychiatry in much less time than she had originally been told it would take.
However, CST can only serve a relatively small part of the student population and despite its benefits, the Department of Psychiatry remains a heavily underutilized resource. “The system is so disjointed that most students don’t even know about the outpatient clinic there,” says Louie. The Psychiatry Department rests under Stanford Medicine, a separate entity from CAPS and the other wellness resources on campus. Because of this separation, says Louie, the people at the Department “don’t understand anything about the Stanford mental health system, despite being a 10 minute bike ride from campus,” she says. And many students don’t even know it exists.
Long Wait Times For Help
For most students, the first port of call for mental health related issues is CAPS. As the main mental health resource on campus, it provides counseling as well as psychiatric care. But due to limited resources, CAPS cannot provide long term therapy. Instead they impose an eight session limit on the number of times a student can attend therapy in one year. After they reach that limit, students are referred to a private therapist, usually in Palo Alto, a 15 minute bike ride away, although sometimes they are sent out further out to Menlo Park and other neighboring towns. This can be a serious problem for many students, since they have to organize the appointments themselves, get there themselves, and unless they have the University’s health insurance, they have to use their own, all while still attending classes and staying on top of homework. “The idea of having to leave campus to seek care while depressed, I don’t think it would have happened,” says one student who spoke on the condition of anonymity. “I didn’t get out of bed for a long time, so there’s no way I would have made it to therapy off campus.” The student has been visiting CAPS for help with disordered eating and anxiety, but at the time of this interview had not yet reached the appointment limit.
While some, like Agarwal, have found the care at CAPS helpful (he is pleased with the psychiatrist he has been seeing there, who helps him manage his depression by prescribing medication), many students say that CAPS is reactionary, rather than proactive, about student mental health. Where most students run into problems is when they try to access care. In order to get an appointment with a therapist, students must first book online for an initial assessment phone call that usually lasts only ten minutes. And even that can be a challenge. “The first diagnostic call I had was with someone who was not helpful and really just kind of shut down my request for help, interrupted me, and tried to tell me what my problem was before I had finished explaining it,” says the student who declined to be identified. Only after this call are students allowed to see a therapist, but then they must face long wait times. “I could literally see the building from my dorm, but they told me it would take five weeks to get an appointment there,” the student says. “The logistics need to be refined so there’s not such a large barrier to help.”
The struggle to get an appointment at all with a CAPS therapist is frequent complaint among the students. Last year, the Director of the Vaden Health Center, the overall student health center on campus, where CAPS is located, told the Stanford Daily that although wait times for appointments at the beginning of quarters are typically short, they can stretch to two or even three weeks as the quarter progresses. “The university is definitely aware of [the long wait times]. Enough people have raised enough flags,” says Agarwal.
Understaffed and Underfunded
One look at the CAPS website makes it clear why such long wait times exist. At the time of this article, there were 34 mental health caregivers listed on the site to care for a student body of over 16,000 people. “CAPS is understaffed and underfunded,” Louie explains, “so there’s a very quick turnover rate for therapists and other mental health professionals who work there.” The core issue, she says, is that “the upper administration of Stanford isn’t willing to give more funding to CAPS, even though my organization is trying to request for it. They’re saying the system needs to be changed from within and it’s not a matter of money, but the problem is that we can’t necessarily change the system without the funding to do so,” Louie says. When asked for this story if the new CAPS director planned to hire any new staff, the university spokesperson, Ernest Miranda, declined to comment, and instead pointed towards a public message from the director, which did not reveal whether she intended to hire more staff, nor did it reveal CAPS’ budget.
This status quo can be quite damaging for students with long term mental health issues. “[CAPS] is supposed to be about getting mental health care before you need it, but many times it just deals with crises as they occur,” says Louie. The result of this is that people who may have been dealing with serious issues for a while don’t get prioritized. “They don’t get seen because they’re not suicidal at that moment, which can lead to more critical issues later on,” she says.
Though without the necessary staff or funding to deal with the large numbers of students needing help, it remains unclear how CAPS is supposed to change this. “In my opinion, Stanford as a whole preaches a lot about how they care about mental health, but those words are very rarely actually put into action in a way that is helpful for the student body,” says Louie. Stanford has been aware of CAPS’ issues for some time, even giving it a funding boost back in 2015 to increase staff size. But that seems to have done little to reflect the needs of the student body. “Stanford may do more than most universities, but I also think Stanford has more troubled students than most universities” says Holderman. Indeed, not many other universities can treat students in the psychiatric ward of their own hospital. And, says the anonymous student, “Once you get care, it can be good. It just takes time.”
It does seems strange that a University with a $26.5 billion endowment isn’t willing to commit more money to its students—and won’t do more to fix a glaring problem.
How Other Schools Are Leading Change
“Often it’s not a matter of a lack of resources, more so it’s a matter of priority,” says Laura Horne, Director of Programs at Active Minds, a prominent non-profit organization supporting mental health awareness and education for students. Every two years, Active Minds grants their Healthy Campus Award to universities that have committed themselves to bettering the way they approach mental health. A winning university, like Duke University in 2018, or Cornell University in 2015, is usually one that is “holding itself accountable across multiple departments to make sure they are improving student wellness over time,” Horne says. “And a lot of universities put systems in place to evaluate how they’re doing.” One way Horne suggests universities can begin to do this is to “look at those environmental and structural factors that contribute to increased anxiety among students and address them head on.”
A system that holds itself accountable would be a good fit for a university like Stanford where, when the system fails a student, it can fail catastrophically. Leaving aside those who are actively suing the university, most students’ struggles go completely unreported. Holderman is one of these students. He says that after his brother’s death during the first week of his sophomore winter term, he petitioned the university for a leave. Stanford Residential and Dining Enterprises told him “that if I took a leave then, they couldn’t guarantee I’d have housing my senior year,” he says. And so as a result, “I took 30 hours to fly back to Albuquerque, give the eulogy at my brother’s funeral, and then I was back in classes. I wound up just toughing it out through the worst year of my life.”
When I asked whether the university thought mental well-being was a problem on campus, Miranda, Stanford’s spokesperson, replied in an emailed response: “We know that undergraduate and graduate students struggle with mental health and well-being. That’s because of the pressures of excelling as a student, but also because of the volatile, unstable and changing world we live in. Many also do not feel integrated in our community. Stanford cares deeply about the health and well-being of all of our students, and ensuring strong support for these needs is one of our top priorities in our engagement with students.” Indeed, CAPS’ recent endeavors to embed staff into different community groups on campus is a positive step, says Louie. “I think that having them at community centers really goes to understand the different cultures and the student body on campus.” And as part of his emailed response, Miranda said the administration is continuing to evaluate the Leave of Absence policy.
Stanford’s vice-provost for student affairs, Susie Brubaker-Cole, wrote in an administration blog post that she and her mental health and well-being advisory board, made up of students, faculty and staff, will be devising and implementing a new public-health based approach to mental health once this academic year begins, but offered no further details on what that would be.
The worst part about this story is that it’s not news to students on campus.
So many people already know that CAPS cannot provide long term therapy or that the wait times make it extremely difficult to actually get any care. The purpose of this article is to give people who don’t go to Stanford and who aren’t aware of the struggle that many students go through a glimpse of what that struggle looks like. I hope that whoever reads it might have a better understanding of students trying to manage their mental well-being, and while I believe the way that the university treated the students involved in the lawsuit was despicable, I hope the administration can learn from its mistakes and improve the mental health system on campus.
Whether you’re a student struggling on campus, or know a student who is, here are some microsteps to take to bring hope to the situation.
If you’re struggling…
“You need to find people to talk to,” says Holderman, whether that be friends or an outside therapist. “People get turned away from the first two or three people they talk to and then feel that no-one’s there for them,” he says. But keep reaching out, he says, because “there will always be people who are willing to take care of you.” Horne, of Active Minds, echoes this sentiment: “You don’t need to be in a crisis to seek help, you don’t have to be an expert to provide help, and ‘help’ can come in many different forms. If you are unsure about taking to faculty or staff, find someone else who you can trust and let them help you.”
If a friend is struggling…
“If you know someone who’s going through a hard time, don’t put the onus on them to ask for help,” Horne advises. “A conversation can be life-changing, and you don’t have to be an expert. You just have to listen.” The Active Minds website advises you to follow a system called V-A-R to help a friend in need. We are publishing it here in case it can be of help.
Validate their feelings
Let them know what they’re feeling is okay and that you believe them. Validation sounds like…
“That makes sense.”
“That sounds difficult.”
“I’m sorry you are struggling right now.”
Appreciate their courage
Speaking up can be a challenging step — let them know it’s a good one. Also show you’re there to support them. Affirmation sounds like…
“Thank you for sharing.”
“You are not alone.”
“I’m here for you.”
Refer them to skills and support
Let them know help is available and refer them to appropriate resources. Refer sounds like…
“Sometimes taking time for self-care and listening to a comedy podcast helps me, can we do that together?”
“I’ve been using this meditation app. It’s really helped me slow down my thoughts.”
“I think it might be helpful to talk to someone. I can stay with you while we call/text a hotline.”
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