Sad Face

03.18.13

Mental-Health Breakdown: When Harvard Fails Its Students

After a schizophrenic student said the school failed to help her, calls for reform have escalated. But can colleges realistically both educate and heal? Eliza Shapiro investigates.

What should Harvard students get for $57,950 a year?

It’s a question that has rattled America’s most elite college and other top-tier institutions in the wake of a scathing op-ed published last month in the Harvard Crimson by a student struggling with schizophrenia.

According to the article, which was written anonymously and has received more than 4,500 Facebook likes, Harvard’s mental health services repeatedly failed to care for the student, leaving the student suicidal.

In one example, the student told a counselor about hearing voices and was encouraged “to drink chamomile tea and to practice breathing exercises to cope with stress.”

“Where else can I go?” the student wrote. “I am too sick regularly to be in class; how can I hold a job? I decided to stay as I fight for treatment. Harvard may not be willing to pay for treatment, but at least as a student I hope that they are too afraid of bad publicity to let me die should I need hospitalization.”

In the weeks since the piece was published, an occasional conversation about mental health at America’s most elite university—intensified by three apparent suicides in the last year—appears to be coalescing into a movement. At its core is the question of whether students paying record-high tuition rates can expect to get both a great education and top-notch mental-health care at a time in their lives when they are most susceptible to everything from depression and anxiety to schizophrenia.

At a rally the day after the op-ed appeared, students chanted, “Our Harvard can do better!” and held signs reading, “Harvard we are MAD.” A new Facebook group called the “Coalition to Reform Mental Health Services at Harvard” has more than 300 members so far, and a new video series produced by students and faculty features kids sharing their own experiences navigating the school’s mental-health services, and urging viewers to “speak up, you’re not alone.”

“A lot of people used to feel like they were the only ones struggling,” says Lauren Chaleff, a junior who was inspired by the op-ed to start a new student group to assist kids in getting help on campus. “Harvard students are good at putting on a façade of perfection,” she says.

The question of what it means for a student to slip through the cracks at the country’s wealthiest college has students, alumni, faculty, and administration asking what Harvard—and universities like it—owe its students in the first place.

Paul Barreira is a psychiatrist and director of Harvard Health Services. He says it’s not Harvard’s job to provide long-term mental health care, but rather, to treat students so they can be productive and happy, and get the most out of their four years. “This is not a social service agency,” says Barreira. And though Harvard has a $30.7 billion endowment, “there is no endowment dedicated to providing mental health services.”

“Still,” says Barreira, “it doesn’t matter if most students are being helped if one student feels like they’re being screwed.”

Interviews with several Harvard students who have cycled through the school’s mental health services suggest there are others who aren’t receiving the help they need.

One student who asked to remain anonymous says in her experience, campus counselors “nearly cut short” her recovery from severe depression. After reporting suicidal ideations to Health Services, she waited three weeks for an appointment. After her first meeting with a therapist, she was put on a low dosage of a common antidepressant that, she says, has a rare side effect of increasing suicidal tendencies. The therapist warned the student of the side effect and arranged a followup appointment for the following week. The student, sleeping nearly 20 hours a day due to depression, missed the appointment. The therapist never followed up.

The student, sleeping nearly 20 hours a day due to depression, missed the appointment. The therapist never followed up.

The student describes the two days after missing that appointment as some of the worst days of her life. “I didn’t leave my room, nor did I allow anyone inside. I didn’t check my phone or email. I could have quite easily been dead for three days.”

The student’s mother picked her up from campus and she spent the rest of the semester recovering at home. When she returned to Harvard, her father insisted that she seek help from an outside therapist, telling her, “these people clearly don’t care whether you’re alive, so they can’t be in charge of your life.”

Another student, Monica Wilson, says she struggled with attention deficit disorder her freshman year. “Dealing with something that impairs your learning when you’re at one of the best learning institutions in the world is so frustrating and challenging,” she said on a recent afternoon in Harvard’s Ticknor Lounge. “As much as Harvard wants to nurture its freshmen, I’d never felt so neglected in my whole life.”

Wilson said she was on the wrong dosage of medicine, and was having severe depressive mood swings. She said she hit rock bottom one night when her parents drove up from Delaware to talk to her resident dean about finding help.

At the end of her freshman year, Wilson joined an ADD support group through Harvard’s Bureau of Study Counsel, a student resource center offering academic tutoring, counseling, and other self-help resources. She visited Mental Health Services a few times, but says she didn’t connect with the therapists she was assigned. “I’m careful to say I had a bad experience,” she says, “because they were still there for me.”

Wilson says she’s seen progress in the intervening years, and has become a “mental health liaison” to help other Harvard students get the help they need. Freshman year, “I couldn’t tell anyone I was struggling—and now those conversations are common,” says Wilson.

In an interview with The Daily Beast, the student who wrote the op-ed said, “I think it was pretty clear that I did everything I was supposed to do.” Today, the student is getting help and is still enrolled at Harvard.

Other elite schools have been forced to rethink their approaches to mental health in the wake of high-profile suicides. After a freshman jumped to her death on the first night of college at Columbia this fall, students formed a version of Harvard’s mental health liaisons, working to better connect students with counselors. Students at NYU recently accused that school of failing to build a “comprehensive infrastructure for support,” even as the school erected aluminum screens in the library. In the past decade, three NYU students have committed suicide by jumping off the library’s top floor.

“NYU prides itself on its Wellness Exchange and counseling services, but walk into the Wellness Center on any given day, and you will find yourself waiting anywhere from 15 minutes to half an hour to see a counselor—and that’s only after you’ve filled out a mountain of paperwork,” wrote student Emma Dolhai in the school’s newspaper, The Washington Square News, in September. “Speak to a counselor about your issues and you will receive sympathetic nods, a few smiles and the recurring phrase, ‘I understand.’ Now, it merits recognition that not all counselors are created equal, but the lack of effective health care for the struggling verges on the absurd.”

A spokesman for NYU said the school’s program is “considered a model mental health program in the higher education community” and said NYU offers 60 hours of counseling per week as well as a 24/7 emergency Wellness Exchange Hotline.

Harvard has said the school’s suicide rate is about 5 per year for 100,000 students. But the Crimson has disputed this figure, estimating it at 18.18 per 100,000, or as much as 24.24, if students taking leaves of absence are included. The national average for college-age suicides (18 to 25 years old) is 6.18, according to a survey out of University of Virginia.

The Harvard Health Services Building is one of the storied campus’s few drab buildings, a hulking gray concrete slab with industrial wall-to-wall carpeting inside. It’s adjacent to the Holyoke Center, a mall with pizza and sandwich stores, and it houses the Rosenthal Center for Wellness (workshops on meditation and breathing, massage therapy) and Mental Health Services, where students stream in for appointments with one of the school’s 17 full-time therapists.

About 17 percent of Harvard’s undergraduate population, or 1,150 students, use Mental Health Services every year. In addition, the school’s Bureau of Study Counsel offers free professional and peer counseling and support groups, which about 720 students a year take advantage of.

Angela Lee, a Harvard junior studying social anthropology, says she’s managed to make it this far in large part because of the help she’s received in her darkest moments.

Lee has struggled with a mood disorder since high school. She says one of her depressive swings left her suicidal during her freshman year.  Unlike some of her peers, she credits Harvard Health Services with helping to save her life. “I don’t know where I’d be right now without them,” she says.

Lee says her therapist at Health Services worked after hours to ensure that she got appointments and would check in via email to see how she was doing. “They were validating, supportive, and had my best interests at heart,” says Lee. She says she came to Harvard wanting to study English, with the dream of being a writer for The New Yorker, but her personal experiences led her to a focus on the stigma of mental health in East Asian cultures. She now hopes to become a psychiatrist.

Mental health experts say part of the problem for schools is that there is generally more demand than supply. Some 2.2 million students across the country sought professional counseling assistance during the past year, according to 2012 survey data from the American College Counseling Association, and there often aren’t enough therapists to fill that need. Harvard, for example, says its counselor-to-student ratio is 1:750, and that’s compared to a national average of 1:1,600.

Also, many of these students enter school having never seen a shrink before, and may have unrealistic expectations of what a therapist will do for them, says Josh Gunn, director of counseling and psychological services at Kennesaw State University in Georgia. “I have students who come in here, sit down, and ask, ‘So are you going to help me or not?’ They want help by the end of the hour. I say, ‘Yeah, I can, but your expectations are different from the reality of how this works. It’s a process.’”

As the stigma around mental illness is shed and more students ask for help, students have to adjust their expectations for college-centric care from long-term help to short-term treatment focused on getting through school, says Monica Osburn, president of the ACCA.

Osburn gives the example of a student struggling with an alcohol or drug addiction: they may need to be seen five times a week and have someone on call all hours of the night and day in case of a relapse. “That’s not something a counseling center could do,” she says. Instead, mental health programs at colleges around the country are increasingly referring their students out in hopes that they will receive high quality, long-term care in the community that can extend past graduation.

“We reach a threshold,” Osburn says. “If we meet with a student for a month or two and the issue hasn’t been resolved or there isn’t movement, it’s time to go ahead and get that student connected to a higher level of care.” That could mean a therapist in private practice, a support group, or, in extreme cases, a psychiatric hospital.

Says Wilson, the Harvard student who suffered from ADD, “I’m not necessarily sure if it’s the university’s responsibility to take care of a person as a whole. They help you to be your best student.”