“Are You Suicidal?”
The recommended dose and University Mental Health Services
After three panic attacks in a few days during freshman year, I called the University Health Services mental health line. The first question they asked me after my name was “are you suicidal?” I wasn’t, so I received an appointment for the next week. My therapist was caring and helpful, but the sessions quickly became limited to thirty minutes every other week. The doctor apologized that he couldn’t do better—there were simply too many patients. “There are lots of people with much worse problems than you,” he told me sternly. I couldn’t argue with this, but the panic attacks recurred. Eventually I gave up on University Mental Health Services, found a private provider, and recovered. In this last part I was lucky—my family has the resources to pay for a private provider, and my symptoms were minor compared to those of many others.
In contrast to the treatment that I received at UMHS, the recommended dose for those who are diagnosed with depression or anxiety and recommended for cognitive-behavioral therapy (one of the most common types of therapy) is one to two hours of contact with their therapist a week—four to eight times more than what UMHS offered. Of course, nearly every student can repeat some story of a bungled treatment at UHS—most especially of waiting. But what is remarkable about mental health services in particular is that rationing such services means not that students have to wait for the proper treatment, but that they aren’t ever getting the right dose. Mental heath therapy works like chemotherapy treatments—getting the full amount over the right period of time is key. My case is far from unique and one of the least serious I’ve heard of. Other friends have been pressured to leave the system after a certain amount of time, or substitute student-run counseling services, or take medication instead.
This isn’t responsible care, although I believe that most of the doctors are doing the best they can with limited resources. The “are you suicidal?” question is asked first because it is an “urgent care” line, and suicidal patients must be addressed with particular care, but as well because suicidal patients must be prioritized, leaving less serious cases by the wayside. But this kind of response to the shortage of slots creates a number of problems. First, “are you suicidal?” is not the same kind of question as “are you bleeding?”; people are not qualified to recognize the severity of their problems, especially during a crisis. Sometimes patients are worse off than they know—many instances of self-harm and suicide are impulsive. Further, even those who are not suicidal know that if they present themselves as too troubled, they may be given more serious treatment than they want (anyone care to go to the hospital?) and thus downplay their symptoms. Self-reporting, especially over the phone, is a dangerously unpredictable method of diagnosing and assigning priority to patients.
Part of the underlying problem with the availability of UMHS services is that mental healthcare is often dismissed as not as important as other kinds of healthcare, just as mental illness is stigmatized and dismissed. But mental health is crucial to students’ happiness, ability to succeed academically, and—occasionally and most unfortunately— to their lifespan. In the past, the Crimson has not always published the cause of death of Harvard students who commit suicide, but the silence in these articles often indicates that this was the case.
Though suicide presents by far the most serious sign of mental health problems, the real issue is that all mental health cases ought to be taken seriously and addressed with the best quality medical care. Naturally, a system that gives everyone enough care sometimes means that people will be over-treated, just as they are for any other kind of illness; doctors will see patients who need less care than they think they need. But on the whole, the well-being and academic success of students would be best safeguarded by an improved number of mental health clinicians. There are certainly other reasons mental health is a problem at Harvard. Many have commented on the culture of always appearing “fine” rather than admitting weakness, and the level of academic pressure can’t help. These things are important and should be addressed, as well. But given that mental illness is, in fact, an illness, having enough doctors and treatment is the simplest and most obvious necessity. It’s a basic health and safety issue and is also of critical importance to the happiness and success of members of the Harvard community. We have far too many patients; we need more doctors.
Sarah C. Stein Lubrano ’13, a social studies concentrator in Kirkland House, is spending spring 2012 in Cambridge, United Kingdom. Follow her on Twitter at @SarahSteinLubra.