Students Reach For Help in Vain

One Saturday night last spring, Ry an Wilkes ’04 showed his entryway tutor the suicide letter he had written earlier that day.

The tutor told him to make an appointment with a counselor at the Bureau of Study Counsel on Monday.

For Wilkes, who had attempted suicide once before at Harvard and suffered from severe depression, the tutor’s reaction was shockingly dismissive.

“I figured they would send me to [University Health Services (UHS)], call UHS...I was going out of my mind. I was going to jump off of a building,” the former Winthrop House resident says of the hours spent waiting after he took the letter to his tutor.

“I was just waiting, I thought someone was going to come in my room and take me to UHS and get me help. I thought, ‘Someone’s going to help me.’ And no one did,” he says.

The next day, Wilkes placed his computer, with the letter on the screen, in front of a friend in the dining hall. The friend took him to UHS, where doctors checked Wilkes into a psychiatric hospital.

He’s now home in Atlanta, not sure if he’ll return to school.

Through three years of on-and-off enrollment at Harvard, Wilkes says he reached out to administrators and residential advisers several times and was unable to get lasting help.

Wilkes says his mental health problems started his freshman year when he was “dragged out of the closet” by one of his four roommates.

He attempted to commit suicide by overdosing on pills just before Thanksgiving and was sent to a nearby psychiatric hospital. After agreeing to get therapy for the rest of his freshman year, Wilkes was allowed back in school, and met regularly with Assistant Dean of Freshman Philip A. Bean and his hall proctor.

Wilkes stayed through freshman year and entered again as a sophomore, his mandatory therapy over. Throughout the entire semester, he says, he received no contact from Harvard administrators or tutors regarding his mental health. Wilkes never heard from Bean and, even after he sent his former proctor an e-mail asking to meet, she never contacted him.

“I don’t know if it was because I was a sophomore, or they thought I was better, but there was no contact at all between me and any of those people who had been in contact with me before,” Wilkes says. “I really didn’t feel like I could go to those people like before...what was the point of talking to them, they don’t give a shit.”

By the middle of spring semester, Wilkes’ depression had escalated. He left school, returning almost a year later for the spring 2003 semester. But Wilkes says coming back to Harvard aggravated his depression almost immediately when he was placed in a double with a roommate whose friends used homophobic slurs.

As he grew more anxious and depressed, Wilkes began doing illegal drugs. He read a book on euthanasia to learn what type of pills to use to kill himself, and ordered the pills online.

“I gave up on school. I was sick of dealing with depression, being gay, homophobia—I decided to kill myself,” Wilkes says. “I had to wait a long time for the pills, and I was just going more and more downhill.”

Wilkes’ friends noticed something was wrong, and his resident tutor e-mailed him to suggest another leave of absence. But he says he was beyond caring about his recovery and decided that staying in school would be easier than going through the withdrawal process yet again.

Finally, Wilkes actually wrote the suicide note, and took it to his tutor.

Wilkes says his visit to the tutor that weekend was his cry for help—and it went unanswered. Though his friend did take him to UHS, Wilkes says the incident with his tutor, and the persistent distance between him and his residential advisers following his one year of therapy, left him thinking that no one at Harvard cared enough to help him.

He took a second leave of absence soon after, and has not returned to school.

Wilkes’ experiences with Bean, his proctor and his tutors by no means represent all students’ interactions with advisers in the College residential system. Student interaction with tutors is extremely variable—some say their residential and academic advisers have been caring and helpful in dealing with their mental health problems, while others say they’ve never even met them.

And students say the response of residential advisers, teaching fellows and professors to mental health problems can have an overwhelming influence on recovery.

“In my experience, the presence of caring and accessible tutors…has quite literally been the difference between despair and success,” Elizabeth J. Quinn ’04 wrote in a letter to administrators about mental health services.

But the current College system—comprised of residential and academic advisers whose level of training and interest in helping students with mental health problems varies widely—makes finding that crucial support a gamble.

Health in the House

Katherine T. Kleindienst ’05 says her academic adviser and sophomore tutorial leader was “unquestionably the biggest figure” in getting her help for her depression.

After spring break last year, Kleindienst says she felt inexplicably sad even though everything in her life was going well. She had just been placed in a higher crew boat and her grades for the semester were better than usual.

Around that time, her tutor e-mailed Kleindienst about academics and also asked more generally about how she was doing. Kleindienst confided that she had been feeling depressed, and her tutor scheduled her an appointment at UHS.

“Would I have gone to UHS myself? I doubt it,” Kleindienst says. “Especially when you’re depressed, you’re not taking very much initiative for anything. It really does take someone from the outside saying, ‘I think maybe you do have a problem.’”

UHS Mental Health Services Director Richard D. Kadison says tutors or other administrators can often successfully encourage students who may be unwilling to seek help or to enter treatment.

He says that it’s “very common” for House administrators to refer a student to UHS for care, estimating that several times a week a tutor or proctor will make an appointment for a student with UHS Mental Health Service.

A Crimson poll of 343 undergraduates in December found that of the 9 percent of students whose tutors, teaching fellows or professors ever encouraged them to use mental health services, 24 percent had also received help scheduling appointments.

Even if the student does not listen the first time, intervention from these adults can gradually make students more aware of the state of their mental health, Kadison says.

“Sometimes it’s just planting seeds—you hear from a tutor, then a friend, then a professor, maybe you put together that you ought to talk to someone,” Kadison says.

But students say few tutors show the time or commitment necessary to become close enough with them to be able to recognize a shift in behavior and suggest getting help.

Some students with mental health problems say their tutors were not aware of their trouble, either because they were not available in the House or were not responsive to calls for help.

Jeremy R. Jenkins ’97-’98, the co-founder of the Mental Health Advocacy and Awareness Group (MHAAG), says the residential tutor in his entryway had no idea he was suffering from severe depression—until Jenkins wrote an op-ed about it in The Crimson.

In the December Crimson poll, 30 percent of students reported speaking with their resident tutors or proctors once a month or less, while 54 percent spoke once a week or more frequently.

Jenkins says his tutor was in residency at Harvard Medical School and as a result was hardly ever around the House, resulting in Jenkins seeing him less then once a month, like almost 20 percent of students polled.

Kleindienst says because many of the tutors are so busy—and students with mental health problems may not be pushing for help—it’s easy to “fade yourself out of the picture.”

Sarah J. Ramer ’03, a former MHAAG co-chair, says because tutors are the adults who interact most with students, they must be around and able to recognize mental health problems.

“But the tutors have to take time to know their students,” she says. “They have to know their students’ baseline to notice if anything is unusual later.”

Some students say that even if tutors know their students well, they are sometimes uncomfortable discussing mental health with them.

Ramer says that tutors should “err on the side of prying” in order to make sure students are getting help for their problems.

“People are very afraid of being direct, but the times when you need help the most are often the times when it’s hardest to ask,” she says.

While Kadison says he agrees it is a tough balance, he advises tutors to invite students to talk and that they should feel free to give students feedback if they notice anything wrong.

In the past, tutor selection and training was completely controlled by individual Houses, causing a wide variation in quality.

Now, all tutors attend a standard three-day training session at the beginning of the year that includes panels with UHS mental health clinicians such as Kadison. MHAAG also hosts a series of tutor training panels to raise awareness about identifying and helping students with mental health concerns, and some Houses continue to hold optional panels on mental health care during the year.

New senior tutors receive a week of training over the summer about House issues, with one day devoted to mental health, according to Assistant Dean of the College John T. O’Keefe, who helps organize tutor training across the College. Counselors from UHS and the Bureau of Study Counsel speak to the senior tutors and take them on a tour of UHS.

Each House also has a liaison at UHS and the bureau whom tutors can consult about mental health and whom House Masters can invite to monthly meetings with tutors.

But Quinn says tutors should be trained to play a more comprehensive role in student mental health.

“People talk about this as a pipeline. Tutors screen and say, ‘UHS,’ and the problem is taken care of,” she says. “But if you really want to help this person, it’s a reciprocal relationship, where the tutor really knows about UHS, but also residential support, keeping lines of communication open, and just being here.”

The uniform training program has not produced enough awareness of the mental health problems Harvard faces, according to Quinn.

Senior Tutors

As more students seek help with mental health problems, senior tutors have been forced to become almost full-time mental health counselors while juggling their other duties, both within and outside the House.

Senior tutors are responsible for overseeing the academic and social lives of the approximately 400 students in the House. They serve as liaisons between the Masters and students, oversee the House tutors and run pre-law and pre-med programs and fellowship applications.

But with approximately 80 percent of respondents to the Crimson poll reporting that they have felt depressed while at Harvard, senior tutors are now forced to deal with a host of academic and social problems rooted in mental illness.

The situation in Eliot House during exams last spring, when around two dozen students faced academic problems—many due to mental health problems—spotlights the severe burden placed on senior tutors.

Last May, Eliot Senior Tutor Oona B. Ceder sent an e-mail to Eliot House Master Lino Pertile telling him about what she called Eliot’s “troubled students.”

Ceder wrote that she was “swamped in student troubles” and went on to describe a hectic two weeks of tracking down students for their parents, mediating between undergraduates and teaching fellows and keeping tabs on students with severe mental health problems.

Shocked by the extent of student problems—and Ceder’s struggles—Pertile forwarded the e-mail to University President Lawrence H. Summers.

“It goes without saying that I’m also concerned that so much of the weight of this problem falls upon the shoulders of senior tutors who are supposed to devote to the Houses only half their working time,” Pertile wrote in the e-mail exchange obtained by The Crimson. “In the case of Eliot House, we are fortunate that Oona Ceder is such an outstanding senior tutor, whose devotion to the House has no limits. However, I would not be surprised if one day the weight she is bearing turned out to be too much, even for her!”

Ceder declined to comment on this e-mail exchange.

For a student with a mental health concern, the senior tutor’s main job is helping the student get to care, according to Lowell House Senior Tutor Jay Ellison.

Ellison writes in an e-mail that senior tutors are not expected to be mental health professionals, but rather to be aware of all the resources available to students.

But in recent years, some senior tutors and Masters say the role has expanded beyond its original intent.

“It’s certainly getting harder,” Cabot House Master Jay M. Harris says of the senior tutor’s role. “They are obviously still doing it, but I think it’s an enormous task.”

Harris says he thinks senior tutors may need more assistance because of the “enormous proportion” of time that they now need to devote to student academic and mental health issues.

“It may be time to start looking at getting them some help,” he says.

Leverett House Master Howard Georgi writes in an e-mail that he thinks perhaps Sept. 11 and the war in Iraq may have contributed to an increase in issues for senior tutors to deal with in the past few years.

“The past few years have been a little more difficult then the few before that, and the senior tutors have had an even tougher job,” writes Georgi, who has been Master for six years.

He also suggests that senior tutors have gotten better at identifying mental health problems and, as a result, have more work.

Quinn says this huge work load is impairing the ability of the House system to help students with mental health problems.

“Given the increased need, the current system, which places the lion’s share of responsibility for 400 students on a single part-time administrator trained only in an academic discipline, seems dangerously outdated,” Quinn wrote in her letter to administrators.

University Provost Steven E. Hyman says he wants to work to improve training for tutors and outreach efforts from senior tutors and Masters.

Making the Grade

Some students say that, like the House system, the academic advising system is ill-equipped to deal with increasing student mental health problems.

Besides House tutors, the adults with whom students most often interact are their teaching fellows and professors. But, like residential tutors, their attitudes and responses to mental health problems are extremely inconsistent, according to some undergraduates.

And many students say that these academic advisers can be equally as crucial to the recovery or demise of a student suffering from mental health problems.

Quinn says that her experiences in telling her teachers about her anxiety disorder have run the gamut—and greatly influenced her well-being at Harvard.

After having a panic attack during a Calculus test and a second attack the next day, she approached her chemistry professor about her problem. Quinn says he responded “compassionately” and scheduled her an appointment at the Bureau of Study Counsel. He kept in touch with Quinn throughout the semester, inquiring about her appointment and providing academic and personal help.

But when Quinn told her Calculus teaching fellow about how the panic attack prevented her from completing the test, she got a far more discouraging response.

“His reaction was like ‘Wow, that’s really weird,’” Quinn says. “I came at talking to teachers naively, thinking that I’m going to tell people that something’s wrong with me, and I expected some kind of support. I don’t think he’s a terrible person, but just that he didn’t know how to deal with it.”

Quinn says she then tried to attend the Calculus professor’s office hours, but was told that those office hours were only for students in the professor’s sections.

She ended up failing the class.

For Quinn, however, it was the apathy of her TF—not the F on her transcript—that had a far more negative, enduring effect on both her academic experience and mental health. “I spent the rest of…the semester regretting that I had told him about that first panic attack,” Quinn writes. “I often told myself…that I should forget about that one terrible meeting; but in fact it colored the way I spoke and thought about mental illness more than any other experience: I felt ashamed and thus did not tell other teachers, advisers or even friends how I felt.”

For several years, Harvard administrators have been aware of the influence the teaching staff can have on students with mental health problems and have been trying to correct the inconsistency Quinn experienced.

A 1999 report from a Provost’s committee on student mental health concluded that many members of the teaching staff are unaware of the appropriate responses to mental health issues and, busy with their own academic obligations, are unable to provide guidance to students.

“It was evident that a number of faculty care deeply about their students but feel inadequately informed to help,” the report states. “Minimal training in subjects such as recognizing the warning signs of depression and knowing University resources would be helpful in directing both their students and themselves to seeking help when necessary.”

As a result of the report, Harvard formed the University Student Health Coordinating Board in 2000, a committee of University mental health experts who coordinate outreach efforts and mental health services within the University.

The board released a brochure called “What Can I Do? How to Recognize Students in Distress . . . And How to Help,” and inaugurated “Caring for the Harvard Community,” a week of panels with speakers and workshops on mental health, some of which are aimed at the teaching staff.

The board’s 2001 annual report stated that the brochure was “highly acclaimed,” and that UHS reported a spike in student visits soon after its distribution.

But the “Caring for the Harvard Community” events were optional and members of the teaching staff receive no formal, mandated training about how to help students concerned about their mental health.

“I can tell you what training we receive—none,” says Levin Professor of Literature William M. Todd III, chair of the Department of Comparative Literature.

Todd says he relies on common sense to determine how to address students’ mental health problems, and usually refers them to proctors or senior tutors.

Associate Professor of Government Barry C. Burden says professors receive literature about the University’s mental health resources and how to help students with mental health concerns in academic settings.

Burden says that it is common for students to come to him with mental health-related academic concerns, and he says he also tries to direct students to residential advisers.

“The most common path is to talk to the student indirectly through their senior tutor, because the student probably feels more comfortable talking through their senior tutor, and the tutors usually have a better grasp of the situation and options,” Burden says.

Some students say that making information available is not enough to teach academic and residential advisers how to approach a student about mental health.

“It’s sometimes hard because it’s like teaching a course in compassion,” says MHAAG secretary Andrew L. Kalloch ’06.

Hyman says that the administration is wary of mandating mental health training for professors.

“I would welcome any professor who would want to learn about this, but I don’t think you would want your biology professor to be coming up to you in an academic setting, and saying you look kind of glum in lab,” Hyman says. “I have nothing against providing information, but I think our major targets have got to be students and those involved...in House life.”

Outgoing Undergraduate Council President Rohit Chopra ’04 says the current drive by Summers’ administration to emphasize academics could move the University farther from a compassionate stance towards mental health-related academic problems.

“The direction of the University is getting more intense, not more focused on student life, so I worry that we’re not looking to students’ well-being,” says Chopra, who has focused on improving mental health services this semester. “Healthier and happy students will affect more change in the world than people who haven’t had good experiences here.”

Prioritizing academics to the detriment of other facets of student life can seriously hurt students who feel they must fulfill academic goals and ignore other concerns, Quinn says.

“This is a place that for whatever reason compartmentalizes a student’s academic life from residential life from health life, and they are seen as students first and people second,” Quinn says. “As soon as you have mental health problems it starts taking over your entire life, and if there’s no one to communicate to in the academic portion of life—it’s really isolating.”

In the end, she says, students with mental health problems often sacrifice their academic performance.

“You [only] take care of one part or the other,” Quinn says.

—Staff writer Katharine A. Kaplan can be reached at kkaplan@fas.harvard.edu.