Students' Complaints About Mental Health Services May Mean Fewer Calls for Help

Part II of a three-part series on mental health at Harvard. Part I was published on Dec. 10, and Part III on Dec. 14.

In retrospect, Mackenzie believes she grew up with depression. Forced to deal with serious medical issues and abuse at home from a young age, Mackenzie found herself living with negative body image and self-esteem. Questions of sexuality and gender identity that arose in high school only complicated her emotional development.

When two of her blockmates decided to take time off due to mental illness in her sophomore year of college, Mackenzie became more withdrawn. When a third blockmate attempted suicide, the stress became overwhelming.

Mackenzie realized she needed serious professional help. Instead of visiting Harvard’s Mental Health Services, she opted to see an outside therapist.

“I had heard from a lot of people who didn’t trust them. I felt that just by the nature of being a college mental health organization with hundreds of patients per therapist, it’s not possible to deliver the care I needed,” she says.

Like other students interviewed for this series, Mackenzie had heard rumors from her peers about University Health Services. The reports she heard were “almost uniformly negative.”

Anyone confessing a mental illness will be forced to take time off, some fear. Others worry that those who do need time off campus to heal are hemmed in by the school’s insurance policies. Many share frustration with the process by which students who need less urgent care arrange appointments. In sum, these concerns paint a discouraging picture of Harvard’s services for some of its most fragile students.

TAKE A TIME OUT

Martin’s depression and suicidal thoughts escalated during his freshman fall. In November, when he was unable to sleep for nine days after a personal assault, Martin admitted himself to the hospital for suicidal ideation and paralyzing depression.

Though the rest of his freshman year was successful by many measures—nearly perfect GPA, lots of extracurricular activities, plenty of friends, and parties almost every weekend—Martin still suffered from feelings of inadequacy.

“The thoughts continued to haunt me throughout the summer. A few weeks before school began, I realized that I didn’t want to come back at that point,” he says.

He had discussed the possibility of taking a year off with his resident dean in the spring. The dean had assured Martin that voluntary leaves do not entail contracts, so Martin made his travel arrangements.

Then, just weeks before he was scheduled to depart, Martin heard from his dean that he would have to sign a waiver forcing him to work for six months of his year off and undergo a UHS evaluation before he would be allowed to return.

“It was a really upsetting interaction with the University,” Martin says. “I was told all the way up through summer that I would not have to sign a waiver since I was not being forced to take time off.”

Martin worries that stories of administrative pressure like his might prevent students from reaching out for help out of fear that they might be forced off campus or prevented from returning if they choose to go away.

Katherine A. Lapierre, chief of Student Mental Health Services, says that though misperceptions about leaves of absence abound, students are never forced to leave the University involuntarily because of mental health problems.

In a statement, UHS spokesperson Lindsey Baker echoes that assertion. “SMHS is not in a position to require leave of absence,” Baker writes. “Our only policy is that students receive the best care possible, and the student, together with the University, makes decisions about the leave of absence.”

Even though the College does not compel students to deal with their mental health problems away from Harvard, it can put pressure on them. Alexa, who suffers from bipolar disorder, says that both before and after she attempted suicide, UHS doctors, tutors, her resident dean, and her House Masters all often encouraged her to take time off, an option she did not want to exercise.

Students who anticipate hearing similar suggestions from therapists and deans might avoid telling Harvard administrators about their mental health problems, Alexa worries. “The fear of mandatory time off thwarts any positive things that are going on,” she says.

Christine, who suffers from post-traumatic stress disorder and depression, reached out to UHS after attempting suicide her sophomore year and was surprised no one forced her to take time off. She says she worried that visiting UHS could jeopardize her future.

“I thought my career at Harvard would be over,” Christine says. “I was shocked by the extremely nurturing support I received from my resident dean and resident tutors as well as Harvard Mental Health Services. No one at any point viewed me as a threat to Harvard or the wellbeing of the community. Everyone wanted me to get better.”

DISTANCE LEARNING

A leave of absence, for some who do elect to spend time off campus, is just the right medicine.

During his year away, Martin backpacked through sixteen countries, held an internship in politics (where he learned he “absolutely” did not want to go into politics), and painted. He returned to Harvard free from suicidal thoughts.

“Getting out and experiencing the world gave me perspective of what I could do in the world,” he says. “It made me realize that I did not have to succeed on Harvard’s standards in order to succeed in the world. I could really do what I wanted with my life.”

Mackenzie left Harvard after her junior year. Living at home, she was able to hold a job and receive counseling. “I met people who didn’t think less of me away from Harvard,” she says. “I actually realized that life outside of here is a lot easier. For the first time I thought, ‘Maybe life won’t actually get harder. Maybe some things will be easier outside of Harvard.’”

For Christine, life away from Harvard was not easier at all. She took a year off after her second hospitalization in the spring of her sophomore year, but she had no money and no ties to her family to fall back on. No longer living in a dorm, she moved into an abandoned building in Central Square.

“It took a lot of courage,” she says. Yet away from an academic environment, she found right away that she could focus on religion, which brought her solace despite her health concerns and her living situation. “I remember not being stressed out not knowing what I’d do for my year off.”

Christine eventually found a job at a West Coast company, though she had no money to fly across the country.

“I told them, ‘You need to fly me out there and you need to advance my first paycheck.’ They said it wasn’t a problem, and I got to start building myself a life and a home,” she says.

Christine worked at the company and began studying the Bible four times a week. Coming to believe that Jesus loves her, Christine was able to find the hope needed to start recovering.

OUTSIDE AND UNINSURED

Those who might benefit from time away, like Christine, Mackenzie, and Martin did, must take into consideration the fact that leaving Harvard means losing not only access to libraries and dining hall food, but also, perhaps, their much-needed health insurance.

For those who rely on student insurance plans, finding a therapist, prescriber, or affordable drugs during a leave of absence can become a barrier to effective care.

Despite the many people who told her to take time off, Alexa stayed on campus because, as an international student, she could not find adequate health care at home. Now, she says, she regrets staying at Harvard while she was sick.

“This place is the most extraordinary smorgasbord of opportunity. If you’re not well, it’s hard to take advantage of it all,” she says.

Harvard allows students to apply for an extension of their health insurance benefits for up to four months after they leave campus. But for Martin, one semester did not seem enough time to fully recover. Since he knew he was going to lose his Harvard insurance, he returned home to file through his state as unemployed. After lots of time and paperwork, he received free insurance.

Mackenzie, who was able to take time off because she has private, non-Harvard insurance, says, “I was lucky, but I know many people who feel alone in a bad way when Harvard removes the needed support.... Also, it disproportionately affects the poorer students on campus, and that’s just an added stressor.”

UNDER PRESSURE

Every year, 1,150 undergraduates—roughly 17 percent of the student body—take advantage of the mental health services offered by UHS. Another 2,478 students from the graduate and professional schools also seek the help of Mental Health Services’ 17 full-time therapists and five full-time and one part-time prescribers. In addition, 720 undergraduates see counselors at the Bureau of Study Counsel, which offers therapy as well as academic workshops.

When students like Alexa, Christine, Mackenzie, and Martin come in to report severe depression and suicide attempts, UHS therapists take note right away. But such cases are not the norm for the practitioners in the Holyoke Center. On a daily basis, they are flooded with calls from much of the 25 percent of the student body that reports some symptoms of depression.

To handle the volume of requests, Mental Health Services employs what Lapierre calls a “triage system.” In a brief phone conversation, one of two access coordinators—a recently created, full-time position—determines the urgency of the patient’s case. Those coordinators see students themselves that day or within 48 hours if necessary. Otherwise, they schedule appointments for students with therapists.

Lapierre says that the system works. But in dorms and dining halls, students who talk about UHS—especially the mental health care branch—raise a constant drumbeat of complaints.

One student passed a Google doc around listservs last year, soliciting “horror stories” about UHS to present to administrators. One published her own experience, writing in a Crimson column last spring that she sought help from a private therapist when she was frustrated that her UHS appointments to treat her panic attacks were limited to half an hour every other week, since her UHS therapist said other students were more seriously ill. Commenters on any article touching on mental health frequently deride the UHS offerings, saying treatment is delayed, not frequent enough, or poorly coordinated.

Sophia V. Ohler ‘15 sought help for stress and depressive moods. Her encounter with the UHS triage system left her disillusioned.

During her diagnostic call, the practitioner on the other end of the line said she should visit the Bureau of Study Council instead since she “sounded fine.”

“It was just shocking to be told that you don’t need therapy,” says Ohler, a Crimson magazine writer. “I was furious. I was down for a while, and it was weird to be told, ‘Your issues aren’t big enough or important enough to be dealt with at UHS.’”

Even those who have benefited from UHS attention point to gaps in care for less severe issues. “They don’t have the staff needed,” says Martin, who was pleased with his personal experience at UHS.

“I think a large proportion of the Harvard population goes without the care they need and deserve.”

Though the complaints seem persistent, the policies do change as UHS makes strides toward seamlessly handling its caseload. Baker says that the recent addition of the access coordinators, who not only take calls but also track patients from urgent treatment to long-term clinicians, has helped reduce jarring “hand-offs” of patients.

Another new policy allows students on the Harvard health insurance plan who pursue therapy outside of UHS 24 visits per academic year, up from 12 visits under the last academic-year plan.

“Mental health care is a constantly developing field, and we work hard to remain abreast of the current treatment recommendations,” Baker writes. “We are always trying to improve the system of care as the science is continually moving forward.”

—Melanie A. Guzman contributed to the reporting of this article.

—Staff writer Quinn D. Hatoff can be reached at quinnhatoff@college.harvard.edu.