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The Trouble with Triage

By Taonga R. Leslie

The vast majority of Harvard students will graduate without having a nervous breakdown or attempting suicide. Very few of us will become so violently ill that we won’t be able to make it through the night. Only a handful of us will drink enough alcohol or do enough drugs to put our lives in danger. Of the students who seek refuge in Stillman Infirmary, the vast majority could objectively have spent the night at home and waited until the following morning for their concerns to be addressed.

In the eyes of University Health Services Director Paul Barreira, these facts are reason enough to merit a restructuring. In an email sent out early Thursday morning, Barreira outlined plans to replace the Infirmary, which provides in-person urgent care and overnight services from 10 p.m. to 8 a.m. every night, with a telephone triage system. By directing the few students who truly need urgent care to other resources, including nearby Mt. Auburn Hospital, Barreira hopes to make more services available during the day.

What Barreira and HUHS fail to understand is that Stillman provides a vital presence on campus precisely because it is a place where objective standards are not the primary determinant of care. A student who decides to spend the night at Stillman does not have to prove they are sick enough, or depressed enough, or intoxicated enough to merit attention. It is one of very few places where simply reaching out for help is a guarantee that help will be provided.

Despite attending the world’s wealthiest college, Harvard students often operate in an environment of scarcity. When we choose classes, we are well aware that many of the most popular options will have a lottery or application for entry. When we join selective student organizations, we often endure a probationary period in which we are reminded that student interest exceeds the number of positions available.

The ethic of limited resources also permeates most of our care and support resources— most of the advisors the college assigns us have their own administrative or academic burdens to bear. Before seeking help, Harvard students often calculate their own worthiness, the burden they will be imposing, along with any potential harm to future relationships. Help is a commodity that carries with it a social cost. Seeking help too often may cost their reputation and even hinder their ability to find help in the future.

For better or for worse, Stillman Infirmary is one of few places on campus where a student’s perceived need is the only prerequisite for receiving help. Replacing Stillman with a triage system would destroy a vital and unique resource for student self-care, and perpetuate a culture where students are incentivized to constantly measure themselves against external standards.

Adding a triage call to the process of seeking help after hours seems beneficial from a purely logical perspective. Ideally, students with borderline symptoms would either be reassured that they could make it through the night at home or they would be transported to Mt. Auburn hospital for necessary care.

However, the very process of describing one’s symptoms over the phone is itself a deterrent to seeking care and can be deeply invalidating, especially in cases of mental health concerns. Students who seek mental health resources afterhours already struggle with social stigma that prevents access to care—including the idea that one should simply “get over” mental illness, or that mental illness concerns are not “real.” Telephone triage adds yet another level of self-doubt to the process.

The phone triage system currently in use at Counseling and Mental Health Services already receives considerable negative feedback from students. In a 2012 interview with The Crimson, Sophia V. Ohler ’15 reported being told she should visit the Bureau of Study Council because she “sounded fine” over the phone. A commenter on the same post described “baring her soul” to someone she couldn’t even see face to face as a humiliating process.

Under the current system, these students are at least afforded the possibility of speaking with a care provider face to face, and provided a safe place to stay for the night. For some students, having this option could mean the difference between reaching out for help, and choosing to endure their problems alone— a choice that could have serious negative consequences in the long run.

HUHS must recognize that the quality of a healthcare system depends on more than the number of visitors it serves, the speed in which it serves them, or even its rate of correct diagnosis. Strong healthcare systems are based, above all, on the relationships between patients and their caregivers. To improve campus healthcare, HUHS should focus on fostering an atmosphere based on trust, not triage.

Taonga R. Leslie ’15, a Crimson editorial comper, is a sociology concentrator in Winthrop House.

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