The Problem
This past November, Harvard Graduate School of Education hosted a panel discussion entitled “Education Now: Mental Health and Wellness at College Today.” The discussion, featuring both academics and practicing counselors, emphasized the importance of creating a “holistic campus culture” as well as the role of faculty members in providing wellness resources for and soliciting feedback from students to tackle concerns about student mental health.
Such organized conversations on Harvard’s campus are not merely casually timed discussions riding the waves of well-meaning albeit oversimplifying Instagram posts; youth mental health concerns are on the rise across most college campuses, compounded by the effects of the COVID-19 pandemic and its emotional, psychological, and financial drain. After two years of Zoom school, restricted social and academic gatherings, and relentless COVID scares and testing cadences — not to mention illnesses and losses of loved ones — many students are increasingly anxious, isolated, and depressed. At some institutions, including Dartmouth and UNC Chapel Hill, there has been a troubling series of suicides. According to a survey by the Healthy Minds Network and the American College Health Association, students have reported lower levels of psychological well-being during the pandemic than before.
At Harvard, Counseling and Mental Health Services (CAMHS) Chief Dr. Barbara Lewis and social worker and gender and sexuality specialist Dr. Addie Wyman-Battalen both noticed increases in concerns regarding social isolation and related anxieties among students in CAMHS care, relative to pre-pandemic.
Wyman-Battalen noted, in an interview with the HPR, that the pandemic itself, especially in March 2020 when Harvard students were first sent home — had a direct impact on students. “I’ve had a number of students say things were going pretty well until March, and then ‘my anxiety spiked,’ or ‘my depression worsened,’” she said. Concerns regarding “how to maintain relationships with friends, long-distance relationships, create new relationships… [and] a lot of concerns in the social domain,” she explained, were prime stressors.
Lewis added in an interview with the HPR that students’ anxieties related “to balancing the need for socialization, but then also concerns about infecting family members.” Students also felt pressure, she noted, to consider “how safe are their peers being?” with regard to socialization behaviors.
Other events which occurred during but were unrelated to the pandemic also left a mark. “Following the George Floyd murder, that really had an impact on the mental health of students, especially students of color,” Wyman-Battalen said, also citing the impact of ICE’s executive orders on international students. In summary, she stated that “everything that’s happening in the news in addition to COVID, politically, we’re also seeing the trickle-down effects and the direct impact too.”
The Landscape
Given the glaring mental health crisis, institutions across the nation have been forced to look up and take notice. In 2021, the National Academies of Sciences, Engineering, and Medicine released a report regarding student wellbeing, focusing on topics similar to the Harvard panel discussion, such as the role of holistic approaches that involve all sectors of the University, including top leaders and faculty members, to better meet students where they are, foster a culture of non-competitiveness, and mitigate the negative wellness implications of the pandemic.
However, the National Academies report acknowledges that mental health issues were on the rise long before the pandemic, noting that 18% of students reported experiencing major depression in 2018-2019, a full year before the pandemic’s onset, compared to 8% in 2007. Similarly, 14% of students reported thinking about suicide in 2018, up from 6% in 2007.
Although reports of mental illness have risen across the population as a whole, the National Academies report also finds that university students display a distinct need for mental health support; graduate students report depression and anxiety at rates six times higher than that of the general population. In addition, the report also notes that, although universities incur significant financial costs when investing in mental health resources for students, the financial costs of ignoring the issue only compound it. Universities lose revenue from students who drop out of school or cannot succeed fully due to mental health difficulties.
Such a distant cost-benefit analysis, however, completely overlooks the humanity of students and the fact that a university, by definition, is only as good as the students who inhabit it and contribute to its active scholarship. Simply by virtue of their humanity, shouldn’t students deserve to be well and trust that their universities will prioritize their mental health concerns?
The Data
The answer to our question is yes, and this past winter, Harvard’s chapter of the national organization Active Minds, dedicated to mental health advocacy and awareness across college campuses, sought to examine just that. More specifically, Active Minds conducted a survey aiming both to gauge students’ experiences with mental health and campus wellness resources as well as assess Harvard’s oft-touted administrative focus on mental health. More specifically, we hoped to gain critical knowledge about student resource access and campus wellness needs in order to ultimately create a centralized wellness resource hub for students.
Our survey, distributed to students through College and Undergraduate Council communication channels over the last three weeks of December 2021, received 106 responses. We asked a myriad of questions requesting that students rate their feelings on their mental health concerns, familiar and unfamiliar campus resources, and potential reasons for resource inaccessibility. All responses were anonymous.
“Trouble concentrating,” selected by 74 students, was the most frequently chosen mental or emotional health challenge, closely followed by anxiety, social isolation or loneliness, difficulty coping with stress in a healthy way, and depression. Distractions caused by the aforementioned stresses of the pandemic could certainly be dividing students’ attention, but the difficulty with concentration could simply be a new, separate, standalone concern. Similarly, according to data from the Center for Collegiate Mental Health at Penn State, loneliness or isolation, along with loss of motivation or focus, are among the top concerns of college students who have sought counseling during the pandemic, reflecting a trend running across multiple campuses. In addition, a 2020 report from Harvard’s Task Force on Managing Student Mental Health noted that depression, anxiety, suicide ideation, and suicide attempt rates have been on the rise since 2014, underscoring the depths of the issue. Finally, Harvard students were most likely to rate their comfort with how they were caring for their mental health at a six out of a scale of 10, with one being poor and 10 being very well. This result, only slightly above neutral, reflects the effects of the concerns students have been grappling with.
When asked about wellness resources, support systems, and self-care measures utilized, students most frequently reported relying on speaking with trusted family and friends to cope with mental struggles, followed by exercise, meditation, CAMHS counseling, and the Academic Resource Center. On the other hand, off-campus counseling services in the community and Center for Wellness Events were tied for least familiarity among students surveyed. Somewhat surprisingly, despite a well-documented rise in the amount of CAMHS Cares line use as the semester started, the CAMHS Cares hotline registers in the top five resources with which students reported unfamiliarity. Among these top five, also, were CAMHS workshops, CAMHS support groups, and House wellness events.
In response to student need, Lewis noted that CAMHS has continued hosting support groups throughout the pandemic and even some summers, organizing several gatherings about struggles experienced by students of color, about maintaining sobriety, as “some students reported drinking more” during the pandemic, and about queerness and sexuality. Lewis also added that a couple of clinicians have piloted a “Let’s Talk” workshop about “race and current issues,” first for athletes and then for the Education schools, which have been set up “as kind of a pop up workshop that people can request.” Lewis also pointed out that the pandemic witnessed a “big drop” in Urgent Care use, “consistent across other schools,” despite CAMHS remaining steadily at counseling capacity throughout the period.
Students had the chance to clarify their reliance on their friends and family in the survey’s open-ended responses section. Some referenced creating systems of roommates caring for each other, seeking advice from peer mentors who had supported them, attending events hosted by student extracurricular organizations, or speaking with upper-class-students willing to chat about their own experiences with mental health. Others stuck to speaking with trusted friends and family generally. However, in the recent report of the aforementioned Task Force on Managing Student Mental Health, students from their focus group discussions describe these practices as positive but cite concerns about overreliance on friends, as it places additional burdens on the peers and may further result in “circuits of distress” that affect groups of friends simultaneously. Focus group students noted that friends of a struggling student themselves are often unsure whether they can or should reach out to resources.
Interestingly, our survey revealed a discrepancy between the share of people who report speaking with trusted friends and family, with 73 individuals selecting this option, and the proportion of respondents who actually stated that they were struggling with a friend’s health difficulties, with 39 students choosing this. Such results beg the question: Are Harvard students actually relying on fellow Harvard students to unburden their minds, or do they feel that their relationships with friends and family from home are stronger, less transactional, and more honest?
One piece of the puzzle may lie in the prevalence of duck syndrome, a phenomenon wherein, in front of peers, students try to seem externally put-together despite struggling underneath their self-created veneer of productivity and perfection. Usually caused by external stressors, including separation from home, duck syndrome can hide or even exacerbate the effects of mental illnesses and can result in the perpetuation of mental health stigma. Due to heightened self-criticism and professional stakes, the behavior is most common in high-achieving students living in high-pressure environments — a representative description of Harvard’s student body. Consequently, because students are so focused on hiding the severity of their struggles, they fail to be transparent with and discuss their emotions alongside other Harvard students. One student from the Harvard report’s focus group discussions stated that “Anxiety is everywhere but talking about anxiety is not normalized at all,” emphasizing the role of campus culture in enforcing the need to hide one’s struggles.
Moreover, a Harvard student blog touches on another piece of the puzzle. The student states that “College movies don’t prepare you… They don’t warn you about FOMO — the anxious Fear Of Missing Out.” Movies, books, and social media posts about college often reflect only the positive sides of the experience. On Instagram, students are inundated with posts that display fun tailgates, parties, and other social experiences, excluding the lonely nights spent in one’s dorm, studying for Zoom classes. Students, consequently, feel alone in their experiences of solitude. No wonder they feel the need to hide their emotions. Results of the aforementioned Harvard report’s investigation align with this discrepancy, noting that students “expressed a reluctance to be vulnerable with peers.”
If students aren’t sharing emotional struggles with each other, then, how often are they using campus resources at all? On a scale from zero (low frequency) to 10 (high frequency), students rate themselves at a startlingly low average score of 2.5 for campus resource use, although they rate themselves closer to a 5.3 for use of their personal resource toolkits. However, students note that they hear about others accessing resources slightly more frequently than they themselves access resources, implying a bias in the stories being shared by students about their wellness struggles.
So why are students using resources so infrequently? A plurality of survey respondents reported “not having the time or energy to do so,” followed by finding the resources themselves either difficult to use, not trustworthy, or inapplicable to their concerns.
Given these results, although the centralized resource hub Active Minds first set out to create could assist students with understanding resources and perhaps finding them more easily, the effort required to engage with the resources would still exist. To address this, the aforementioned National Academies report emphasizes the importance of resource-use training for students.
At Harvard, the College does provide some training, largely to first-years, about the resources available to them. Historically, Student Mental Health Liaisons, a now-shuttered peer-education organization whose role Active Minds, alongside Wellness Educators, has since undertaken, also provides mental health training workshops to first-years. But, what about upper class-students? Or students who transfer after their first-year? Although student groups can reorganize resources, a wholesale revision of the way in which resources are developed and distributed at the University level is necessary to truly allow students, the intended beneficiaries of these resources, to take advantage of them.
Another trend, especially evident in students’ responses to open-ended survey questions, was a feeling of being unsupported by CAMHS, which is designed for more short-term student care, coupled with a lack of familiarity regarding off-campus counseling services in the community for long-term concerns. To explain their mistrust, students cited reports from peers and from their personal experiences about lengthy wait times for appointments and for the hotlines, along with other mixed feelings about CAMHS care more generally. One student stated that they would recommend CAMHS, “but the understaffing and underfunding for it really do show – it takes weeks to get an appointment, and it is very easy to fall off the radar.” Students also noted that finding outside counselors or therapists, even through referral processes, could again require resources and time that many students do not have.
That said, CAMHS counselors themselves have been feeling the weight of working through a high volume of patients, especially when they are on Zoom for long periods of the day. Lewis explains: “Doing zoom appointments back to back is pretty exhausting…It’s more intense in a way because you’re constantly looking at each other and it’s harder to look away because it feels like you’re disconnecting. And I think that that work is more intense, because when you’re in an office, you know, a student can look away or you can look away…I think also when you’re working in your home environment, the workday can bleed into night.”
Although Zoom has allowed for some students, especially graduate students, to access CAMHS more easily, the other implications of pandemic care-provision have resulted both in more clinical and non-clinical work for counselors. With the addition of more full-staff meetings and other responsibilities, Lewis adds, “We did feel like we needed to check in more. We needed more space to be able to communicate about what was happening because, with COVID, things are changing rapidly, and they continue to change on a week-by-week basis.”
It seems, then, that both students and counselors alike agree: The need for more support around mental health is clear. But resolving the root causes of these difficulties with wellness, vulnerability, and resource access on campus will require much further investigation and a commitment to fundamental shifts in University policies, such as through the recent recommendations from the task force on managing student mental health. Only then can students — the lifeblood of any campus — truly benefit.
