It had been less than two weeks into the fall semester when Harvard sophomore Luke Tang took his life on September 12, 2015. Tang was a polished violinist and keen mathematician who had recently been branded with the Lowellian crest; in just one month, he would have declared a concentration in the Physics Department. His profound academic record, however, ran alongside a tremendous mental burden that would eventually lead to self-harm.
His death ignited new inquiry into the responsibility of universities to address the mental health needs of their students and prevent against suicide, a concern which has grown in recent decades. A 2010 NCBI report found suicide to be the second-leading cause of death among college students in the United States, with 1,100 students taking their own lives each year. Yet, mental health services at universities have been termed “woefully inadequate” to handle this crisis, leaving many young people in the lurch of despair.
Lowell House. Photo: Charles Hua.
Now, amid a pandemic, student mental health presents an increasingly alarming crisis to which universities across the nation must respond. At Harvard in particular, an ecosystem fueled by curiosity and knowledge but also by achievement and expectation, the conversation takes on new dimensions. How the university, the people within it, and the culture inhabiting it respond to this crisis holds great consequences for the wellbeing of our student body.
The Imperfect Storm
Tang had already attempted to take his life once before, in the spring of his freshman year. His mental malaise had been accumulating for some time before then, a swirling combination of academic pressure and high expectations. Still, his death came as a shock to those close to him.
“I was completely unaware, and I think most of his friends were completely unaware that he was struggling with these suicidal thoughts or questions,” shared one of Luke’s friends in “Looking for Luke,” a documentary produced by the Clay Center for Young Healthy Minds at Massachusetts General Hospital. The MGH Clay Center declined to discuss the documentary and has temporarily put a hold on new film screenings.
The loss of a promising life leaves friends and families with lingering questions that sometimes haunt them for decades. “There’s this unfathomable ‘why … why?’ question,” noted David Thomas ’76, whose friend and classmate Nick Minard had died by suicide at Harvard College a year before their graduation. “One can never really know, because we don’t really … we think we see and perceive each other; we don’t, we construe others. We assume that other people’s minds are more or less like our own, but they’re not. We’re all uniquely shaped by history and circumstances and constitution.”
In the case of suicide, our attempts to construe one other often lead to improper conjectures and haphazard speculation. George Colt ’76, who authored November of the Soul: The Enigma of Suicide, explained that humans carry an impulse to answer the “unfathomable ‘why’ question” by attributing suicide to one or another particular cause. He pointed to old newspaper headlines reading, “Student Kills Self Over Watergate,” “Bride Late; Groom Kills Himself,” and, perhaps most absurdly, “Suicide: English Boy, 15, Kills Himself Over Bad Haircut.” These headlines ran in the New York Times and the San Francisco Chronicle.
The desire to put a pin on one particular motive is psychological, Colt continued. By picking the wildest cherries from what could be a whole shrub of factors motivating an individual to take their own life, we attempt to distance ourselves from suicide. Once we attribute suicide to a certain cause, Colt said, we can easily step back and say, “Well, it’s not something that threatens me.”
But such a linear model — one that traces suicide as the point B stemming from a singular point A — is inadequate to explain why people take their lives. Instead, suicide is better conceptualized not as a line but rather a node where multiple axes intersect and overlap. “Suicide can only be understood as a series of factors or causes or influences that all come together at one place in time, like a steadily tightening knot,” Colt said. “In many cases, the person who kills himself thinks they have no other option, that suicide is the only way to end their pain. What those different factors are, of course, different for every person.”
Perhaps a more familiar model for those who misconstrue suicide is that of a slot machine. This particular slot machine is populated not with candy-colored icons and golden dollar signs, but with representations of the different achievements, responsibilities, and struggles we balance in our lives. Colt said, “Any one of us in this world probably has one or two things in that slot machine, things that are going not so well for us — our career or relationship with a spouse — but the rest of it’s going well … It’s difficult for somebody to get to three or four bad images on the slot machine, but when somebody gets to six or seven, that’s when people are at high risk for suicide.”
Colt, who graduated from Harvard College in 1976 with Thomas, was a student at the time that Nick Minard took his own life. The three were juniors at the time, and Minard was living in Mather House. His slot machine likely would have shown a postcard from Bangkok, for the year spent there and in Taipei completely alone prior to his freshman year; a loosening knot, for the slowly drifting marriage of his parents; and a stack of books piled high like a Jenga tower, for the workload that became too much.
Though his death occurred in the 1970s, Minard’s experience is not altogether foreign from those of students in the present day adjusting to college. Nance Roy, Chief Clinical Officer of the youth mental health nonprofit Jed Foundation, pointed to two factors in college students’ lives that can render them particularly vulnerable to mental health struggles. First, having to learn the basic life skills that consume college life, such as managing time, navigating interpersonal conflicts, and handling money. And second, experiencing the removal of a social safety net in the form of friendships. Kyle Carney, co-founder of Cambridge’s Mount Auburn Counseling Center, added that the availability of drugs and alcohol, as well as risky sexual behaviors, only adds to the stress that students endure.
For some, these factors make it acutely difficult to navigate challenges that arise throughout college. Such was the case for Tyler Clementi, a freshman at Rutgers University who took his own life in 2010 after facing severe harassment and social rejection from his roommate and his roommate’s friends due to his sexual orientation.
For Clementi, the harassment came at a time when he was still adjusting to college life and building new relationships, and it obscured his view of the resources and support that existed for him. It was an “imperfect storm,” said his mother, Jane Clementi, in which multiple burdens converged at once and rendered his decision making “cloudy and distorted.”
Whatever the metaphor of choice — the slowly-tightening knot of twine, the whirring casino slot machine, the raging storm of imperfection — the convergence of multiple miseries often results in a slowly setting quicksand of hopelessness.
“In the research we did, we found it was more about hopelessness,” shared Susan Furr, a professor in the Department of Counseling at UNC Charlotte. “It wasn’t a particular trigger event like failure or relationship breakup or humiliation; it was that they couldn’t see that it would ever get better.” While an individual might be able to conceptualize combatting any one particular trigger, it is the slowly pressing weight of multiple burdens that makes amelioration appear impossible.
But such a vision of hopelessness often belies the impermanence of these issues, grave as they may be. Clementi shared of her own son’s decision to take his own life, “It was a permanent solution to a temporary problem.”
Heightened Risks
While college itself already presents a new environment filled with risks and responsibilities young people must navigate for the first time, it further burdens students of particular identities who might need additional time, space, and resources to adjust to their new circumstances.
Marian H. Smith, then a junior in Winthrop House, took her own life in December 2002. Her death marked the 12th suicide at Harvard since 1990. A Crimson memorial to her life cited her distinctively global upbringing, writing that she was born in Kenya and raised in Somalia and Luxembourg.
As an international student, Smith confronted additional challenges to navigate in college beyond the run-of-the-mill worries of choosing classes and making friends. “One of the stressors is taking on American ways and becoming a part of this culture, while still wanting to retain their cultural identity,” shared Cynthia Rosenberger, who at the time was the House Dean of Winthrop along with her husband, Paul Hanson. “And I think that struggle, or the tension between those two, has to be very hard.”
Furr concurred with Rosenberger, adding that a clash of cultural values and perceptions could lead to further difficulties. “There can be cultural connotations about how other people view you, and that’s a strong cultural value,” Furr noted. International students may also have more difficulty accessing care than domestic students; as the Harvard Task Force on Managing Student Health reported in 2020, international students with a diagnosed mental health condition report lower rates of treatment than their U.S. citizen counterparts.
Following Smith’s death, Rosenberger and her husband focused on bolstering student wellbeing and ensuring the student community had a place to speak openly about what had occurred. Given that it was finals, they provided students with the resources they needed to navigate extensions and postponements.
“The whole community in the house, on the campus needs to have opportunities to be open about [suicide],” Rosenberger shared. “And of course, what one always fears is that one suicide might lead to another suicide. And so, one wants to be particularly out in front of that.”
Smith’s story is generally less common in that it centers a woman; suicide is often accompanied by gender imbalance, with the pattern disproportionately affecting young men more than young women. A study conducted jointly by the Suicide Prevention Resource Center and the Harvard Injury Control Research Center in 2002 found that 88% of young adults who committed suicide were male. Similarly, the American Foundation for Suicide Prevention reported that while women are 1.66 times more likely to attempt suicide, men more frequently succeed, with suicide rates 3.63 times the rate of women.
The reason boils down to means, Furr explained. “Males have been more likely to use guns, and [those are] means that you don’t have any stepping back from. People who take pills, it takes a while for them to work, and it’s more likely they can change their mind and let somebody know or that somebody could intervene,” Furr noted. The American Foundation for Suicide Prevention also found that 50.39% of all suicides in 2019 were by firearms. Furr continued, “When somebody jumps, there’s no stopping the action.”
Mental health also uniquely impacts other identities, such as first-generation, low-income students.
Fernando Soca ’23, a rising junior in Quincy House who identifies as FGLI, found that the university let down his expectations when he first set foot on campus. Among the offending realities were the competitive class application process (especially as certain well-equipped and savvy students networked their way into high-demand courses), the exclusive Finals Clubs scene, and the “ludicrous” work culture accompanying extracurriculars without compensation. Other students have similarly pointed to the pervasive environment of competition — including “comping,” or engaging in a rigorous and exclusive selection process in order to join clubs — as a major source of anxiety.
“I was first-gen low income, I had no idea how to navigate any of this,” Soca shared. “In the first semester I really felt like there were tools, I just had no idea how to access them.”
Scenes of first-year life. Photo: Charles Hua.
Soca’s situation often left him feeling alone and without recourse in the face of challenges. “Dealing with mental health and not having anyone to reach out [for] anything, I felt myself just alone and helpless. In a lot of situations, it was just, I don’t even know what to do.” This experience illustrates some of the unique stressors facing FGLI students; a study in the Journal of College Counseling found that first generation students exhibit greater levels of stress and depression and report lower levels of belonging than students who are not first generation.
For Soca, his situation led him to crave flight from his circumstances. “Luckily, I don’t actively self-harm, but the anxiety, those crises where you’re just done, and you’re like, ‘How do I continue? How do I even do this? Why am I even here right now?’ … it’s like I either hurt myself or I leave, but since I don’t want to hurt myself, I might as well book a flight and get out of Harvard.” Knowing he did not have Friday classes, Soca would sometimes call an Uber in the middle of a Thursday night to escape campus and visit his girlfriend in Wellesley College.
“I just felt like everything was overwhelming, everything was coming down on me, and the space I had at Harvard to deal with it was so small.”
A Lasting Thumbprint
While suicide itself remains frozen at a particular moment in space and time, its shockwaves continue to reverberate across both dimensions.
Rosenberger, who is still impacted by Smith’s suicide almost 20 years after it occurred, stated, “It’s a very sobering event, and has to be processed in the immediate future, as well as over the long term.”
This processing is likewise still underway for Becky Minard, almost five decades after the death of her brother Nick. A few years ago, their mother mailed Becky all of Nick’s belongings, including his pictures, postcards, and letters. Becky then undertook a project to collect together the strands of his life, sifting through the layers of guilt, blame, heartache, and love that had built up like sediment since 1975. It was a task in archaeology — piecing together the remnants of a life from the relics left behind.
“I want my sons to know who he was, and I think my brothers would probably find them painful, but my mother sent me everything, and I feel like I have this responsibility to both read the letters and to share them,” Becky said.
In scouring through the artifacts of his youth, she began slowly to assemble a mosaic of his life in hindsight. She was primarily concerned with discovering the kind of person Nick was among those who knew him well. “He was a bit of a loner, though it turned out he had lots of friends at Harvard,” Becky said. In youth, his family had rechristened him with the moniker “natureboy” following his deep harmony with the natural world; he would frequently escape into the woods, a redolent realm of solitude and content.
Upon sorting through the pieces her mother had sent her and reflecting on her brother’s life, Becky also noted that Nick was a dedicated student. In academics, he devoted himself to politics and collective action, even driving to Boston on occasion to help galvanize liquor workers in pro-union protests. “He was pretty cerebral,” Becky said.
However, the dig also resurfaced old memories of Nick’s seeping internal pressure. Becky recalled him screaming in the fourth grade after receiving poor marks on a class assignment. Later, in junior high, he put his fist through a window out of anger with himself. “It was always internal,” Becky said, noting her amiable and loving relationship with him. Nick also exhibited a dogged and unyielding drive in his academic pursuits. His attitude toward college applications was consumed by the mantra: Harvard or nothing. And once in Harvard, he set his sights on the competitive Social Studies program, which in its inaugural year of 1960 accepted only 18 students.
Becky remembered meeting Nick on several occasions in Boston as she was enrolled in a nearby boarding school. She recalled that he would talk frequently about the intense workload; it was on his mind when he met with Becky for the last time.
Despite his mentions of academic pressure, Becky has since come to the conclusion that her brother’s suicide was impulsive, not contemplated. Furr similarly drew attention to “overwhelming impulse” as a driver of suicide, particularly among young people. “College students are still very much in the area of brain development where the prefrontal cortex is not as well developed,” Furr noted. “So there [is] a lot more — if you look at mid-brain development — with impulsiveness, emotions dominating, without the logical thinking through the process.”
At the time, though, Becky never saw it coming — nobody did. She learned about her brother’s passing through another sibling: Michael, who knocked on her door in the dead of night a week after she last saw Nick. She remembered wishing she could be transported 10 years in the future, with the gift of distance easing the shock and horror of the moment.
In the following week, Becky stayed close with her family. “I just remember sitting in our living room laughing some of the time. It’s very strange … you do find yourselves having to laugh and tell stories.” They sat together and recounted Nick’s physical foibles, such as his tendency to perpetually misplace his glasses. “Why did he have to succeed at this?” they questioned the open air. “I mean it’s very dark humor, but it’s the kind of thing that comes out,” Becky said.
For the students left behind, the minutiae of quotidian life suddenly felt extraneous. “The university, the people in the house and everybody in his circle of [friends], we all just kind of stopped. The idea of classes seems suddenly irrelevant. Nobody could do anything, we all just huddled in groups trying to make sense of it all.” Speaking of his own reaction, Thomas added, “I just kind of went blank.”
In one class in particular, Thomas faced the specter of a failing grade as he struggled to turn in a final paper. When his professor encouraged him to turn in something — anything — or else fail the course, Thomas recounted responding, “I understand. I just cannot, I just cannot bring myself to think about the history of theater in the wake of this calamity,” his reprise accompanied by a sardonic chuckle. Thomas took the fail.
While the immediate shock of Nick’s passing may have waned since the more than 50 years that have passed since his death, he still lives vibrantly in the minds of those dearest to him.
Thomas recalled a moment in the autumn of his junior year when he got into a scrape with Nick. It predated the incorporation of the Quad into Harvard College (it was then part of Radcliffe, Harvard’s sister school), and at the time, Mather was the newest and farthest house from Harvard Yard. Thomas had just haggled with a dealer to get his hands on a used Yamaha 300 bike to cover the distance, and he was eager to try it out. After the first turn, however, the bike didn’t slow down and instead rammed into the back of a parked car. Thomas said, “I went over the handlebars and landed on my teeth; Nick landed on me.”
Thomas said, “He walked away from it unscratched, but I’ve had trouble with my teeth for the rest of my life. My front teeth. So every time I have to go to the dentist, I recall Nick Minard.” He later added in a wry tone, “I never went too long without remembering him.”
When Becky connected with Thomas years later, this unwitting dental memorial to her brother’s life stood starkly in her mind. “For me, it was a very tangible connection to my brother,” Becky shared. “Here’s somebody who knew him and is still, literally, feeling the physical effects of his relationship with my brother, and I think it’s kind of funny and it is a comfort to me.”
Others who knew Nick recalled particular aspects of his persona that have persisted in memory through the years. Mary Pickering, who was in Nick’s year and graduated alongside Thomas and Colt in 1976, spoke in particular to his humor, charm, and distinctive style of dress. “I remember so clearly what he wore; he wore brown pants and white shirts that he would roll up to his sleeves. Isn’t that funny? I just remembered that, immediately. I couldn’t tell you what my husband wore or anything.” Years later, Pickering named her son Nicholas, in part a homage to a classmate with good character.
While memories of loved ones lost to suicide often carry the nostalgia of lives lived, they are sometimes accompanied by an undercurrent of guilt.
After Nick’s suicide — maybe even until his own death, Becky speculated —, his father carried a small notecard in his wallet that read, “Forgive me, son. I did not know what pain you were in.”
This feeling of guilt spread outwards, seeping into all those who knew Nick. “Even those tangential people wondered what they could have done,” Becky recalled her mother saying, laughing grimly.
Becky shared, “It’s just amazing how you mention somebody’s suicide … and the overwhelming sense you get is, ‘I didn’t know.’ That’s the first thing they say: ‘I didn’t know’ or ‘I should have done something,’ as if people have the power to do that.”
Still, both Becky and Pickering shared that upon starting their own families in the years after Nick’s death, they became especially sensitive to their own children’s changes in moods — even when, in some instances, they had little reason to worry. Nick’s lasting thumbprint molded them to try to better perceive others’ mental troubles, a power that has evaded so many in the past.
Mental Health Services (and Disservices)
While passersby in the plot of an afflicted person’s life might not always be privy to their internal plight, certain individuals and institutions may actually have the power to prevent a suicide. In recent years, advocates have directed heightened attention at university mental health services for their responsibilities to screen and treat students who display signs of mental health conditions.
As the American Foundation for Suicide Prevention reported, 90% of individuals who took their own lives in 2019 exhibited a diagnosable mental health condition at the time of death; among those who were diagnosed, 43.8% had not received mental health services in the past year. Those services might have made a difference; a Rand assessment of existing literature determined that many studies demonstrated an association between greater availability of mental health services and decreased suicide risk.
At Harvard, these services take the form of the Counseling and Mental Health Services, an institution which has constantly grown in response to student needs over the years. In recent years, CAMHS has increased its professional staff by about 40%, now hosting 47 mental health clinicians. The university also offers a suite of peer counseling services: Room 13, Eating Concerns Hotline and Outreach, Contact, Response, and Indigo.
However, mental health services were not always widely available at college and university settings. While Princeton University established the first mental health service in the nation 1910, such services and counseling only became common on university campuses in the 1960s.
These services were burgeoning at the time that Nick Minard, Thomas, Colt, and Pickering attended Harvard. In 1976 — the quartet’s graduation year —, the New York Times reported on the “booming” presence of mental health services throughout the country, writing that they have “become fixtures on so many campuses” amid heightened postgraduate and job competition. Still, they were the first on the chopping block when universities faced financial insecurity, despite the suicide rate among 15- to 24-year-olds having doubled since 1960s.
One particular artifact of Minard’s time in the 1970s — stigma — especially encumbered students’ ability to seek care. Thomas said, “I also think there’s a question of vocabulary here. We didn’t have the language to process it in the mid-70s, when there was still a certain amount of stigma attached to the idea that one might seek mental health therapy or counseling of some kind.”
Still, Thomas did find himself seeking mental health care when things became difficult. In his freshman year, he had sought out what was then called the Bureau of Study Counsel, which provided services related to “psychology but not explicitly therapy.” He was seen by an uncredentialed graduate student who mostly stayed silent as he explained his woes.
“I blithered on for a while and at the end of the hour she interrupted me and said, ‘Our time is up but I’ll be very interested to hear how you work it all out.’” Recalling the experience, Thomas erupted into amused laughter, adding, “That was useless.” The therapist’s line soon became a running joke among Thomas and his friends. Needless to say, Thomas never returned to the bureau.
Thomas was not the only student to look past the idea of visiting counseling services. His fellow classmate Pickering noted, “People would get depressed quite often, but I don’t remember anyone going to counseling.”
In 1999, years after Thomas graduated, Harvard’s mental health services received a “sweeping upgrade.” “People are receiving treatments earlier,” noted Dr. Heidi Levine, frequently for “some things that maybe in the past we chalked up to adolescent moodiness.” Even then, stigma still persisted, though, with students hesitating to seek help from the house tutors and proctors who would soon be attesting to their capabilities in letters of recommendation.
In 2003, when Stephen Black ’07 entered the university, Harvard had a more formal process to handle mental health. However, Black felt like he was only receiving a “cookie-cutter version of therapy” that left no real impact. His sophomore year, he encountered severe depression and dealt with suicidal ideation for the first time in his life, brought on in part by his solitary battle against chronic illness. “I was so resistant to get help,” Black shared. “One of the reasons was I had tried UHS at Harvard, and I had seen maybe two different counselors or something there, and I didn’t feel like I was being heard.” It did not help that his two UHS therapists were radically different in their approaches to mental health, “like night and day.”
Smith Campus Center, University Health Services. Photo: Charles Hua. 
University Health Services. Photo: Charles Hua.
With his first therapist, Black recalled, “I just felt completely dismissed.” When he shared what he was going through, he alleged that the therapist responded, “That’s just all in your head … you have to tell yourself that’s not the truth.” He said that the response belittled the depth of his experience, treating anxiety as a figment of the imagination that could be cast away on command. But, as Black shared, “You can’t just flip the switch.” While his next therapist listened openly and did not flatly negate his experiences, Black said that she made him feel dismissed in a completely different way: Her treatment came in the form of a “worksheet” with mental health tips for depression and anxiety. “It’s like, cool — if depression and anxiety can be solved by a worksheet, they wouldn’t be an epidemic in our country,” Black said.
At one point, Black noted that his experiences with University Health Services turned him away from seeking help altogether. He recalled thinking, “Okay, if three times of me going there haven’t been helpful at all, I’m not going to go back a fourth time.” Instead, Black found a private practitioner in the Cambridge area with whom he stayed for the remaining two years of his college experience.
“You would think that one of the best universities in the world would really deeply care about their students’ mental health, because their students are ultimately a reflection of how they’re doing,” Black stated. “Even if they’re looking at their students as a commodity, you’d still want to protect that somewhat. And it’s just heartbreaking that they don’t.”
Still, CAMHS looked to grow and expand its services over the years. In 2018, CAMHS took on a new physical presence with the designation of its own space on the fourth floor of the Smith Campus Center. A big focus was promoting accessibility as well as privacy, with two new separate spaces within the waiting area.
This change came the same year that Fernando Soca ’23 first set foot on campus. Due to Harvard’s health insurance plan and his newfound status as a legal-age adult who didn’t need parental permission, Soca sought mental help. Getting a foot in the door of counseling services in a reasonable amount of time proved challenging; while Soca remembers trying to make an appointment since either August or September, he notes that his first appointment was slotted at the end of October.
Soca had a strong relationship with his psychologist, who was young and thus reared in a generation more cognizant of stigma and sensitivity. While they initially met once a week, Soca said that his appointments were soon cut in half without any verbal communication. Soca shared, “Having some someone there to talk to consistently every single week was basically my only support system at Harvard, so to have felt like that was being taken away from me and really feeling like I had no power in changing it … that was just a big deal for me.”
Soca turned to his patient advocate to learn why his appointments had been cut. He remembered that he repeatedly left voicemails for days, after which his complaint went through. Still, Soca said, “I did not get a concrete answer. No one specifically wanted to tell me how they decided all of a sudden that I was fit.” He suspected a decision might have been determined based on his responses to an intake survey he filled every time he arrived for a session, but he pointed to a lack of transparency surrounding the survey’s purpose and use.
Soca had a more difficult experience navigating his relationship with his psychiatrist, who, unlike his psychologist, was tasked with prescribing him medication. He shared that he was diagnosed with borderline personality disorder and immediately prescribed Quetiapine, a drug which felt too strong and only worsened his mental state.
While taking the drug, Soca recalled sharing with his psychologist, “The Quetiapine is really numbing, I feel really numb. … It’s not like I’m relaxed or whatever. It’s — I literally feel like I don’t have any emotions, it’s just a baseline, like this medicine is really not working, it’s really make me feel just … robotic.”
It took persistent efforts to switch medication and secure an antidepressant instead, a move only approved by his psychiatrist come spring semester.
While the antidepressant provided a needed antidote, it still proved insufficient to fully counter the extent of Soca’s mental health condition, which he believed to be generalized anxiety. At some point during his freshman spring, Soca said that he started getting chest pains in the heart region which he feared was some sort of “baby heart attack.” When the X-ray and blood tests came back with negative results for any physical conditions, he said, his psychiatrists determined that he was experiencing severe panic attacks. “Finally, that is when they maybe started taking it a little seriously,” Soca shared. “But up until that point, when I was still trying to get anti-anxiety medication, treating the [anxiety] and treating the depression, it was just a constant battle to be heard and a constant battle to get something that was gonna work for you.”
In addition to these difficulties, Soca pointed to a deep stigma embedded within the very institution whose guiding principles worked to combat it. Soca, who held a medical marijuana card in the state of Massachusetts, smoked cannabis but shared that he felt stigmatized and judged for doing so, as if his smoking devalued his need for mental health care or medication.
Finally, during his spring semester finals, Soca experienced a severe bout of anxiety and panic that sent him through the doors of CAMHS once more. He tried accessing additional medications to help him get through the next few days before his flight home, but he stated that he faced difficulty in doing so. “They thought I was a drug addict who was withdrawing, and I was begging for pills because I was withdrawing,” Soca said.
He soon got into a dispute with a CAMHS staff member, which he alleged spiraled into the two “haggling” over the number of pills he could receive. The dispute — carried out in the recently renovated waiting room that didn’t protect student privacy after all — left Soca sure that he would never return to the services again. Before he left the room, Soca recalled saying, “This has been one of the most dehumanizing experiences of my life, because never in my life have I had to literally prove that I deserve help.”
“I just left feeling so bad with things. They didn’t tell me, ‘Oh, try Boston hospital, or go to a different provider, or even a hotline.’ They were just like, ‘Here are the five pills, get out of here,’ and you know, that’s it. No help,” Soca shared. Black added that Soca’s experience with CAMHS, coming 15 years after his, was “heartbreaking.”
In pursuit of the help he could not find on campus, Soca began looking outside of Harvard. The process was daunting, with the Boston area presenting a number of options, many of which were closed off to him due to his age or another factor. “But the issue is for me and a lot of people I know, it’s like CAMHS is so bad, you’d rather risk that than go back.”
Once Soca was able to reach a provider from outside of the university, he said that his experience changed dramatically. “My experience with psychiatrists, psychologists, outside of Harvard has been refreshing,” shared Soca, pointing to a “radically different” culture that appears largely purged of stigma. “It’s genuinely refreshing to get a psychiatrist, who you can tell, ‘I’m smoking weed,’ and will not look at you or treat you in a certain way, or even, you don’t feel like your treatment plan is in jeopardy because of smoking weed.”
Other students have frequently voiced concerns about the prolonged wait times to secure an appointment at CAMHS, though Roy pointed out that universities still generally offer much speedier services than external provider networks. In 2019, Harvard reported that the median wait time for an appointment falls between less than a week to around three weeks, depending on time of year and means of contact. On multiple occasions, CAMHS did not respond to or said they could not accommodate requests for comment.
While shortcomings still exist, CAMHS provides Harvard students with a much more robust net than exists for many other college-aged students around the nation. The 2002 study conducted by the Suicide Prevention Resource Center and the Harvard Injury Control Research Center found that only 14-20% of 18-24 year olds who died by suicide were current or recent students enrolled in postsecondary education. This disparity in suicide rates persists after postsecondary education as well; a 2014 study published in the American Journal of Preventive Medicine found that individuals over the age of 25 with only a high school diploma exhibited the highest rates of suicide; their college-educated counterparts, on the other hand, displayed the lowest rates of suicide.
“We have a lot of work to do. But I would appreciate some attention to the mental health of young adults who are not fortunate enough to attend the likes of Harvard or the University of Pennsylvania,” shared Faheem Zaman of Cambridge, Massachusetts, in a New York Times letter to the editor regarding a 2015 article concerning suicide on elite college campuses. “Mental health is not an elite college issue — it is a national issue.”
The Liability Question
When first-year students walk the cobblestone streets of our Cambridge campus on move-in day, they are cast into a world of radical independence in which they take on newfound responsibilities and decision making powers. In many cases, they are separated from their legal guardians for the first time. Within this void of legal guardianship, it is unclear where universities fit in, especially with regard to mental health concerns.
Historically, institutions of higher education were once driven by the philosophy of “in loco parentis,” which places colleges “in the place of the parent” — not as only a purveyor of knowledge, but as a regulator of health and safety. The policy was once so deeply embedded within university practices that Berea College had enshrined a rule which forbid students from frequenting local businesses not owned by the universities in an attempt to preserve their money and time; in 1911, the school expelled a handful of students for violating that rule — and survived legal muster for doing so.
Over time, and particularly as a consequence of the free-wheeling 1960s, universities became beholden to the “bystander era,” a laissez-faire approach which treated the institution less as an active regulator and more as a passive onlooker. In recent history, however, the pendulum has begun to swing once again in the direction of a university’s responsibility toward its students. “Self-governance has kind of died this slow, painful death over the last decade or so,” said Gentry McCreary, a representative of risk-management consultancy Ncherm Group.
This emergent swing toward greater institutional responsibility is reflected in recent legal literature regarding university liability for student suicide.
In the 2018 case Nguyen v. Massachusetts Institute of Technology, the father of a graduate student who died by suicide filed a lawsuit against MIT, two professors, and a dean. While the Supreme Judicial Court ruled against the family in that case, it laid out a framework to be used in order to determine whether this duty of care did exist. The decision stated that a university maintains a “special relationship with a student and a corresponding duty to take reasonable measures to prevent his or her suicide” in the following two circumstances: when the university has knowledge of prior suicide attempts on campus or immediately preceding matriculation, or when the student has stated intentions or plans to take their own life.
In the most recent case concerning suicide liability, Tang v. Harvard, the lawyers representing the Tang family have built a case upon the first of those two circumstances outlined in Nguyen. Luke Tang had already attempted suicide as a Harvard first-year on April 11, 2015, and continued afterward to be visited by suicidal thoughts. Eleven days after the attempted suicide, Harvard transferred Tang to McLean Hospital for in-patient care. During his time there, hospital staff noted that he “believed philosophically that suicide can make sense” and described the student as “immature, a contrarian, stubborn and lacking full insight,” according to the facts of the plaintiff’s complaint against the university.
Tang repeatedly underplayed the gravity of his suicidal ideations and shrugged off the university’s attempts to arrange mental health counseling for him. His ostensible nonchalance was no cause to dismiss concern, however; a doctor at McLean Hospital informed university staff on the day of his discharge, April 29, that while Tang exhibited a tendency “to minimize and underreport,” his testing revealed “significant depressed mood and really poor coping mechanisms.”
It was decided during Tang’s time at McLean that he would have to sign a contract with the university in order to continue enrollment, an aspect of Tang’s case that has since received significant attention and speculation. The contract held that Tang was expected to comply with the recommendations of his treatment team, attend and actively participate in his treatment plan, remain on any prescribed medications, immediately pursue a medical evaluation at the request of any College official, and immediately visit HUHS Urgent Care or the Cambridge City Hospital in the case of inclinations toward self-harm. “If you cannot meet these conditions, then the College will need to re-evaluate whether you may continue to be enrolled and in residence,” the contract stated. Its terms were non-negotiable.
Many have grated against the presence of the contract. To some, it reflects a series of checkboxes for the university to fulfill in order to wipe its hands clean. Indeed, in a 2019 court hearing, Harvard’s attorneys remarked that they had fulfilled their duty — outlined in the contract and in the Nguyen case — toward the student by assisting Tang in the spring semester.
Tang’s family, however, alleges that the university failed on these grounds. After signing the contract, Tang missed therapy appointments and “remained skeptical of the value of treatment”; Harvard faculty also expressed concern that Tang had no treatment plans for the summer. Tang did not receive any mental health counseling between May 16, 2015, and September 12, 2015, the day he took his own life.
David Heinlein, a Tang family attorney, argued that the university should have done more as fall classes approached to ensure that Tang was still receiving treatment. “They should have said, ‘How did your summer go?,’” Heinlein said. “‘Before you get back in the heat of the classes, we want you to meet with the appropriate people.’ They did nothing.” Martin Murphy, another lawyer representing the Tang family, declined to comment, citing the pendency of the case.
“Colleges and universities have legal and ethical duties to college students who exhibit signs or symptoms of depression, mental health illness, or suicidal tendencies and they can, depending on the applicable law, be held liable for failing to meet these duties,” stated HBM Law, the group representing Luke Tang’s family, in a webpage pertaining to student suicide broadly.
For some, the Tang case represents a failing on the part of the university and an unrelenting fealty to the bottom line. As Black shared, “What Harvard doesn’t want to admit was that his death was preventable. If they had reached out to him, if he had had adequate mental health care, if Harvard cared about student health rather than liability, this student would still be alive.”
While it is uncertain what precise impact Harvard’s services could have had on Tang’s decision to take his own life, the case has become symbolic of the crisis facing young adults and questions the responsibility of universities in counteracting it.
The Cult of Silence
As suggested by the title of Colt’s book, The Enigma of Suicide, the act of taking one’s life remains a riddle to many. Moreover, it has been shrouded in institutional secrecy and exiled to the muted conversations and rumors of students.
Part of this silence is due to shame. Black, who was visited by serious depression in his sophomore year at Harvard, said, “It’s something that just brought a lot of shame. Especially when you have a place like Harvard [with] students who are high achieving and want to keep up the illusion at least that they’re fine.”
The desire to keep up this illusion has been exacerbated by social media. During Black’s freshman year, thefacebook.com dropped on campus — a fledgling, student-built app that would soon become a multi-billion dollar leviathan. The app — and many others like it which have developed in the years since — became “a yardstick for measuring your own success,” prompting even struggling students to adopt a guise of composure and self-assurance. “It’s so exhausting to try to act one way when inside something else is going on,” Black said.
The competition, further roiled by the growing facade-culture of social media, chipped away at any ability to talk openly and seriously about mental health. Black shared, “I remember at college hearing other students, even friends of mine, talking about mental health in a derisive way.”
That silence has also become institutionalized and bureaucratized.
Black pointed to one particular incident in which this was especially apparent. During his time at Harvard, a classmate jumped from a ninth-story window of Leverett House, an imposing beige block of a building with uniform black squares for windows.
He said that the email he received from the Dean of Harvard College stated simply that “one of our undergraduate students apparently fell from a window.” He argued that the claim contravened the physical layout of Leverett windows — one large, perennially-shut panel, flanked by two smaller 2 foot by 4 foot windows that must be physically cranked open. Not to mention the vertical metal bar cutting across the smaller openings. A student could not fall without intention, Black concluded.
“In order to fall out a window in Leverett, you need to be sitting pretty high up on the shelf, because small windows have bookshelves on top. You need to be sitting high up on the shelf, and not just leaning against an open window, but repeatedly thrusting your bodyweight against it. There’s no way to fall out of it,” Black claimed.
Yet, the university stuck by its script. “They just went with the ‘fell out the window’ line,” Black shared, aghast by what he saw as patent mendacity. The university continued to repeat its refrain across publications, official documents, and communications, leading to a vast curtain of silence surrounding the attempted suicide. Black said, “Nobody talks about it, Harvard didn’t talk about it, you can’t find anything about it in Harvard news, in any kind of news or anything. You can’t find a thing about it; it was just scrubbed clean because he survived.”
“We all knew what happened, and nobody would talk about it,” Black emphasized.
The cult of silence goes back much farther than Black’s time at Harvard, though. Even in the 1970s, when Minard had died by suicide, his sister Becky noted that the university had rushed through with a vigil two or three days after his death — short notice that encumbered the family’s attendance. A friend had speculated that the school viewed Minard’s death, which came around the time of finals, as a “distraction” to the student body, one to be swept away quickly.
This evasive attitude has characterized the institution’s relationship with suicide in other ways as well. For instance, Harvard has remained notoriously silent about the exact number of student suicides. Instead, it has furnished a statistic of 5 suicides for every 100,000 students, a figure that has been disputed by The Crimson for including students across all of Harvard’s schools and excluding students on leaves of absence. A Boston Globe investigation found the figure to rest at 11.8 deaths for every 100,000 undergraduates between the years of 2005-2015.
Institutional silence around suicide statistics only exacerbates the issue. “When campuses try to hide things, it creates more stigma,” Furr shared.
This year, in the Luke Tang case, Harvard was ordered to provide data and police reports “related to Harvard student suicides” from 2005 to the present — including the initials, year of death, and location of each student who took their own life.
The transparency thrust unwittingly upon Harvard might provide an opportunity for the university to acknowledge the severity of the mental health crisis and work toward changing it. “What an incredible thing it would be — it would never happen — for Harvard to say, ‘Hey look, maybe the culture that we’ve created at our university around mental illness and topics like suicide, maybe that is actually making this problem worse and not better. What a powerful admission that would be.” To Black, that admission remains a pipe dream.
Pandemic Complications
Even prior to the pandemic, mental health presented a serious and growing fault line in the terrain of young adulthood. In 2018, The Task Force on Managing Student Health reported that the percentage of Harvard students who disclosed having seriously considered taking their own lives rose from 4% to 6% between 2014 to 2018; it went on to cite the percentage of undergraduate students nationwide who reported the same having increased from 10% to 13% from fall 2015 to spring 2018.
At Harvard in particular, a culture of achievement and pressure often siloed students into isolation. In July 2020, the Harvard Task Force report found that 62% of first-year students scored highly on the UCLA Loneliness Scale. One student in the Task Force’s focus group referred to Harvard’s culture as “sleep Olympics,” citing students’ proud proclamations of getting even less sleep than their peers — a futile bid to inflate reputation as mental health sinks lower. Another student confided that the traits which defined academic excellence — “obsessiveness, attention to detail” — were often channeled in unproductive ways.
One student subject in the focus group invoked the “duck metaphor” — it was one I had not heard myself before arriving at the College and speaking with my first-year proctor about the seeming impossibility of the workload. The metaphor casts college as a pond, populated by ducks gliding serenely with the visage of tranquility and repose; it is only when you submerge yourself underneath the blue satin surface that you see the ducks pedaling their webbed feet wildly, struggling to stay afloat.
John Harvard, or, “The Statue of Three Lies.” Photo: Charles Hua.
Growing mental health concerns prior to the pandemic also translated into a rising incidence of suicides. A report published in the JAMA Network found that the suicide rate among young adults of ages 20-24 rose by 36% from 2000 to 2017, the latter year marking a peak within that period. Data from earlier years shows that the suicide rate has tripled among those aged 15-24 since 1950.
If mental health and suicide already had presented a fault line before the pandemic, they soon threatened to burgeon into a crisis as students grappled with social loss, academic backsliding, and moral malaise.
In a recent nationwide poll by the Harvard Public Opinion Project, a think tank at the Institute of Politics, 53% of college students reported that school or work-related issues have damaged their mental health. Further, 51% of young Americans as a whole — defined as adults aged 18 to 29 years — reported feeling “down, depressed, or hopeless” at least several days in the past two weeks. This translated to direct self-harm: Approximately a quarter of young people reported thoughts of self-harm or suicide “several days or more” in the past two weeks.
This data has been accompanied by anecdotal references as well. Just a few months ago, a Yale freshman and budding civil rights lawyer, Rachael Shaw-Rosenbaum, took her life. She had spoken with the Yale Daily News in September about a lonely arrival on campus after COVID-19 shut down much of the typical festivities of a new class induction.
At Dartmouth, a string of three first-year suicides over the course of the past year has prompted an institution- and community-led reflection on student mental health. The university’s COVID-19 policies — which included isolated move-ins and virtual orientations — bore an especially heavy toll upon first-year students who had no established friend networks going into a rigorous academic environment. Dartmouth first-year Robert Abel told the Boston Globe that while the university attempted to improve its support infrastructure for its students, it left intact the underlying bedrock of academic pressure and loneliness. Abel said, “It was isolation like I’d never known isolation.”
A Temporary Problem
If the pandemic has widened the fault lines of the student experience, it has also given universities an opportunity to stitch them back together. Advocates for mental health awareness among young people have proposed a number of solutions — from the institutional to the interpersonal — to curb the mental health crisis.
In May, Dartmouth administrators announced that the university would be hiring additional wellness staff as well as partnering with the Jed Foundation to build a four-year plan to protect student mental health. The Jed Campus Program, an arm of the Jed Foundation which works with universities to address mental health concerns on campuses physical and virtual, deploys a seven-pronged plan to prevent suicide.
Chief among these seven priorities is reforming university policies surrounding leaves of absence. “If there’s a single thing I would point to that most schools need to work on, it’s their policies around when students need to take some time away,” stated Nance Roy, the foundation’s Chief Clinical Officer.
A report from the Ruderman Family Foundation termed leave of absence policies in Ivy League institutions “confusing at best and discriminatory at worst.” The report went on to assign Harvard a grade of “D-” for its own leave policies. In coming to this grade, it cited Harvard’s policy of setting nonviolent “community disruption” as grounds for imposing an involuntary leave upon a student. The report criticized the term as “broad and vague such that it can improperly be used to punish students who engage in help-seeking behaviors (i.e., sharing suicidal thoughts with their friends).” It also cited the school’s blanket mandatory minimum amount of time away for all students on involuntary leave, which it noted ignored the particularity of each student’s case.
These policies have had a chilling effect on students seeking mental health care, deterring them from obtaining help for fear of being placed on mandatory leave. “It was either like I didn’t get help, or I did get help, and it would have just cost me a medical leave,” shared Soca.
Once on leave, students do not always have access to university resources. At Harvard, for instance, students on leave may lose their automatic student health coverage. While stating his belief that CAMHS is well-intentioned, Soca expressed concern that policies such as this one often brush aside the need for long-term help. “It doesn’t seem as if they’re there to permanently try to be helping you. It seems more as if they’re trying to help you cope [and] manage your time specifically at Harvard. If you leave Harvard — like I said, winter break, spring break, outside Harvard — they’re not really there to help you.”
The Ruderman report also went on to highlight a number of “good” leave policies, including ones that exclude “threat to self” as grounds for imposing an involuntary leave, instead trusting that decision to students and their medical providers; allow students to work with the mental health professionals of their choice; and give students the choice to start and end their leaves at any time.
Regardless of whether a student is placed on leave, Kyle Carney expressed support for involving parents in decisions related to mental welfare. Carney, who co-founded Mount Auburn Counseling Center, stated, “College administrators can be reluctant to involve parents because of HIPAA, but I actually feel it’s absolutely critical that they involve parents.” Carney cited cases in which parents weren’t involved and the student’s suicide came “completely out of the blue.”
Apart from leave of absence policies, the Jed Foundation also recommended reducing access to violent means by limiting student access to weapons, windows, poisonous chemicals, and rooftops. Colt concurred, stating, “Within reason, you don’t want to make anything easier than it could be, you don’t want to make things easier for troubled and possibly suicidal people; and why make them easier when you can make it harder and keep them alive at somewhat minimum expense?”
Additional guidance included following crisis management procedure for suicide, such as establishing a 24-hour university hotline. “It’s important for colleges to have 24 hour services for mental health — not just during work hours but 24 hours a day. … Because to have nine to five mental health does not make sense,” shared Carney. While Harvard previously did not offer a mental health-specific hotline, just this past month CAMHS announced the launch of “CAMHS Cares,” an around-the-clock hotline service to answer student questions and concerns, regardless of whether there’s an emergency or whether a student is on campus. Furthermore, the Samaritans of Boston offers a 24-hour helpline which answered over 80,000 calls in 2020 alone.
Further, a number of recommendations have emphasized expanding the site of mental health care beyond counseling services. For instance, Roy recommended that all universities screen students for mental health conditions in primary care health services, not just in counseling. “Usually around 12-15% of the student body will go to their counseling center,” shared Roy, “Whereas the health center oftentimes will see upwards of 80% of the student body, so we really are missing a lot of students who might otherwise fall through the cracks if we’re not screening in primary care or the health center.”
Counseling and health services, Roy stated, “are one small cog in a very large wheel to support the emotional well being of our students.”
An even broader approach would fold in not only health services but also the adult figures with whom students regularly interact. One of Nick Minard’s college friends, Becky shared, went on to become a college professor who to this day knocks on students’ dormitory doors when they miss class frequently. That friend is Jill Abramson, former executive editor of the New York Times and currently one of the flagship professors of the Harvard English Department.
Furr shared that in order to promote faculty members like Abramson, “campuses could do a better job of making training available [and] training frontline staff.” Those on the frontlines include resident hall staff as well as the administrative workers who often serve as gatekeepers to professors. On Harvard’s campus, CAMHS trains house staff — including resident deans, faculty deans, tutors, and proctors — but does not train professors, faculty, or other administrators to be able to pick up on mental health concerns among young people.
In the end, Roy said, suicide is a public health crisis that requires an all-hands-on-deck response. “We really need to begin to take a public health approach to supporting students well being on campus, and by that we mean, everyone has a role to play in supporting student mental health — from your coaches to your teachers to your dorm people to the dining hall to security to the Greek system if you have it,” Roy shared. “We don’t mean become therapists, but we need the climate on campus of culture and caring and compassion, where there’s no one door for a student to walk through for support.”
In describing this public health approach, Carney opted for a modified transit mantra: “If you hear something, say something.” She urged students to check in with their friends and keep a lookout for signs of withdrawal from classes, friends, and activities.
Jane Clementi referred to this friend as the “upstander,” one who serves as the “eyes and ears of the school” and is able to actively help those in need. “I think it takes a lot of helpers and advocates and eyes and ears and good listening skills to be the best help we can to people,” shared Clementi. She currently runs the Tyler Clementi Foundation, which is focused on promoting upstanders, bolstering youth mental health, and ending bullying in schools, workplaces, and religious communities.
“There are resources available on campus, and even sometimes it’s just one student to another making sure they know that there are students there to be their friends, to be supportive of them, and that they’re not alone,” Clementi shared. “It’s really key to know that you’re not alone.”
Open doors. Photo: Charles Hua.
Below you will find a list of the most established support resources for the Harvard community, listed in no particular order:
- Room 13: Confidential peer to peer mental health support.
- Counseling and Mental Health Services: Confidential and open to all members of the Harvard community: 617-495-2042.
- University Ombudsman Office: Confidential space to discuss academic and workplace concerns: university_ombudsman@harvard.edu, or call 617-634-9826.
- Samaritans: Suicide prevention helpline serving the Greater Boston and Massachusetts community: +1-877-870-4673.
- National Suicide Prevention Lifeline: Confidential and free 24/7 support for those in emotional distress or suicidal crisis: 1-800-273-TALK (8255).
- Crisis Text Line: Free, 24/7 crisis counseling for depression: Text HOME to 741741.
Data Visualization: Dominic Skinnion
Audio Editing: Charles Hua
Correction: Aug. 23, 2021
An earlier version of this article incorrectly stated the age ranges of the Harvard Public Opinion Project poll on mental health. The correct age range is 18 to 29 years, not 18 to 19.
