Transcripts:

Jay Ruderman: Experts in the field of mental health have announced that a college mental health crisis is plaguing the United States. Why it exists, and what should be done about it?

Announcer: All Inclusive, a podcast on inclusion, innovation, and social justice, with Jay Ruderman.

Jay Ruderman: Welcome to All Inclusive. I’m your host, Jay Ruderman, and today I’m joined by Dr. Miriam Heyman, a senior program officer at the Ruderman Family Foundation, and author of our latest white paper, Mental Health in the Ivy League. Today we’ll be discussing college mental health. Popular notions of college depict these four years as the best times of our lives. College students are living away from home for the first time, and they gain an incredible amount of freedom and independence. They develop new friendships, new romances, many of which last a lifetime.

Jay Ruderman: And yet, experts in the field of mental health have announced that a college mental health crisis is plaguing the United States. Miriam and I will talk about this crisis, who it is impacting, why it exists, and what should be done about it. Miriam, welcome.

Dr. Miriam Heyman: Thank you.

Jay Ruderman: So, let’s start from the beginning. What is the college mental health crisis and why is it here now?

Dr. Miriam Heyman: We are seeing an epidemic of mental illness on college campuses across the country. According to national data, 40% of undergraduate students have felt so depressed within the past year that it’s been difficult for them to function, 10% have seriously considered suicide, and these numbers are higher than the numbers for kids and young adults of the same age who are not attending college.

Dr. Miriam Heyman: We’re seeing this for several reasons. First of all, anxiety overall is increasing throughout all age brackets and demographics in our country, and on college campuses in particular, more students are arriving to college with pre-existing conditions because we as a society are doing better at supporting students with mental illness in high school, so more of them are successfully completing high school and enrolling in college. But they’re coming to campus in need of support, and we are failing at providing that support.

Jay Ruderman: So, these statistics are really astounding. It sounds like college today is a real pressure cooker, and mental health is being impacted by the experience on college campuses. How are colleges and universities reacting to this crisis? What are they doing?

Dr. Miriam Heyman: So, the short answer to how are colleges reacting is that, not well. There is not an infrastructure on college campuses to support students with mental illness. The best-equipped colleges have about one clinician for every 1,000 students, and on larger schools, we’re seeing one clinician for every 2,000-4,000 students. So, there is not the infrastructure of support that students desperately need.

Dr. Miriam Heyman: The majority of college students who meet diagnostic criteria for mental illness, like depression or anxiety, do not receive any treatment. Virtually every college reports that there is a wait period before college students can access counseling services, and this has catastrophic consequences. 86% of college students who die by suicide never receive treatment for mental illness.

Jay Ruderman: One of the focuses on the white paper that you recently authored was the issue of a leave of absence. Talk a little bit about what is a leave of absence, and why is it relevant to this issue?

Dr. Miriam Heyman: So, the Americans with Disabilities Act prohibits discrimination on the basis of disability, and that includes physical and invisible disabilities like depression, anxiety, post-traumatic stress disorder, and others. And this makes it illegal for colleges to discriminate on the basis of mental illness or any other disability, and it also requires colleges to provide reasonable accommodations to students with disabilities, including mental illness.

Jay Ruderman: In other words, they don’t want to deal with the issue. They’d rather it be off the college campus and away from them, and not deal with the liability that the mental illness may bring to light. Can you talk about, without naming names, or … Any specific instances where this has really had very detrimental impacts on students who have been asked to take a leave?

Dr. Miriam Heyman: I think you’re right, that colleges are scared of the repercussions of potentially allowing students to stay on-campus. Specifically, they want to avoid suicide on campus and the liability that might come with that, or perhaps more relevantly, the negative PR that would accompany a suicide on campus. While that is understandable, a leave of absence has been implemented in a way that has resembled exclusion and discrimination.

Dr. Miriam Heyman: For example, colleges are imposing reentry criteria on students who take a leave of absence, and this criteria is often vague or impossible to accomplish. For example, colleges will require that a student demonstrate stability before returning by taking classes in another academic institution, and many students’ financial aid won’t transfer from the original school to the second academic institution. So, financially they are not able to meet that criteria, and thus they are prevented from ever coming back.

Dr. Miriam Heyman: Many leave of absence policies also include prohibitions against visiting campus while a student is on leave, meaning that if a student goes home to their families for a semester, and if that home is near the school, that that student cannot come, even to have a coffee or attend a sports game with their friends. So in those situations, they are compounding social isolation with existing mental health disability.

Jay Ruderman: Do you know of examples, through your studies, of students who have been asked to leave, that in your opinion this leave has led to suicide?

Dr. Miriam Heyman: There is a story from one of the Ivy League schools where a student, she died by suicide before taking a leave, and in her suicide note, she actually mentioned the restrictive leave of absence policies of that school. Her note said, “I don’t want to take a leave,” and I’m paraphrasing here, but, “I don’t want to take a leave because I don’t want to be forced to stay away from school in this type of restrictive way.” What she was referring to in particular was that that school, their policy specified a minimum length of time for a leave.

Dr. Miriam Heyman: This is problematic because trajectories of mental illness, and recovery, vary from one person to the next. A student, for example, who has a breakdown in November, and needs to go home, take the rest of the semester off, adjust their medication, that student might be healthy and ready to return in January, but then that school might say the minimum length for a leave of absence is one full semester, or perhaps even two. And in that case, the student would be forbidden from coming back until the following September. So, they’re at home without a sense of purpose, and also likely socially isolated.

Dr. Miriam Heyman: Yes, there are stories in the news where fears of this type of exclusion imposed in these umbrella ways through these policies that do not look at cases on a case-by-case basis have led to suicide.

Jay Ruderman: So let me put myself in the shoes of a university president or a dean. I want to keep the school safe, and I don’t want any of the other students who I’m responsible for to be hurt. How do you respond to those type of concerns?

Dr. Miriam Heyman: I would respond by saying I absolutely agree. Keeping students safe should and is the first priority of the school. But actually many of these restrictive or exclusionary policies, I think, decrease campus safety, and I’ll give you an example of that. Some schools, their policies state that community disruption is grounds for an involuntary leave. Community disruption is a very vague term that can be very broadly applied.

Dr. Miriam Heyman: An example of community disruption that actually has been brought to light in some of these high-profile cases is a student saying to his roommates, “I’m having suicidal thoughts. Please accompany me to the campus counseling center.” That is a help-seeking behavior. We want students to speak up when they need help and to not fear that that speaking up will be construed as community disruption and could result in unnecessary exclusion.

Dr. Miriam Heyman: We hear this a lot, anecdotally, that students are not seeking counseling services because they fear that they might be placed on a leave of absence if they go to the counseling center and get the help that they need.

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Jay Ruderman: In a recent paper you authored, the Ruderman White Paper, you focused on Ivy League schools and their leave of absence policies. Why the Ivy League schools?

Dr. Miriam Heyman: Why the Ivy League schools? I think that this is a problem that is confronting the entire nation, the entire sector of higher education. Schools around the country are struggling with the mental health needs of their students, and basically they are failing to support their students. I think that the sector of higher education desperately needs some leadership, and the Ivy League schools are role models for the other schools in the country. So, I think that if the Ivy League schools take this criticism to heart, and reexamine their policies and rephrase them to communicate institutional commitment to supporting students with mental health disabilities, I think that other schools will follow.

Jay Ruderman: What would be your recommendations of policies that the schools could change to make the situation better?

Dr. Miriam Heyman: In the Ruderman White Paper on Mental Health in the Ivy League, we examined 15 indicators, or 15 characteristics of policies that, for better or for worse, communicate either a commitment to support or exclude students with mental health disabilities. None of the Ivy League schools received a score higher than a D+, so there is a lot of room for improvement here.

Dr. Miriam Heyman: Again, I would frame this as an opportunity for leadership. I would encourage the Ivy League schools to seize this opportunity and lead the entire nation in improvement. And I do recommend very specific changes. For example, out of the eight Ivy League schools, three of the policies currently prohibit students on leave from visiting campus. I would recommend removing that prohibition, enabling students to stay connected with their peers while they’re on leave.

Dr. Miriam Heyman: Four of the eight Ivy League schools specify minimum lengths of time for the leave. I would recommend eliminating this minimum length of time and encouraging students to come back when they are ready, and when they have documentation from a healthcare provider that supports their readiness to return, even if it’s not one full semester.

Dr. Miriam Heyman: Four of the policies do not communicate that students are entitled to accommodations that might reduce or eliminate the need for a leave. If a student is suffering from anxiety, things like a reduced course load might alleviate that anxiety, and that might be an option to explore first before putting a student on leave. But the policy should communicate that. I think that transparency is an essential buffer against discrimination, and schools should be very upfront about the support that students are entitled to receive.

Dr. Miriam Heyman: A fourth recommendation is a low-hanging piece of fruit. Most of the leave of absence policies do not identify someone on campus who can support students reentry. I mentioned, I think, that in a lot of case, the reentry criteria are very vague or ambiguous, and it’s important for students to know that there’s someone on campus they can contact who can help them answer questions they might have, and facilitate that process. What that does more broadly is to communicate that even though you’re at home for the semester, you are still a student of this school, and you’re still entitled to school-based supports. And I think it’s pretty straightforward for colleges to add the name or title of a liaison person for students who are on leave, and yet something so small will still go a long way in communicating their commitment to supporting their students.

Jay Ruderman: Let’s talk about the grading. Why give the schools grades? What impact does that have?

Dr. Miriam Heyman: I mentioned that no school scored higher than a D+. I think there was not so much variability in the grades. They were all in the D or F range. I think what I hope is that that communicates that this is a problem across the board. That this is something that schools, I think, are obligated to address from the perspective of social justice, civil rights, inclusion, and really every single school in the Ivy League, and I would venture to say every school outside of the Ivy League, has room for improvement here.

Jay Ruderman: What is the incentive of colleges and universities to make these changes? How does it benefit them?

Dr. Miriam Heyman: I’m delighted to say that the majority of the school newspapers have covered this research in their student paper, so I think that is very important to context for this national conversation. I absolutely think that schools have an incentive to make these changes. Schools benefit financially when their graduation rates increase, and supporting students is a, I think, foolproof way to increase your graduation rate.

Jay Ruderman: But it seems, at this point, that there’s been a defensive reaction by the schools, instead of a embracing, “We can do better on addressing mental health on college campuses.”

Dr. Miriam Heyman: I would agree with that. In all of the articles that have come out, the schools have either failed to provide an official comment, or have been critical of some element of the analysis of the paper. I would encourage them to step away from the defensive and work with us as partners. We would be happy to partner with the schools to suggest smaller and easier to implement changes, that they can make immediately, and then perhaps, over time, tackle some of the larger changes that we’d like to see, as well.

Jay Ruderman: Since the publication of the Ruderman White Paper on Mental Health in the Ivy League, have you had any contact from students and what has been their reaction to it?

Dr. Miriam Heyman: I’ve spoken with students who have been writing the articles for their school papers, and they are eager to bring this issue to the attention of their administrators. I know that the newspaper staff, and also student body presidents, have brought these findings to their administrators, have not yet heard what the reaction of the administrators has been, but I do hope that this research motivates college students to get involved and to speak out, and to also continue to speak up when they need help.

Dr. Miriam Heyman: I mean, I think part of our mission at the Foundation is to destigmatize mental illness and to make all people, college students and not, feel comfortable accessing help when they need it, and I hope that this contributes to that conversation as well.

Jay Ruderman: I hope so. In addition to the leave of absence policies that we’ve covered, what else do you think that schools … What steps should they take to improve the mental health crisis in the schools?

Dr. Miriam Heyman: Schools clearly need to build their infrastructure of support, expand the availibility of counseling services. I think all schools recognize that and are starting to take steps, but that will be a long process, because there is not nearly enough available counselors on campuses for students. And then, I think schools also should educate the entire school community about mental health.

Dr. Miriam Heyman: One event that we co-hosted, former governor Dukakis who’s now faculty member at a college, spoke about how he responds to struggling students with empathy. So, if a student sleeps late or fails to turn in an assignment, Governor Dukakis will approach that student and say, “Are you okay? Are you struggling? Do you need a referral for counseling or any other service?” As opposed to, I think, the traditional reaction from a professor would be, “That student is lazy. If you don’t come to a class, you’re going to fail.”

Dr. Miriam Heyman: I think that Governor Dukakis is perhaps a rare leader in that way, and I think that schools should train all students, resident advisors, and other students as well, and faculty members, to recognize the signs of mental illness, things like sleeping through class, not turning in assignments, and to not provide counseling services, it’s not the professor’s responsibility to do that, or the RA’s responsibility to do that, but they should be prepared to refer students to services.

Jay Ruderman: I think that it’s important to say that Governor, or now Professor Dukakis and his wife, Kitty, have been leaders on the issue of mental health and have been very outspoken about the importance of being open in addressing issues of mental health.

Dr. Miriam Heyman: Absolutely.

Jay Ruderman: Thank you, Miriam, for joining me today.

Dr. Miriam Heyman: Thank you.

Jay Ruderman: I hope that this podcast will encourage schools to prioritize mental health and wellbeing. Clearly there’s a lot of work that needs to happen, and bringing these issues to light is a critical first step.

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