This is the third in a four-part series on crisis response and mental health resources on campus. For part one, a look at how the University responds to mental health crises, visit here. For part two, an examination of Stanford’s safety net to prevent mental health crises, visit here. 

Roughly 3,000 undergraduate and graduate students utilize Counseling and Psychological Services (CAPS) or receive off-campus treatment each year, according to CAPS director Ron Albucher. CAPS has experienced growth in student use consistently over the last five years.

Student experiences — both positive and negative — shed light on the organization. Satisfaction with CAPS services differs widely among students.

The Daily examined the resources offered by CAPS and The Bridge Peer Counseling Center and undertook an informal survey of student experience.

 

Increased usage

Both CAPS and The Bridge Peer Counseling Center have experienced increases in student usage in recent years. Both organizations cite relationship issues, depression and stress as the primary factors that bring students in.

Albucher, who said CAPS sees about 2,200 unique students per year, or 14 percent of the campus population, said that an additional six to seven percent of campus seeks treatment outside of CAPS, according to self-reported data.

CAPS has seen an influx of funding and personnel since Vice Provost for Student Affairs Greg Boardman initiated a Mental Health and Well Being task force in 2008, following a string of student suicides. Since 2008, CAPS has hired the equivalent of nine full time employees who are psychotherapists, psychologists and case managers — rounding out a workforce of roughly 40 people.

In that time, Albucher said, the University has gone from having less than the recommended ratio of one counselor per 1,500 students to having about twice the recommended number of specialists.

As CAPS reports a steady increase in the number of students utilizing its services, The Bridge Peer Counseling Center says it has also experienced an increase in traffic.

The Bridge — which offers 24/7 counseling by phone — has roughly 30 staff counselors and four live-in counselors at Rogers House, which is open for drop-in counsels from 9 a.m. to midnight. Between 30 and 40 students take The Bridge’s two required training classes each quarter.

A student Bridge counselor said this size is feasible given space and personnel constraints, but added, “it would be nice to scale that up a little bit.”

Albucher said the same about CAPS resources, commenting that “we could always use more.”

“Each year has always been busier than the last, going back the last five years,” Albucher said, commenting that this year’s data will not be analyzed until the end of spring quarter. “I would expect overall that this academic year, we’ll still see this kind of an increase.”

This quarter, The Bridge has experienced a spike in calls, possibly caused by two recent student deaths.

“We are getting a spike of calls related to mental health and illness — and the loss of Cady and Sam,” said Bridge counselor Akshay Gopalan ’12 to The Daily in April.

CAPS has seen a similar trend, Albucher said.

But Gopalan, who currently teaches the Bridge training classes and has served as a financial coordinator for the group, said that the majority of calls are related to relationships issues — romantic, social and familial — followed by academic issues — general stress and anxiety about pending probations or suspensions.

Depression-related counsels ranked third in 2011 data on the Center’s work.

CAPS reported more counsels related to mental health than The Bridge, and Albucher said that the factors that cause students to utilize CAPS have remained constant over the years.

“The number one issue that brings people in are relationship issues,” Albucher said. “Two and three are depression and anxiety symptoms.”

Albucher said that generally, students are reporting less stigma about mental health care.

 

Short and mid-term solutions

The Bridge and CAPS each offer, respectively, short- and mid-term counseling to students, with each serving as a transition to care for students who need psychiatric treatment in longer increments.

The Bridge is meant to serve as a one-time, short-term resource for student counseling. The Bridge’s general counseling style, Gopalan said, is driven by the counselee and not the counselor.

“We [have] students talk through everything they’re going through and systematically break down complex thoughts and emotions into manageable steps, [and] create an action plan that is feasible and short-term,” Gopalan said, saying that many students like talking to peers to resolve issues.

Bridge calls tend to last one to two hours, Gopalan said.

Alejandro Martinez, a senior associate director at CAPS, a primary advisor to The Bridge and an instructor of its training courses, said The Bridge is a great first resource for mental health.

“If a person has a place to call, that is the most critical step in getting help,” Martinez said. “And that is something The Bridge does exceedingly well.”

Kai-Yuan Neo ’14 said he went to The Bridge and CAPS each for the first time last month and described positive experiences.

“I highly recommend both,” Neo said, commenting that access to The Bridge was convenient because it was open late and didn’t feel as serious as talking to a professional counselor.

While The Bridge is meant for one-time counseling, CAPS — which has both psychologists and psychiatrists, who can prescribe medication — offers more regular meetings.

CAPS used to offer students 10 free counseling sessions per year, but shifted to a less rigid model four years ago, Albucher said. There is no longer a fixed number of available sessions, but CAPS prefers to perform short-term counseling in the interest of seeing more students.

There is no fixed number for the amount of sessions available to students, and counselors make a determination based on the student’s progress and counselor caseloads.

“For some [students] it might be 5 to 6 [sessions] — for others it may be 12,” Albucher said.

Neo, who said he had been experiencing feelings of loneliness and a lack of excitement since winter quarter, said he had not considered either resource before last month because he perceived he did not need psychological help.

Now, he said, he recognizes something does not need to be “wrong with him” to utilize CAPS and has schedule a follow-up meeting.

“Everybody has small problems — it’s nice to talk about them, to make sure everything is on the right track,” Neo said.

 

Scheduling an appointment

“One of our key priorities is talking to students the same day they contact us,” Albucher said, referring to the triage system, in which students schedule a 5 to 10 minute call with a clinician to assess his or her counseling needs. At the end of this triage call, students schedule initial sessions with counselors.

The average wait time between triage and initial meeting is five days, Albucher said.

Most students who spoke to The Daily said they have had to wait a week before seeing CAPS. Multiple students said they have experienced waits of longer than a week, commenting that even a week can be too long for a student with a non-crisis health concern.

Jen Wylie ’13, a resident assistant (RA) in Suites, where sophomore Sam Wopat lived and attempted suicide in March, said that even though she wishes to see a counselor, the CAPS schedule does not work with hers. Wylie is a member of the diving team.

“After Sam’s funeral I was really sad,” Wylie said. “I tried to make an appointment with a CAPS counselor, but my schedule was so busy. Anytime they can meet, I can’t meet. Anytime I can meet, they can’t meet. It hasn’t happened yet. I feel like it’s a lot of emails back and forth.”

Albucher said CAPS sometimes receives complaints about wait time and that he would personally follow up with students who report grievances.

“We’ve had complaints about people not being able to get in a timely way,” Albucher said. “I take those seriously and want to hear about those from students.”

 

Switching counselors

A student may not find a good match with his or her initial counselor. While some might stick with a partnership and others might decide to stop going to CAPS altogether, one RA spoke of a time when his own RA helped him switch counselors.

“When I felt that my CAPS counselor was a little too stoic and didn’t seem to understand me, my RA checked in,” Charlton Soesanto ’11, a co-term student, wrote in an email to other RAs as part of a thread on “what to do about suicide/death” after The Daily began this series. “When he found out CAPS wasn’t going too well, he sat next to me, called the director of CAPS for me, and told him that I needed someone new. Now. The next day I got an appointment with a new counselor.”

Soesanto emphasized that his new counselor was “fantastic” in a follow-up email to The Daily.

Another RA, who identified as a varsity athlete who dealt with major depression, said she was dissatisfied with the services of both CAPS and The Bridge.

“My experience with CAPs has not been the best,” she wrote. “Both in times of crisis and in times of simple distress, it has taken up to a month for me to have a session where I get to seriously address issues with a trained counselor. At the Bridge I do not feel that students who wish to talk to a trained counselor can really get what they need.”

 

Addressing sexual assault

A female sophomore reported waiting two weeks to be seen after a sexual assault on campus in 2011.

“I called triage on February 8 and the first available appointment they had was February 21,” she said, adding that she had described symptoms of depression, said she had been assaulted, and reported not being at risk to harm herself. “They said that I could come in for an on-call clinician.”

The student said she canceled her relationship with CAPS after two counseling sessions because of the tone she perceived when discussing strategies for avoiding a future attack.

“Within two appointments, it was recommended that I take Prozac and that — in order to avoid being assaulted in the future — I reevaluate my clothing choices,” she said.

The student said she could not sleep for four days after being blamed for her attack and spent the following month ridden to her bed.

“It confirmed my fears that what I was experiencing was my own fault,” she said.

“The whole goal of sexual assault counseling would be to not make the student feel like they are to blame for any of it,” Albucher said, commenting that he could only speak generally and not to any specific case.

Albucher expressed that such an incident was concerning.

“I would hope that the student can come and set up a time to meet with me and I’d be happy to figure out what went wrong, what was said, and take steps to — if there was a problem on our end — to fix that,” he said.

“I certainly don’t want anyone — in any way, shape or form — getting that message.”

Despite her experience, the sophomore said she would still recommend CAPS to people dealing with most mental health issues.

“I would recommend CAPS to friends, because I’m sure my experience isn’t a universal one,” she said, though she added that given her experience she would not recommend CAPS to a student who is a victim of sexual assault.

“I wouldn’t feel comfortable recommending CAPS if that experience had even been a possibility.”

The University opened the Office for Sexual Assault and Relationship Abuse (SARA) Education and Response last June to serve as an additional resource for students.

 

Addressing serious depression

Two students with serious mental health issues reached out to The Daily following the first article in this series. Both students, who said they had not discussed their experiences with many others on campus, agreed to speak with The Daily under the condition of complete anonymity.

Student X is an undergraduate who has an anxiety disorder and major depression. Student X has taken multiple leaves of absence and is currently home seeking long-term treatment.

Student Y is a junior with a family history of depression and has battled the illness since early childhood.

Student X said she appreciated resources from The Bridge, but that it could not meet her needs.

“I used The Bridge a few times, but I feel like the severity of my depression was a little bit too much for a peer counselor to handle,” student X said. “I thought it was nice that that resource was there.”

She expressed similar sentiments about CAPS.

“I really appreciated the fact that there were 10 free sessions per quarter,” student X said. “My qualm was that I didn’t really feel connected with my personal counselor.”

“My counselor gave me general tips — deep breathing, writing down worries,” she said. “I wish he’d listened more and taken me a little more seriously in terms of my concerns, worries, fears.”

Student X said she didn’t know that it was an option to switch counselors.

While neither resource worked for her, she said she was “very grateful” to Stanford for connecting her to treatment at home.

Student Y said no one at CAPS communicated that seeing a regular psychiatrist at Stanford Hospital was a viable option, even though she began seeing a specialist there following an experience of suicidal ideations.

“I brought it up earlier with someone at CAPS,” she said. “They said there was no insurance — it would be so much more expensive. It really discouraged me.”

Student Y said “it was not the case” that going to Stanford Hospital was expensive.

 

Off campus referrals

If a therapist, when coming up with an assessment for students, thinks the student’s difficulty cannot be handled short term, CAPS will recommend students to seek longer-term treatment in an outpatient center, Albucher said.

Albucher said that Stanford will partner with a new mental health insurance benefits company in the 2012-13 academic year that will help students in Cardinal Care find good providers in the local community.

“If they don’t want to come to CAPS that’s fine, we’ll help them get healthcare elsewhere,” Albucher said.

Sarah Quartey ’14 said she also left CAPS after a few sessions, but because she thought long-term care would be more beneficial.

“I came to campus with a lot of mental health issues — definitely depressed, showing signs of OCD, anxiety disorder and other things,” Quartey said.

Quartey said that she went to CAPS for a while, but now sees an off-campus counselor every week. She said that Stanford’s Office of Financial Aid was able to cover her co-pay for the off-site services and that CAPS led her to that resource.

“CAPS was a really user-friendly way to start,” she said.