By Sarina Deb
Students face both additional mental health challenges and additional barriers in accessing quality care, as Stanford and its students adapt to remote instruction and changing public health regulations in the wake of the COVID-19 pandemic.
“We know that the COVID-19 situation is causing significant disruption and distress for our community,” said Counseling and Psychological Services (CAPS) Director Bina Patel. “This is an unprecedented event, and CAPS is committed to supporting students wherever they may be.”
Eating Disorders Specialist and CAPS Clinical Care Manager Sheila Levin noted that social-distancing regulations can negatively impact students’ health.
“Naturally, many students crave connection,” Levin wrote in a statement to The Daily. “I’ve noticed that bothersome symptoms are often exacerbated by the social distancing and isolation. Many students resort to unhelpful behaviors such as binge eating, food intake restriction, excessive exercise, purging and substance use to cope if they have not developed other mechanisms.”
Levin added that the uncertainty of the crisis may also be affecting students negatively.
“Students seem to be much more concerned with future uncertainty, particularly graduating seniors,” Levin wrote. “Future uncertainty is difficult under the best of circumstances. But when the entire world is faced with this problem, it can be terrifying for young people. Therefore, I’ve observed there is a greater need for psychoeducation and skill-building at this time.”
For students that live in California or on campus, CAPS continues to provide individual services via Zoom or phone. These telehealth services include initial consultations and evaluations, follow-up therapy and medication visits, psychiatric medication evaluation and care management and referral coordination help.
But for students who are living outside of California, Patel said, the transition to telehealth is not as simple. As CAPS clinicians may only be licensed to provide ongoing care within California, they are unable to provide students who did not live in California with consultations, evaluations, psychiatric care or follow-up therapy. Out-of-state students, however, can seek consultation support, which includes discussion of a student’s situation and needs, strategies for managing those needs and assistance with accessing clinical services and other resources.
For students who were already in treatment with CAPS but had to move out of state, CAPS will also provide interim clinical support until students can connect with local care resources.
CAPS, which is located at Vaden Health Center, is offering only some of its in-person services due to social distancing protocols. The center is currently staffed by a small number of clinicians from 8:30 a.m. to 5 p.m., Monday through Friday, who can meet with students who may be in crisis.
CAPS has also postponed its offering of clinical groups and workshops for the spring term due to “concerns about ensuring confidentiality for group services delivered via telehealth,” according to Patel. But CAPS hopes to still offer students a version of their group sessions, she added, through developing videos based on their curriculum that students can access for free on the CAPS groups and workshops web page.
“We are very grateful for the ability to continue serving students via telehealth through this time of crisis,” Patel said. “Students have also expressed appreciation for being able to receive care through telehealth. The advantages of virtual care include increased convenience, flexibility, and access.”
Students can also seek support through the Well-Being at Stanford coaching team, who offers coaching, workshops, office hours, and nutrition visits to help students maintain wellness.
“We’ve seen an increase in students seeking coaching who want help dealing with uncertainty, but also want to take advantage of differently structured time to focus on goals previously on the back burner,” said program manager Colin Campbell ’11.
Campbell said students are putting pressure on themselves to be “extra productive” during this time, citing the downtime they feel they have.
“They’re struggling with self-compassion in an extraordinarily stressful time,” he said.
Student Support Specialist and Graduate Student Well-Being Coach Sanne Lim said graduate students in particular may be facing stressors due to worries about the economy and job market when they graduate.
“On top of a general challenge to transition, it is very challenging to job search at this time, knowing that nobody knows what the world will look like,” she said.
Some communities, the Well-Being team said, are especially disadvantaged during this time.
“Queer students have lost community, whether they remained on campus or went home,” said Director of Well-Being at Stanford and Weiland Health Initiative Inge Hansen. “At home, they may have to go back into the closet, deal with misgendering, microaggressions or lack of acceptance from family and community, and a lack of inclusive resources.”
Hansen added that Asian and Pacific Islander students may struggle with being falsely blamed for COVID-19 due to the novel coronavirus’ origin in China, and that first-generation and/or low-income (FLI) students might be facing stressors due to financial concerns and home environments that are not conducive to learning.
In response to the changing environment, the Well-Being team and staff from various departments collaborated to create the workshop “Coping, Caring and Connecting During the COVID Crisis,” which supports students in coping with and processing the pandemic and its effects on their lives.
“I began building this presentation shortly after the move to distance learning began as a way to help students, staff and faculty come together to pause, connect and process the torrent of disappointment, change and uncertainty flooding our heads and hearts since the beginning of the crisis,” said Well-Being Senior Health Educator Donnovan Yisrael ’89.
For both students and providers, however, accessing and providing mental health care virtually has presented new challenges. Some students struggle to find a private space and stable internet connection to engage in a therapy session or consultation. Providers, who often observe facial expressions, body language and other subtle characteristics of a patient in their evaluations, must now attempt to gage this information through a screen.
“Personally, conducting virtual therapy sessions is a huge adjustment,” Levin wrote. “No matter what, there is simply no replacement for face to face contact. I like to pay close attention to things such as: body language, gait, clothing, aromas, hand and leg movements, eye contact, responses to certain stimuli (i.e. sounds, light…) and lots more that might not be portrayed virtually.”
“The physical separation causes me to worry much more about their well-being in case the technology prevents an accurate portrayal of what is really going on,” Levin added.
Campbell said that making group activities virtual has also affected the quality of the sessions.
“Our educational services are engaging and high touch,” he said. “These activities just don’t carry the same impact over Zoom.”
Like CAPS, the Well-Being team faces restrictions in offering some types of care to out-of-state students.
“Practice exclusivity licensure laws prevent dietitians from offering telehealth to students in certain states,” said nutritionist Bryan Lian.
Some students are also facing barriers to continuing therapy remotely due to insurance issues. Polly Moser ’22, who lives in Maryland, was told that her insurance company would stop covering her sessions with her Stanford-based therapist.
“I definitely cannot afford my therapist without insurance,” Moser said. “But when I called the company, they told me that because my therapist is not licensed in my state, they would definitely not cover sessions.”
A first-year student, who asked to remain anonymous due to the personal nature of their health, also described trouble finding a therapist in her hometown who would accept Cardinal Care insurance and meet her needs.
“When I came back home, I lost all ways of managing my eating disorder and was dealing with extreme grief with the loss of spring quarter, my job, and everyone I loved,” the student said. “I found that there were no treatment centers covered under Cardinal Care, which is not totally surprising because even Intensive Out-Patient (IOP) and Partial Hospitalization Programs (PHP) can rack up huge bills.”
The student said she was also surprised to find that there were very few counselors, therapists or psychologists in her area that could treat eating disorders and were taking new patients.
“I tried for three weeks before I could finally get an appointment,” she said. “And the day before the appointment, the provider called me to tell me that they actually don’t cover my insurance. Another week goes by, and I’m able to find another appointment at a different place, but they require four in-person meetings before they will let me transfer to telehealth, which has only increased my anxiety regarding COVID-19.”
Patel said that CAPS urges students to reach out to University resources for support.
“This is a time of unparalleled change and loss for our entire community, in ways both large and small,” Patel said. “We also know that crises of this scale magnify the impact of existing systemic inequities in the home communities for many of our students — disparities that affect access to crucial health, economic, and social resources. We are especially concerned for students who feel isolated and disconnected from vital support systems, whether they are on campus or at home.”