By Ari Gabriel
The students mentioned and quoted in this article have been granted anonymity for their privacy and safety.
Thirteen student staff, students, and Counseling & Psychological Services (CAPS) and Confidential Support Team (CST) patients said they were left in the dark about changes, often blindsided or never informed of changing policies surrounding campus mental health services.
Students, including student staff, contended that CAPS and CST have not communicated consistent policies or practices about options for mental health resources, creating confusion and distrust. Without clear communication, student staff said they are struggling to refer their residents to proper channels for mental health support.
Additionally, students using CAPS and CST said those resources have provided conflicting information about how the on-campus mental health resources will function during virtual quarters, complicating access to mental health resources for students outside of California. They said confusion has been made worse by a lack of transparency by on-campus resources regarding the treatment and referral processes in virtual quarters.
In an email to the student body, Vice Provost for Student Affairs Susie Brubaker-Cole and Vice Provost for Undergraduate Education Sarah Church announced on Aug. 13 that CAPS would provide full mental health services to students located in California and supportive services for students located outside of the state.
Since late winter quarter, when campus transitioned to virtual learning due to the COVID-19 pandemic, CAPS and CST have been operating with a supportive service model. Telehealth care was made available only to those located in California, and various supportive services were made available to others based on location.
Before spring quarter, student staff said they would refer students to CAPS and CST on a weekly basis, but due to policy changes they have stopped doing so.
CAPS director Bina Patel and CST director Helen Wilson jointly commented on allegations that CAPS and CST had never informed student staff of changing treatment and referral practices in a statement to The Daily, citing the CAPS message to the student body sent on Apr. 14 as the main source of communication about CAPS’s new wellness initiatives. In the message, CAPS outlined five ways students could connect over the virtual quarter and said they would provide supportive services to out-of-state students.
Patel and Wilson also pointed to communications to students like updates on the CAPS website and messaging through campus partners like Residential Education, Residence Deans, Graduate Student Life Deans, the Vice Provost for Student Affairs and the Dean of Students.
“I wish that CAPS had been transparent.”
Students said they received conflicting and, at times, inaccurate information from CAPS and CST providers.
One female international student ’22 called CST two times over the spring and summer quarters and said she received varying responses.
During her first emergent call to the 24-hour hotline, she said CST asked her a series of intake questions and then was unable to provide care because she was located internationally. She then called CST on a different day during regular business hours with the same emergent issue. In the second call, she said she received short-term aid and the opportunity to continue service with CST, an option which had not been presented on her first call.
A female student ’21 said that moving out of California left her with few options when she sought treatment in winter and spring quarters.
After Stanford went online at the tail-end of winter quarter, she transitioned to teletherapy and informed her therapist before leaving California in spring. When she told her therapist she would be leaving California, she said she was then apprised of her limited options due to licensing and legal implications for CAPS counselors.
Once the student left the state, treatment stopped and she felt as though she could no longer contact her therapist because of the licensing guidelines that had been explained to her. Additionally, she said she has been unable to find a therapist after CAPS ended her treatment in the spring quarter due to financial concerns.
In another account, a female student ’20 told The Daily that she was seeing a nutritionist at CAPS during the winter quarter and continued to do so in spring.
She notified the CAPS staff that she was no longer in California at the beginning of spring quarter. She was told this wouldn’t be an obstacle to treatment because the CAPS guidelines regarding out-of-state treatment was a prioritization guideline and not a licensing rule.
“My nutritionist has told me that this [only seeing students located inside California] was more of a priority thing,” the student said. “So, the issue was that they had to prioritize students who were in states that they could serve.”
When asked to comment on the prioritization of care for students located in California, Patel and Wilson wrote “CAPS did not decide to prioritize care of in-state students over students who are residing out-of-state. Our ability to provide full-spectrum care for students in California is due to current legal processes that CAPS is obligated to follow.”
When asked why campus mental health services did not request cross-state licensing exemptions so that counselors could treat students who had to relocate, Patel and Wilson cited guidance from the University’s Office of General Counsel and their malpractice insurance carrier.
“CST and CAPS have continued to provide support for students who are out of state through a variety of approaches,” Patel and Wilson wrote. “For students outside of California, CAPS and CST will continue providing care management services, helping students connect with mental health resources in their communities and providing interim support for their needs, regardless of their location or situation.”
Patel and Wilson also encouraged students to come forward to CAPS when concerns about service arise.
“Wherever they may be located, students should definitely know that they can reach out to CAPS when they need help. We want to hear directly from students to address their needs and concerns in real time.”
“Mental health resources on campus don’t know what they’re doing.”
Before the virtual quarters, residential student staff members served as a main source of campus mental health resource referrals for students. A male student staffer ’21 described staffing as being “on the front line when it comes to mental health for residents.”
A female student staffer ’20 said there had been a lack of communication about CST and CAPS policy changes regarding referrals and treatment options during the virtual quarters.
“Nobody from the mental health resources on campus reached out to student staff to let us know how to make referrals or help students access their virtual resources,” she said. “They did not discuss the online transition or discuss how to make referrals.”
All student staff members interviewed by The Daily agreed that during the first two quarters of this school year, they would often refer residents to on-campus mental health resources.
A male student staffer ’21 would refer people to on campus mental health resources “multiple times a week the first two quarters.”
During digital quarters, however, all interviewed staff members said that factors such as a lack of communication from on-campus resources, a lack of trust in those resources during spring quarter, a lack of communication with their residents and a lack of transparency made them unlikely to refer students to on-campus resources.
“[Right now] mental health resources on campus don’t know what they’re doing,” a second male student staffer ’21 said.
“So I just tried not to refer people to CAPS during spring quarter specifically, just because I already knew that they were like on thin ice,” the staffer added. “And I didn’t really trust them as a resource.”
He said that at the beginning of his staff term, in fall 2019, he was hopeful that CAPS would improve after policy changes and restructuring. He added that he had lost faith in CAPS after the lack of communication and clarity about access to mental health resources during the pandemic.
A female student staffer ’20 said, “I wish they had been transparent about [treatment guidelines] so that they [CAPS] could get students more resources on how to get the help they needed.”
Additionally, multiple student staffers told The Daily that they believed the University should be doing more to help students outside of California access mental health resources.
When asked about how CAPS is addressing the needs of students during the COVID pandemic, Patel and Wilson wrote, “CAPS remains very focused on student mental health and wellbeing, especially at this time of crisis and isolation for so many students.”
Patel and Wilson also wrote that CAPS is working on providing interim care together with other campus organizations.
“Staff have been working extensively with campus partners including Well-Being, CST, Departmental and Community Center staff, Bechtel, Residence Deans, and Graduate Life Deans to offer virtual outreach events to support students and communities impacted by Covid-19 and other national/global crises,” they wrote.
Student staffers emphasized the importance of community approaches when dealing with mental health on campus during the pandemic.
A male student staffer ’21 said “dealing with mental health is a communal thing. It’s not an individual thing.”
A different male student staffer ’21 brought attention to the urgency of the situation.
“The University needs to immediately find another solution because students need a resource,” he said. “And it’s a really important resource especially during super delicate times like now.”
When asked to comment on what CAPS and CST are doing this year to address the student staff members’ concerns about mental health care resources on campus, Patel and Wilson wrote that “staff training, especially this year, needs to be an evolving and ongoing process, and it is the goal of [Residential Education] to provide student staff with ample resources to support our residential communities.”
Despite the recent lack of communication and transparency with staffers and worries about negative experiences, some would still recommend on campus resources to their residents.
A female student staffer ’20 said, “you might be surprised, and it might work out for you.”
Contact Ari Gabriel at arijgab ‘at’ stanford.edu