This is the first in a series of articles on mental health and wellbeing on-campus.

The students mentioned and quoted in this article have been granted anonymity for their privacy and safety. 

Katherine, a rising senior, was denied on-campus housing at the start of the pandemic. Her mental health — already tenuous before the pandemic started — quickly worsened. 

On paper, Stanford has resources to help students like her. But Katherine has never used Counseling & Psychological Services (CAPS) — she’s concerned that if anyone knew she was suicidal she would be removed from campus and forced to return to an unsafe home environment.

“I’ve been terrified to use CAPS,” she said.

She’s also not the only student who has these fears. Katherine says her friends are hesitant to engage with on-campus resources, even when not doing so means their mental health worsens, sometimes to the point of suicidal ideation or self-harm. And nine other students The Daily interviewed shared similar concerns.

They’re worried that if they access care, they could be placed on an involuntary hold or face other punitive measures from the University. Others say that CAPS has consistently provided inadequate care — yet another reason to not sign up for an appointment. And the pandemic has only compounded issues: Students say CAPS has not been accessible or provided care alternatives for students located outside of California. 

These fears are not new, but they are exacerbated by a pandemic that has tanked students’ mental health across the country. In the past students have raised concerns through ASSU town halls and student organizations like the Mental Health & Wellness Coalition about confidentiality, wait times and the University’s involuntary leave of absence policy. The University responded to these concerns by hiring more CAPS counselors and changing the CAPS treatment model to reduce wait times.

CAPS Director Bina Patel wrote in a statement to The Daily that “CAPS has been working hard to support students through the pandemic and to prioritize access to services. Our shift to telehealth has allowed us to serve students more flexibly through the pandemic.” Additionally, Patel urged students to visit the CAPS website for further information on accessing the resource. 

In August of last year, in an email to the student body on Fall plans, the University and CAPS pledged to provide accessible mental health services and referrals to students regardless of location. 

‘I would never tell anyone to go there’

Students have expressed mixed opinions about the quality of care that CAPS provides. Several students mentioned that, despite logistical challenges in accessing care, they found individual providers to be kind and helpful. However, this experience was not universal.

Lauren, a junior, who has seen mental health professionals on an ongoing basis for more than a decade, said “CAPS counselors are under-trained and would just cause more psychological distress. I would never tell anyone to go there.” 

She said the counselors were under-trained in handling psychiatric conditions and offered advice that could harm students’ wellbeing.

Mia, another student who is a sophomore, said she isn’t sure CAPS providers are trained to adequately treat students. Mia said she saw a therapist at the Confidential Support Team (CST), a University resource offering trauma-informed counseling for survivors of relationship abuse and sexual violence, and later one at CAPS, but both were unable to provide support. 

“I saw a therapist at CST, and she recommended I try to get into Stanford Outpatient Psychiatry and Psychology for treatment as soon as possible because the school is not equipped to help people with mental illnesses that are persistent or require any substantial knowledge base for treatment,” the student said.

Patel did not directly comment on concerns that staff were under-trained. Instead, she wrote that CAPS “clinicians have remained deeply committed to supporting students throughout the challenges of the past and present year, and definitely would not want any student to feel that they cannot consult with us when difficulties arise or recur.” 

Furthermore, Patel cited a January survey that was sent to hundreds of students who used CAPS services throughout the month. Although CAPS did not provide direct survey data upon request, they wrote that 477 students received the survey, and 158 responded. 

Patel wrote that the survey results indicated that “100% of students agreed that their CAPS provider was considerate of their identities, 97% of students agreed that they had been able to get an appointment with relative ease, and 99% agreed that the response by their provider had been appropriate for their presenting need.”

In addition to concerns over quality of treatment, students have said that they were unaware that CAPS was still open or providing services to students not located on campus. 

Since the beginning of the COVID-19 pandemic, CAPS has operated with a supportive service model. Telehealth care is only available to those located in California and consultations to other providers are available based on location. This model — and the lack of increased mental health support for students regardless of geographic location — has been critiqued by students and residence staff for its lack of clarity and impact on overall student wellbeing. 

Jason, a senior, said they faced a re-emergence of mental health concerns that were worsened by the pandemic. Additionally, because of their home situation and insurance they have been unable to find a provider locally. “I didn’t even know CAPS was still a thing,” the student said. “I really wish I did, especially during COVID. It would have been really helpful.” 

Patel wrote that “CAPS has been working hard to support students through the pandemic and to prioritize access to services.” CAPS has information on their website that indicates resources available to students based on their location. 

Additionally, the website lists non-confidential resources like coaching, where a student can meet with a wellness coach to discuss skills, as available to all students. However, unlike CAPS providers, wellness coaches and other non-confidential resources do not provide the privacy or mental health support of individualized therapy. 

Students also said that they have not used mental health resources when necessary and in times of crisis because they faced barriers to access or stigma — or they feared losing housing or being forced to take an involuntary leave of absence.

The concerns about a leave of absence relate to a 2018 high-profile lawsuit against the University. The Mental Health and Wellness Coalition alleged that the University discriminated against students with mental health conditions — particularly those at risk of self-harm or suicide — by restricting their access to campus and housing. 

The case was settled in October 2019, and the University agreed to change its involuntary leave policy, adding a subsection about non-discrimination. Even with this change, students said they are hesitant to share information regarding self-harm or suicidal ideation with University-affiliated mental health providers both because of the lawsuit and a distrust of CAPS. 

Out of the ten students interviewed by The Daily, all said they had experienced suicidal ideation or thoughts of self-harm. When asked if they would consider sharing these concerns with a CAPS clinician all said they would not over fears surrounding the University’s involuntary leave policy.

Marcus, a senior said that they didn’t access mental health resources because they feared judgment from peers, family and faculty. The student said that hearing from friends, student staff members and other students that CAPS had forced students on leaves and involuntary psychiatric holds made them unwilling to reach out to the resource even in times of extreme crisis. 

“There definitely have been times where I should have used mental health resources and didn’t,” Marcus said.

The experience of withholding information about self-harm or suicidal ideation is not unique, as Mia shared: “In frosh year my PHE and RCC told me that if I ever went to CAPS or CST I should just say ‘I’m not suicidal,’ because if I did they would send me home. And I would do anything to not go back home.”  

When asked about the role of CAPS in involuntary leaves of absence, Patel wrote “CAPS does not have an administrative or decision-making role regarding involuntary leaves, which are very rare events. CAPS is here to consult with any students who may be taking a leave to support them in making a care plan.”

When asked about their fears with engaging with mental health resources on campus when in times of extreme crisis, Marcus said, “I think it’s disappointing that like the reason I don’t want to go through a mental health crisis at Stanford has nothing to do with like how hard, that is, and has more to do with how I think it would go.”