Emma Master ‘19 is a staff member in student mental health and well-being. She serves as the Program Coordinator for “Meeting the Moment,” run by the Office for Religious and Spiritual Life, the Stanford Storytelling Project, LifeWorks Program for Integrative Learning, Health and Human Performance and Wellness Education.
In Part One, I introduced the widespread problem of mental health distress in Stanford’s student body. I also reevaluated the University’s responsibility to address its students’ mental health needs, especially when those needs are becoming a safety concern and are created in part by the University and its high-achieving culture. Here, in Part Two, I offer some pathways to progress for mental healthcare at Stanford. There are concrete steps that Stanford can take to address this distress in a preventative and communal way rather than as a reactive response to tragedy.
Many students have relationships and communities that support them when they face challenges; often at the heart of this are the Resident Assistant (RAs). I will not address RA roles much in this piece, but the topic deserves an article of its own. Student RAs are on the front lines, serving their peers in some of their most extreme moments of crisis, as well as providing everyday support that should not be overlooked. They do their best despite training that is inadequate for the mental health crises that they must handle, struggles to be heard and supported by the administration, low pay and more, all on top of leading their own lives. Currently, student RAs bear the brunt when formal institutional resources for student well-being lack the funds to meet student demand.
In terms of these formal institutional resources, I see two major areas in which increased funding would greatly benefit students: Counseling and Psychological Services (CAPS) and wellness-oriented curricula (spanning Wellness Education, Health and Human Performance, LifeWorks, Institute for Diversity in the Arts, the Office for Religious and Spiritual Life, the Leland Scholars Program and more).
Last fall quarter, Wellness Department classes at the University filled up even before freshmen had their enrollment holds lifted, so they could not enroll. For this spring quarter, my 35-person Wellness class “Meeting the Moment” filled as soon as enrollment opened, as did our 40-person waitlist. We are still getting emails from students asking to be added to the waitlist. CAPS is also under-resourced relative to students’ demands for care. Students have long complained of multi-week wait times between sessions and the difficulty of procuring long-term placement after they are referred out.
When I was an undergraduate (2015-2019), Stanford was constantly encouraging students to reach out for help when they needed it. At that time, the common narrative among students was, “I’m capable and competent. I can’t let anyone know I am struggling.” That narrative has changed. Now, many students are asking for help; the departments who give that help just do not have enough resources to meet that demand.
Immediate-Term: Increase Resources to Meet Student Need
As an immediate-term measure, both CAPS and Wellness require more funds to employ enough staff members to meet student needs. CAPS needs to be able to employ enough staff to effectively triage short-term mental health care and reduce wait times. While CAPS does have an on-call service for immediate crisis response, students in distress cannot experience weeks of wait time in between appointments. Wellness departments need to be able to offer enough classes to meet student demand, instead of having consistently long waitlists that are filled with students who are asking for skills to manage their distress and are being denied appropriate and timely care.
Longer-Term: Structural Change
As a community, we need to be clear about what CAPS is and is not. With 37 clinicians (some of whom work part-time), CAPS physically cannot provide long-term care for a student body of almost 17,000 — nor is it meant to. What CAPS is meant to do, as efficiently as possible, is to triage care so that students can be seen in the short-term, and then *ideally* be referred out to long-term providers if they still need care or ongoing support.
Here’s the problem: the referral process is so long and arduous that students often give up before they are connected with long-term care, leaving them in a distressing state of mental health care limbo: needing care but not being able to get it because their short-term care expired and long-term care is extremely difficult to obtain. CAPS gives students a provider search engine called “The Shrink Space,” which seems straightforward enough. However, due to high demand in the Bay Area, many providers on that list do not have openings, are not responsive to phone calls, or have openings too expensive to sustainably afford. The process of contacting a ton of therapists and having to keep track of all the threads is especially grueling when, as is the case for most people in this position, you are already in mental health distress. If you have a stomach condition and your doctor at Vaden cannot help you, they will refer you out to a specialist, where you can get an appointment through your Cardinal Care insurance. The same process should apply to mental healthcare.
One possible solution here is for Stanford’s insurance to partner with long-term providers (both in-person and telehealth options) to subsidize the cost of appointments, so that students can be referred out reliably and affordably. Stanford already has partnerships through its SHCA insurance with local providers that subsidize long-term therapy with copays as low as $5. While this is a considerable investment, further partnerships with long-term providers would be a powerful statement of Stanford’s commitment to supporting student mental health.
With regard to an integrated Wellness curriculum, I propose a Wellness class requirement for frosh year, perhaps in collaboration with pre-existing programs such as FROSH 101. We have STEM and humanities requirements. Why not a life skills requirement where students learn orientations and practices to cope with the darker sides of high-achieving and develop healthier relationships with perfectionism, stress management, self-criticism and dealing with failure? Students can learn emotion regulation and communication skills to strengthen their relationships, which are one of the strongest protective factors for mental health, according to the Harvard Study of Adult Development. These classes can also be spaces for reflection and the cultivation of values, which are critical for meaning-making, another protective factor. In such a highly stimulating, fast-paced environment, students would hugely benefit from scheduled time in which to pause and reflect on how they want to make use of their time at Stanford and why — before launching into the workforce.
While a wellness course is not a remedy for mental illness, it is a preventative measure which, when taken early, can encourage students to be more balanced and internally resourced. It gives them enough knowledge about their own emotional state to know when they need to outsource help to mental health professionals, as well as how to communicate with their peers if their peers are the ones who need support.
Student mental health is multifaceted, and these issues run deep. While increased funding for CAPS and wellness curricula are necessary steps, there are many other factors outside of the scope of this article that I hope my peers and colleagues will bring to light; for example, the unsustainable pressures on RAs previously mentioned and efforts to support ongoing cultural competency initiatives at CAPS.
Culturally, we stand at an inflection point with respect to mental health care. High-achieving athletes such as Simone Biles and Naomi Osaka are speaking out publicly about their struggles with mental health and the strain of high performance. Health insurance providers are now covering more telehealth therapy and beginning to see mental health as on par with physical health after a surge in therapy use during the pandemic. Bay Area tech companies are expected to provide mental healthcare benefits in addition to physical healthcare benefits for their job offers to be considered competitive. Given the modern mental health crisis’ disproportionate impact on our young people, universities are sure to follow suit.
For any institution, where it puts its money is the true sign of its values. I invite Stanford to take accountability for what it is — one of the most selective schools in the nation with the best and brightest high-achieving students, taught and guided by an innovative faculty and administration — by stepping up in a concrete, financial way to prioritize the mental health of its students.
Stanford is a national and global leader in research, academics and athletics alike. And comprehensive, accessible mental healthcare has become a basic, pressing student need. Let Stanford now lead in this arena.