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.
Content warning: this article contains references to suicide. If you or someone you know is in need of support, you can call the National Suicide Prevention Lifeline at 800-273-8255. Additional resources are available here.
I was heartbroken by the news of another Stanford student’s passing by suicide. Over the past seven years, I have engaged with student mental health from several angles: first as a student, then as a student staff member and now as a staff member. I want to share what I have observed about mental health on campus in a two-part article to encourage the University to better support students going forward. In Part One, I give my perspective on the mental health distress students are facing and reevaluate the modern university’s responsibility to its students. In Part Two, I offer some concrete changes that Stanford can make to address its students’ mental health needs.
During my time at Stanford, I have used Counseling and Psychological Services (CAPS) myself, called CAPS on behalf of friends in crisis, served as a Resident Assistant (RA) in an all-freshman dorm and now help teach wellness courses. I can only speak to my own experiences and not those of all Stanford students. If other members of the Stanford community have noticed important facets of this issue that have not been represented, I encourage you to speak out or to write about what you are seeing. Change that addresses the true root and scope of this issue needs to be guided by a diversity of perspectives.
Last month, President Biden announced his strategies to address our “national mental health crisis.” He particularly emphasized the alarming data concerning young people’s mental health. This distress has only been compounded by the pandemic. Stanford’s recent student mental health survey is an appropriate first step for assessing student needs, but it is not a reason to delay immediate, concrete action. There are clear steps that the University can take now to address the stark mental health needs of its student body.
For one, student mental health services struggle to receive adequate funding and are unable to meet student demand, which is further addressed in Part Two. After witnessing widespread student distress as an RA, I asked senior Stanford staff members why more money was not going towards supporting student mental health. I was told that Stanford, like many universities, has historically seen the mental health issues affecting students as a product of larger societal forces or as individual problems, and thus somewhat outside the University’s scope and responsibility.
Recent events and trends require us to revisit the question with a greater sense of urgency: given the state of youth mental health, what is a modern university’s responsibility to its students’ well-being and, at this point, safety? And the natural follow-up: is the University fulfilling this responsibility?
The line of responsibility can be blurry. There is no standardized approach, and the climate surrounding mental health needs and care is changing rapidly. I acknowledge that it is not possible for universities to mitigate all forms of pressure that students face today. But some pressures that affect student mental health fall firmly within a university’s scope. For example, universities are uniquely responsible for the pressures of a campus culture they create and the effects of those pressures on student mental health.
An important contributing factor to the state of student mental health at Stanford is distinctly within the University’s scope: high-achieving culture. Stanford perpetuates high-achieving culture as an elite school that admits only the very top high-achievers. This comes with a responsibility to equip its students with resources to manage the less-publicized, darker sides of high achieving.
|Year||Number of Applicants||Acceptance Rate|
|1970 (Class of 1974)||9,800||22.4%|
|2007 (Class of 2011)||Almost 24,000||10.3%|
|2011 (Class of 2015)||34,348||7.1%|
|2021 (Class of 2025)||55,471||3.95%|
College admissions, and specifically admissions at Stanford, have become markedly more competitive over the past few decades. This is not simply a case of more applications – the caliber of applicants has skyrocketed too. Students face intense pressure to excel across multiple disciplines to even have a chance at being accepted into a school like Stanford.
As one of the most selective universities in the country, Stanford has become a gleaming symbol of high-achieving culture. It exemplifies the grueling grind that pushes kids to extraordinary limits and then selects for the very top of the applicant pool, the students who drove themselves the hardest within this system. The highest of high-achievers. Hyper-achievers.
Currently, Stanford only addresses the upside of high-achieving. Stanford highlights its high achievers’ successes readily, fortifying its brand as an elite institution with groundbreaking innovators and leaders. All brands do this. That is the easy part. What is harder, but perhaps more important, is to formally acknowledge and address the darker side of high-achieving.
After all, the same factors that fuel high-achieving, such as perfectionism, make students more vulnerable to mental health issues, as they entail having unrealistically high expectations for themselves and being hypercritical of themselves when they do not meet these expectations. The causality can go both ways; high-achieving behaviors are also common coping mechanisms for underlying mental health issues such as anxiety. In the Journal of Clinical Psychology, Limburg et al.’s 2016 meta-analysis of 284 studies found that high perfectionism correlated with depression, anxiety, eating disorders, obsessive-compulsive disorder, self-harm and suicidal ideation. In a 2020 study from the journal American Psychologist, Luthar et al. showed that at high-achieving high schools, teenagers’ rates of clinical depression and anxiety symptoms were three to seven times higher than national norms for their peers.
Excellence does not happen without enormous amounts of pressure. What we see highlighted in Stanford’s social media profiles on students is the shiny end product of achievement. We see only the “perfect diamond” at the end of the process. Not the many years of high pressure that created it, nor the lasting effects of that pressure on a young person’s psyche.
These issues start long before students reach Stanford and go deep, all the way down to students’ senses of identity and worth. These core beliefs began forming based on what they were given love and validation for as children and have been reinforced ever since. Stanford’s hyper-achieving students have been so conditioned to conflate their self-worth and value with achievement and “being the best” that it makes them particularly dependent on external validation and vulnerable to intense psychological distress when they fall short of perfection. Often lurking beneath high-achieving is the belief: “In order to be lovable or worthy, I need to be perfect/achieve.”
I chose to stay at Stanford after graduating to work in student wellness, in large part due to the emotional distress I saw among my friends and residents as an undergraduate. While working as an RA, I would often see students who were “high-functioning,” in the sense that they could maintain good grades and were skilled at hiding that they were not doing well emotionally. But when they entered my room and sat down on the couch, the masks would drop. I learned that being “high-functioning” can conceal high distress, especially given that for high-achievers, getting good grades and performing well is a coping mechanism in itself. (If you’re not doing well, just study harder. Be busier.) I witnessed multiple residents who were suicidal for most of the year, and one never would have known from the outside.
What especially disturbed me about this high level of distress was that it was largely invisible. It remained for the most part between RAs and students, sometimes RFs. RAs and RFs knew anecdotally that severe mental distress was a problem, but there was a lack of aggregate, publicly accessible data about it. So there was a disconnect between the reality of high-frequency/high-severity mental health crises and formal data reporting its existence to the administration and larger Stanford community. Because so much of this information remains siloed in individual dormitories, most people on campus cannot see the magnitude of distress that is happening, so they are unable to hold the University accountable for making changes to address it.
One formal measure that can reflect a subset of this distress is the data on 5150 holds (5150 is a section number from the California Welfare and Institutions Code). A 5150 is issued when someone is experiencing a mental health crisis severe enough that they are evaluated to be an imminent danger to themselves or others, “or gravely disabled.” They are then placed on a 72-hour hold by a clinician or a deputy and transported to a hospital. Most often this call is made when someone is experiencing acute suicidality, not just experiencing suicidal ideation. Stanford’s Department of Public Safety provided the official numbers on 5150 holds from 2016-2021.
These numbers are not publicized. Furthermore, they only represent cases in which someone received formal institutional help. These numbers do not account for the much larger number of students who were experiencing the same levels of distress but were supported privately by friends and student staff, or the number of students who kept their distress to themselves. They do not capture voluntary hospitalizations, where students checked themselves into the hospital, or cases in which a student was off-campus when a 5150 was issued. SUDPS did not respond to requests for data going back decades to track these numbers over time.
Part Two of this article addresses concrete steps that the University can take to better support its students’ mental health. The cultural narrative around young people’s mental health is shifting rapidly. I invite Stanford to take this opportunity to become a university leader in prioritizing student mental healthcare.