Half a dozen students sat quietly in the waiting room of Penn’s Counseling and Psychological Services (CAPS), checking their phones and waiting to be called for their appointments. A flat-screen TV on one wall cycled through an array of targeted announcements. Take a break with weekly meditation , read one. Free to all Penn students. No experience necessary. Another mentioned an upcoming session of I CARE, an intensive, seven-hour program for faculty and staff that trains them to detect the often-subtle distress signals students may be giving off that warn of a brewing mental-health crisis.
CAPS’ new facility, on the ground floor of 3624 Market Street, is larger and more accessible than its old quarters at 36th and Walnut streets. The extra space is needed; over the past three years the percentage of students receiving “direct service” has steadily increased. And the stakes are high. Some 15 months ago, following a series of suicides by Penn students, President Amy Gutmann and Provost Vincent Price appointed a Task Force on Student Psychological Health and Welfare [“Gazetteer,” May|June 2014]. Led by Rebecca Bushnell (the SAS Board of Overseers Professor of English) and Anthony Rostain (professor of psychiatry and pediatrics and director of education for the psychiatry department), the task force released its report this past February.
The report praised the University’s many programs and policies, as well as the commitment of its staff and faculty. (In addition to CAPS, campus organizations include such resources as Student Health Service, Student Intervention Service, the Office of the Chaplain, and the Division of Public Safety.) But it also acknowledged the high-stress realities of student life and the pressures created by the “perception that one has to be perfect in every academic, co-curricular, and social endeavor,” noting also the lack of sleep and dalliances with alcohol and drugs that can further dial up the volatility. As a result, the task force made a number of recommendations, which fell under four main categories:
• Communicating the importance of mental health and wellbeing “at every level of the student experience,” starting in freshman orientation.
• Making information about “available resources and supports” easily accessible.
• Educating and training faculty, staff, students, and families about “fostering mental health and responding to students who need help.”
• “Optimizing the resources devoted to CAPS” while engaging the entire community in “sustaining and improving” students’ psychological health and wellbeing.
Some of the specific recommendations, which are either in the process of being implemented or have been already, are tangible and easily grasped. One was creating a 24-hour HELP Line (215-898-HELP or 215-898-4957) for those trying to “get help with personal problems, either their own or those of a partner, friend, colleague, or student.” Another, which addresses the sometimes-bewildering range of information and policies across the University’s 12 schools, is a single, centralized website (scheduled to open this fall) that will serve as a “portal to the wealth of Penn resources for support of student psychological health and welfare.” A “wellness app” providing “information about warning signs of distress and the many places where students can get help” is also in the works.
Although the recommendations did not include a call for additional personnel, the administration had already authorized CAPS to hire three additional clinical staff plus a postdoctoral fellow last spring. According to the report, wait times for appointments have dropped from an average of 21.6 days to 8.5 days, while “those who are in crisis are seen immediately”—despite the fact that the number of students seeking help has steadily risen.
Underlying the report was an ambitious, less easily delineated goal—one that involves essentially changing the culture at Penn, or at least the way that culture is perceived. The CAPS staff refer to this phenomenon as “Penn Face” and the “Imposter Syndrome.”
“In a very insidious way, students walk onto campus with this idea that somehow they have to have this game face on, appear perfect, because everyone else around them appears perfect,” explains Meeta Kumar, CAPS’ director of outreach and prevention. “So there’s no room here for any vulnerability or struggle. Students walk in here hour after hour with this sense of ‘I guess I must be the only one here on this campus who struggles.’ The distress they have is so huge that, if it is not checked, it can slowly undermine their confidence and competence—and then they suffer.”
As a result, she adds, “we’re glad to see that the focus is really broad-based, recognizing how stress is a multifaceted experience in student life and really trying to improve that.”
Reactions to the report across campus have been mixed. Some students expressed disappointment that there were not more concrete offerings, such as hiring more clinical staff and setting benchmarks to measure progress.
“We were expecting something that just wasn’t there,” says Elana Stern C’15, a member of the Green Ribbon Movement, which advocates for better mental-health care on campus. “Telling Penn students: ‘You’re at Penn, stop being such a perfectionist and you won’t be stressed,’ is not an answer to anyone’s problem. Penn students by their nature are going to be competitive and perfectionistic because they were admitted for that. That’s not going to change, and it also doesn’t address the deeper issue of, Penn students are struggling, and Penn students need help.”
“A change in culture cannot happen by a fiat from above,” says Rebecca Bushnell. “It will involve effort on the part of everyone in the Penn community—administrators, faculty, staff, students, and parents and families. But the role of students is particularly important, since they more than anyone else tend to enforce the image of what they call the ‘Penn Face.’”
CAPS director William Alexander argues that by choosing to tackle the culture at Penn, the task force took on a much more substantial challenge than if it had recommended more tangible steps, like adding staff.
“They could have dealt with the public-relations issue quickly and easily by just throwing money and staff at it and saying, ‘Done, done, and done,’” he says. “To go in this other way, toward the origins of the stress, towards the culture that produces it, and how can we support each other—that is a much more difficult task. It’s much more ambiguous and not very well studied or understood. So I actually thought it was pretty courageous of them to do that.”
In Stern’s view, Penn’s mental-health services need to be given the same financial resources as its hospitals and other physical-health services.
“If a student calls Student Health Service and says, ‘I have a sore throat, I think it might be strep; can I come in?’ they’ll say, ‘Sure, how’s 2 p.m.?’—that same day. Penn’s access to mental-health services needs to be that good.”
Addressing CAPS’ stated policy of providing same-day appointments to students in distress, Stern says:
“Having someone who is actually in distress identify that they’re in distress, on the phone with a stranger they’ve never spoken to, is not acceptable. And it’s dangerous. Someone who is in crisis is not their own best advocate—and they’re being asked to be.” Within the past couple of weeks, she adds, several students she knows who have tried to get initial appointments were “told that the wait time is a week or more.”
“Wait times at CAPS ebb and flow during different periods of the year,” notes Valarie Swain-Cade McCoullum, vice provost for university life, and a task force member. “This semester it’s been roughly three days.”
Her sense, she adds, is that students are glad the discussion is happening. “Students tell me that they are pleased that the University is having this ongoing conversation about wellness. They’re happy we are talking about how physical health and mental wellness are intertwined. They see, through the listing of all our current resources, what a caring community Penn is.”
Rather than focusing on specific recommendations, “I hear them talking about the value of talking,” she adds. “They’re working to erase the stigmas around these conversations, to help their peers see that asking for help is a sign of strength.”
The emphasis on wellness is, in Alexander’s view, an important one.
“Focusing on the various illnesses and stressors and disorders, and the diagnoses and the interventions, is really good and really important,” he says. “But it really speaks to what happens after the event. We’re always thinking about what happens before the event … We’re creating a dialogue and communication so we can hopefully culturally reset a norm.”
Another recommendation being implemented involves a partnership with the Jed and Clinton Foundation Health Matters Campus Program (thecampusprogram.org).
“It’s a pretty big program,” says Alexander. “It’s broken down into a dozen or so facets of campus life. Delivery of clinical care is one, but there’s also everything from policies and procedures to the connectedness of students.” An oversight team comprised of faculty, administration, and students “will be charged with managing and overseeing the campus program for four or five years,” he explains. “It’s very connected to the clinical staff of the Jed Foundation, with webinars, and they make site visits several times a year and kind of guide the university. Their philosophy is very holistic, very community-based, and it’s kind of ultimately what we’ve been talking about—promoting wellness while still keeping cutting-edge and delivering clinical care.”
That partnership should address the question of benchmarks that some students have raised, and Alexander believes that the various components of the foundation’s program will result in something “much bigger than the task force recommendation.”
The goal is “not to have a kneejerk response to a series of tragedies, but rather to build a response that can be in place in an ongoing and permanent way,” he concludes. “Because we’ve had some serious tragedies, and people want to respond to that and dig in. But we need something even bigger. We need something that’s going to be sustainable.” —S.H.