Someone to Watch Over Me

About once a month, Steven Millman bakes a batch of cookies or brownies. Taking them around to students in his wing of Next House, he knocks on doors, checking in with as many of his 45 students as possible. He wants to see how they are doing, help them solve any small problems that have come up, and just let them know he’s there-an adult presence they can rely on. But Millman, a doctoral candidate in political science who is now in his fifth year as a graduate resident tutor, has more on his mind than just shooting the breeze. “It’s to see what their rooms look like,” he confesses. “If things are really trashed or broken, that tells me something.”

Millman and 79 other graduate resident tutors are the Institute’s front line of contact with its students who live in MIT residence halls. Through the resident tutors and the resident advisers, who oversee MIT’s fraternities, sororities, and independent living groups, the Institute keeps watch on the emotional well-being of its students. And their well-being is very much a priority these days. Since the death of Scott Krueger from alcohol poisoning in the fall of 1997 and the suicides of Elizabeth Shin and Julia Carpenter in the springs of 2000 and 2001, the Institute has undergone a painful period of self-assessment, examining all aspects of student life, discovering where it falls short, and working diligently to improve the quality of student life outside the classroom. Nowhere is this introspection more intense than in the evaluation of students’ mental health needs and the services the Institute provides.

As a result of that self-scrutiny, the Institute has begun implementing a host of changes aimed at ensuring that students get the support they need. In addition to expanding the staff and extending the hours at the Mental Health Service, MIT has inaugurated an expanded Web site, coordinated a campuswide health-education program, and designed a “social marketing” campaign that uses traditional marketing techniques to overcome barriers that keep students from asking for help.

Changes in Student Needs

Since the mid-1990s the demand for mental health services has skyrocketed at universities around the country. The International Association of Counseling Services conducted a national survey of college and university counseling-center directors, and the results, published in 2001, revealed that 85 percent of directors reported an increase in the number of students with severe psychological problems. Furthermore, 55 percent of directors reported a rise in self-injury cases over the previous five years. Despite these changes, 63 percent of the 274 centers surveyed reported that the resources available to them had remained static or had been reduced during that time.

At MIT, the situation is similar. Between 1995 and 2000, the Mental Health Service recorded a 63 percent jump in the number of undergraduate student patients, a 59 percent jump in the number of graduate student patients, and a whopping 69 percent spike in the number of students who required hospitalization for mental health problems. Yet there was no increase in staffing.

No one has a clear explanation for the surge in demand. But because institutions are microcosms of the greater society, there’s no shortage of theories. Vivian Boyd, past president of the International Association of Counseling Services and director of the counseling center at the University of Maryland, cites rising stress in our society, information bombardment, and perhaps above all, a widespread sense of isolation.

Alan Siegel, who came to MIT last fall as chief of the Mental Health Service, says changes in the definition of success and the grueling competition for admission to top universities contribute to students’ anxiety. Kristine Girard ‘86, associate chief of the Mental Health Service, points to the presence of mental health professionals even in elementary schools, high divorce rates, and the proliferation of psychotropic medications. But Robert Randolph, senior associate dean in the Office of the Dean of Student Life, believes the most telling factor at MIT may be the growing percentage of women in the undergraduate student body. “Women are more accustomed to asking for help than men are,” says Randolph, who has been at the Institute for 24 years. “Women will not tolerate what men will.”

Searching for Answers

In the summer of 1999 administrators and mental health professionals at MIT Medical began informal discussions about ways to meet the intensifying demand for services. The next fall, the then chancellor, Lawrence S. Bacow ‘72, appointed MIT’s Mental Health Task Force. This committee of students, faculty, and administrators investigated the changing needs for mental health services on campus and recommended ways the Institute could most effectively meet those needs.

The task force conducted two surveys: one was internal, and the other compared MIT’s mental health services to those of nine  select universities with graduate and undergraduate students. The results of the wider survey showed that MIT ranked seventh in the number of mental health professionals per student. Moreover, MIT’s mental health staff was seeing only 12 percent of the student body as opposed to the 14 to 16 percent treated at the comparable schools. And MIT was the only school that did not offer evening appointments. The results of the internal survey were even more troubling. Seventy-four percent of MIT students responded that emotional problems interfered with their daily functioning, but only 28 percent of that group had sought help from the Mental Health Service. Thirty-five percent of those who did seek help reported they had waited at least 10 days for their initial appointments.

Millman reports having had plenty of firsthand experience with those long waits. “When I first started, I would often have to threaten support staff to get a student in early,” he says. “Eventually, I found that if I said the student is a risk to him or herself, regardless of whether they were, then I’d get a student in within a day or two.”

But in the last couple of years things have changed. Now students can have a 20-minute telephone conversation with a senior clinician the same day they contact the Mental Health Service. Students can choose walk-in appointments in the afternoon or schedule evening appointments for as late as six o’clock. And their appointments will be scheduled within a few days instead of two weeks out.

Implementing Change

Some of the modifications recommended by the task force have already been realized, but those that require a shift in campus culture will be years in the making. The most immediate and obvious differences are apparent in the Mental Health Service itself. In addition to offering later hours and the walk-in service, clinicians now tend to administrative tasks in the morning hours and schedule more afternoon appointments-a change students said would be helpful. In the fall semester of 2001, the extended hospital-insurance plan came into play, offering students unlimited psychotherapy visits with no copayments. And last fall MIT implemented a written communications protocol to ensure immediate notification of all appropriate campus personnel whenever a mental health emergency arises.

In April 2002 the Institute committed $830,000 to upgrading the Mental Health Service. The money is funding salaries for four new clinicians and two new mental health educators, as well as a long-term social-marketing campaign aimed at lowering barriers to students’ seeking help. It also supported the development of a more comprehensive mental health Web site to increase students’ awareness of services. The site went live last fall.

“The sense of concern for the person is different here,” says Siegel. “There’s a sense of [everyone’s] being responsible for the students, committed to them, concerned about them, wanting them to make a go of it. I think it’s remarkable, and it’s very different from the other institutions I’ve been at.”

Altering Perception

The Institute’s more arduous task is to persuade students to ask for help. Students have myriad reasons for not seeking help. Many young adults believe that it’s a sign of weakness or failure. And most MIT students are problem solvers who think they should be able solve to their emotional tribulations. “They are so competent and so used to success,” Millman says. “They assume no matter what challenge they are presented, they’ll be able to overcome it on their own.”

Robbin Chapman, a doctoral candidate in electrical engineering and computer science, spent the first six of her seven years as a tutor in New House. She says the taboo against seeking mental health care is especially strong among certain ethnic populations. “For many of these students it is a cultural thing,” she says. They’ve been raised to think that anyone who seeks psychotherapy is “crazy” and is labeled that way forever. Resistance is strong especially among Asian students and first-generation Asian-American students, she says, because their culture regards asking for such help as shameful.

Millman adds that students have told him they will not go to the Mental Health Service because doing so could jeopardize their ability to acquire federal security clearances that may be necessary for jobs they might pursue in the future. And sometimes students simply don’t know they need help. “A lot of times you don’t know if you’re tired, stressed out, or what,” says Larry Colagiovanni ‘04, a past risk manager for the Interfraternity Council. “You’ve got all this stuff running around in your head. Students just don’t have time to think.” And, he admits, “People are scared to death taking that initial step.”

Students who do seek help generally have more acute problems than did troubled students of the past. Charles Stewart, professor of political science and housemaster of McCormick for the last 11 years, says, “It used to be when students were having a hard time coping, they had not been part of any sort of mental health care. Now I’m discovering when the acute crises occur, it’s almost always the case that they involve people who have a prior history and have been treated for certain conditions.”

Changing any campus culture is a long-term process, one that at MIT is further complicated by its multitude of distinctive communities. Administrators believe it could take five to 10 years before culture changes are apparent.

In the long run, it will be the educational and outreach programs the Institute creates-along with the relationships that clinicians, housemasters, and tutors develop in residence halls-that will have the greatest impact. Today there are many ways students can get mental health care, and MIT is making a concerted effort to develop existing options and put new ones in place.

Maryanne Kirkbride, who joined the staff last fall as the Institute’s first clinical director for campus life, is charged with strengthening those efforts and relationships between MIT Medical-particularly the Mental Health Service-and the campus community.

“We’re rethinking health promotion,” she says. “It’s not just a series of workshops or information about stress or kiosks or just outreach, although that’s important. It’s really about developing programs that make a difference and being able to get them to a scale to improve the health of the campus community.”

The most pervasive of all the programs is a two-pronged social-marketing campaign that addresses alcohol use on campus and encourages troubled students to seek mental health care. Student committees are driving both campaigns, determining which educational efforts will be most successful, and working with an outside consulting firm to develop the programs.

Alcohol education efforts MIT initiated in 1998 are closely linked with the Mental Health Service. “A lot of times students rely on alcohol as a way to cope with stress,” says Danny Trujillo, associate dean for community development and substance abuse programs. “Problems with alcohol are often symptomatic of an underlying mental health issue.”

Last fall one of the pilot efforts of the alcohol education program included a series of ads in the Tech that were supplemented with chalked messages on campus sidewalks. The message stated that 74.6 percent of MIT students report having zero to two drinks a week. According to Trujillo, the national average ranges from 51 to 62 percent. By informing students about norms at MIT, Trujillo hopes to discourage excessive drinking.

Although many colleges have used social-marketing techniques to address alcohol issues, the mental health campaign will break new ground when it is introduced next fall. In addition, last year the Institute started screening freshmen to identify students who might develop drinking problems. These students participate in a two-session program that helps them evaluate the role alcohol is playing in their lives. And this year’s freshmen were the first whose initial health screening included questions meant to flag mental health needs. Siegel personally contacted all students who said they wanted an appointment.

At the grass-roots level, the Institute is putting more emphasis on training for housemasters, tutors, and resident advisers. Training sessions that previously had been held only during orientation have been extended throughout the year. About 60 undergraduate liaisons to MIT Medical take training classes spread over a semester and supplemented with periodic updates. These students, called MedLINKS, provide all kinds of medical information and referrals to students who are comfortable talking only with their peers.

Siegel plans to emphasize a community-based prevention model for the Mental Health Service, with clinicians presenting programs to students in their own residences. Stewart cautions that “it’s touchy bringing mental health into the dorms, because sometimes students wonder if they’re being spied on.” Starting last year, clinicians from the Mental Health Service were assigned to every on- and off-campus residence. Serving as resources for housemasters, tutors, and advisers, these mental health professionals attend house meetings with housemasters and tutors and upon request present programs to the students. Randolph-who once headed Counseling and Support Services, a center that provides students with emotional and academic counseling-is now a housemaster in Bexley and is a resource to all housemasters and students.

In another effort to reach out to students, in 2001 MIT hired new student-life support professionals. Known as residential life associates, they live in the dorms, develop relationships with students and help housemasters with programming. And an experimental residence-based advising program for freshmen, now in its third year in McCormick and Next House, pairs freshmen with older students-all MedLINKS-who help new students make the transition to college life. The hope is that students will feel more comfortable talking about mental health issues with people they know well in their residence halls.

And for those students who feel threatened by the Mental Health Service, the more approachable Counseling and Support Services provides help with academic and personal issues. This arm of the Office of the Dean for Student Life works closely with mental health clinicians to solve problems and coordinate outreach efforts.

Despite all the improvements, some believe MIT could do better. One of the more persistent desires is for the Mental Health Service to extend its evening hours to 11 o’clock. Students would like adults to be available to them in their residences after hours, and some housemasters and graduate tutors would like to see more associate housemasters and tutors. MedLINKS, who most often work alone, say they would like opportunities to network with one another, and tutors express enthusiasm for working in teams with MedLINKS.

Above all, Randolph cautions, mental health problems are not easily solved. That reality is difficult for people who are accustomed to solving problems. “This is a pastoral endeavor,” he says. “It’s a process, not an outcome, and that’s really the hard part. We will have tragedies from time to time. The real issue will be how we respond and [whether] we learn from our experiences and grow as things change.”