A Focus on Mental Health on Campus
A first-year undergraduate, living away from home for the first time, struggles to manage a previously diagnosed bipolar disorder. Following the euthanasia of a feline patient, a veterinary student just starting clinical service becomes increasingly despondent. An M.D./Ph.D. candidate whose spouse is hospitalized develops severe anxiety as licensing exams loom.
On any given day, students across Tufts experience a range of mental health concerns. And like their peers across America, they’re seeking treatment and support services in record numbers. The Counseling and Mental Health Service serving the Medford/Somerville and Boston SMFA campuses has seen a significant increase in student usage and now sees more than 25 percent of the students on those campuses each year. Demand for urgent appointments and the number of students with significant, ongoing mental health needs are both rising.
Although the reasons for the trend aren’t clear—and may reflect in part a welcome reduction in stigma surrounding mental illness—Tufts’s Mental Health Task Force has been tackling the challenge. Launched by President Anthony P. Monaco in December 2016, it has been actively examining the issue and possible responses.
On October 10—World Mental Health Day—the task force released its report [PDF], which concludes that while significant efforts to meet student needs are in place, Tufts must implement a broader, more strategic suite of mental health and wellness services. Many of the report’s recommendations have already been implemented.
“As a university, Tufts has a responsibility to support each student’s intellectual, personal, and social development, which are very much intertwined,” said Monaco, who co-chairs the task force with Paul Summergrad, Frances S. Arkin Professor and chair of the Department of Psychiatry at Tufts School of Medicine. “Anxiety or depression can impair academic performance; likewise, academic difficulty can lead to mental health issues. We must be sure we understand our students’ needs and are doing the very best we can to provide support on all our campuses. The faculty, staff, and students who served on the task force and the many others who offered thoughtful input have laid an excellent foundation for what will be an ongoing effort.”
The task force’s charge was both broad and deep: examine the state of student mental health on campus; assess mental health services and related resources; review Tufts policies and practices; and develop actionable recommendations—no easy task for an institution with undergraduate, graduate, and professional schools on four Massachusetts campuses.
The task force relied on empirical data and qualitative information. A key piece was the Healthy Minds survey, a confidential web-based tool that examines mental health among students at participating institutions nationwide, and for the first time included the Grafton and Boston health sciences campuses, as well as the Medford/Somerville and Boston SMFA campuses.
Dozens of listening sessions—small group meetings and one-on-one conversations with student organizations, affinity groups, faculty, and staff—gave stakeholders opportunities to weigh in. Community members also offered anonymous input through an online tool. Task force members also pored over information from other institutions to identify benchmarks and best practices. Subgroups focused on specific issues surrounding undergraduates, graduate and professional students, and clinical care models.
Increasing Access to Support
The task force found that while students face different stressors—an undergraduate may be anxious about making friends in the dorm while a graduate student may experience conflict with her spouse—they share a need for timely, convenient, affordable clinical services and supportive academic and community environments.
The cross-campus collaboration fostered by the task force has already played an important role in enhancing services on the Boston health sciences campus.
“Mental health is a serious issue in veterinary medicine, as it is for caregivers in human medicine,” said task force member Barbara Berman, assistant dean for student affairs at Cummings School of Veterinary Medicine. “The Grafton and Boston health sciences campuses historically referred students offsite for support, but several years ago we contracted with an outside provider to bring onsite counselors to the Grafton campus. They’re available into the evening for good student access, and the service also offers 24/7 phone counseling. The task force provided a way for us to share that experience with colleagues.”
Drawing on this model and school-specific data from the Healthy Minds survey, in April 2019 the Boston health sciences campus launched Talk One2One, which gives students confidential access to counselors in person and by telephone, which is particularly helpful for students at off-campus clinical sites.
“This is huge, and an important complement to efforts to incorporate wellbeing programming into the curriculum,” said School of Medicine Dean for Student Affairs Amy Kuhlik, who was not on the task force, but collaborated with it. “I’m not sure we would have implemented our service had it not been for the task force.”
Tufts has also enhanced access to clinical care by lowering copays for off-campus referrals and adding a referral manager to help Medford/Somerville students find the right resources, said Executive Director of Health and Wellness Michelle Bowdler.
Tufts is also looking beyond clinical care models. “Not everything requires clinical care, and if we look at clinical care as the only way of managing issues, we’ll never have enough,” said Summergrad. “The task force found that we need to think about this from a community standpoint and from a policy and procedure standpoint. Are there things we can do administratively or in collaboration with faculty to make Tufts more supportive?”
Strengthening Academic Policies that Affect Mental Health
The task force recommended strengthening academic policies and practices, particularly at the undergraduate level, to support students more effectively. With faculty buy-in, undergraduate academic standing criteria moved to a grade point average of 2.0 (C), from 1.67 (C minus), with benchmarks for satisfactory credit progress, bringing Tufts in line with its peers. Earlier deadlines for dropping and withdrawing from courses will encourage undergraduates with academic problems to seek help sooner.
“Our goal is to identify struggling students to keep them from falling through the cracks. We want to step in sooner rather than later with resources to stop what could otherwise be an academic slide from which there is no recovery,” said Jennifer Stephan, dean of academic advising and undergraduate studies for the School of Engineering and co-chair of the task force’s undergraduate working group.
“Although many academic policies impact student well-being and mental health, the task force could easily have avoided looking at these policies. As someone with roots in teaching, I’m especially grateful that the academic voice was part of the conversation,” said Stephan, who taught computer science at Wellesley College for fourteen years.
Tufts has also streamlined undergraduate medical leave policies to enable students to take the time necessary to tend to health needs yet remain connected to the community while away; students will also receive more support upon returning. A more structured personal leave process is planned to provide multiple opportunities to connect students with resources and advice, including information on financial implications.
“We strive to find the right balance that gives students agency and autonomy and also recognizes our responsibility as a university to support that process and give students help, guidance and information to enable informed decisions,” said Stephan.
The task force recommended that Tufts pursue philanthropic support to advance mental health and wellness, and individual donors and foundations have already underwritten provision of initiatives such as Koru Mindfulness, an evidence-based curriculum that incorporates meditation and other stress management techniques designed for college students.
“We can’t control everything that life throws at us, so we need to help students develop skills that will build resiliency and enable them to manage stress in healthy ways,” said Bowdler.
She said that philanthropy will also fund online training for faculty, staff, and students on how to identify and respond appropriately to students experiencing stress and mental health difficulties.
Tufts’ commitment to student mental health garnered the university the inaugural HBC Foundation scholarship to join JED Campus, the leading program helping colleges and universities enhance mental health, substance abuse, and suicide prevention. JED Campus will begin meeting with students, faculty, and staff this fall to learn more about how JED and Tufts can work together most effectively. Complementing these efforts, thanks to donor support, is collaboration with The Haven at College, which offers an outpatient center at 200 Boston Avenue providing substance abuse assessment and treatment and a residence for students who are in recovery.
Task force members said that significant work remains, and a steering committee chaired by Monaco will spearhead continued progress across Tufts and provide updates to the community.
“We have a lot more to do,” said Bowdler. “The issues are real. But that’s not the whole story. We should also celebrate the fact that people are talking more openly about mental health, recognizing that it is as important as physical health, and paying attention rather than ignoring their mental well-being.”