Behind the façade: Helping, hurting and healing

by Caroline Berens and Kelsey Flower | 10/8/15 9:41pm

graph-for-mental-health
How often in the past month have you felt hopeless, despondent, uninterested in activities you typically enjoy or lethargic?
by Jessica Avitabile / Jessica Avitabile/The Dartmouth Senior Staff

A cursory glance around any area on campus — Baker Lobby, Collis’s pasta line, the Green — will reveal an idyllic, picturesque scene. Smiling, chatty students eagerly discuss weekend plans and love life drama or offhandedly joke about how unprepared they are for an upcoming midterm, but deeper anxieties or troubles are rarely revealed. You may never know that the put-together, confident girl describing her busy social calendar over King Arthur Flourhad trouble getting out of bed this morning.

Jessica Avitabile

How often in the past month have you felt hopeless, despondent, uninterested in activities you typically enjoy or lethargic?

Mental health is undoubtedly a stigmatized issue on campus, but students from a diverse array of activities that span the campus landscape are beginning to speak out about their personal experiences with mental wellness and use their roles in their organizations to impact the way mental health is discussed and treated at the College.

The Dartmouth conducted a survey examining the state of mental health on campus, to which 517 students responded. Of these students, 155 were male, 356 were female and 6 identified as other or gender non-conforming.

The survey revealed that 30 percent — the greatest percentage of students — believe that between 41 percent and 60 percent of students have suffered from anxiety while at the College, while 42 percent of respondents said they believed that between 21 percent and 40 percent of students have suffered from feelings of depression or hopelessness.

Sixty-four percent of respondents said they had experienced depression, hopelessness or disinterest in activities in the past month either some days or rarely. Approximately 17 percent of students said they had experienced such feelings half the time, most days or every day.

Sixty-two percent of students reported that they have experienced persistent, seemingly uncontrollable or overwhelming anxiety since coming to the College at least once. Over one third of respondents said they had never experienced this.

The data indicate that students underestimated the prevalence of anxiety and depression on campus.

There are several different ways that mental health is being addressed on campus currently, ranging from preventative care to treatment and from clinical to student run.

The Student Wellness Center, for example, looks at wellness from a holistic perspective, Student Wellness Center director Caitlin Barthelmes said.

“Our mission is to empower students to thrive,” Barthelmes said.

The Wellness Center achieves this by examining the framework of seven different roots of well-being: intellectual, physical, social, emotional, spiritual, environmental and financial wellness. The center encourages each student to look at themselves as “whole beings” who experience all seven, Barthelmes said.

“We help students reflect on those roots and recognize that at some points some roots will be strong, others not so much,” Barthelmes said.

She said that many of the Center’s programs take a “preventative” lens, preemptively helping students to strengthen these roots before they reach high levels of stress.

“It’s more about upstream recognition of early signs,” Barthelmes said.

The Center subsequently encourages healthy coping mechanisms or ways to help students return to their normal state of mind when anxiety levels increase.

Flagship preventative programs include the Dartmouth Bystander Initiative, which focuses on violence prevention; Refresh, a sleep intervention program; and BASICS Alcohol Screening, which is secondary prevention for high risk drinking that students can access through self-referral, a dean or an alcohol incident.

Peer supporters plan on launching a program that invites students to come, check in about wellness and have an informal discussion any given Saturday morning.

Thriving@Dartmouth is a more holistic wellness program, which includes a physical education class that focuses on mindfulness and doing things with intention, Barthelmes said. The Wellness Center is also partnering with Dick’s House Counseling to launch a “Relaxation Fest” this November, she said, and will host a “recharge retreat” that will span a few days over winterim.

Ultimately, Barthelmes said if students are noting things about their mental health or life balance that feel off, they should come in and have a wellness check-in with staff. She said that the center uses “reflective conversations” to “learn what they can to do help” and “tap into themselves to come up with change,” in addition to be able to suggest prevention programs or other resources on campus like counseling or the financial aid office.

Other services that the center offers include SAD lamps, a massage chair, reflection journals and comfort dogs in the office two days a week that students can play with or take on walks.

“This is our first year of being a student wellness center,” Barthelmes said. “We are really excited to interact with students and help them prevent stress from building up.”

Mental health discussion and advocacy are approached from a student perspective through student groups like Active Minds, Active Minds president Jake Donehey ’17 said.

“Our goal is to increase discussion and dialogue in hopes of decreasing stigma,” Donehey said. “If we make it more apparent and okay to have a mental disorder or wellness problem, more people will be comfortable getting the services they need.”

Donehey said that while there are no requirements to be a part of Active Minds, club attendees tend to be interested in neuroscience or psychology. He said he considers people’s own mental health experiences “less talked about and less necessary” to be involved, and that people do not need a personal relationship with mental health to participate.

The club hosts activities like dinner discussions, distress events and speakers, as well as outreach to the general student body to promote mental health awareness. It also works with Dartmouth on Purpose, Student Assembly and the College administration to tackle the policy side of mental health, he said.

Student Assembly president Frank Cunningham ’16 aims to achieve a similar goal of destigmatization and increased discussion through his “I’m Here For You” campaign, sponsored by the Assembly.

Cunningham’s impetus for the campaign stems from his own struggles with mental health beginning during an off-term over his sophomore year. He described his severe depression and anxiety, constant insecurity and occasional thoughts of self-harm. It was not until the end of his sophomore summer when he opened up to family and friends and began seeing a Dick’s House counselor that he began to recover.

Cunningham said the campaign aims to increase discussion and de stigmatize the stereotypes and misconceptions associated with mental health.

“It’s really about changing a community and the way we handle mental health. The one thing that I want when I am no longer president in spring term is for people to tell me I helped them get through dark days, that I brought a problem to light,” Cunningham said.

Speight Carr ’16, chair of Student Assembly’s health and wellness committee, has worked alongside Cunningham to spearhead and direct the campaign. Although Carr said he has never battled with mental health personally, he has felt its indirect effects through seeing its prevalence in his family growing up.

“I was affected through my family [members] with eating disorders, depression, alcoholism — a lot of different things that have affected how I thought,” he said.

He said this served as his impetus for getting involved in the discussion of mental health at Dartmouth, as he realized that others must indirectly affected as well. The turning point came for him during his sophomore year, when someone close to him went to rehab.

“Knowing that it affected me in such a profound way, not even being the one suffering, made me really think that there is such a multitude of issues surrounding it. I couldn’t be the only one who knew people who had mental health issues,” Carr said.

Carr said the family members and friends of people struggling with mental health can sometimes feel reluctant to share how they are feeling, as they are not experiencing the issue directly.

“Mental health has very much significantly affected my life through the people around me. And I think that’s a more common story than you hear, but people are afraid to talk about it, in that they don’t want to assume that their feelings in being affected by someone with mental health issues are as important,” Carr said.

Carr said this increased discussion on all fronts of people affected by mental health is crucial for developing a sustainable change in the perceptions of mental health.

Donehey expressed a similar sentiment to Cunningham regarding the importance of having a permanent effect on the discussion of mental health.

“It’s really important to keep discussion going and make more permanent marks on mental health landscape,” Donehey said.

One of Active Mind’s main roles is serving as the “primary student liaison between the counseling center and the student body,” Donehey said.

In the past, Active Minds has worked with Dick’s House Counseling and Human Development director Heather Earle, who aims to be in touch with the student body, Donehey said.

A new initiative is the revival of a student advisory board to Dick’s House and Counseling and Human Development. Approximately 20 organizations from diverse undergraduate and graduate communities were contacted in order to get as many different identities on the new board, Donehey said. The group met for the first time on Wednesday.

Dick’s House is interested in hearing what “is needed and wanted” by students on campus, and for students to bring back information to the student body to educate others on why things are the way they are, Earle said.

She said that students have questioned why it is not possible to schedule counseling appointments online. Student board members could communicate that the counseling department had chosen to forgo this change so that someone calling for mental health help will be talking to a real person on the phone, in case of an emergency.

Donehey said that while thinking about problems in a holistic way is helpful, the advisory board is important for smoothing out the “nitty gritty details” of the mental health help process.

“If we can we can smooth those out and make it as user friendly and positive as possible, it will do so much to better the impact that those services have on students,” Donehey said.

Counseling and Human Development provides the most serious form of mental health help on campus. According to The Dartmouth’s survey, 32 percent of students said they had sought counseling or psychiatric help from Dick’s House since matriculating.

Earle said that students can either make appointments on their own, or get referred by someone else such as an undergraduate resource advisor, coach, dean or parent.

The counseling work is usually short-term clinical work because CHD serves the entire undergraduate and graduate population, but there is a clinician on call for crises 24 hours a day, seven days a week, Earle said.

This short-term work usually includes eight to 10 sessions over a term, which might be supplemented with weekly student group meetings. Earle said that if the student wants to continue with therapy long-term, CHD will help them find a counselor in the community.

Twenty percent of survey respondents have sought psychiatric help from a source other than Dick’s House since coming to Dartmouth.

Andi Norman ’18 had struggled with depression during high school, but said she had always been able to manage it and still go about her daily life. But when she started to experience the symptoms and signs again during her freshman fall at Dartmouth, her mental health hit a “downward spiral.”

“I had extreme anxiety — I was isolating myself socially, didn’t want to be around anyone. I wasn’t eating, wasn’t sleeping much, and workouts were terrible because I just didn’t really care,” Norman said, noting that she lacked motivation to do her schoolwork.

In the middle of January, Norman, a member of the women’s varsity basketball team, finally reached out and explained her situation to her mother, who subsequently called her coach. Norman and her coach met the following day to discuss ways to combat her depression and anxiety. Norman visited a Dick’s House counselor throughout winter and spring terms, she said.

She also noted that she was prescribed medication through Dick’s House.

Norman explained that upon calling Dick’s House to schedule a counseling appointment, she was put on hold. She said this did nothing to bolster her confidence, especially after calling itself had been difficult.

“Picking up the phone and calling is hard enough, if you’re struggling. When they put me on hold, I was already feeling so inadequate and insignificant, it didn’t help,” Norman said.

Norman said that had she not been sitting beside her basketball coach, she likely would have hung up the phone.

Carr said that due to Dick’s House’s somewhat isolated location, the process of going there can be challenging in itself.

“I mean, even the counselors are located in Dick’s House, and it can be a very intimidating experience to go in there,” Carr said.

Cunningham, Norman and Carr all spoke of the lengthy wait time after making an appointment at Dick’s House. Cunningham said that last he had heard, it can take weeks to see a counselor.

“What I’ve heard so far this term is that there’s a wait time of three weeks. And that’s just ridiculous,” Cunningham said.

Carr agreed, saying that although he himself has not faced mental health struggles, from an objective perspective such a lengthy wait time is unbelievable.

“If you call Dick’s House and say you’re having suicidal thoughts, the quickest you can get to see a psychiatrist is three weeks. Which is…insane to me,” Carr said.

Norman said that waiting even one week to speak to someone could be agonizing.

“If you’re in a crisis, a week is a long time to wait to see someone,” Norman said.

Norman also said that simply scheduling an appointment can be difficult due to the high prevalence of students seeking counseling.

“It’s also hard to get an appointment — it gets very packed — and it’s hard to schedule in a timely manner,” Norman said.

Carr said that -— though the discrepancy is obviously not deliberate — Dick’s House is severely understaffed.

“Dartmouth is not purposely trying to have a lack of resources for its students. But I do think there’s not enough,” Carr said.

Carr said that although there are several counselors at Dick’s House, there is only one psychiatrist. There used to be more psychiatrists completing their residencies, Carr said, but they left and were not replaced.

Cunningham questioned how the College could expect students to receive adequate help without providing sufficient resources.

“I mean, how can we properly take care of students when we don’t even have the resources present here?” Cunningham said.

Cunningham spoke of College President Phil Hanlon’s “Moving Dartmouth Forward” initiative, and how he believes such rigorous academic ambitions warrant the hiring of more counselors.

“The thing is, I say, Dartmouth wants to focus on academic rigor so aggressively, but in focusing on that I hope you are investing large dollars into Dick’s House counseling,” Cunningham said.

According to the survey, of those who had utilized Dick’s House counseling, 62 percent said the services had been very or somewhat helpful.

Counseling and human development also determines whether a student should take mental health leave. If a counselor is working with a student whose symptoms of depression are not decreasing and it is impacting their ability to perform socially and academically, Earle said that she will talk to the student about what time off might look like.

A medical leave is usually a minimum of three terms. Earle wants to make sure that students do not come back too early so that when they do come back, they are at a place where they can “come back and perform to the level that they know they can,” she said.

After CHD makes a final decision about medical leave, the dean’s office will sign the paperwork and discuss other potential concerns with students, including financial aid or logistics for international students. Earle said she helps to communicate with parents if needed.

During this time, students will go through some therapy, and some also get a part-time job or do volunteer service so that they can keep on a schedule.

“The underlying focus is to take time away from Dartmouth to focus on taking care of yourself,” Earle said.

Norman said when she first when to Dick’s House, her counselor asked if she wanted to take a medical leave. Norman considered it, she said, but ultimately realized that her issues were not being caused by the College, and that going home might not help significantly.

“I didn’t want to be playing basketball, didn’t want to be here. But it wasn’t Dartmouth that was causing it. I was thinking about the possibility of leaving...but I said no, I want to stay -— it wasn’t the College,” Norman said.

She added that it was “absolutely the right decision to stay.”

In addition to one-on-one student counseling, CHD does training with undergraduate advisors, community directors, athletic coaches and trainers and has a website called “Dartmouth Cares: Mental Health Awareness and Suicide Prevention.” One clinician also recently did a four-part series on reducing anxiety.

Earle said that groups like Active Minds, the Assembly, residential life and the athletics program should be involved in mental health.

“I really see mental health issue is not just a counseling-centered issue, it’s everybody,” she said. “We are really focusing on yes, doing counseling behind closed doors, but really getting out there and talking to student groups.”

Earl particularly thinks that initiatives that the athletic and residential life programs are taking are helpful.

The emphasis on creating residential communities that “Moving Dartmouth Forward” has created is important because when students feel like they are part of a community, they are less likely to feel isolated and have symptoms of depression, Earle said.

In the training that CHD is doing with athletic coaches, Earle said they talk about why it may be hard for an athlete to come forward since athletes may feel like they are expected to put a game face on and work through the pain.

Norman spoke of this expectation of athletes, too, in others failing to perceive her struggles.

“People think, ‘You’re a freshman at an Ivy League school, a student-athlete, living the dream, living the life,’” Norman said.

She said her experience felt more like a “nightmare.”

Earle said this misconception is not necessarily specific to athletes.

“This happens in the athletic world, but also in the Dartmouth world,” Earl said. “You work really hard to get here at Dartmouth, so you think you have to work through pain.”

Cunningham said that he believes such misconceptions impact many students at the College.

“That’s the thing people don’t understand -— when you deal with depression, it’s not just like a pill can help you,” Cunningham said. “It’s really you every day taking it one day at a time to find the strength within to keep getting up every morning and having a positive attitude, and trying so hard to work through every problem you have.”

Both Earle and Donehey said that they think the mental health climate on campus has improved during their time at the College.

Donehey said that in his two years on campus he has seen an increase in “casually important talk about wellness and mental health.”

He said he thinks that Dartmouth on Purpose has succeeded in encouraging people to focus on personal wellness and that the Assembly has devoted much time and effort to the mental health landscape.

“There’s so much more do be done, but I’m in no way disappointed with the evolution I’ve seen so far,” Donehey said.

Donehey said he has also personally noticed change is the way people are using their off-terms, and that he has heard many upperclassmen say they are using their term to spend time with their family and work on their mental health.

Donehey said he thinks that a focus on mental health is particularly important at a college like Dartmouth, since everyone here already has tendencies and qualities within them that make them at greater risks for anxiety.

“The demographic here is already more predisposed to anxiety than a lot of the population,” he said.

Earle also stressed the importance of a focus on mental health on campus and the reduction of mental health related stigma, both of which she thinks have improved during the past 16 years she has been with CHD.

“The broader student population is really getting more involved and becoming more aware of mental health and the importance of it,” Earle said. “To perform academically, athletically, socially we all have to be mentally healthy and when that starts breaking down, it affects all areas of our life.”

Cunningham said that in order to continue enacting these positive changes students need to be aware and compassionate about such issues.

According to the survey, 92 percent of respondents reported that they believe other students would be supportive if they discussed struggles with mental health.

“It takes one person to simply just ask how are you, what is going on, because you never know — that conversation you have with someone might be the thing that keeps them alive,” Cunningham said.

He also explained that although there are several resources students can utilize, ultimately everyone bears some measure of responsibility in alleviating these issues.

“I’m a resource, Student Assembly members are a resource, Dick’s House, the Health and Wellness center, Active Minds...There are so many groups out there trying to do this job. But really it’s not on one person or one facet of Dartmouth — it’s on everyone,” Cunningham said.