Dartmouth mental health resources prove insufficient to manage rise in mental health struggles

An investigation by The Dartmouth has found that the College has room for reform in its mental health policies after pandemic isolation and three freshman suicides.

by Soleil Gaylord and Arielle Feuerstein | 7/16/21 5:10am

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College resources, strained before the pandemic, were unable to keep up with a rise in anxiety, depression and other mental health conditions throughout the last year and a half.
by Oliver De Jonghe / The Dartmouth

During spring term, C.J. Henrich ’24 learned that his friend had just discovered a student in her building attempting suicide. Henrich rushed to North Massachusetts Hall, where his friend lived, and he watched another student walk out with paramedics as he tried to comfort his friend. He said that everyone on Mass Row must have seen the ambulances. 

“I did not know this guy. I did not know his name. I do not know who it was that I saw walk out, but when I explain this story to other people, I’d have to reassure them that everything was okay,” Henrich said. “Not because I knew that everything was okay, but because the College hasn’t sent another email about a suicide.”

As rates of anxiety and depression among Dartmouth students spiked during the pandemic, the College’s mental health resources were tested more than ever before. A weeks-long investigation by The Dartmouth has revealed that many students feel the existing support infrastructure failed to handle the strain of a year characterized by isolation and grief. The deaths of four undergraduate students — three of which were by suicide, according to reporting from The Dartmouth and the Boston Globe — brought widespread grief and sorrow to the campus community — and also, in the eyes of many, highlighted Dartmouth’s apparent inability to adequately protect its students. The College’s treatment of mental health has been widely criticized as insufficient at best and actively harmful at worst. 

A number of students report that their existing mental health issues intensified in the past year. One member of the Class of 2024, who requested anonymity in order to discuss their mental health struggles candidly, said that their depression worsened when COVID-19 cases skyrocketed on campus during the winter term and Dartmouth reverted to strict quarantine rules. A combination of seasonal depression, anxiety surrounding the threat of being kicked off campus for potentially violating COVID-19 rules, isolation from their friends and academic stress all exacerbated the student’s mental health struggles. 

“You couldn't leave your room, so I couldn’t see my friends. They were all feeling the same way, but we couldn’t even commiserate together,” they said. “I found myself just laying in my bed, not doing anything, and for people already struggling with mental health issues, it’s very hard to get out of bed when you sink.”

Inaccessibility of appointments and shortage of staff

The Dick’s House Counseling Center advertises a number of options to address student mental health concerns, including on-call services, short-term therapy, medication management, consultation, nutrition services, help with community referral, workshops and discussion groups. During the pandemic, students were unable to walk into the Counseling Center to schedule an appointment, but they could call to schedule an appointment between 8 a.m. and 4 p.m., and crisis services were available 24 hours a day via an on-call provider. 

However, many students feel these resources were, and remain, insufficient to address Dartmouth’s mental health crisis. Just 30% of members of the Class of 2021 reported satisfaction with the College’s mental health resources, a 14 point drop from the senior class the year before

When Henrich attempted to schedule a counseling appointment, he was initially sent to voicemail. 

“It was kind of an issue, because it felt like they were overwhelmed,” he said. “...Therapists ended the therapy sessions early a few times, [and I had] difficulty scheduling preferred times repeatedly from week to week.” 

According to Counseling Center director Heather Earle, a student would only be sent to voicemail if the clinical coordinator, or front desk administrator, is on the line with another student. If a student calls after hours and leaves a voicemail, Earle said, the call would be returned within the next business day. Earle also said that while in the past, students may have experienced longer wait times for appointments, the College has recently hired more counselors to meet demand.

When Gabi Rodriguez ’23 was a freshman, there was only one psychiatrist at Dick’s House, Da-Shih Hu, and she recalled that students had to book an appointment over two weeks in advance in order to see him.

“Not having that ability to see someone right away — especially psychiatrists who can prescribe medication that can alter the chemicals in your body — is very problematic,” Rodriguez said. 

The College hired a second psychiatrist, Benita Walton, in February. In addition, there are currently 12 counselors serving Dartmouth’s population of approximately 6,500 students. Following the death of Elizabeth Reimer ’24, College President Phil Hanlon announced that the College would add two new counselors, a student wellness coordinator and a second on-call nurse to minimize the likelihood that students would be routed to voicemail. According to Earle, one has already been hired and will join the Counseling Center’s staff this September.

Naina Bhalla | The Dartmouth Senior Staff

Students held candles during the candlelight vigil, “Dartmouth Remembers.”

Student Assembly president Jennifer Qian ’22 said that she and SA vice president Maggie Johnston ’22 are also advocating for more on-call nurses during the night shift — when Dick’s House isn’t fully operating — as well as a new phone system at Dick’s House to make sure students’ calls are answered.

“We hope to significantly improve the current system and want to supplement it with third-party telehealth providers if the system proves not enough for 24/7 support,” Qian said.

Resources unavailable for out-of-state students

Regardless of the availability of counselors, some students were unable to use Dick’s House counseling services at all if they weren’t living in New Hampshire — which, during the pandemic, was a significant fraction of students. Dick’s House advertises teletherapy services for out-of-state students on its website, but offerings can differ based on state-specific restrictions. This cut many students off from the Counseling Center’s full resources.

According to Earle, mental health providers are not allowed to provide services to someone physically located in a state where they are not licensed. She added that the College’s counselors worked to get temporary licensure — which are typically valid for 90 days — in other states during the COVID-19 pandemic. Earle said these regulations are the responsibility of state agencies, not the College.

Earle also said that students located outside of New Hampshire are offered triage appointments — in which a counselor speaks with a student for at most 60 minutes and then makes recommendations for how the student should proceed — by the Counseling Center to determine appropriate care and counseling, and students can participate in discussion groups and workshops regardless of where they are located. 

Many students still felt that College resources were inaccessible. Vania Ding ’23, who began to see a Dick’s House counselor near the end of winter term, was only able to have a few sessions before state laws prevented her from continuing when she moved back home for spring term. 

“When the term was over, I was going to be unable to contact [the counselor] again because I live in Arizona, and according to Arizona laws, you’re not allowed to get remote counseling. You have to get a counselor within the state,” Ding said. 

Some students think the College should have made more of an effort to provide support for those off-campus. Rodriguez said that the College “completely mishandled the situation,” and suggested that they should have put effort into implementing alternative mental health resources for students away from campus, such as promoting counseling apps or programs like Headspace, which offers guided meditation. 

“I don’t care if there are licensing laws: They’re a billion-dollar institution. They can figure out a way,” Rodriguez said. “...It should not be up to us, the grieving students, to figure this out.”

Last fall, Rodriguez was a Freshman Orientation Peer Leader. One of the freshmen in her group, Beau DuBray ’24, died by suicide at the end of fall term. While grieving, Rodriguez was unable to use many campus mental health resources because she was living off campus.

“I was personally affected by the loss of a close friend, and then had no support from counselors, was isolated during the winter, was not on campus and was not able to see a counselor because I was out of state,” Rodriguez said. 

Kyle Mullins | The Dartmouth Senior Staff

Signs on the River Trail along the Connecticut River honor Beau DuBray ’24, one of the students who died by suicide this year. 

She felt that the burden of handling not only her grief, but the grief of other students as well, rested entirely on students, with no weight shouldered by adults or professional resources.

“I was crying for help for myself because I was not able to talk to anyone after someone killed themselves, and I know the rest of my ’24s, who I call my kids, were extremely close with him,” Rodriguez said. “I’m not even sure if they were offered counseling or immediate support, so the support came through us. As a 19-year-old, it’s a lot to provide support for others as you’re grieving.”

Short-term solutions

Once a student is able to secure an appointment, there are limitations on the scope of Dick’s House’s therapy services. The College currently only offers short-term therapy — a term or less — rather than long-term therapy, which many students said does not provide adequate support for their mental health struggles. 

When Ding was a freshman, she initially sought out Dick’s House services and scheduled a triage appointment. She ended up making several over the course of her freshman year, but never received a substantive treatment plan until she reached out again this past winter. 

“Each time, I was told either that ‘It’s too late within the term to get someone to talk to you personally,’ or ‘It seems like you have real issues, so I don’t think that can be solved within a term, so maybe you should just go get a counselor in [Hanover],’” Ding said. 

Last winter and spring, Dick’s House referred 11% and 15% percent of students who came to counseling to outside therapists, respectively, according to Earle. However, the cost of seeing a counselor in Hanover can be financially difficult for students. When Ding was instructed to find a counselor in town, she didn’t know how to pay for the service, so she simply stopped seeking one-on-one therapy. As a replacement, Ding sought out group counseling, which she said is the best resource the College could offer for students that have “nothing else,” but it wasn’t personalized enough to serve her needs. 

Multiple students said that they believe Dick’s House’s short-term counseling model prioritizes College convenience over student well-being. 

“It just makes you feel like you don't have the ability to see someone longer [...] You only have this amount of sessions before they’re trying to kick you out and see someone else,” Rodriguez said. 

Medical leave policy

Under Dartmouth’s current medical withdrawal policy, students experiencing “health issues that significantly impact their ability to function” are encouraged — or in some cases, required — to pursue medical leave. During this time, students are prohibited from returning to campus or participating in any campus activities, and they are no longer able to access the College’s counseling services. Many students have criticized Dartmouth’s medical leave policies, which received an “F” grade in a 2018 Ruderman Family Foundation white paper that assessed several schools’ leave of absence protocols.

Photo obtained on condition of anonymity

Graffiti was left on Parkhurst Hall — as well as at Webster Ave. in front of College President Phil Hanlon's house — that criticized the College's mental health policies. 

The official rationale behind the policy is to “foster an environment in which students are able to fully engage in their academic, residential and/or campus life.” If a student feels that they would benefit from a medical leave, then they can discuss options with their dean and a provider at Dartmouth College Health Service. 

If a student does not request a voluntary medical withdrawal, Dartmouth can institute a mandatory medical withdrawal. For this to occur, the student’s senior dean must consult with the appropriate DCHS provider. After the provider assesses the student, the dean can implement mandatory medical leave once a student has declined the opportunity to leave voluntarily, there is confirmation that the student has a health condition and the student meets certain additional criteria, including an inability or unwillingness to carry out “substantial self-care obligations,” a risk to the health or safety of others or themselves or obstruction of “lawful activities” of other members of the Dartmouth community. 

Dick’s House estimates that there are approximately 50 to 60 medical leaves each year, and over 90% of them are initiated by students. Yet, not every student leaves Dartmouth willingly. 

In spring 2018, Jeremy Hadfield ’21 struggled intensely with depression and suicidal thoughts. He did not seek help because he did not want to be forced to take a medical leave from campus, and he was concerned that going home would aggravate his mental health struggles, according to a winter 2020 interview for a previous article in The Dartmouth. 

“I would be alienated from the support networks I had at Dartmouth, including my friends, Dick’s House and professors. Some people have [that support] at home, but I personally don’t,” Hadfield said in 2020.

Before a student is placed on mandatory medical leave, they are offered a chance to take a voluntary leave first. Hadfield criticized this in an interview this month as an “illusion of choice.”

Multiple students have criticized mandatory medical leave for not properly taking a student’s personal situation into consideration. Returning home is not always best for a student’s mental health, and Elizabeth Reimer ’24, one Dartmouth student who died by suicide in the last year, did so after the College sent her home on medical leave, according to reporting by the Valley News.

“I think that's just morally reprehensible — they’re putting the student at risk, and I think that the College bears a lot of responsibility,” Hadfield said. “It applies an inflexible standard to every single student, without any regard for their personal situation or home circumstances.”

Henrich said that many students previously forced off campus by the College’s mandatory medical leave policy expressed that it was worse for their mental health, and students shouldn’t be treated “like a bomb about to go off.”

“They should focus on whatever the person going through needs. In Elizabeth’s case, it was clear that [medical leave] was not what she needed — it was to be on campus with her friends,” Henrich said. “For [the College], it’s all about how to cover their asses, rather than protect students.”

Madeleine Bernardeau | The Dartmouth

Shortly after her death, students created a memorial for Reimer using photos and candles and wrote down notes in memory of her.

Hadfield believes that the policy, due to its harshness, “prevents people from going to counselling and seeking out resources that are extremely valuable.” Henrich experienced this personally, expressing that he felt uncomfortable disclosing all of the details of his emotional state with Dick’s House counselors due to the policy. 

“I was not completely honest with everything and how tough it was, because I could not trust them,” Henrich said. “If I say how much anxieties and pressure I’m under and everything else, I might just go home and then have to face all the drama and pressure from going home.”

More harm than good

Multiple students report that their experiences with Dick’s House counseling have been either ineffective or harmful. 

The anonymous member of the Class of 2024 called Dick’s House to speak with a counselor after having a panic attack, and they said that the counselor didn’t offer any feedback for how to improve their mental health. 

“You know that talk, where ... basically, you’re repeating what the person is saying and confirming it? I feel like that’s what they're doing without actually providing good input as to what would make the situation better,” they said.

Other students have found that counselors provided unsolicited or harmful suggestions. Once Henrich finally secured a therapy appointment, the Dick’s House counselor mainly tried to discourage him from remaining on campus, rather than expressing a willingness to help him address his mental health concerns, he said. This only exacerbated his already overwhelming anxieties. 

“When I actually had the therapy appointments ... I was just blatantly encouraged to go home early, and even to change colleges.” said Henrich. “It’s not good to hear another person in a position of authority as a therapist legitimize everything your anxiety and negative experiences say. I did not feel like I was actually seeking medical help, I was just having someone try to have me not have mental illnesses on campus.”

Henrich felt the counselor was trying to convince him that he could not belong at Dartmouth if he was struggling with mental illness. 

“My mom was thinking about me switching schools … but the therapist somewhat legitimized that, suggesting ‘You could definitely start looking at other schools, this place is not for you.’ Henrich said. 

Another member of the Class of 2024, who also requested to remain anonymous in order to speak candidly, said that she did not feel that many Dick’s House counselors and nurses properly listened to her.

During winter term, the student said that she called Dick’s House because of an infected ear piercing, but was pressured by the on-call nurse to see a counselor after revealing she had recently pulled an all-nighter. 

“I was calm at first, and I started getting more and more emotional as they kept pushing counseling services on me,” the student said. 

Later that week, the student decided to try Dick’s House counseling, and she felt that the counselor she spoke to invalidated some of her experiences, especially relating to her relationship with her parents. 

Later in the session, the student told the counselor that she sees another therapist from home, and the counselor told her that it is against policy to see a Dick’s House counselor routinely — a choice she made only after pressure from the nurse on call, she said — if a student already has another therapist.

“Based on my experiences, I’m not comfortable calling on-call services anymore. And I’m not sure who to call if I can’t call them,” the student said. 

Photo obtained on condition of anonymity
Soon after Elizabeth Reimer ’24’s death, a banner appeared on the library calling for change.

Going forward, Earle said, the College hopes to increase workshops and outreach programs, hire more clinicians and extend mental health services beyond the Counseling Center — to the Office of Residential Life, for example. She added that the College also plans to further support faculty members in “knowing where to refer students.”

Earle added that the College aims to incorporate the Interactive Screening Program, a program developed by the American Foundation for Suicide Prevention, into the College’s mental health policies in order to help students get connected with appropriate services. Through an anonymous online screening, Earle said, ISP aids in identifying individuals who may be at risk for depression, suicide and related mental health concerns and encourages them to seek support.

Hadfield, on the other hand, said that the changes announced by the College are “performative,” noting that the medical leave policy, for example, has yet to be changed. 

“I think that we need a comprehensive overhaul of Dartmouth’s medical leave and mental health policies — the administration needs to take a deep look at their policies,” he said. “Individuals in the administration are incentivized to care about liability, reputation and funding. What matters is not liability, but keeping our students safe.”

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