The root of Penn's mental health problem

As he walked to the class that he told himself he would definitely not miss again, Jack stopped to focus on the cars whizzing by on Spruce Street. With each passing car, flashing visions of closing his eyes and darting into the street became increasingly vivid and realistic.

“It felt like a bad horror movie – everything was fear and everyone felt like enemies that would never understand or be able to help,” said Jack Park, a second semester freshman at the time. “Every day and everyone around me seemed to prove how meaningless my life was.”

Shaking his head in hopes of erasing this impulse, he continued walking briskly to class until the looming high rise buildings to his left once again invited intrusive thoughts about what it would be like to jump from the top.

“I know it’s not logical to feel like the only option is no option, but with my disease at the time, I just felt that leaving this world would end my misery and be better for everyone around me.”

Earlier that year, Park had gone into Penn’s Counseling and Psychological Services in hopes of finding support after arriving to an unfamiliar campus from his home of Seoul, South Korea. But after a twenty minute meeting and assessment, Park did not reach out to CAPS or other mental health resources again when CAPS determined his case as mild and never followed up with him.

“I realize my condition was in a mild state at that time and it’s really tricky because they do have to prioritize the more urgent cases, but following up with milder cases could probably prevent mild problems from becoming more severe and potentially fatal in the future,” Park said.

After his first attempt at suicide a couple weeks into second semester, Park finally called to tell his parents in Seoul about the severe state of what would be diagnosed as clinical depression and bipolar disorder. Park did not want to give any description of his attempt because he believes that people suffering from suicidal thoughts are more likely to take action when they hear details of another person’s attempt.

After getting a diagnosis in New York and then taking a semester-long leave of absence back in Seoul, Park now feels settled in his fourth year of studies at Penn and values the power of open discussion and the support he has recently gotten from Penn resources.

“In the bad place I was in during my freshman year, I thought I was a worthless person who didn’t deserve any help,” Park said.

The lack of sufficient follow ups is just one of the many inefficiencies that continue to impact the effectiveness of Penn’s mental health resources. For many students who deal with mental illness, the problem at Penn is not the lack of resources, but the barriers involved with first reaching out for help.

Released last month, the Report of the Task Force on Student Psychological Health and Welfare focuses on the key issue of Penn’s campus culture, a problem that Penn students also highlight as a crucial obstacle to getting people to open up about mental illness.

While the report may have invigorated student initiatives and new awareness programs to foster a more supportive culture at a school that saw six suicides in 15 months, many students who have used Penn’s mental health resources are disappointed by the Task Force’s inadequate discussion of ongoing problems with existing services.

Inefficiencies

Within the University’s existing mental health services, the Task Force recommendations only point out one major inefficiency that Penn has improved upon: long wait times to see a counselor at Counseling and Psychological Services.

According to the report, wait times for CAPS appointments have already been reduced from an average of 21.6 days in December 2013 to an average of 8.5 days in December 2014.

But even with this progress, students continue to face long waits before getting treatment.

Coming from a conservative household where mental health was considered taboo, College freshman Grace Pak saw Penn as an opportunity to finally open up about her anxiety and depression. But after reaching out to CAPS, she was confused when she did not receive a call back.

“When I got to Penn, I thought it would be the first time I’d be able go out and get real help,” Pak said. “My whole life felt like everyone had been putting my mental health on the backburner, so I was extremely disappointed when I felt like my mental health also wasn’t a priority here and that the school didn’t care.”

After continuing to hope for a call back during the first overwhelming weeks of freshman year, Pak decided to call CAPS back herself. Two calls and three weeks later, she was able to see a counselor.

“It’s great that Penn has so many mental health resources and now I’m really thankful for the help I’ve gotten from CAPS, but I still think that Penn needs to do more to make its services more accessible,” Pak said.

Many students ultimately find Penn’s mental health resources helpful, but several inefficiencies — even beyond the CAPS wait time — undermine the value of these services. These sorts of barriers to mental health resources provides an experience much different than the process of accessing Penn’s physical health services.

Before even before starting classes his freshman year, College sophomore Luke Hoban, who is diagnosed with Congenital Muscular Dystrophy, was set up with accommodations for getting around in a wheelchair and managing his academic needs for the next four years. By affecting the communication between his brain and his muscles, Hoban’s illness prevents him from fully using his muscles and causes them to progressively weaken.

Student Disability Services immediately secured his transportation resources, note takers and counselors, and each of his semesters begins with meetings to re-evaluate his services for his new schedule.

“In June, we send out an informational email about our resources and we try to accommodate all incoming students as soon as possible,” Student Disabilities Service Director Susan Shapiro said. “We have liaisons in each school at Penn and meet with different advisors to ensure we are collaborating with other parts of the school and communicating our presence to student and faculty networks.”

On a day when her anxiety and depression felt especially acute and unmanageable, Pak turned to Penn’s HELP line, another entry point to Penn’s mental health resources. Based on an earlier recommendation of the Task Force, the University implemented the 24/7 HELP line to provide an over-the-phone referral service for students seeking information about how to get assistance with personal issues. CAPS director Bill Alexander said the crisis line works well by “calming people down over the phone until CAPS personnel can bring assistance to the caller.” But Pak’s first experience with the service involved more waiting than expected.

“When I called in on the verge of a mental breakdown, I had to wait for thirty minutes as this man with no experience talked about completely irrelevant things until I was finally transferred to someone licensed to help me,” Pak said. “I did find it helpful once I was finally transferred to a professional, but I was having a really rough time and it should have been much more efficient.”

Like Park’s decision to take time off back home in Seoul, College junior and DP columnist Katiera Sordjan took a year-long leave of absence after struggling with her anxiety and depression and falling behind in courses. While the time off helped her recuperate and she now feels settled in her classes, the bureaucratic process of returning from a leave made her transition more complicated than she had hoped.

“I finally felt ready to come back to school, but the process to come back was so confusing and hard for me since nothing was streamlined,” Sordjan said. “CAPS, academic and all other advising and paperwork were all so separated and I think it made things worse for me.”

Sordjan has also had to deal with the process of being referred out to a therapist outside of CAPS since Penn only offers short-term psychological services — an average of less than seven sessions per student, according to the report. Since her insurance did not cover the first therapist Penn recommended, Sordjan is still looking for consistent professional help.

“I understand it’s not practical for CAPS staff to be able to work with all students on a long-term basis, but the process to refer students to outside therapists needs to be improved,” Sordjan said. “It felt like I was just handed a list of information and there wasn’t any check-in as I searched for a fitting therapist.”

Though these students stressed that inefficiencies in Penn’s services had serious consequences on their mental well-being, the Task Force did not find the quality of existing resources to be a major reason for the students’ mental health problems.

“There are so many great resources here and people really are doing great work,” said Rebecca Bushnell, the Task Force Co-Chair and former dean of the School of Arts and Sciences. “The problem is that not enough students know about or have access to these services, which is why the suggestions focus on communication and centralizing information about services.”

The Task Force Report does mention the need for “a smooth transition” back from a leave of absence, as well as the need “to ensure that the care provided to students by other providers is optimal.” But with only these general observations and without even touching on the HELP line wait or insufficient follow-ups, the recommendations fall short of highlighting what many students see as an ongoing source of the problem — the many specific inefficiencies in existing mental health resources.

Cultural Barriers

While the report does not make logistical or structural change a focus, the Task Force recommendations do hit on a major concern of Penn students: the cultural barriers to reaching out for help.

Unlike the services for visible physical conditions, mental health resources are much harder to initially access. Beyond the logistical obstacles to overcome within the services, Penn’s culture plays a significant role in discouraging students from taking the necessary first step to confront their mental health problems.

“Physical unhealthiness — basically any problem with the body besides the brain — seems more socially acceptable than mental problems, because people seem to think that an illness of the mind is something you can control,” Park said. “It feels like a weakness much more than something apparent like physical health does.”

While many have criticized the report’s limited implementation plan, the inherent abstractness of cultural transformation means that the most important shifts “require collaborative action from the students, since culture change can’t come from the top down,” Bushnell said.

College junior and Active Minds president Devanshi Mehta — who suffered from chronic anorexia — thinks Penn’s resources helped save her life, but she emphasizes that students must take the initiative to secure their own mental health care, even though speaking out about personal issues is difficult at Penn.

“If I hadn’t taken the first step, I wouldn’t have been introduced to CAPS and all the other student health resources that saved my life,” Mehta said.

Mehta said the transition to Penn initially worsened her eating disorder and mental state due to the competitiveness and overall environment fostered on campus.

“In high school, at least I had grades or something to be proud of in academia, but coming to Penn with so many competitive people, I lost my sense of identity and uniqueness,” Mehta said. “I couldn’t find a coping mechanism with finding no way to stand out, and food was the only way I felt I could control something.”

Pak also stressed the role of Penn’s culture in contributing to mental instability and the obstacles to opening up about personal issues.

“The desire to be perfect at Penn — or make everything seem perfect — leads to this great stigma around mental health here that I think is a huge portion of the problem,” Pak said. “Only a handful of people at Penn know about my mental illness because I feel like mental health is really stigmatized here since it seems like there’s a certain way you have to be.”

Park agreed that Penn is not the ideal environment for students’ mental well-being, but he refrained from encouraging a complete culture change.

“The environment here does make things worse, but Penn naturally attracts a self-selected group of competitive, perfectionist students who do enjoy and thrive off of this sense of challenge,” Park said.

Though the report identifies the competitive, achievement-oriented culture at Penn, Anthony Rostain — the other Task Force Co-Chair and Director of Education for the Psychiatry Department at the Perelman School of Medicine — said the goal is not to eliminate students’ desire for excellence, but to make sure that this mindset does not turn into a “destructive perfectionism.”

“People need to make sure to appropriately care for themselves and for their relationships,” Rostain said. “Striving for excellence without focusing on mental wellness is actually what often prevents students from succeeding.”

Since students struggle to reach out for mental health help, CAPS is promoting its I CARE program, which trains teachers, faculty and staff to recognize and approach students with mental health concerns.

“It’s hard to recognize when someone is in trouble so we want people to be able to better identify it and know what to say,” CAPS director Alexander said.

Rostain and Bushnell emphasized that the logic of the I CARE program needs to be extended to the way that everyone interacts with each other at Penn.

“The Task Force Report is a call for all members of the community to do something, so the University must emphasize that taking care of yourself and others is critical to success,” Bushnell said.

Similar to Student Disabilities Services’ liaisons around the school, Penn is hoping to have I CARE-trained students or faculty members in many networks throughout campus, such as fraternities, clubs and sports teams.

Over the past year, student-driven initiatives, such as the recently released UA Wellness Guide and DAB’s “Deconstructing the Penn Face” project, reflect the hope that idealistic calls for community-wide change may be turning into action.

“Student-led efforts are exactly what we were hoping the report would trigger by sparking more discussion around the issue,” Rostain said.

To foster more open dialogue about mental health, Park has begun sharing his experiences on his blog to encourage students to talk about their past and current struggles with mental illness. He emphasizes the need for much more improvement in the services, but he believes that the core problem with mental health ultimately extends beyond the abilities of Penn.

“It doesn’t help to point fingers at CAPS or anyone else because there really is an entry barrier to all mental health resources at Penn or anywhere in the world,” Park said. “Blaming [Penn’s resources] completely is like thinking they can simply alleviate the symptoms of something almost always caused by internal sources; the patient’s will is one of the most important determining factors in starting to help with their mental problems.”

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