MCQ Issue 9 | First Quarter | 2018 by Mary Christie Quarterly

Mary Christie Quarterly A publication of the Mary Christie Foundation

Help Along the Way

How mental health partners are supporting students and colleges p. 16

School Spirit at Tulane p. 10

Issue 9 | First Quarter | 2018

Mary Christie Quarterly The Mary Christie Quarterly is a publication of the Mary Christie Foundation, a thought leadership and philanthropic organization dedicated to the health and wellness of young adults.

STAFF Publisher & President Editor & Executive Director Program Manager Art and Layout Director

Robert Meenan Marjorie Malpiede Dana Humphrey Ashira Morris

BOARD OF DIRECTORS Chair

John Sexton

Vice Chair

John P. Howe, III

Vice Chair

Robert Caret

President

Robert F. Meenan

Secretary

Marjorie Malpiede

Treasurer

Maryellen Pease

Member

Frederick Chicos

Member

Zoe Ragouzeos

CONTE NTS 04 Q&A: Dr. Paul Barreira 07 Opinion: An Ounce of Prevention Has Never Weighed More 10 School Spirit 16 Help Along the Way 26 The ADA and Mental Health on College Campuses 30 Opinion: College is Tough Enough 33 Q&A: Dr. Paula Johnson 38 A Few Good Men 42 Science Summary

Cover art by Jia Sung Spot illustrations by Fran Murphy

Q&A: Dr. Paul Barreira The director of Harvard University Health Services on creating new models for students’ mental and emotional health Interviewed By Dr. Kaitlin Gallo

Paul J. Barreira, M.D., Henry K Oliver Professor of Hygiene, has been the director of Harvard University Health Services (HUHS) since 2012. For the previous eight years, he led Behavioral Health and Academic Counseling at HUHS and was an associate professor of psychiatry at Harvard Medical School. Despite his long tenure in the Ivy League, Barreira hardly fits the stereotype of the change-resistant academic. Barreira believes the traditional model for treating college students for a range of emotional and behavioral health issues is broken. His views on how to engage the academic community in partnering with health centers to address student mental health are anything but “old school.” Dr. Kaitlin Gallo, a clinical psychologist and former undergraduate mentee of Dr. Barreira’s, recently interviewed him on the subject. Their exchange follows. 04

Dr. Kaitlin Gallo: You have been on the front lines of student health, especially emotional and behavioral health, for many years. How do you see the field changing? Dr. Paul Barreira: I would say there are two areas where it is changing. One is the volume and frequency of students who want to come in and receive services. The other is the chronicity and severity of the problems that students are experiencing. We had 40 psychiatric admissions last semester. We used to have 20 in a year and the number has been increasing over the last five years. It’s not just a spike, it’s a trend. KG: How do you handle that as a university mental health service? PB: We have come to the realization that we can’t just hire more counselors. We need to change the model because the traditional model

for providing services simply doesn’t meet the needs of our students. I think of this as a bell-shaped curve. On one end, there are the students coming in for three or fewer visits – many of whom are having normal human reactions to stressful events. A number of these students could have a conversation with someone outside of the health service, within the academic community, that could satisfy their need to express their problem and think about ways to relieve their distress. On the other end of the bellshaped curve, there are students who need a higher level of care who should be helped by mental health professionals who can provide more intensive services in the community outside of Harvard. In the middle of the curve are the majority of students who can benefit from meeting with a mental health provider

for a shorter course of treatment or on a more intermittent basis. If we can create opportunities in the learning environment to have supportive conversations with the students who need a less intensive level of care, and if we can ensure that people who need a higher level of outpatient treatment can reliably get that care in the community, then we have created the capacity for students in the middle of that bell-shaped curve, who are struggling with depression, anxiety and panic attacks, to get the right course of care. Right now, what’s happening is we can’t see students for 7 to 12 visits on a regular basis because the volume is so high on either end. So, in many ways we’re saying that the learning community will have to actively participate in making this change. The health services can’t do it alone. KG: So how do you go about making these kinds of changes?

Photo by John Gillooly

Harvard University Health Services Director Dr. Paul Barreira in his office.

PB: We need to foster a culture within the learning community which supports helpful conversations about the real stresses of student life. A few years ago, we stumbled on something in my work with graduate students that I’ve been searching for for 10, 12 years. It is a tool that engages the graduate departments and the professional schools in talking about behavioral health and wellbeing. It came about quite organically when I was invited to speak to a group of Harvard economics graduate students following a death by suicide of one of their colleagues at MIT. I was talking about sui-

cide, including information about the rates and causes of suicide, but the only data I had pertained to undergraduates. After the meeting, two students approached me and said, “we need to get data on graduate students in econ.” I said “great, let’s do it.” We worked together to create a survey instrument that incorporated typical clinical screening tools, all the measures you would recognize. But what was unique about the survey was that students wrote specific questions about the learning environment and factors they thought would make a difference in emotional wellbeing. Then they mar05

keted it to their fellow students. The response rate was 60 percent. That was the “aha” moment for me. The way to engage all the departments and all the schools is to partner with the students to create a university-wide survey that includes the usual screening measures but also poses department and school-specific questions about the learning environment. After completing the process with the economics grad students, we partnered with the life science students, then law students to create a survey tailored to their unique experiences. We’re using the survey for three primary purposes: One is measuring and comparing rates of different types of distress. Not only do we learn the rates, for example, of depression and anxiety in each school, but we can make comparisons across schools. A second purpose is to use the survey data as an intervention tool. The student or students who have worked with me to construct the survey can join me in presenting the data to deans, faculty and administrators. And that is the beginning of a conversation in which participants pose questions such as: “What can we do in our school or department to improve things? What is the role of the health center?” In essence we’re using the survey tool to 06

facilitate a conversation that has been hard to initiate. How does this relate to the problem I outlined earlier? We’re exploring how to best utilize resources in health services and in the schools so that people get what they need, not necessarily what someone thinks that they need. The third function for the survey is as an evaluation tool. Once we make changes to the environment, we can survey again and see if those changes have made a difference in the type or rates of student distress. KG: Is there something about today’s students that makes this broader approach to student wellness even more important? PB: College health professionals have begun to observe that as a group, students who are entering college today and who eventually go on to professional and graduate schools, have less well-developed coping skills than previous cohorts of students. A consensus is building that students are coming in with what I consider two large gaps. One is the gap between their intellectual development and their relative emotional development. Being incredibly smart does not help you with intense negative affect if you don’t have sufficient emotional coping skills. Students may resort to cutting, disordered

eating, excessive drinking, sexting or other unhelpful behaviors in an attempt to manage uncomfortable thoughts and feelings. A significant number of students engage in these or other possibly dangerous behaviors. The second gap is much more common. It is the gap, or discrepancy, between how we present ourselves publicly and how we feel about ourselves privately. This gap is often exacerbated by social media. Each gap can exist alone or in combination with the other and both are associated with emotional distress. KG: Do schools need to do more from a leadership perspective to nurture emotional development overall? PB: Yes. I think that, traditionally, schools like Harvard, emphasized intellectual development and performance, sometimes at the expense of personal development. I say to my colleagues and administrators here and at other schools that unless the university or college says openly “we have a responsibility to help you in your emotional and personal development and we are offering ways you can achieve that,” then these gaps are more likely to be maintained. Dr. Gallo has an A.B. in Psychology from Harvard, and a Ph.D. in Psychology from BU.

Opinion: An Ounce of Prevention Has Never Weighed More Advancing prevention efforts for marijuana use in a changing legal climate By Jason Kilmer, Ph.D.

IT can be hard to keep up

with where various states stand on cannabis or marijuana access, ranging from adhering to federal guidelines that prohibit use and possession, to allowing medical access, to providing outright legalization for personal use for those over 21 years of age.

Jason Kilmer, Associate Professor, Psychiatry & Behavioral Sciences and Assistant Director of Health & Wellness for Alcohol & Other Drug Education, Division of Student Life, University of Washington

Many people hear things like marijuana is “safer” than alcohol, believe it’s “not addictive,” or had personal experience when younger and feel that it’s “not a big deal.” Some talk about the money that presumably could be made if marijuana were to be legalized; yet, from a public health standpoint, at what cost? What follows are a few considerations in this changing legal climate.

Marijuana potency has changed – dramatically The psychoactive ingredient associated with the “high” from marijuana, THC, has been increasing in potency. It has been estimated that THC content in the 1980s was 3 percent, reached 4 percent by the mid-90s, and was close to 12 percent by 2012. In Washington, the most recent Marijuana Impact Report showed that the average THC content in one store in Seattle (as an example) was 21.62 percent. This reflects a potency that has simply not been tested in a controlled way for impact on the body. In some ways, states that put their foot on the gas for legalization passed right by any scientifically assessed limits in a

way that what is being made available to people surpasses any controlled research – science desperately needs to catch up. There is a diagnosable cannabis use disorder, as well as documented cannabis withdrawal Can people get addicted to marijuana? Absolutely. There are clear criteria for a cannabis use disorder. The symptoms of withdrawal, ironically, often mirror the very reasons people cite for their cannabis use.

problems, and headaches. If people report frequent use for medical conditions, and assume they are getting a medical benefit because every time they stop they see symptoms emerge, it could be more a matter of feeling better because they are relieving withdrawal symptoms, not that an underlying issue is being treated. There are misperceptions that “everyone” uses marijuana

ages of 12-17, 32.2 percent for those 18-25, and 10.4 percent for those 26 and older. So, what do “most” people do? Abstain from marijuana use. However, a number of studies have shown that there are gross misperceptions in the prevalence of marijuana use; among those with marijuana use, this misperception is even more pronounced.

This misperception could prompt initiation of use if a Data from the Substance person wanting to fit in genuAbuse and Mental Health inely believes that “everyone” For example, many peo- Services Administration’s Na- is using, could result in an inple report using marijuana tional Survey of Drug Use and crease in use for those already to help with using, and sleep, reduce might even anxiety, cope be a barrier with depresto making a sion, boost Research shows that the more college students change (i.e. if appetite, or people want use marijuana, the more they are dropping out of relieve headto stop using aches. but believe classes and taking longer to graduate. they’ll be the Among the only abstaincriteria for er if they cannabis do, their use w i t h d ra w a l Health shows that any past might persist). are sleep problems, anxiety, year marijuana use is 12.6 depressed mood, appetite percent for those between the Marijuana is not without 08

risks and harms, particularly in an academic setting A full review of the effects of marijuana is outside the scope of this article. But, as someone who works in a college setting, it is so important that people understand this is not a harmless substance and it can absolutely impact cognitive functioning. Research consistently shows that the more people use marijuana, the more they experience decreases in attention, concentration, and memory. Among those who use daily, it takes 28 days for these abilities to return. For students struggling with memory and/ or attention who are also using marijuana, it is clear that a move toward abstinence would result in improvement in these domains. Additional research shows that the more college students use marijuana, the more they are dropping out of classes and taking longer to graduate (if they make it to graduation). As conversations take place

about how to make college more affordable for everyone (a worthwhile conversation for sure), part of affecting cost involves seeing students get out on time. Marijuana gets in the way of that. Parents matter The Washington State Healthy Youth Survey shows that although 13 percent of 10th graders who believe their parents think it’s wrong for them to use marijuana nevertheless used marijuana in the past 30 days, rates of past 30 day use are almost 5 times higher (59 percent) among those who believed their parents think it’s not wrong for them to use.

There’s the old saying that “an ounce of prevention is worth more than a pound.” When we consider the issues discussed above, as well as those not addressed here (e.g., driving under the influence of marijuana use, potential harms to heart and lung health, etc.), it seems to be the case that an ounce of prevention has never weighed more. While more research is needed on the effects of marijuana (particularly at the potencies we see today), it is important to keep prevention and intervention efforts moving forward to address emerging needs.

Communicate your values and expectations to your children, and understand that this matters in the decision that they will make. 09

School Spirit

How Tulane teaches students to take on the world By Marjorie Malpiede OUTSIDE the administra- New Orleans’ Uptown District gest party in the world. But tion building at Tulane Uni- remains a significant draw it is clear Fitts is referring to versity, there is a large southern Oak tree with hundreds of colorful Mardi Gras beads hanging from its branches. It is yet another reminder of how intrinsically linked this university is to the city of New Orleans. From its founding as a medical college that treated residents during the yellow fever epidemic, to its role in the city’s rebirth after Katrina, Tulane University has a commitment to New Orleans that goes far beyond that of institution and host city. It is the only major research university in the country with a service requirement, much of which is applied to New Orleans’ public schools and community organizations. Tulane administrators are quick to note that the relationship with the city is far from one-way. Its location in 10

for students from all over the world. Tulane ranks number one in the country in the distance that students travel to attend college, an indication of its strong brand.

According to its President Michael Fitts, what makes Tulane different from other urban schools is the shared personalities of an outward-facing university in a city unlike any other. “New Orleans is known for its jazz, creative food, diverse cultures and innovation. You put all that together and you come up with a university that’s a little different with students who are a little more innovative and willing to try different things,” he said. There is something refreshing about a college president who embraces the culture of a city that throws the big-

its virtues, not its vices, and is honest about the fact that Tulane, like New Orleans, has plenty of challenges to overcome. Fitts says the fact that young people come here from so far away means that they are more independent and, perhaps, more risk-taking than their peers at other schools. He sees this as a key strength, if in moderation. “What I view myself doing is articulating a vision for a successful life for our students that involves balance,” he said. “We are an institution that really supports balance – balanced academics, balanced extracurricular activities, and a balanced social life.”

Gregarious and thoughtful, Fitts appears the embodiment of that balance, though his career trajectory veered to the serious. He jokes that when he was a Harvard undergradu-

ate, his roommates tried to get him to join the poker games upstairs that a guy named Bill Gates was running but he was always too busy studying. He went on to Yale law school, inspired by the crusading character Atticus Finch from “To Kill a Mockingbird” and then to Washington where he was an attorney in the U.S. Justice Department. Before coming to Tulane, he spent fourteen years as the Dean of the law school at the University of Pennsylvania. Being Well Fitts believes being away at college is a textbook example of when people are most likely to experience emotional and behavioral distress. “First year students, for the most part, are in the most vulnerable periods of their young lives. They come to a place that’s very different and far from home when all of their life supports are not there anymore.” Tulane, like colleges and universities around the country, is experiencing a surge in

on Bourbon Street. Greek life here is mostly non-residential which avoids some of the negatives associated with fraternities. That said, Fitts admits, “We have the same problems all schools do when it comes to unhealthy behaviors.”

demand for counseling services, with students reporting higher levels of anxiety and depression. The school is addressing this with increased resources in mental health, a focus on prevention with new wellness initiatives, and building a stronger sense of belonging. Fitts says his number one job is to make sure everyone who comes to Tulane has a home and a community. Excessive drinking and the consequences that accompany that remain an issue though Fitts resents the perception that Tulane is a party school simply because it is in a party town. He says the “guilt by association” myth is un-founded and that today’s students are more likely to be at a creole bistro than a bar

In a recent survey of Tulane students, forty-one percent of undergraduate women say they have experienced a sexual assault since enrolling at the school. Fitts called the findings “deeply disturbing” and pledged an expanded campaign to end sexual violence. When asked if he was surprised at the number, Fitts replied, “yes,” though he believes more schools will discover similar statistics if they examined the issue. He also thinks the fact that more survivors are encouraged to come forward added to the percentage. It is clear that Fitts is more of a problem-solver than an apologist. He sees opportunity in challenges and encourages his students to do the same. In acknowledging the difficulties students have in

transitioning to college, Fitts says, “We also have to understand that this is actually an incredible growth experience for them, a remarkable moment for them to learn a set of life skills that is going to be

critical for them forever. The experience of change is something they will experience over and over again for the rest of their lives in a way that older generations never did.”

Fitts’ attempt to articulate that opportunity, within the backdrop of Tulane’s strengths, is what led him to launch “The Undergraduate Experience” – an examination and subsequent recommendations on how to better support Tulane students as they prepare for a changing world. He initiated a campus master planning process that is making physical changes with philosophical undertones. One of the first initiatives that came out of that effort was the creation of residential learning communities which are dorm environments with themes to them like community engagement, health or social justice. The idea is to make residence halls more than just where you live but also where you connect with people, including faculty.

Photo by Sally Asher

Tulane University President Michael Fitts 12

The architect of the plan is Robin Forman, Tulane’s Senior Vice President for Academic Affairs and Provost. It is clear he delights in his role and its connection to student success. “Our students are very aca-

demically accomplished, talented and ambitious but they also want a more energetic social and cultural life than you can find on many other campuses. You can see this is a great combination when you look at some of the accomplishments of our alumni,” he said.

Forman believes bringing resources close to one another will help. The school is currently combining its career center, success center and academic advising into one, newly-constructed building with study and relaxation spaces. The move is both practical and symbolic -- an acknowledgement that supporting students’ wellbeing is everyone’s job.

Navigating institutional resources can be even more difficult for first generation students, students from marginalized communities or those with fewer family resources. For these students, the school has created the Center for Academic Equity. Open to anyone, the Center is meant to help students without builtin supports (aka helicopter parents) take advantage of the many resources and opportunities something [our that are availand over again able to them.

One of the ways Forman hopes to improve the undergraduate experience is to do a better job of help- “The experience of change is ing students students] will experience over navigate supports that are for the rest of their lives in a way that older “We want available to generations never did.” to make sure them, partic- — Michael Fitts, President of Tulane University this is a reularly if they ally incluare strugsive campus, gling. “We where everytend to rely on students to “Your academic advisor one here has the same chance not only recognize when the has to be someone who very to be respected, valued, supneed help, but to self-diagnose quickly is able to recognize ported and celebrated,” said what the problem is and find that maybe you are having is- Forman. “This is the kind of a way to get to the right of- sues that aren’t just academic experience we want everyone fice,” he said. “We’re trying to and they have to do more than to have.” get away from all that by hav- say ‘here, go see a counselor’ At Tulane, a big part of that ing a team approach among because in most cases, it won’t experience involves diversidepartments and helping stu- happen,” said Forman. ty in every dimension -- from dents find their way to what Putting a value on diversity embracing different cultures, they need.” 13

to moving beyond your comfort zone, to learning what you think you already know through community service. Tulane students have to take two academic service or community engagement experiences to graduate, a requirement the school instituted after hurricane Katrina. Fitts says that while Tulane’s commitment to the community is in its roots, they doubled down on their efforts after the hurricane. “We understood how important the rejuvenation of the city was to us and the city understood the role we could play in that. We are co-dependent in a million ways,” he said. Katie Houck is the associate director of the Center for Public Service at Tulane. She also runs the Peace Corp prep program and manages Get Engaged, one of the school’s residential learning communities. In explaining the goals and the premise of Tulane’s service program, she makes it 14

Photo by Sally Asher

The quad at Tulane.

clear that it is far more than hooking kids up with internships. “A lot of times, the work we do is really focused on issues of diversity and inclusion, power and privilege. Our students learn how to listen and to understand the root causes of what they see,” she said. Forman believes the community service program is an

invaluable teaching opportunity for students facing a new world which requires them to relate to different people in different ways. “When you go to a fancy grade school and fancy high school and then to a fancy college, there’s a sense that the only people you can learn from are people with fancy degrees,” he said. “Then there’s this remarkable mo-

ment when you work with a community leader who has dedicated their whole life to something and brings an enormous amount of wisdom and insight to the experience and you realize you can learn so much from this person.” Looking ahead Fitts is hoping that what makes Tulane different will be its best asset going forward. “It used to be that students bore down on one discipline

with their goals set on a single career. Our students may have multiple careers in disciplines we don’t even know about today.,” he said. Preparing students for the new world means changes both inside and outside the classroom. As examples, Fitts points to new ways of teaching at the business school that involves groups and teamwork and advising staff that are not limited to one subject or major. Once again, Tulane

is using the city as its muse for teaching to the future. Thirteen years after Hurricane Katrina triggered floods that devastated the city, New Orleans is now a very different place. While tenacious disparities remain, there is a tremendous sense of hope in a city that has become a laboratory of reinvention. As people with big ideas come here from all over the world, Tulane hopes the university will remain at the center of it all.

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Help Along the Way How mental health partners are supporting students and colleges By Marjorie Malpiede

ENSURING the healthy development of teens and young adults is more important than ever. Economic, environmental and technological changes have altered the world in a relatively short time, bringing a host of new challenges to our next generation of leaders. Over the last decade, and certainly over the last five years, the mental health of college students has become a national concern. The prevalence of students with mental health challenges on college campuses has increased significantly over this time-period, indicating some positive movement in the stigma around seeking help. But the surge in demand for campus counseling services continues to overwhelm the capacity of even the most well-resourced schools. And for every student who is proactive about their mental health, there are many more who are suffering in silence. · According to the 2017 Healthy Minds Study at the University of Michigan, 35 percent of students have symptoms indicating a potential current mental disorder such as depression or anxiety. · Three college students a day die by suicide and 2,000 college students die every year from alcohol or drug-related injuries · Nearly one in six college students has been diagnosed with or treated for anxiety within the last 12 months, according to the annual national survey by the American College Health Association. · More than half of students visiting campus 16

clinics cite anxiety as a health concern, according to a recent study of more than 100,000 students nationwide by the Center for Collegiate Mental Health at Penn State. The risks and consequences of not addressing the rising demand for mental health services, or reaching those who need help, include: lower graduation rates; litigation and reputation damage; as well as tragic loss of life. For distressed students, being within an institution that can’t meet their needs can feel like another reason to keep their problems to themselves. Experts are now calling this “the campus mental health crisis.” The crisis may have caught many in the higher education community off-guard but it is not something they are taking lightly. Even schools that focus solely on academic performance appreciate the impact of mental health on their ability to graduate well-educated students. In a survey this year at Ohio State, just over half of the student clients said that counseling was instrumental in helping them remain in school. Many more institutions are viewing the crisis as a metaphorical crowbar to open up new opportunities for teaching to the whole person and infusing personal and emotional development into their core curriculum. Higher education is where problems go to be solved, and it is not surprising that there are a number of innovative partnerships between colleges, non-profit organizations and industry associations that are making great strides in supporting students.

From the expanding safety network of The Jed Foundation (JED) to the data mining of Michiganâ&#x20AC;&#x2122;s Healthy Minds, to the student voices of Active Minds, these organizations are working together, and with partners in advocacy and policy, to bring a new way of thinking to the old way of addressing student emotional and behavioral health.

The Jed Foundation What sprung from the unanswered questions of a grieving family has become the most influential change agent in student mental health.

years later, JED can lay claim to the fact that over 195 colleges and universities, representing more than two million students, are now participating in JED Campus -- a nationwide initiative that helps colleges and universities assess and enhance their policies, programs and systems to support the emotional well-being of their students.

Launched in 2014 and based on a comprehensive, evidence-based framework, JED Campus includes an assessment to help schools identify gaps in student mental health and suicide prevention programming. JED provides schools and students with feedback, including recommendations, education and health promotion information to support their efforts.

JED was launched in 2000 by Phil and Donna Satow who set out to ensure colleges and universities had a framework for how to support student mental health and prevent suicide, something that did not exist at the time their son Jed died What sprung from the unanswered questions of by suicide at a grieving family has become the most influential the University of Arizona. change agent in student mental health. Eighteen

JED Campus incorporates a public health approach, involving the

entire campus community in supporting student emotional well-being with support from senior leadership. Technical assistance is provided by a dedicated JED Campus Advisor throughout the 4 year program who assists in creating a school-specific strategic plan with concrete goals, objectives and action steps. “Around 2011, 2012, we reflected on our work and asked ourselves ‘Are we an awareness organization or a change organization?,’ said JED Executive Director John MacPhee. “We were working hard to raise awareness of these concepts, but how do we help schools more directly implement these changes? That’s when we created JED Campus.” MacPhee says the Foundation’s work is now focused in four areas. One is making sure that teens and young adults know how to take action to care for their own mental health: how to reach out for themselves or someone they know who may be

struggling. The second area is promoting the importance of emotional readiness as preparation for life after high school which involves working with schools, students and parents on the transition to college and adult life. Three is making sure that everyone at a college or university attends a school which has a thoughtful, purposeful plan for how to support mental health and

ness campaigns, and the continued expansion of JED Campus, both in numbers and in scope. JED has recently begun a partnership with the Healthy Minds Network, the U Michigan-based student mental health research and advocacy organization to measure the impact of systems change through JED Campus on student outcomes. All schools who participate in JED Campus now take specific modules in the highly-regarded Healthy Minds Survey, which tracks students’ attitudes, awareness and behaviors on emotional well-being and substance use issues.

reduce the rates of substance abuse and suicide. Lastly, MacPhee says, is getting communities to support teen and young adult mental health more broadly. These big picture goals are backed by action plans that include accelerated research efforts; multi-media aware-

Just as the school now takes the JED Campus Assessment at the beginning of their participation in JED Campus and again at the beginning of the final year of participation, students take the Healthy Minds survey at baseline and again at the end of the project. By mapping the JED Campus program, policy and systems changes with the Healthy

Minds Study, schools are now able to evaluate the impact of systems change (via JED Campus) on student outcomes. “For years we’ve been tracking improvements in policies, programs and protocols over time at our participating schools and it is evident that schools have made tremendous progress in enhancing their systems to support student well-being. With the addition of the Healthy Minds Study, we can now analyze the impact of this systems change on direct student outcomes – which is the most important piece of this puzzle,” said Nance Roy, JED’s Chief Clinical Officer. “We’re looking at suicide prevention similar to the way the medical community looks at high blood pressure and hypercholesterolemia relative to preventing heart disease,” said Dr. Victor Schwartz, JED’s Chief Medical Officer. “We are helping schools identify people who are heading into risk rather than people in the middle of a crisis.”

This “up-stream” perspective is behind two of JED’s new educational initiatives. One is “Set to Go” -- an online resource for high school students and college freshman that helps prepare for the realities of college life. It is based on JED’s understanding of the issues college students face in adjusting to college and transitioning into adulthood. Its content provides practical information on everything from roommate relationships to preparing a campus support plan for students with a history of mental illness. MacPhee says the latter is becoming increasingly important as more students arrive on campus with acknowledged disorders, often unknown to their college due to a variety of reasons including confidentiality laws. The Foundation is helping parents understand that, while they want their son or daughter to have a fresh start, they need to be cognizant of the supports schools have available if their student begins to struggle.

The Foundation is developing additional Set to Go resources for teachers and other high school professionals as part of a larger effort to help high schools do a better job of preparing students emotionally for college. The Foundation has also launched a major public awareness campaign with the Ad Council and the American Foundation for Suicide Prevention called “Seize the Awkward” – a digital platform and series of videos. With graphics and language that appeal to the average Snapchat user, Seize the Awkward helps kids overcome barriers to discussing mental health with their friends. Schwartz hopes the campaign will do for suicide prevention what the “Friends don’t let friends drive drunk” campaign did for drinking and driving. “It introduces the idea that if your friend is struggling, it is part of your friendship identity to speak to them about it and, if necessary, help them get help,” he said.

As for expansion, MacPhee says JED can onboard up to 100 new schools a year in JED Campus which they hope will create a tipping point at which the practice of supporting student mental health will

become the norm for colleges and universities. “I think that collectively we can create a world where it would be unheard of for a university president to not list

student mental health among their top three priorities,” he said. Just as Phil and Donna Satow had hoped.

Healthy Minds If you are a clinician or administrator interested in data on student mental health, there is one place you want to be in March and that is the University of Michigan. Here is where the Healthy Minds annual Research Symposium, followed by its Depression on College Campuses Conference, leads the conversation on how knowledge informs practice in the field of college mental health.

The Healthy Minds Network for Research on Adolescent and Young Adult Mental Health (HMN), was launched here in 2005 by Daniel Eisenberg, a Professor of Health Management and Policy in the University of Michigan School of Public Health. Eisenberg leads the center with Dr. Sarah Ketchen Lipson and a multidisciplinary team of experts in public health, education,

medicine, psychology, and information sciences with a stated mission to “improve the mental and emotional wellbeing of young people through innovative, multidisciplinary scholarship.” The JED Foundation’s Nance Roy calls them the “gold standard” of college student mental health research. The organization known for the

is best Healthy

Minds Survey -- an annual population-level web-based survey that examines the mental health and mental health service utilization of college students. The Healthy Minds Survey began with a single random sample of Michigan students in 2005 and now includes over 200 colleges in the US and a handful of other countries. Over 200,000 students have participated in the survey.

“All along, we’ve had the dual goal of producing scholarly research that is going to increase understanding of student mental health while also providing data right back to the participating schools to help them assess their needs and priorities in this area,” said Eisenberg. The findings, provided to participating institutions on an interactive data interface, can be used to evaluate

Photo courtesy of Daniel Eisenberg

Daniel Eisenberg launched the Healthy Minds Network in 2005.

existing programs on campus, assess the need for new programs or services, and raise awareness of mental health and campus resources. The survey provides schools with a sense of how they compare to their peers and is used by counseling center personnel to make the case for a stronger investment in student mental health – be it increasing staff or adding more preventative efforts. Eisenberg has put together a widely-referenced economic argument for these investments with a return-oninvestment (ROI) calculator that can identify how much money could eventually be saved through mental health programming. “Our data suggest that a program that reduces depressive symptoms for 500 students (whether through treatment or prevention), can yield several million dollars in economic benefits while costing less than one million dollars,” a recent report cited. This powerful use of data has

led to numerous interactions with schools and non-profit organizations which was the impetus for the Healthy Minds Network which aims to foster collaboration among stakeholders and strengthen the link between research and practice.

investment in student mental health, Eisenberg believes there needs to be other solutions to the college mental health capacity problem than hiring more counselors. Here’s where the organization’s public health approach comes in.

would receive in-person counseling but then there’s a much larger group – maybe 20 or 30 percent who have milder symptoms who may be struggling but not necessarily in a crisis. These students might do well with something less intensive than counseling.

With reports, conferences and webinars, and partnerships with groups like the JED Foundation and Active Minds, Healthy Minds is a leader among thought leaders in this field.

“There’s a whole population of students out there and you need to think of everyone at some point of time as being somewhere on a continuum of mental health.

“So the question is -- What goes in that middle space? And I don’t think schools have figured that out yet.”

As he advocates for increased

“There’s maybe 10 percent of the population that ideally

The schools that do, are likely to use Healthy Minds data to get there.

Active Minds Active Minds brings to student mental health what no other national advocacy organization can – the voice of the young people who are affected by the way mental health is addressed on college campuses and acknowledged in soci-

ety. Alison Malmon, is Active Minds’ Executive Director.

died by suicide while a student at Columbia.

Now in her early thirties, Malmon started the organization in 2001 when she was still a student at Penn, the year after her beloved brother Brian

Active Minds is a non-profit young adult mental health education and advocacy group that opens up the conversation around mental health

on college campuses, steering students to resources and reducing stigma around seeking help. Now in its fifteenth year, Active Minds has 450 chapters across the United States, mostly in colleges, though their high school chapters are growing. When asked to describe the organization’s mission, Malmon talks about Brian. It is not out of a personal need to share the details of the devastating loss that changed her life. She tells Brian’s story because it is the story of thousands of young people who suffer in silence; who, despite their large numbers, think they are totally alone. “Brian was at an Ivy League college, a Dean’s list student, president of the acapella group, sports editor of the newspaper – a typical star student who started struggling with mental illness his freshman year but didn’t tell anyone until he was a senior,” she said. Brian was diagnosed with schizoaffective disorder –

a type of schizophrenia that includes psychosis and depression but does not typically impair a person’s sense of reality. He left school to enter intensive therapy and psychopharmacological treatment which managed his psychosis but didn’t affect his depression which only worsened. Still, he hid his distress from his friends.

Photo by Eric Krupke

Alison Malmon founded Active Minds in 2001 after her brother Brian died by suicide.

Malmon says, “The depression had created a space for him where he

felt like he was the only one, that all of this was his fault.”

After he died, his friends came forward to say they had noticed changes in Brian but they wanted to respect the privacy he was holding on to so they didn’t intervene. It was only after he died that Brian’s family could tell his friends why he had been home from college.

realized this was really pervasive and the only way it was going to get better is if young people started talking about it.”

goal was to spread the word that seeking help is a sign of strength, not something to be ashamed of.

Malmon gives an example. “There we were at a table at the student activity fair right alongside the juggling club and the fraternities and sororities. But we were talking Malmon went back to the about mental health. So when University of Pennsylvania freshmen would come in and She wanted to mobilize hear that, they would think, where she was a freshman and hoped to make sense of young people to be the initia- ‘Wow, no one talked about this what had happened. Like Bri- tors of that change. stuff in high school, I guess an, she felt scared and alone Malmon started Active Minds they do that at college. I guess though she soon realized that as a student group at Penn. Its its ok to talk about when I’m so many of her peers at Penn impact would grow as more having anxiety, or when I’m and beyond dealing with were imdepression, p a c t e d , or the eating sometimes “I felt strongly that young adults deserved to have disorder I’ve t r a g i c a l l y, their own voice, their own space, and their own been strugby mental gling with.” identity.” health. — Alison Malmon, Executive Director of Active When she “I came to graduated, she Minds realize that realized that what had the national happened to void in adBrian was happening to a lot dressing the mental health of of people – that mental illness students realized that others young adults would go unmet starts at this age – that suicide shared their concerns, heard unless people like her stayed is the second leading cause of their stories, and also want- with it. In 2003, she founded death for college students. I ed to talk. Their number one Active Minds as a national

But still, nobody was. Malmon says when she started Active Minds, there were no role models, no celebrities standing up saying “yes, I have depression.”

non-profit organization that seeds and supports college chapters across the country. She had offers to join well-established advocacy organizations but she wanted Active Minds to stay independent. “I felt strongly that young adults deserved to have their own voice, their own space and their own identity because from what I was seeing they were going to be the ones that changed this for future generations.” Active Minds grew faster than Malmon could have imagined, perhaps because of its straightforward mission. Though student-led, Active Minds is not a support group. Its job is to lead students to resources that schools have available, not to treat or counsel students themselves. This collaborative relationship has allowed them to stay relatively conflict-free and in close partnership with college counseling centers. Every year, Active Minds bestows Healthy Campus Awards to colleges and universities that

are working hard to improve how they support the mental health of their students. One of the organization’s most powerful initiatives to date is “Send Silence Packing®,” a traveling exhibition displaying donated backpacks in high-traffic areas of college campuses, that represent the college students lost to suicide each year. The exhibition aims to give a visual representation of the scope of the problem, raise awareness about the incidence and impact of suicide, and connect students to mental health resources. As Active Minds continues to change the conversation on mental health, the organization is front and center in every important conversation on the topic, partnering with high-profile advocacy groups, making frequent media appearances and headlining national conferences. Its message that mental health needs to be part of the public vernacular has resonated with organizations be-

yond higher education. Active Minds now has a partnership with the NFL Players Association which identified mental health as a major concern for professional athletes. The NFL’s “My Cause/My Cleats” initiative included two players who wore and donated their cleats to Active Minds. Malmon believes the way the public views mental health today is vastly different from when Brian died, though barriers like stigma continue to thwart progress. She sees mental health as the final frontier of public health issues. Like breast cancer and AIDS in the 80’s and 90’s and LGBTQ issues in the 2000’s, she hopes society will make a collective shift in bringing suicide and mental health into the open. “The good news is that this generation has identified mental health as their social justice issue – it is theirs to tackle because nobody else has done it.”

The ADA and Mental Health on College Campuses A civil right that is often ignored By Mansie Hough ALTHOUGH they are According to the ADA Nation- students with mental disabiliowed assistance under Fed- al Network, under the ADA, a ties such as dyslexia or ADHD. eral law, college students with mental illness are often denied their right to accommodations under the American with Disabilities Act (ADA). The reasons for this vary and include lack of awareness on the part of the institution and a sense of futility among students who bear the burden of continually making their case to their professors and deans.

The ADA is a civil rights law that serves to protect individuals living with disabilities from discrimination by actors such as potential or current employers, owners of places of public accommodation, and all public entities. This applies to students experiencing a wide range of disabilities at both private and public colleges and universities. As is required by law, this should include students with mental and substance use disorders.

mental illness must be considered â&#x20AC;&#x153;a physical or mental impairment that substantially limits one or more major life activities of an individualâ&#x20AC;? to receive a reasonable accommodation in the workplace. Similar requirements apply to students seeking accommodations. Additionally, schools required by the ADA to make all programs, including extracurricular activities, accessible for students experiencing disabilities.

are

This can be done in a number of ways, from providing assisted listening devices to students who are deaf to modifying test or workload accommodation policies to

These rules are significant and necessary. According to the National Alliance on Mental Illness, 50 percent of all lifetime cases of mental illness begin by 14, and 75 percent begin by 24. This means that a significant amount of college students are entering their first year already having a mental illness. On top of this, the transition from high school to college can often trigger conditions that werenâ&#x20AC;&#x2122;t there before. When it comes to disabilities that are regarded as concrete and easily identifiable, especially if they are visible to the public, the ADA has helped make higher edu-

cation a much more flexible, The Bazelon Center for Men- Ph.D., Director of Counseling safe, and welcoming environ- tal Health Law, an organiza- and Psychological Services ment. While adherence to the tion that advocates for civil at Brown University and lilegislation hasn’t been perfect rights for individuals with censed psychologist. – many students still face stig- mental disabilities, said in a “There might be a knowlma and higher barriers to aca- Health Central story that it reedge gap on this topic,” Dr. demic success and social well- ceives “several” calls a week Meek said. being – it “ C o n d i t i ons has certainlike ADHD are ly improved identified and While the ADA requires that schools provide realearning c o n d i t i o n s sonable accommodations to students with men- d o c u m e n t e d for those tal illnesses, students have spoken out to say they for academic accommodawho may have been were denied these accommodations when they tions for a lot of students denied an requested them. from an early education age because 40 years there’s just ago. more general knowledge out from students who were susHowever, students with pended, expelled, or forced to there.” mental and substance use dis- withdraw from their schools Because the public has a orders are potentially being due to their mental illnesses. left behind. While the ADA And, according to a report by more tangible grasp on what requires that schools provide the National Council on Dis- it means for someone to live reasonable accommodations ability, 10 percent of students with disabilities like ADHD, to students with mental ill- surveyed said that institution- it is much easier to quickly nesses, students have spoken al bias could be creating road- identify what kinds of chalout to say they were denied blocks to accessing mental lenges students experiencing this condition may be facing these accommodations when health services. – and, in turn, what kind of they requested them through their schools’ official processThe reasons behind these assistance they might need. es. Students often need to misperceptions may have This can include a wide arseek legal assistance to navi- more to do with awareness range of accommodations gate these conflicts. and familiarity than bias, such as extended deadlines, according to William Meek, modified workloads, expand27

ed office hours, and specialized academic advisory services. “But for folks with conditions like anxiety and depression, people generally are not thinking of it in the same way. It seems that the more common an issue is, the more unlikely it is for people to think of accommodations as something to look into.” This is a serious issue when considering current rates of youth and young adults with mental illness – in 2016, nearly 11 percent of young adults aged 18 to 25 experienced a major depressive episode within the last year, according to the National Survey on Drug Use and Health. And, in 2016,

about 64 percent of youth with major depression did not receive any treatment for this condition, as shown in a report from Mental Health America. Students with behavioral health conditions who don’t receive assistance typically have lower GPAs and higher dropout rates. But, when they receive the support they need, they are successful and live fulfilling, productive lives alongside their peers. According to Dr. Meek and other experts on this issue, transparency about institutional processes for acquiring accommodations for mental illnesses is a key component to solving this. Outreach materials during first-year orientation, a user-friendly Web (and/or social or

mobile) presence, and personable staff who integrate themselves into the community are all examples of ways this can be accomplished. Additionally, according to the National Council on Disability, students are more likely to seek support when the offices providing mental health and accommodation services are not difficult to find or navigate. A significant and likely path towards improvement in this area is the relationship between staff and faculty and students. Advocates urge staff and faculty be educated on ADA-protected mental illnesses and trained to see providing accommodations as a useful tool, as opposed to a “slippery slope.” They believe fostering a more open culture among all students (not just those with disabilities) would help alleviate this issue. They argue that Improvement in this area would help schools and students. Students who receive adequate accommodations and assistance are more likely to suc-

ceed academically and professionally, as well as graduate on time – meaning better retention rates and a thriving student population for the school. From a policy perspective, more transparency, inclusion, and access for students has certainly seemed to be the goal. Since it was signed into law, the ADA has regularly received expansions and progressive modifications focusing on higher education and supporting students with disabilities. However, the direction the ADA is headed under the current administration is unclear. Most notably, in February 2018, the U.S. House of Representatives passed legislation – the ADA Education and Reform Act – which would prolong the process for seeking accommodations or compensation for damages due to discrimination. So, while the core of the legislation will most likely stay intact, there is less certainty surrounding the direction of the ADA as it pertains to col-

lege students moving forward. This means that the onus of protecting students with behavioral health conditions is, now more than ever, on the institutions and the students themselves. The good news, according to Dr. Meek, is that progress is being made every day by the hands of local advocates, community leaders, and educators. “Movement on these issues is coming from the people,” he said. “I’ve seen a lot of activists on the grassroots level raising awareness for accommodations for students with mental health concerns and for disability rights. Anyone interested in this issue should continue to gather more information from their institution about process for acquiring accommodations. Being able to advocate for access for students with mental health concerns will be a key moving forward.”

aims to support students and young adults with mental illnesses. The organization consists of students who have experienced behavioral health conditions and are trained to support their peers “outside of their therapy appointments, and in an alternative, friendly way.” Anyone seeking more information on the ADA at large can visit the ADA National Network’s Web site at ADATA. org, which provides guidance and information on implementation of the legislation. If you are a student struggling with mental illness or a substance use disorder, talk to someone at your school’s counseling center or visit the Mary Christie Foundation’s list of credible resources.

Those who are interested can follow the lead of organizations like Project LETS, a nonprofit organization that 29

Opinion: College is Tough Enough Why do schools make it so much harder for students with mental illness and disabilities? By Stefanie Lyn Kaufman “mild” symptoms, because then you’ll have difficulty getting the accommodations you need.” It was one of the first moments I became acutely aware of the discrimination that exists in academic systems, especially higher education. It was one of many experiences I would have with ableism.

Stefanie Lyn Kaufman, Founder and Executive Director, Project LETS

THE first time I discussed

academic accommodations with my psychiatrist, it was an intricate and unfamiliar song and dance. He looked at me coldly, and stated, “In terms of your severity of symptoms, you and I know they are severe. However, I am going to choose “moderate” on the form so the university doesn’t put you under undue surveillance. Similarly, I am not choosing

Early on in life, I learned how to advocate for my needs. Simultaneously, I learned that more often than not, my needs could be rejected, ignored, dismissed, or violated in some capacity. Over time, I started to think: why bother? As disabled university student, Mary G. stated, “Self-advocacy, the golden ticket of access can become a trigger when every attempt to self-advocate is met with subtle or overt violence.” During my four years at college, I was faced with many uncomfortable and discriminatory conversations with

Professors and administrators who had my “best interests” in mind. My requests were often met with suspicion or insult. “I don’t think you actually need that accommodation”; “I think you just need to improve your time management skills”; Often, the responses stung. “I don’t know how to differentiate from students that really need extensions and students who just didn’t start their work on time.” “I don’t want to give you an unfair disadvantage.” These exchanges would pile up until what was once a microaggression felt overwhelmingly macro. Receiving these accommodations, however, and having these conversations in the first place, is still an important privilege to recognize. If a student’s grades slip and they don’t receive proper support from the university, they are often presented with a “choice” between academic probation or a voluntary medical leave (a tool that has been utilized to filter out mentally

ill, disabled, and neurodivergent students from higher education). And often, students who are most marginalized and struggling do not have the means or resources to professionally verify a DSM-based diagnosis, making academic accommodations almost completely inaccessible. Their voices should not be left out of this conversation. In March 2017, The Chronicle of Higher Education published an article titled Why I Dread The Accommodations Talk. The author, Gail Hornstein, states, “Like many faculty members, I dread such moments … The reason I dread such encounters is that they have become formulaic and often defensive — distant from the actual needs and talents of the student thrusting the form at me.” Professor Hornstein - do you know what I, and many other disabled, mentally ill, and neurodivergent students dread? Proving ourselves over and over again; Explaining every symptom or experience we have. How we’re working to address it. Wondering if not using our accommodations would make a “better” impression on our Professors; knowing that, often times, the only way to get the accommo-

dations we need is to disclose far more information than is legally necessary; sharing intimate details about our lives to appeal to your humanity. We dread begging for your understanding and forgiveness. A central principle of ADA & 504 law calls for Full and Equal Opportunity (i.e. reasonable accommodations).” According to the Bazelon Mental Health Law Center, “Accommodations simply provide an alternative way to accomplish the course requirements by eliminating or reducing disability-related barriers. They provide a level playing field, not an unfair advantage” When it comes to accommodations, it’s not just about can you do this? It’s about what do you need to be able to do this?, and what does it take out of you to do this? As a college student, I repeatedly went through an internal process to determine my limits, and what I am able to do in any given moment. If I have a 10-page essay due in the morning, and I’m on page 2 at 3:00 AM, I can potentially finish the assignment. And I often

did -- by abusing substances, inducing psychotic states through limited sleep, dissociating, numbing out, and triggering some of the worst, most severe suicidal episodes I had experienced in my life. So, what I need to be able to do this becomes: drugs that are not prescribed to me, the ability to “work” all 24 hours in a day, hyperfixation. What it takes out of me to do this becomes: my stability, health, ability to properly cope and process my emotions, ability to focus or concentrate, my hope, and desire to be alive. Can I just get that extension? To Those Who Teach & Support Us (Professors, Administrators), I say this with love: You are not the gatekeepers of student health and wellness. It is not your job to “teach” disabled, mentally ill, and neurodivergent students how to manage their life experiences, and to cope with crises. It is not your job, as Hornstein

argues, to be “determining who actually requires assistance, and in what form, and discouraging students from defining themselves by what they can’t do.” Legally, you are responsible for responding to our needs. Legally, we do not need to respond to any inquiries about our disabilities. It is highly inappropriate to offer coping strategies and ask students personal questions about how we manage our disabilities. Our accommodations form does not give us space to list our strengths. In fact, neither does the majority of the mental health care system -- in which we are defined by our weaknesses and our deficiencies; often pathologized for our normal reactions to abnormal situations or experiences of oppression. Disabled, mentally ill, and neurodivergent students have had to learn, from our history and our communities, what makes us strong and resilient. We have spent countless hours trying to become more “neurotypical;” wishing we could produce like you expect us to. We know ourselves better than you do and our accommodations meeting is time for you to listen. I am here, in your office, because I have accepted my limits. That is a blessing, not a curse. I have not “given up.” There is nothing wrong with being disabled. 32

I am allowed to fight against the compulsory able-bodiedness and able-mindedness that force me into a box. I should not have to use all of my available energy to do what neurotypical students do, to complete assignments like neurotypical students can. Though I have had the privilege of accessing mental health care services (often out-of-pocket), I have spent 8 years misdiagnosed. At age 22, after recently graduating from college, I was diagnosed with Autism Spectrum Disorder (ASD). Autism is not a mental illness -- it is on the spectrum of neurodivergence, a different neurological state of being, thinking, and feeling. I breathed a heavy sigh of relief upon my diagnosis -- “I wasn’t making all of this up! I couldn’t have just “worked harder!” I think back, wondering if this new lens I am viewing myself through would have made a difference in college. I wonder if I would have stopped trying to fix myself sooner. If maybe, just maybe, the shame I felt and still feel would weigh less, be less imprinted in my memories. What would have happened if I were given the time and space to properly focus on healing, instead of wasting my energy trying to run away from myself? If I could have

explored my differences and learning styles without shame and fear, but with openness and acceptance? As Alice Wong states, “Accessibility is more than just adherence to a law. It’s an ethos that values different ways of being in the world.” Accessibility at college requires thinking beyond the structures of the institution, and imaging a university in which all students, of all abilities and capabilities, can thrive and succeed. One of my favorite parts of the Project LETS Peer Mental Health Advocate (PMHA) training is when we ask students to design an anti-ableist university system: what would assignments look like? How would we motivate students? One disabled student described an experience where they knew they could complete an assignment, but it wouldn’t be their best work due to recent symptoms. The professor asked them instead to write an outline of the paper they knew they were capable of completing, and to submit it when they felt ready. A week later, when the student submitted the essay, they felt calmer, more organized and proud of their work.

Q&A: Dr. Paula Johnson The president of Wellesley College on guiding students in a complex world Interviewed By Marjorie Malpiede

On a cold day in December, Wellesley’s campus is a curious dichotomy as modern, young women move purposely amidst Gothic architecture and historic grounds. Much has changed since Wellesley College was founded nearly a century and a half ago to provide an outstanding education to women across the socioeconomic spectrum. But its mission to “graduate women who will make a difference in the world” is as relevant today as it was in 1870. Famous alumnae include Hillary Rodham Clinton ’69, Madeleine Albright ’59, Diane Sawyer ‘67, and Nora Ephron ‘62. Wellesley’s current leader is their highly-accomplished 14th president, Dr. Paula Johnson. Before coming to Wellesley in the summer of 2016, Johnson was already making a difference in the world as the Grayce A. Young Family Professor of Medicine in Women’s Health at Harvard Medical School and Professor of Epidemiology at the Harvard T.H. Chan School

of Public Health, as well as the head of the Connors Center for Women’s Health and Gender Biology, which spearheads breakthroughs in the medical treatment of women. A cardiologist and public health expert, Johnson’s training became evident as she talked about a preventative approach to student wellness, where developmental issues among young people are acknowledged and anticipated. President Johnson spoke of the school’s enduring mission in a complex and challenging world and its implications for today’s “Wellesley women.” She talked about the role of colleges and universities in helping students find their path. Asked to choose what one thing she would give her students, she said it would be more time, a commodity rarely enjoyed by millennials, particularly the hardworking women who make it to Wellesley. Mary Christie Quarterly: Health and wellness is your background, but how are you thinking about the

emotional and behavioral health of students in your new role as a college president? Paula Johnson: I think it’s very important for us to think about the emotional and behavioral health of our students in a way that puts it in context on several fronts: Who are young people in the 21st century? What is the context in which they live? What are the issues they face even before they step foot on campus? And how does that all play out once they are here? It has become very clear to me that our campuses are far more complex than they were 25 years ago. We fortunately have far more diversity in our student body, including greater racial and ethnic diversity, gender diversity, economic diversity, more first generation students and more students from around the world. That’s the good news. But when you think about that in terms of community (and that 33

Photo by Kate Douglas

Wellesley President Paula Johnson in her office.

our students come from so many different backgrounds), and when you think about a world that is far more complex and uncertain, we have to take a step back. We must more clearly understand our campuses as a reflection of that world. We need to both better understand our students who enroll and better understand the experiences they will have as they struggle to make sense (and interact) with the world. Within that context, what, then, is our goal? At Wellesley our goal is to educate young women who are going to make a difference in the world. That’s been our mission since

our founding. What does that mean in today’s world as we prepare very well-educated women for lives that require resiliency and perseverance? Resilience is key, given that our students are facing an interconnected and fraught world that is changing perhaps faster than at any other time in recent memory. This reality lays the foundation for a critically important mental health agenda. MCQ: What do universities and colleges need to do to address that? Is it a new awareness of students’ mental and emotional development? Does that translate into changes in program-

ming? Do you deal with it at the health center level? What are some of the things you’re thinking about? PJ: All of the above! It’s everything from having a clear picture of our students, as they are, when they walk in the door; to then understanding what our community, as an ecosystem, does or doesn’t do to promote their health; to evaluating (and tracking) how we address all of that. I think the right approach is to really think about this as a public health initiative, one that is intimately connected with the day-to-day work that we do here. As we look at our students

as the primary focus, we have to understand what they will be experiencing in their four years in college at a time of rapid change in their lives. What does that look like today in a world that is driven in large part by technology, in a world in which we are increasingly focused on what divides us rather than what connects us, and in a world where screen culture has created a very different sense of aloneness? MCQ: Do you think that might be part of a lot of the escalating rates of anxiety we’re seeing, this worry? PJ: I think that the increased competitiveness to get into college leads to a lot of anxiety. There are enormous expectations placed on high school students. I like to call it the “check the box” culture. How many boxes did they have to check in order to gain acceptance into a school Community like Welles- ago. ley or other competitive colleges or universities? That is the psychology they come to college with, so our job is to lessen the deleterious impacts of that culture, that mentality, and to begin to work with our students and let them know “you’ve made it.”

Students need to allow themselves to take advantage of all that we have to offer, in a way that allows them to reflect deeply on their experiences. In this way, they can then integrate these experiences into the next phase of their lives. What does that take? It takes time to reflect. Students today have not been given permission to take that time. Part of the role of college is to both educate in and outside of the classroom and to integrate these new experiences as you’re beginning to shape your sense of self. This is the work that must be done over the four years of college. Students are coming to us today with tremendous worry about what their lives will be like. Work and careers are very different today and are highly evolving. The good

don’t necessarily understand that you are being prepared or even what exactly you’re being prepared for. MCQ: What are some of the ways you are helping students with their development? PJ: We have a new, very robust career education program that connects every student who enters Wellesley with an assigned career counselor the moment they step on campus. The purpose of this is not to start thinking about what you’re going to do on day one but rather to have a guide by your side who is helping you think about your experience throughout these four years—and beyond.

This is not something that students have to actively seek out. It’s something that we offer them, and it is provided to every single student. This is critically importlooks different than it did 25 years ant because Wellesley is need-blind. We have a very significant population of first generation news is we know that a liberal arts education prepares students, in addition to all students in the most robust the other forms of diversity, way for handling those chang- so students come with differes. But when you’re 18 to 22, ent levels of preparedness for that’s hard to understand, taking advantage of resources because you’re looking at and meeting challenges. a world that’s shifting. You

This is a resource that we 35

strongly believe will better enable our students to take full advantage of a liberal arts education. We’ve seen a national discourse about the practical value of the humanities, for example, and what that brings to a career. We believe strongly that the humanities provide a foundation and context for who we are as humans, critical to how we understand and integrate into our lives the sciences and social sciences. Wellesley’s innovative approach to career education helps our students to be far more open to considering all kinds of options, areas, and pursuits that they might not otherwise have. MCQ: What is counseling like at Wellesley? PJ: We have a long history with an organization called The Stone Center which was founded in the 1970s with a vision for providing mental health services as well as conducting research to prevent mental health issues. Over time, the Stone Center’s clinical practice was separate from the research work, and today it is our primary center for counseling.

that we need today—including helping students who arrive on campus with documented disorders for which they need medication as well as students with short-term issues that are prevalent in the larger population. We realized we needed a better connection between the campus and our students who are getting services in the community; we needed to ensure the alignment of these services, and not just when there is an emergency. We needed an ongoing connection between campus and students receiving external care. To meet this need, we created a new position and hired a community liaison. Of course, we need an expert on campus who can address our students’ medical issues, so we have a psychiatrist. But we then need to address a broader range of services. Not everyone needs a one-on-one appointment. For example, there are problems that we might consider “life issues” that are much better addressed with a different kind of support. Right now, we’re examining closely how to move forward with all of this in mind.

Right now, we are looking to better integrate that model with our health services, but we are also taking a step back to evaluate and ask how we can improve.

MCQ: What about affirmative wellness and general wellbeing? It sounds like this is such a core part of your mission. What are you doing in this area?

There is a range of services

PJ: A lot of this work is about

defining community in the 21st century. Community looks different than it did 25 years ago. It’s very normal for students in this phase of their lives to be exploring identity, and frequently our students are thinking deeply about community and self. We have to support the development of their identity within those groups, but we also have to support a strong sense of overall community in residential living, for example. We have a new Dean of Students, Sheilah Shaw Horton, who also has a Ph.D. in counseling psychology. She is spearheading work to more fully integrate residential life and student affairs with the academic program. Our faculty are deeply committed to our students, which is one of the joys of being at a liberal arts school. We’re all very proud of the fact that our student body is diverse, but what does that mean for pedagogy? What is inclusive pedagogy? That may not be, on its surface, related to mental health, but it surely is related to belonging. Together, we are asking how we can engage students more in their overall wellbeing beyond just being “eyes and ears”? Some brilliant work is happening here led by faculty in our math department and in the sciences.

We are asking, “What does it mean to embrace the true diversity of our students? How do we teach differently, but also how do we reach students in the various spaces they inhabit across campus?” As we think about the actual physical space, we are thinking about how we encourage and facilitate this sense of interconnectedness, health and wellness, all of which has been shown to enhance one’s wellbeing. We’re building a new science center, and a teaching and learning space will be built very specifically with the idea of intersections integrated into its design—intersections amongst disciplines, intersections between students and faculty, and amongst students themselves. We’re going to be using light and color and bringing our beautiful landscape into the building, so we are really thinking about this in a very holistic way. MCQ: That’s the public health approach, right? PJ: Public health is about an integrated approach to pre-

vention, and it’s about the built environment as well. It’s about how our environment can enhance health. For example, we have a gorgeous landscape. How can that landscape help to promote health and wellness as well as peaceful reflection and meditation? We are going to begin some really interesting work with the Harvard T. H. Chan School of Public Health that revives that original Stone Center vision of prevention research I spoke of. We are looking at evidence-based public health approaches through which we can engage our students. It is a community (and participatory) activity that will give us a better understanding of some of the different ways of integrating health and wellness into our campus. MCQ: We have seen an abundance of political tension on college campuses since the 2016 election. What are you seeing at Wellesley?

political environment. We cannot ignore major issues around immigration. There’s the travel ban; there’s DACA [Deferred Action for Childhood Arrivals] and issues around TPS [temporary protected status]. Imagine being a student who personally is threatened by these developments, or being a student whose family or loved ones are threatened. Meanwhile, they’re attempting to study and take part in residential living just as any other student might. It’s our job to provide them with understanding and support. We’re working on a host of initiatives in this regard. To take a second example, issues around healthcare are devastating for so many, especially women. Contraception and women’s health is significantly threatened. All of this impacts our students’ sense of stability and well-being. These are not just political questions. The consequences are real, impact our students’ lives in complicated, myriad ways, and we must be committed to principled leadership and sustainable solutions.

PJ: There are so many issues occurring in the United States today that have been further heightened by our current 37

A Few Good Men

Sexual assault prevention programs on campus are increasingly engaging college men By Dana Humphrey THE rise of the #Metoo prioritized the engagement of Traditionally young men and #Timesup movements boys and young men in efforts have been socialized to be have thrust the country into a cultural reckoning around issues of sexual harassment and assault. For colleges and universities, the issue has been front and center for several years. Recent surveys show that one in five women report having been assaulted while at college. Traditionally, prevention efforts have focused on women, who are overwhelming the victims of sexual assault, however, initiatives are emerging that put men at the forefront of prevention. In 2011, President Obama released guidance to colleges investigating sexual assault on campus, pushing them to take the issue more seriously. In 2014, the administration created a special task force aimed at ending campus sexual assault, and introduced the “Its on Us” campaign, which 38

to reduce violence, especially violence against women.

Engaging people as allies and training them to intervene in potentially harmful situations is a strategy known as bystander intervention. Research has shown that men are less likely than women to intervene in situations of sexual assault and that the difference is attributed to the social norms of traditional masculinity. A valuable part of bystander intervention training is working to help men understand how social norms can prevent them from intervening to stop sexual assault.

tough and dominant and to eschew stereotypically “feminine” qualities, like being overly emotional or sensitive. Addressing these aspects of masculine culture and learning healthy masculinity can be a cornerstone of curbing campus sexual assault. “Healthy masculinity” is a term that represents the practices of recognizing violent or harmful behavior, challenging that behavior in yourself and others, and focusing instead on empathy. Healthy forms of masculinity, can help boys and men become part of the solution by practicing prevention, and to reframe sexual assault as a men’s issue, placing the onus of preventing vi-

olence on men. It’s refreshing to see that college men are increasingly stepping up to push for campus sexual assault and violence prevention initiatives, with a focus on promoting healthy masculinity and stamping out toxic representations of maleness. Many colleges and universities have turned to national organizations for help with these conversations. Schools like Howard University, Washburn University, and Wheaton College, have engaged the help of Men Can Stop Rape, (MCSR), an organization that mobilizes men to create cultures free from violence through initiatives that generate positive, measurable outcomes. MCSR, founded in 1997, was a pioneer in the effort to address the epidemic of violence against women by engaging men as allies, shifting the responsibility of preventing sexual assault by promoting healthy, nonviolent masculinity. The organization’s Healthy Masculinity Action Project (HMAP) is a national

grassroots movement specifically aimed at eradicating the harmful expectations and stereotypes that boys are taught about what it means to be a man. The Healthy Masculinity Campus Conversation project brings that movement to colleges and universities, providing college men with a space and opportunity for critical, constructive, and contemplative dialogue around healthy and unhealthy masculinity. The Campus Conversations program uses storytelling to spark conversations about masculinity. Participants in the conversations, which can range from 10 to 100 individuals, hear powerful personal narratives about masculinity from a set of campus-based storytellers before coming together to engage in a guid-

ed discussion of unhealthy and healthy masculinity. The Conversations push men to replace unhealthy masculine social norms and behaviors with healthier, nonviolent masculine prosocial norms to create a safer campus culture. Nicholas McGinty, the Manager of Training & Technical Assistance at MCSR says that storytelling “helps bring out the humanity in the room. The language of storytelling removes some of the preconceived notions we might have as we walk in.” Of the programs success, McGinty said, “I’m always reinvigorated by the enthusiasm, the excitement, and the willingness for folks to really talk about the subject. We may be talking about hard subject

Initiatives are emerging that put men at the forefront of prevention.

matter, things where you have to inspect, look at yourself and realize there may be some behaviors or actions that you should adjust or evaluate. People are really willing to do that.” One might wonder how much a discussion about masculinity can actually do to change attitudes and prevent sexual assault on college campuses. But according to McGinty, the goal of the MCSR Campus Conversations is to move the discussion beyond the confines of one group, with the hope that the men who attend the event will influence others on campus to practice healthy masculinity, and will have an influence campus sexual assault and gender-based policy. Similar examples are emerging on campuses throughout the country. The Women’s Center at Duke University launched an initiative focused on redefining masculinity for male students. The Duke Men’s Project is a nine-week long storytelling-based program during which participants meet 40

weekly to discuss masculinity, feminism and intersectionality. The goal of the initiative is to create a space where men look inward and critique and analyze their own masculinity, acknowledge unhealthy patterns or thoughts and create healthier ones. The sessions cover a wide range of topics including male privilege, masculinity and the language of dominance, sexuality and gender diversity as well as intersectional feminism. The project was inspired by a program at the University of North Carolina at Chapel Hill, which uses a similar curriculum. The UNC Men’s Project, initiated in 2013, creates opportunities for students of all gender-identities to listen, reflect, and work together to increase men’s involvement in gender equity and violence prevention efforts. The program promotes healthier masculinities and works to shift the culture of masculinity toward non-violent norms.

BWell, Brown University’s Health Promotion office, created programming around healthy masculinity to help men unpack their notions of masculinity and to unlearn the conditioned need for dominance. BWell hosts Masculinity101, a weekly discussion group about toxic masculine norms and healthy alternatives, publishes The Masculinity Storybook, a biannual publication of personal stories about struggles and triumphs related to toxic masculinity, and produces Conversations on Masculinity, a video compilation of interviews with students about masculinity. Princeton University’s Men’s Allied Voices for a Respectful & Inclusive Community (MAVRIC) Project is an alliance of students, staff, and alumni committed to promoting healthy masculinity and fostering a respectful and inclusive community for all genders through education, mentoring, activism and fellowship. MAVRIC’s focus is on education, hosting bi-weekly conversations.

The Better Men, Better Hawkeyes program at the University of Iowa was created in the spring of 2017 in response to the UI Department of Public Safetyâ&#x20AC;&#x2122;s recommendation to put a greater focus on addressing the prevalence of sexual assault on campus. The program is based on research from three programs: Mentors in Violence Prevention,

Step Up Bystander Intervention, and Coaching Boys into Men, and includes a one-hour workshop combining discussions and training on healthy and unhealthy relationships, the meaning of consent, and bystander intervention. Encouraging a small percentage of college men to intervene in a potentially harmful situation can have outsized effect.

One widely reported study indicates that only six percent of men on campus have committed rape or attempted rape, and that most sexual assaults are committed by repeat offenders. Having a group of men on campus who are empowered to intervene is a vital component in sexual assault prevention. Thereâ&#x20AC;&#x2122;s still a lot of work to be done to stop sexual assault on college campuses. But engaging men as allies in the conversations, discussing healthy masculinity and promoting bystander intervention are all positive steps forward.

Science Summary A recap of research worth noting. By Dana Humphrey

A new meta analysis in the Journal of American College Health reviews the effectiveness of bystander programs that address sexual violence on college campuses. The systematic review examined twenty-four studies to ascertain their effect on college student attitudes, beliefs and bystander behaviors, such as intervening in a potentially harmful situation. The analysis found that students who participated in bystander programs, when compared to those who had not, were more likely to hold pro-social attitudes and beliefs about sexual violence and engaged in more bystander behavior. The study found that though the positive effects diminished over time, meaningful changes persisted for at least three months after the intervention, and that longer programs had the largest effects on attitudes and beliefs. The authors concluded that bystander programs can be a valuable addition to collegesâ&#x20AC;&#x2122; violence prevention efforts.

Sexual Assault Prevention Programs Prove Effective

Another study published in the Journal of American College Health, Unblurring the lines of sexual consent with a college student-driven sexual consent education campaign, examined the effectiveness of a college student-driven sexual consent education campaign at a large, public Midwestern university. Researchers surveyed 992 undergraduate students before, during, and after the campaignâ&#x20AC;&#x2122;s implementation about their exposure to the campaign and their understanding of sexual consent. They found that the consent education campaign improved students understanding of consent with college men and members of university-affiliated Greek organizations experiencing the greatest improvements in understanding.

According to a new study by the National Council on Disability, colleges are Disability and Sexual Assault not effectively addressing the needs of Prevention students with disabilities in their sexual assault prevention efforts, policies, or procedures. Recent research has revealed that 31.6 percent of undergraduate females with disabilities reported nonconsensual sexual contact involving physical force or incapacitation, compared to 18.4 percent of undergraduate females without a disability. This means one out of every three undergraduate students with a disability was a victim of sexual violence on campus. Through two national questionnaires, and phone interviews with college administrators, and experts on sexual assault on college campuses and sexual abuse against people with disabilities, the National Council on Disability examined how colleges respond to and prevent sexual assault, and support survivors of sexual assault with disabilities. The study found that campus sexual assault prevention and education programs are not inclusive of students with disabilities, staff are not trained in disability accommodations, and college staff lack awareness that such programs should be accessible to students with disabilities. 42

A new research study published in the journal Psychological Bulletin shows that today’s college students strive for perfection more than previous generations, which may be damaging their mental health. In an analysis of nearly 42,000 college students from the United States, Canada and Britain from 1989 to 2016, lead author Thomas Curran of the University of Bath and co-author Andrew Hill of York St. John University defined perfectionism as “an irrational desire to achieve along with being overly critical of oneself and others” and identified three distinct types: self-oriented, socially prescribed, and other-oriented. The authors observed that the number of young adults falling into each category has jumped by at least 10 percent since 1989, with the most drastic increase in perfectionism attributed to socially prescribed perfectionism which increased by 33%. These findings indicate that recent generations of college students have higher expectations of themselves and others than previous generations. Thomas Curran said, “Today’s young people are competing with each other in order to meet societal pressures to succeed and they feel that perfectionism is necessary in order to feel safe, socially connected and of worth.” Curran and Hill attribute the rise in perfectionism to a number of factors, including the pressures of social media and the tendency to compare. According to the authors, todays college students are exceptionally driven to succeed academically and compare themselves to their peers, and universities encourage this competition among students. The researchers claim that perfectionism may be linked to the rise in mental health issues on college campuses, that young people are cracking under the pressure to be at their best in school and on social media. They urge schools and policymakers to curb their efforts to foster competition among their students in order to preserve their mental health.

Striving for Perfection and Mental Health

A recent report from the NationRacial disparity in Completion al Student Clearinghouse Research Rates Center highlighted the racial disparity in persistence and completion rates for African-American and Hispanic students. According to the report, “When examined by race and ethnicity, Asian and white students had much higher completion rates (68.9 percent and 66.1 percent, respectively) than Hispanic and black students (48.6 percent and 39.5 percent, respectively). Black students represent the only group that is more likely to drop out or discontinue enrollment than to complete a credential within six years.” Among students who started the education at four-year public institutions, black students had the lowest six-year completion rate, 46.0 percent, almost 10 points lower than Hispanic students (55.7 percent). 71.7 percent of white students and 75.8 percent of of Asian students completed a degree within that same time. Black student fare best at four-year private, non-profit institutions, with a six-year completion rate of 57.3 percent. Asian, Hispanic and white students also complete at these institutions at higher rates.