Northwestern's mental health problem

What happens when we leave our mental health until the last minute?

BY SAM HART Photos by JACOB MESCHKE and ALEX FURUYA

JILLIAN SELLERS WROTE LOVELETTERS TO HER FUTURE SELF.

The high-achieving high school senior was elated. She had gotten into her dream college and was happy with her high school accomplishments. She was a competitive cheerleader, and she planned to continue cheering on the sidelines when she arrived at Northwestern. She knew she loved writing and was excited to do so at one of the best journalism programs in the nation.

The 18-year-old (now a Medill senior) also knew that her Major Depressive Disorder would not allow her elation to last, and that’s where the letters came in.

Written by a younger Jillian, addressed to her future self succumbing to the stress she knew she would encounter at Northwestern, they give her the reminders she needs from time to time.

“‘She’s asking you to fight for the Jillian of the future. And she wants you to be happy, and she wants you to thrive. And you are worth so much more than trying to end your life.’”

Through mental breakdowns, depressive episodes, and her fight with body dysmorphia and an eating disorder that have punctuated her time at her dream school, she’ll pick up the letters to remind herself why she’s here. She sometimes has moments where she has to remind herself that life itself is worth living at all.

And Jillian is certainly not the only one struggling. According to the National Alliance on Mental Illness, more than 25 percent of students at institutions of higher education have been treated for mental illness by a professional, a number that is rising.

Sellers has battled mental illness from the age of three, but its onset varies case by case. For Weinberg senior Becca Dugan, the issues started in high school, and the competitive aspect of Northwestern student life set in a layer of stigma.

“I think being at Northwestern made it worse, because, I was in all pre-med classes and it’s just so competitive,” she says. “For a while I didn’t feel comfortable talking about it because I felt like it was something I would be judged for, or seen as being weak.”

And for Jacob Pope, a fourth-year Bienen and Weinberg dual-degree student, trials with depression and suicide attempts in high school meant he came to Northwestern with a heightened awareness of mental illness.

Northwestern’s Counseling and Psychological Services center (CAPS), an office with a staff size of 18 full-time-equivalent clinicians, reported that roughly 2,000 undergraduate and graduate students (out of a pool of around 17,000) sought their services last year, around 60 percent of whom were undergraduate.

The large uptick in recent years is straining the infrastructure NU has in place. But some argue that while increasing levels of mental illness on college is not an easy issue to deal with, it may be a good sign—a sign that a particular slew of students are making it to college campuses at all.

MENTAL ILLNESS: A NEW FORM OF DIVERSITY?

Alison May has a student crisis to handle before we can sit down to speak. I wait quietly for about 15 minutes until she welcomes me into her office, tucked away in a building I, a Northwestern student without a disability, had never before visited or even really noticed on Sheridan Road.

The delay was a perfect reminder of the nature of her job. As director of AccessibleNU, she’s serving as an intermediary between students, their healthcare providers and their professors. Her office sees dozens of students come in at the end of their rope, desperately trying to navigate through the school’s red tape to ensure they’ll make it through the quarter.

What a lot of students don’t know or may forget is a mental illness diagnosis is a registrable disability, and as such, May has seen a fair share of students with these come through her office for help with accommodations—a fair share that has tripled in the last 10 years, she estimates.

When May talks about mental illness at Northwestern, she does so with a combination of face-value realism and motivated optimism. To her, physical, mental and emotional impairments form a new kind of diversity (demonstrated in her office’s re-brand to AccessibleNU from Services for Students with Disabilities), and accommodating mental illness is one piece of the giant puzzle that is creating an inclusive and accessible community.

“I feel like my role is to make our office not need to exist,” she says, suggesting that rather than having a specific office devoted to accessibility, it could be built in throughout the various aspects of campus life. “If you’re doing a good job, you’re working yourself out of a job.” May has her work cut out for her. She largely sees the upswing in students seeking these accommodations as a result of a huge policy-driven paradigm shift in the early 1990s, and the changing pool of applicants for institutions of higher learning.

The American Disabilities Act of 1990 made it illegal to discriminate based on disability—physical or mental. In the same year, the Individuals with Disabilities Education Act passed, seeking to ensure students with disabilities received the education they need to lead fulfilling adult lives.

“If you think about it, who are the students who had the full benefit of special education or other student services? Students born in the early ‘90s,” May says. “And that’s the students who are undergrad right now.”

Essentially, these laws made college possible for students for whom it was not before. Students who had be-fore been neglected by the school system as having subpar performance for a number of reasons—the fact that ADHD prevented them from sitting comfortably at a desk all day, or that dyslexia prevented them from reading with the same ease as their peers—were granted accommodations that allowed them to succeed.

“This is sobering to say, but I think a lot of the students we work with wouldn’t be alive this long ... medical advances have allowed them to live longer, to function better,” May says.

Accordingly, May says she thinks focusing on students with disabilities and mental illness as exceptions is the wrong approach.

“At what point are there so many exceptions that we decide the rule isn’t working?” she says. “It’s time to change the rule.”

STRAIGHT-A STUDENTS, GRADE-A BREAKDOWNS

Jillian and I were in the same multimedia storytelling section freshman year.

Jillian’s first mental breakdown at Northwestern happened in the middle of a reading week class period leading up to our final presentations.

“[Our professor] himself took me, in the middle of class—he walked me over to CAPS from his office in Fisk and sat with me in the waiting room until I got an emergency appointment with one of the therapists there,” Jillian says.

Jillian had looked fine all quarter. Maybe it’s that I wasn’t looking closely, maybe it’s that she was good at hiding it. But it’s probably some combination of the two that’s not unique to this particular situation. It’s a fact of life at Northwestern.

The New York Times recently identified “Penn Face” at the University of Pennsylvania, a colloquialism used by students to describe the pressure to put on a happy face despite stress and strife underneath the surface. At Stanford, it’s called “Duck Syndrome,” the idea that a duck appears to glide across the surface of the water despite paddling furiously underneath. At Northwestern, we’ve failed to even come up with a conversational name for the phenomenon.

“Because you all have been so successful, and this is the first arena in which you encounter failure, it’s pretty devastating,” May says.

“My colleagues and I, we say we worry so much more about the Straight-A students than we do about pretty much any other group of students,” she continues. “Unfortunately a lot of times they are the ones who just fall to pieces when the criteria for failure is so much lower than it is for most of the rest of us.”

Jillian, with the help of her academic advisor, our professor and her support system, took an incomplete for the class that quarter.

I don’t even remember her being absent for our final presentations.

CHANGING A CAMPUS CULTURE

For as long as Weinberg senior Sarah Moss has been part of NU Active Minds, she’s remembered the group’s ultimate ambition of bringing the Send Silence Packing event to Northwestern. And on Sept. 28, with her as a co-chair of the Northwestern chapter of a national mental health organization, that became a reality.

“At what point are there so many exceptions that we decide [it] isn’t working? It’s time to change the rule.”

All day, 1,100 backpacks sat out on Deering Meadow, each with a story attached detailing an experience with suicide. The location made it difficult to miss, and on a campus where today’s seniors can remember the deaths of five students to suicide, Moss says bringing the conversation to Northwestern was important.

The Northwestern chapter, around since 2011, is one of 400 across the country. Recent achievements include organizing the Send Silence Packing event, a traveling display put on by the national organization, as well as implementing a mental health Essential NU, the information session during Wildcat Welcome that educates all freshmen on mental health resources on campus.

Moss says student life at Northwestern often deprioritizes mental health. When it comes to changing a campus culture, she believes it’s a worthy task.

But Active Minds is one of several recently started student organizations that is trying to do just that—tackle the issue of mental health on campus. NU Listens, an anonymous peer listening service, was started in the 2011-12 school year “with the intention of supplementing the mental health services offered on campus,” according to their Facebook page.

NU Listens assistant director Brooke Feinstein maintains that the organization is not a substitute for therapy or counseling, but rather a service aimed at improving overall mental health at Northwestern.

“I think that there’s a bit of a misconception that mental health is just about mental illness,” the Weinberg junior says. “But the thing is mental health is just like physical health in the sense that everyone needs to take care of themselves in order to be healthy.”

GROWING OFFICES, GROWING SUPPORT NETWORKS

Becca remembers summoning up the courage to finally go in and set up an appointment with CAPS Fall Quarter of her sophomore year. She had been struggling with her depression all of freshman year, and at the persistent requests of her mother and friends, decided to finally seek help from counseling services.

When she was typing her name in on the computer to sign in and take the assessment survey, a drop down box of all the other students whose names began with the letter “R” showed up.

“That really bothered me because that is not something that should be public,” she says.

She says she then proceeded with her initial evaluation, where she was told no one would be able to see her for around three months.

In all, Becca describes her experience with CAPS as “frustrating, but not awful.” For Jillian, however, CAPS was there during a time of crisis, and was able to help her out of it.

“I have to tell people, I’ve never had a problem with CAPS from day one,” Jillian says.

According to Executive Director John Dunkle, CAPS offers same-day crisis appointments—like the one Jillian had—as well as same-day initial consultations. From there, the office will work with the student to determine the best options for future care, which can include outside referral, referral to CAPS group therapy or continued counseling with CAPS for up to 12 sessions (Dunkle says of students who continue with CAPS sessions, the average sessions used hovers around six or seven.) Dunkle also says the office can now accommodate an in-person counseling experience within seven days.

CAPS has been adding staff members, but the number of students reaching out for counseling services from CAPS has also been steadily increasing.

“I think what CAPS can do in that area is we can offer essential mental health services, we can offer psychoeducation programming, we can offer crisis intervention, those types of things to the community. But there’s others that need to also be a part of that,” he says.

And in terms of increasing the size of CAPS, the office has added three new clinicians in the past two years.

Mona Dugo, associate dean of students in Student Assistance and Support Services (SASS), works closely with CAPS in helping students navigate medical leaves of absence. From what she’s seen in the number of students she’s dealt with, adding more staffers to CAPS would not solve the larger problem.

To take a medical leave of absence for mental health reasons, a student must first make a request online to the Dean of Students’ Office. Then, the student is evaluated by CAPS, who makes a recommendation to SASS, at which point a meeting is scheduled with a member of SASS to continue with the final details of the process.

Dugo, who has been in her position at Northwestern for three years, talks about a pervasive perception that the school bullies students into taking a leave. She says when the office sees students who are chronically suicidal or have self-destructive and self-harming behaviors, staff members may talk to the students about taking leave.

“We will talk to them about our desire for them to get treatment,” she says. “But it’s really a decision students have to make for themselves. I can’t make the decision for the students.”

She says a toxic campus culture pushes students to their limits.

“I’m really struck by it,” she says. “I work with amazing students that are so bright and so talented. And they just continue to be so hard on themselves.”

BUILDING IN SELF-CARE

The metaphor May, the director of AccessibleNU, uses is simple.

Picture the ramps in front of Tech. The long, eased-grades slant upward alongside the central steps that lead pedestrians up from the street level to that of the ground floor about ten feet above, a cohesive design compliant with the requirements of the Americans with Disabilities Act. May notes that, to some degree, slapping a wooden ramp onto the back of the building could also comply with these standards, but would not be nearly as graceful or as inclusive as the comprehensive design utilized by hundreds of students and professors every day.

And on any given day walking to your orgo class you might see a student in a wheelchair rolling up the steps to get to class or a mother with a stroller. All who use the ramps are seamlessly accommodated in their journey up from street levels to the doors of Tech, and they barely even notice.

These ramps are universal; they’re not seen as exclusively for students who lack the physical ability to climb the adjoining stairs. In the same way, May believes curriculum and policy could be designed in such a way that students with mental illness could all be accommodated alongside their peers. Support for students can be built in to campus culture and student life, she says.

“In an ideal world anyone would be able to walk in at anytime and get that support, or that support would be built in throughout the campus in more pockets,” she says. “Self-care, looking out for each other and having that supportive environment built in and not having to go to a certain place for that support.”

“This is the first arena in which you encounter failure. It’s pretty devastating.”

To her, the problem at Northwestern is that students bottle their emotions and neglect self-care until they desperately need the professional therapeutic services of CAPS, at which point it becomes harder to navigate reaching out for help due to the severity of their mental state.

The quarter system, implemented in 1942, today requires 45 credits to graduate across the span of 12 quarters (this is standard across all schools with the exception of Bienen and Bienen dual-degree programs, which require more credits), a contributing factor to student stress.

May herself spent her undergraduate years at fellow quarter-system school Dartmouth, which requires only 35 credits, and her graduate years at Northwestern. She described the quarter system workload at Northwestern as a “different beast.”

Dugo adds that she believes a lot of student stress is perpetuated by our quarter system combined with a high number of requirements to graduate, which “naturally create a rigorous system.”

A Faculty Task Force on the Undergraduate Academic Experience is currently evaluating student needs with a particular focus on mental wellness and the academic workload. Interestingly enough, a similar task force in 1988 recommended the school switch to a semester system or lessen the load on the quarter system. Nothing came of that particular suggestion.

Weinberg senior Emily* is currently on a medical leave of absence for her anxiety and depression. While her experience with the leave of absence process was largely an easy one, reinstatement had its hiccups. Because you’re technically not enrolled as a student, you lose access to your netID after a certain number of days of inactivity.

“And that is kind of very difficult when I thought that I would be back in the fall,” she says. “Because I wanted to register for classes in the spring and I couldn’t.” (Emily ultimately decided to extend her leave after hospitalization this past summer.)

There’s now an iPhone app, NUHelp, which allows students to carry in their pocket the contact information for every office (and more) mentioned here. Resources are being built into campus life, and as Jacob Pope tells me, “momentum is on the upswing.”

*This student asked that her real name not be used.

WHAT CAN WE DO?

“I think seeing people that speak about their experience and like, for them that makes it a lot more real,” Emily says. “And I think that people who are dealing with those issues would feel a lot less isolated.”

It’s no coincidence the students most interested in speaking to me about their experiences with mental illness at Northwestern are all in their fourth year at this school.

“By the time you’re a junior or senior you start to realize being this absurdly busy and stressed is not necessarily a natural part of coming to college; it’s a thing that you actually want to fight back against,” Jacob says.

But by the time junior or senior year comes around, half of the college experience is gone.

Support exists and is becoming more engrained in student life. Students are becoming more open about their experiences. But so many more are still suffering in silence. And that’s the nature of Northwestern’s mental health problem, which makes it a difficult one to address.

“There’s no silver bullet,” says Jacob. “[But] there are things that you will never see, that you can still positively influence.”