Committee Calls for Improved Counseling and Mental Health Services

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December 09, 1999

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HARVARD GAZETTE ARCHIVES

By William J. Cromie
Gazette Staff

The findings and recommendations of a special committee appointed to review counseling and mental health services at Harvard and make recommendations for the future have been announced by Provost Harvey Fineberg.

"The purpose of the committee’s report is to ensure that Harvard offers, and will continue to offer, high quality mental health and counseling services to its students," Fineberg noted. "It was extremely important to have such a qualified group able to examine this issue in a dispassionate and objective manner."

Appointed in the fall of 1998, the Provost’s Committee on Student Mental Health Services spent a year reviewing data, interviewing students, faculty, and administrators, and consulting with experts in the field of young-adult development and mental health. It was chaired by Paul Summergrad, associate professor of psychiatry at the Medical School and Network Director of Partners Psychiatry and Mental Health System.

"The years of early adulthood mark the onset of many serious psychiatric conditions," Summergrad commented. "While students at Harvard are extremely gifted, these talents do not protect them from susceptibility to mental health and emotional crises."

The Committee’s recommendations focus on strengthening and coordinating counseling and support services. Proposals call for greater accessibility to clinicians, better ways to gauge student satisfaction, and more after-hours care. The Committee also wants to see more collaboration among different parts of the University that provide counseling and mental health services, more rigorous training for residential tutors and staffs, and widespread distribution of information about available services and about how to recognize students at risk.

These recommendations came in response to a number of areas of concern expressed by students and others:

Long waits to get appointments at the University Health Services’ (UHS) Mental Health Service.

Appointment hours not convenient for student schedules.

Lack of clarity about policies for referral to outside clinicians.

The feeling that managed care was adversely affecting the ability of UHS to work with students in a flexible manner.

UHS is not perceived as having a close relationship with the Harvard community.

Lack of good customer service attitudes on the part of some non-clinical staff.

The Committee concluded that "the Mental Health Service is understaffed, especially considering its multiple constituencies, locations, and its complex obligations to a diverse student community." Despite this, the Service is credited with making, and continuing to implement, improvements designed to address these issues. These improvements include better access to clinicians during extended evening and urgent-care hours, assignment of mental-health liaisons to the residential Houses and graduate schools, and the initiation of customer service training at UHS.

The Committee noted that UHS is taking laudable steps to improve care and outreach, and urged that students be seen more promptly and frequently, and that UHS organize its services and mission primarily around the care of students. Specific actions include:

New standards for access to mental health care should be developed and organized around the principle that students need to be connected with clinicians as soon as possible.

Clinical guidelines for the care of common disorders should be developed and made available to students.

Clear criteria should be developed for referring students outside the University.

The number of clinicians should be increased to meet current and anticipated demand.

Efforts should be made to obtain feedback from students, including periodic evaluation of the effect of service improvements.

Deans of students, residential tutors, and other student contacts need to be regularly apprised of information such as profiles of clinicians, hours of Service operation, and urgent care access.

Satellite clinics at the Law, Business, and Medical Schools, as well as the main clinic at Holyoke Center, should be synchronized with student activities so that more flexible access is possible.

Liaisons have been appointed to the residential Houses and to each graduate and professional School, and that is an appropriate first step in improving relationships between providers and recipients of mental health services.

The report noted that UHS is not the sole provider of mental health services to students. In addition to its tutoring function, the Bureau of Study Counsel, run by Harvard College, is a major provider of individual psychotherapy. Help is also available from the Law School Office of Student Counseling, a contracted psychiatrist in the Chemistry Department, the director of student services at the Graduate School of Arts and Sciences, and the United Ministry. Deans of students also play a semi-clinical role, and peer counseling groups at the College are trained to provide resource and referral services.

To coordinate these resources, the Committee recommends establishing a Student Health Coordinating Board, under direction of the Provost or his designee. Members would include representatives from each School, UHS, and the Bureau of Study Counsel, as well as experts in student health and mental health.

More specific recommendations for coordination, care and training include:

The Bureau should develop closer clinical coordination with UHS.

This coordination should include a system whereby clinicians will be available for consultation and assistance during emergencies that occur on evenings and weekends.

The Bureau should be subject to the same access and clinical standards of care as UHS, as far as possible under current law.

Each House and the freshmen dormitories should consider setting aside temporary "safe space" for students who are under stress and receiving active assistance from UHS or the Bureau.

UHS and the Bureau should be used as central resources for developing appropriate training programs and material for residential staff and others in daily contact with students across the University.

At the College level, a central curriculum for training residential tutors needs to be developed.

As a condition of employment, all tutors must possess strong interpersonal skills, and should undergo annual evaluation with some input from the students.

Each School should offer some avenue of intervention in instances where graduate students become involved in difficult relationships with their advisors.

The Student Health Coordinating Board should develop a short brochure that outlines how to recognize students in distress and lists referral services and emergency phone numbers.

"We welcome the analysis embodied in this report," said David Rosenthal, director of UHS. "Our staff is continuously improving its clinical services and access to health care for all students, in collaboration with the Bureau and with student advisory services."

"Progress is being made on many of the issues raised in the report," adds Richard Kadison, UHS’s chief of mental health. "The Mental Health Service has increased its outreach and collaboration with the College and Graduate Schools. There has been a concerted customer service effort to make access and follow-up easier. There is a new appointment system that better utilizes resources and increases urgent-care times and hours of operation. Satellites in the Medical area and Business School have created evening hours. Discussions are ongoing between UHS and the Bureau to find better ways to collaborate and coordinate care. There are work groups monitoring access standards and working on referral policies."

To evaluate the status of such changes and of the recommendations made in its report, the Committee suggests that it reassess student mental health services in the fall of 2000.

The full report of the Committee can be read at http://www.provost.harvard.edu/.