“My amazing psychologist knows that she is willfully violating your rules.”

Caroline Posner ’17, buoyed by members of a nodding audience, challenged a panel of administrators, including Yale College Dean Jonathan Holloway. She explained that she had long since passed the 12-session limit imposed by MH&C.

MH&C Director Lorraine Siggins pushed against the accusation.

“We do not have an absolute limit of number of sessions,” she said, adding that each case is handled on an individual basis. “When someone comes back from the fall semester and things are still not going well in January, we would not stop treatment.”

She asked that patients who have been given this misinformation reach out to her.

Posner then addressed the audience, asking those same misinformed students to raise their hands. Roughly 50 hands shot up.

Siggins began to explain that the MH&C website doesn’t mention any such limit, when a voice sounded.

“My therapist told me in every single meeting where we were in our 12 meetings.”

“Mine too.”

“Same.”

“P-Set or Mental Well-Being”

Eugenia Zhukovsky’s weekend has been a little surreal. She hasn’t been back much on campus since electing to take time off earlier in the semester. She decided she needed to focus full-time on managing her anxiety and depression. Technically a visitor, she has no ID card to access campus buildings.

Seconds after being guest-swiped into her residential college dining hall, several of her friends materialize, and hug her.

“How is it, being back in the hellhole?” one asks.

Zhukovsky squints a little. “Weird.” She says she’s happy with her decision. “But it’s not fun. It sucks.”

For Zhukovsky, being a Yale student and managing her mental health were mutually exclusive. Panic attacks, medication adjustments, subsequent side effects and bouts of depression — all with little help from relatively infrequent sessions with Yale Mental Health & Counseling — simply took up too much time in an unyielding, rigorous academic environment.

“No one was explaining how I could do it at Yale,” she said, “We’re not given the ‘our health comes first’ [message] as directly as we have to be.”

Instead of feeling that her health was of primary concern, she felt like it was another, unsolicited, course or extracurricular. She added that the same has been true for other Yale students; friends have admitted feelings of anxiety to her but added that they “didn’t have time” to see a counselor. Zhukovsky calls this notion absurd.

Posner and Zhukovsky each described a “P-Set or mental well-being” dilemma: nights when they had to decide between sleep-inducing medication and studying. In other words, they had to choose between missing a deadline and facing the repercussions of a mental illness left untreated.

In Zhukovsky’s eyes, Yalies are high achieving perfectionists. She likes that: their energy, success and drive drew her to the school to begin with. But that same energy can heighten the effects of anxiety.

Julie* said that when she arrived on Yale’s campus last fall, she found her brilliant peers inspiring, but that they also caused her high school confidence to shrink. During her freshman fall, she began to doubt herself and started to experience intense anxiety.

She described her daily routine: class, practice for her varsity sport, and then crying while doing her homework in her single. Meanwhile, she felt that everyone around her was gaining confidence and accolades. Julie felt increasingly inadequate, weak and alone — but she kept her feelings secret.

Almost all of the students interviewed who have experienced anxiety or depression at Yale said that finding and maintaining a supportive social network was one of the most, if not the very most, important way to cope with mental illness on campus. But several have found that the majority of Yale students seem more focused on their own schedules than on the well-being of their friends.

Monica Hannush ’16, who has experienced severe depression at Yale, has felt this on a personal level. In moments of profound despair, she has resorted to sending her friends desperate text messages. Those texts, she said, follow less desperate messages. Often, when she texts her friends less urgent messages about feeling sad, she receives ostensibly empathetic but distant responses: “so sorry! writing an essay, sending you hugs.” “About to go on a date, but you’re beautiful!”

A News survey on mental health resources, completed by 233 students, found that although 61 percent of students have experienced symptoms of depression, anxiety or other psychological conditions, only 28 percent have sought formal treatment, either on campus or elsewhere.

Julie recalled the moment in her freshman year when she felt like she couldn’t take it anymore. She decided to visit Yale Mental Health & Counseling. On her walk over, she was wracked with paranoia and shame. Afraid of being seen, she kept her head down in the waiting room — but she felt comforted by the presence of other people in nearby chairs. She was not alone.

Breaking the Stigma

Once, when Posner went to her chemistry professor to explain why she had been having particular struggles in the class, she ended up in tears. Posner said that when she told him about her severe anxiety and depression, he simply responded, “T.M.I.”

Although diagnoses have been rising steadily for years — a Harvard study showed that the number of patients in the U.S. increases by about 20 percent each year — many still consider mental illness an uncomfortable, even taboo, subject. While 60 percent of the News survey respondents confirmed that they felt comfortable talking about their own mental health with others at Yale, 27 percent of survey respondents said that they were not at all comfortable with such discussions.

And that mindset, according to Posner and Zhukovsky, perpetuates a culture of undeserved shame for the suffering. Anxiety disorders affect nearly one out of every five American adults, a 2014 statistic listed by the Anxiety and Depression Association of America.

Zhukovsky feels that Yale, specifically, needs to better educate its students.

“I didn’t really know what depression or anxiety were until I had them,” she said. “There was this time when I felt alone, and like there was nothing I could do about it, and it was the worst time in my life … it’s so important to me to talk about this, and to help people from getting stuck in that place. It can be treated. It can be helped.”

Following the death of Luchang Wang ’17 in January, members of a shocked and grieving community have resolved to push for the changes they feel are necessary. Concerned students have been speaking up, demanding that Yale reevaluate resources and policies, and that the community take steps to break the stigma surrounding mental illness.

Many have begun fighting for change on campus — friends like Posner, or like Geoffrey Smith ’15, who co-authored a pledge to boycott the Senior Class Gift along with six other seniors. Smith suggested that alumni and the administration regard participation in the Senior Class Gift as a bellwether for student opinion, and so he called on seniors to abstain from what he sees as an endorsement of University policy. Nearly 97 percent of seniors donated to the Gift in 2014. This year, 78 percent of seniors chose to participate.

A few days after Wang’s death, Posner, Korbin Richards ’15 and Charlotte Storch ’15 created “Nox Et Veritas,” a Tumblr blog, where they publish stories, sometimes written anonymously, about MH&C, withdrawal and readmission. With this new forum, they hope to bring untold stories of mental illness to light and foster dialogue on campus. Already, seven entries have been posted, and Posner said that the blog has between two and three dozen followers.

According to Richards, the problem is not that Yalies do not want to talk about mental illness.

“Once the topic is introduced, everyone wants to join the discussion,” she said.

Rather, she believes that the problem lies largely with the Yale administration. She feels that the administration has been less open and eager to converse with students. After Wednesday’s forum, she said she was proud of the active and vigorous student participation, but disappointed in the continued administrative distance.

“If the panel’s job was to not answer questions, then they did exceptionally well,” Richards said.

Even if students are engaged in the conversation on mental health, Genevieve Simmons ’17 worries the renewed discussion may be short-lived.

“The prevalence of talking about mental health has been sensationalist — movements when we hear a horrible mistreatment about behind the scenes, or a loss of one of our peers,” she said. “Then the discourse fades into the background.”

Moments like this have come before. MH&C Director Lorraine Siggins recalled, for instance, student meetings similar to Wednesday’s event that took place in the 1970s. She said that in her more than 40 years of working on campus, she has seen interest in mental health on campus wax and wane.

To many students, like Zhukovsky, letting this moment of heightened discourse slip away is not an option. She said she could not overstate the importance of creating mental health reform: this, she said, is about quality of life, and life itself.

Phone Tag

When Richards was evaluated at MH&C during her freshman year, she only told one lie. She said that she hadn’t been having suicidal thoughts.

She called this self-defense, as some of her friends had been sent home because they had expressed suicidal thoughts. These stories frightened her  — withdrawal was a financial impossibility for her family, and would worsen her condition. Richards says that the fear of MH&C forcing students to leave campus, or keeping them from returning, prevents those with suicidal thoughts from expressing them. And that, she believes, is dangerous.

Holloway agrees that the fear surrounding the treatment policies of MH&C is unsafe. Before Wednesday’s panel, he told the News that he worries many public perceptions of treatment at MH&C are incorrect, and that he hoped the event would clarify misconceptions and alleviate unfounded fear.

Richards told the panel about her lie. She explained that the fear she had felt was pervasive on campus — a statement echoed by the snaps around the room — and asked how the panel planned to address it.

Siggins responded by pointing out that MH&C sees around 2,500 students each year, and that the vast majority of students who withdraw on medical leave do so voluntarily. Later, she described circumstances that might lead to a forced withdrawal. She said that a patient would need to have a plan for self-harm, as well as the means to execute it — “in other words, if we’re concerned imminently that this person in the next 24 hours may be at great risk.” She added that the individual in question would be hospitalized, and never simply sent home, under such circumstances.

Zhukovsky, for instance, withdrew without any pressure from Yale administrators or MH&C clinicians. She said that MH&C could not provide her with weekly therapy, which she needed, and so she saw no alternative to leaving. It was not until she withdrew that her mental health began to improve.

The thought of other students continuing to wade through the support provided by MH&C saddens her.

“I know that they’re struggling, because I struggled through it, and it wasn’t helping,” Zhukovsky said. “The care I was getting was just okay, and ‘just okay’ is not an option.”

Others remember experiences of MH&C therapy that were worse than mediocre.

Richards called her first and only appointment after her initial consultation “one of the worst experiences [she’s] ever had with another person,” recalling how her doctor skipped the handshake in their greeting. “He didn’t shake my hand, didn’t ask about how I was doing. He went straight into ‘Why are you here?’ and then ‘When’s the last time you menstruated?’”

Julie, initially comforted by the presence of other students in the MH&C waiting room, gave up on MH&C after a couple of unsuccessful visits. She said that the therapist she was assigned to was cold, clinical and impossible to open up to, and so she turned to long-distance communication with a therapist from home.

Still, others have had positive experiences at MH&C.

Adriana Miele ’16 has been regularly seeing the same therapist since the beginning of her freshman year, an experience that she said has “kept her afloat in a lot of ways.”

MH&C also allows patients to request a change in therapist if they are dissatisfied, a process Posner went through at the beginning of this academic year. She’d seen a therapist throughout her freshman year, but found their sessions unproductive, so requested a change. Even though she had to wait for six weeks for MH&C to process her request, Posner said that her new therapist has made a tremendously positive impact on her mental health.

On Wednesday, when Posner publicly praised her new therapist’s violation of the supposed 12-session protocol, snaps and murmurs of accordance echoed throughout the forum: evidence, perhaps, of her belief that MH&C’s largest problems have less to do with the quality of therapy that most of its practitioners provide than with its difficult bureaucratic system.

As the MH&C system stands now, according to Posner, students must advocate for themselves in order to obtain quality care. She equated communicating with MH&C to a game of “phone tag,” with constant missed calls and miscommunications. At the forum, when Šimon Podhajskỳ ’16 asked why MH&C does not utilize email communication, students banged their desks in agreement.

Siggins responded that she “couldn’t agree more” with students that communication between MH&C and patients needs to be improved. She explained that the system currently does not allow email correspondence because MH&C had been concerned about the security of emails, but that it was currently pursuing ways of legally incorporating email communication.

She and Genecin have announced their commitment to reforms at MH&C. In an attempt to hear student voices, they held a series of “listening sessions” in the residential colleges last spring. Last week, Genecin sent an email to the College with a set of MH&C improvements, including an increased staff size and expediting the period of time between a consultation visit and a first appointment.

In the News survey, 54 percent said they believed that Yale’s mental health resources are insufficient for those who use them, and 30 percent of students responded that they felt dissatisfied with the reforms described in Genecin’s email. One survey respondent commented that “there were no concrete numbers given to the proposals, which makes me deeply skeptical.”

Indeed, it appears that students crave more numbers and facts from MH&C. At the forum, multiple students asked the panel for more statistics and greater transparency from administrators.

Holloway and Genecin emphasized, though, that many specifics cannot be discussed because federal law mandates strict confidentiality. Holloway told the News that his inability to be fully forthcoming is “totally appropriate,” though he added that he is always as transparent as possible.

For instance, Holloway said that the withdrawal and readmission committee he formed in January cannot disclose information about its discussions until the committee finalizes its recommendations. He expects this to happen in four to six weeks.

Given such legal constraints, Holloway said that he did not believe assertions that the administration has been silent or unresponsive were fair.

At Wednesday’s forum, English professor John Rogers, the chair of the committee, mentioned that one of its six members was a student. He also pledged to take seriously the recommendations and complaints that students had expressed to him.

Zhukovsky worried that administrators would view Wednesday’s event as a way for complaints to be aired, rather than attempt to get to the roots of the grievances. She simultaneously felt that complaints alone would not lead administrators to make changes.

“I’m all for talking,” she said. “I just think that there has to be more push from students to make a specific change. There’s been a lot of reaction, and a lot of opinion, but there needs also to be initiative.”

Alternatives, and new options

Natalie Wolff ’14 suffered from depression between the ages of 13 and 21, and credits her recovery in large part to the care she received at MH&C while she was an undergraduate. At Wednesday’s event, she presented a list of 10 recommendations to streamline MH&C’s system — recommendations that included using the medical program MyChart to schedule appointments, administering screening questionnaires and hiring more secretaries to field more phone calls.

The panelists expressed gratitude for Wolff’s recommendations, asking for her written list, but Siggins noted that some of the items, such as mandatory follow-up phone calls if a patient misses an appointment, are already MH&C policy. She encouraged students whose therapists have broken MH&C policy by sharing misinformation to contact her. She said that, in those cases, she would remedy the misunderstanding.

At the same time, several students said that MH&C policy was so obscure that they would not know if their therapist had misrepresented it. Siggins admitted that MH&C has not done an adequate job in the past of educating Yale students on its policies, but she added that administrators are working to increase transparency. She then cited the MH&C advisory committee, a liaison between the department and students convened at the beginning of the spring semester in 2014.

Corinne Ruth ’15 and Olivia Pollak ’16, currently serving on the committee, seconded Siggins’ view. Pollak recognizes that communication between students and MH&C can often seem “starkly two-sided,” but hopes that both sides can listen to each other.

“They [MH&C] want students to be happy, they want them to be successful, they want them to come back. The discussion then comes to … how do we best listen to each other?” Ruth said.

The Mental Health Advisory Committee began at the end of last spring, as part of the Coalition for Mental Health and Well Being, a larger umbrella student organization. The committee members convey to the administration their impressions of campus culture.

She cites the coalition as key, a way to bring together students in organizations concerned with wellbeing. Last year, the committee updated the YCC resource sheet and the FAQ section of the MH&C website.

Ruth and Pollak assert that the relationship between MH&C and students is a difficult one to navigate — they echoed Holloway’s comment on confidentiality, as did the forum’s panelists, but asserted that some channels between the administration and students have opened in the past few years.  Ruth cited last year’s listening sessions with Dr. Genecin, which fewer students attended than was expected.

Ruth and Pollak also pointed to resources outside of MH&C that they feel are underutilized, notably Walden Peer Counseling, the Chaplain’s Office and the Peer Liaisons.

One day in the fall of 2014, as Natalie Rose Schwartz ’17 wrestled with new symptoms of depression amid long-standing anxiety, her mother told her over the phone that she had to find someone to be with, if she could. Schwartz’s dean, who had been very helpful during regular weekly meetings, was unavailable, so she walked into the Chaplain’s Office. Schwartz knew Sharon Kugler, the University chaplain, from “Cookies and Coloring,” a weekly study break held in the Welch basement.

“I just went to her office, and she happened to be free, and she immediately took me in, and hugged me, and let me talk,” Schwartz said.

In the News survey, only nine students reported they had used the Chaplain’s Office as resource, while 72 students had gone to MH&C and 82 had relied on residential college deans, masters and freshman counselors. Twelve students had gone to Walden Peer Counseling as a resource.

Pollak believes Walden’s minimal visibility on campus is a necessary result of its policy of anonymity. Because confidentiality restricts peer counselors from reaching out and putting a face to their services, students may have misconceptions about the issues that Walden addresses. Pollak worries that students think they shouldn’t call Walden unless they have a very acute problem, although she asserts that this is not the case.

Zhukovsky, on the other hand, said that while Walden allows students to reach out to peers, peer counselors could not and should not replace mental health professionals. She has suggested that Yale implement a its own version of “Let’s Talk,” a drop-in program started at Cornell University, and that 25 other universities have adopted.

Like Walden, “Let’s Talk” offers drop-in hours for students to talk or seek advice. Unlike Walden, though, “Let’s Talk” employs certified counselors. This would provide immediate professional advice — on medication, for instance — that Zhukovsky believes MH&C does not currently offer and that a peer counselor cannot give.

Other students are also considering ways to widen the University’s network of resources. Joseph Cornett ’17 has recently proposed an initiative in a News column to implement mental health fellows in residential colleges. Representatives from MH&C, masters and deans would select upperclassmen to serve as fellows. The main job of a mental health fellow would be to refer students to mental health resources, explaining their nature and functions.

“The mental health fellows should be someone who everyone knows they can talk to about emotional health.” Cornett said. “It will end up normalizing discussion about mental health and destigmatizing it, much in the way CCE’s have destigmatized discussion about sexual health.”

At the forum, Wolff proposed a safe space to discuss mental health, in the vein of the Sexual Education Literacy Forum, a suggestion greeted with snaps and applause.

Ruth and Pollak believe that friends sharing correct information with each other may be the most long-lasting, effective improvement to the current mental health climate.

Smith believes that while friends can complement professional help, they cannot replace it.

“Friends will ideally be capable of listening and providing love and kindness, but it is too much to expect them to … provide serious help with a specific condition,” he said.

***

After reading out her ten recommendations at Wednesday’s forum, Wolff turned to the audience.

“Anyone can be an advocate. You also need to be an advocate for yourself. So when they tell you that it’s going to take two months to switch your therapist, say no,” she said. “Just don’t give up.”

The applause was deafening.

But before Wolff’s recommendations, and before the applause, Holloway opened the forum. He explained that he wants to close an information gap between students and the administration, to make sure that students have enough faith in the system to get help when they need it, instead of being afraid.

“The floor is now yours,” he said. “Raise your hand. Speak loudly.”