In an anonymous op-ed written in The Harvard Crimson in 2013, one student described suffering through their first psychotic episode, adrift from the support of their university. The student’s experience bore resemblance to that of many Yale students seeking mental health and counseling treatment at Yale Health. The op-ed was widely circulated in the Harvard community and beyond.

Mental health and counseling services at Harvard, Princeton and Yale have strengths in different areas. Harvard has the lowest number of therapists per student when compared to Yale and Princeton. But Harvard allows students on the university health plan to see off-campus therapists, while Yale does not. Princeton offers the most group therapy sessions.

But students at all three institutions share the view that their universities are delivering a lower standard of care than they believe is optimal.

“My expectation would be that [mental health services] would be of similar quality across the three schools and that there would be high quality all around,” said Princeton junior Tomi Johnson. “I would like to think my mediocre experience was out of the norm.”

With college tuition rising and high-profile cases of severe depression and suicide proliferating throughout the media, questions have emerged around the Ivy League about the level of mental health care available to students. Experiences with on-campus services converge to a substandard norm, students interviewed said.

COMMUNICATION CONCERNS

In the campus debate about mental health, one common complaint is not about substance, but communication. Students said they do not think there is enough of it. At town halls and in interviews, students have said they have outstanding questions about issues that they believe have been poorly communicated — therapy session caps, length of wait time before initial therapy appointments and the conditions that lead to involuntary withdrawal.

Yale Health’s MH&C website — the interface most students use to access MH&C information — deconstructs the steps that students new to the department must work through in order to schedule an initial appointment, but does not tell students specifically how long they should expect to wait for their intake appointment. Harvard’s Counseling and Mental Health website, in contrast, tells students exactly how long they should expect to wait in between their first call to the department and their phone consultation.

Harvard’s website notes that, regardless of whether students request their first appointment by phone or by using the university’s patient portal, they should expect a call to discuss their needs “no later than 48 hours after [a] request.” At Yale, students are told to wait for “a few days” before being contacted for an intake appointment.

Still, at both institutions, the publicized wait times are far from the reality. According to a report conducted by five students at the Yale Law School, median wait times for an intake appointment fall between one to two weeks for the law students surveyed. Further, they waited a median of three weeks to two months for a subsequent appointment in the 2013–14 academic year.

In an April 2014 News survey, 65 percent of respondents considered the amount of time they had to wait for MH&C appointments unacceptable. Only 34 percent of students in other departments reported wait times they considered unacceptable.

At Harvard, students similarly said advertised wait times are misleading — some have waited up to a month before being referred to a therapist.

Princeton University’s website does not tell students how long they should wait for an initial consultation or how long students must wait for their first therapy session after an intake appointment. Princeton Media Relations Specialist Min Pullan declined to comment to clarify this.

“Our position is that each institution will provide services based on what suits its needs or concerns, and general comparisons … are not constructive,” Pullan wrote in an email.

But Johnson said her experience with Princeton’s Counseling and Psychological Services, which involved only one appointment, Princeton’s counseling service, was much quicker than those that have been reported at Harvard and Yale. Johnson, who booked an appointment for counseling after struggling with a writing assignment toward the end of the academic year, waited “two to three days at the very maximum” to see a therapist.

In Yale’s February open forum on mental health, Director of Yale Health Paul Genecin discussed the potential for appointments to be booked through secure online messages in order to avoid the “phone tag” that often occurs in an attempt to make and confirm appointments. Yale MH&C Director Lorraine Siggins emphasized that this is being strongly considered by Yale Health. At Harvard, online scheduling already exists.

At the same forum, students were told that, if they do not hear back from MH&C about therapy visits after requesting a session or missing one, they should call back or contact Siggins personally.

But students at the forum argued that this advice places an unrealistic burden on students who are undergoing mental health challenges, as such students may be experiencing unusually low motivation. The same criticism was voiced against Harvard, when multiple students interviewed by The Crimson said they had missed appointments and did not get a follow-up call or message.

In the anonymous op-ed to The Crimson, one Harvard student described how, in their early months of suffering from schizophrenia, they had such low motivation levels and fear of the voices in their head, they did little besides sleep, falling behind on school work.

Though Siggins told the attendees of the February open forum that they could attend as many therapy sessions as their therapist thought was medically appropriate, weekly appointments that are projected to last the full academic year are not the norm at Yale. At Princeton, Johnson said, she considered weekly therapy sessions to be “the default” for therapy regularity at Princeton, adding that she was offered weekly sessions after her first appointment at Princeton’s Counseling and Psychological Services.

SESSION LIMITS AND PRIVATE PRACTICE

“Feeling better does not mean that counseling will end abruptly,” reads the message on Harvard’s Counseling and Mental Health homepage. “You and your counselor can discuss options for increasing time between sessions, preparing to end counseling, adding a group or workshop or finding alternative supports.”

Neither Yale nor Harvard has a strict cap on therapy sessions available for students. But students at both institutions report a pervasive pressure to keep therapy visits down to as low a figure as possible. At Yale, students at the February forum reported that their therapists had told them they could only have 12 therapy visits a year. Harvard students reported a similar perception that the University is reluctant to offer extensive treatment or care that extends beyond crisis control.

Though Siggins noted in the forum that therapy can be continued if a therapist deems it necessary, Caroline Posner ’17, who spoke up during the forum to share her experience with mental health issues, told the News that any perception of a session limit whatsoever leaves therapists in the awkward position of ranking which patients they believe are more in need of care. Posner added that perceptions of limited therapy visits could make students who are coping well with mental health treatment become unnecessarily anxious.

According to Harvard’s Counseling and Mental Health Services website, the University prefers a short term model of care when treating mental health issues. Psychiatrist and Director of Harvard Health Services Paul Barreira has confirmed this in public statements, noting that the mental health department’s main objective is to treat illnesses as they arise, so that students are able to progress through their university years, remaining productive and happy.

The care models evidenced at Yale and Princeton suggest that short-term care models are preferred to those emphasizing long term care.

As a result, there is a relatively low therapist to student ratio at all three schools. Yale’s 12,336 students are served by 28 therapists, while Princeton has 20 therapists for only 7,910. At Harvard, 30 therapists are available for roughly 21,000 students. In Harvard’s case, the low ratio is supplemented by allowing off-campus therapy visits. While Harvard students are calling for the number of covered visits to rise, Jessie Agatstein LAW ’16 is encouraging graduate students to opt for private health insurance instead.

According to the YLS study, wait times at off-campus therapy clinics are often half that of wait times at Yale MH&C. Therapist shortages are endemic in all three institutions, students said. To cope with this, all three institutions offer group therapy sessions, with Princeton leading with 13 group therapy options, Harvard following with 10 and Yale lagging behind with five listed on their website.

Even with these measures, all three institutions have a distance to go if they are going able to fulfill their own aim for short-term health care management, students said.

Harvard, Princeton and Yale all offer urgent 24-hour care in the case of mental health emergencies.

Clarification: March 31

A previous version of this article included misleading language about statements made by Paul Barreira, director of Harvard Health Services. His comment was drawn from remarks made to other media outlets, not from an interview with the News.