FEATURE: A Hard Pill to Swallow
Yale students—desperate for relief from mental health issues—are turning to the University’s psychiatric services, where they are met with reckless prescriptions and inattentive care.
David ‘19 was a college junior when his friends encouraged him to seek professional help during a severe depressive episode.
After an initial psychiatric consultation, David, who spoke to the News on the condition of anonymity, was immediately sent to Yale-New Haven Hospital. This was his very first interaction with mental healthcare.
Three days later, he was released from the hospital with the expectation that he would enter longer-term, out-patient care—such as therapy—through Yale Health. Instead, David spent weeks on the waitlist for a talk with a therapist he ultimately never received. He was told his situation was “not that urgent,” he recalled.
David was, however, assigned to a psychiatrist.
He had long suspected that he had bipolar II disorder, a condition characterized by oscillations between hypomania and severe depression. His psychiatrist agreed. “That was basically the extent of the real service [he] gave me,” David said, chuckling.
His psychiatrist recommended he take Lamictal, a popular medication used to treat bipolar disorders, but he warned David about one potential side effect: a “deadly skin rash” called Stevens-Johnson syndrome. Worried, David asked his psychiatrist if there were any genetic predispositions that might put him at greater risk.
“He would just Google these questions in front of me. I kid you not, he would literally go on WedMd,” David remembered.
His psychiatrist suggested a genetic test to allay David’s fears. At their next appointment two weeks later, when David brought up the medication, his psychiatrist suggested the genetic test again, as if their last appointment never happened. Two weeks later, the same conversation, yet again. The test was never ordered by the psychiatrist.
For more than a month, David’s bipolar disorder—a condition which, when untreated, dramatically increases the risk of suicide—was left unaddressed and unaided by either talk therapy or medication.
And when David’s psychiatrist finally prescribed him medication, his symptoms only worsened.
THROUGH THE CRACKS AND ONTO THE PHARMACY FLOOR
A growing number of American college students use psychotropic drugs—drugs that affect the brain’s chemical activity. This group of drugs includes mood stabilizers, antidepressants, and anti-anxiety medication, which are common interventions for mental health issues. Between 2007 and 2018, there was a nationwide increase in the use of nearly every class of psychiatric medication, with the rate of antidepressant use increasing from 8.0% to 15.3%. According to Paul Hoffman, Director of Yale Mental Health and Counseling (MHC), approximately one third of all students who sought treatment through MHC requested to meet with a psychiatrist, roughly 11-12% of the Yale University student body. It remains unclear how many students are actually prescribed psychotropic drugs through Yale Health. Yale Health’s Director of Pharmacy, Bryan Cretella, did not respond to request for comment.
In recent years, Yale Health has been criticized for failing to meet student demand for counseling and therapeutic services, leaving students like David on long waitlists. If they do manage to get off these waitlists, students are often given short and sporadic appointments. The problem is mostly insufficient staffing. With just over 50 employed clinicians and 5,000 students seeking treatment, each therapist would have to see almost 100 students in order to meet current demand—a workload that rules out effective or quality care.
In sharp contrast to the long waits for therapeutic counseling, Yale Health’s psychiatric services move eerily quickly. A survey of 175 students conducted in November 2022 reported that over 60% of Yale students “somewhat agree” or “agree” that it was “easy for [them] to receive a prescription for psychotropic drugs.”
When asked what compelled him to seek psychiatric medication, Michael ‘20, who spoke to the News on the condition of anonymity, cited limited access to therapy as one of the reasons. “Spots are so limited, and time is so limited because so many students are ill. I just [felt] like I needed an additional supplement,” Michael said.
Pressure on Yale’s Mental Health and Counseling services reached a peak in late November when two current students and the mental health advocacy group “Elis for Rachael”—formed after the 2021 suicide of Rachael Shaw-Rosenbaum ‘24—filed a lawsuit against the University, claiming discrimination against students with mental health disabilities. While Yale remains in settlement negotiations, the University announced dramatic changes to its medical leave of absence policy in January. Among the changes was a simplification of the reinstatement process for students on mental health leave.
Still unnoticed, however, are the thousands of struggling Yale students driven to psychiatry by a desperate desire to feel better—to feel happy—only to be met with little support or care from their providers. Students are prescribed serious medications, only to then be inadequately listened to and improperly monitored. Students like David, who need medication for their own safety, but struggle to feel safe under Yale Health’s care.
Robbie ‘22, who spoke to the News on the condition of anonymity, was first assigned a psychiatrist during their sophomore year. They struggled to figure out how to pair this psychiatric treatment with talk therapy. “Ghosted” by the first therapist they were assigned by Yale, they saw another licensed social worker on an “emergency basis,” Robbie recalled. After their first meeting with a psychiatrist, Robbie received a prescription for Lexapro, an antidepressant.
This, however, runs counter to what many psychiatrists consider to be best practice. Dr. Yann Poncin, assistant professor of clinical child psychiatry at Yale School of Medicine, argues that—although there are exceptions—a young patient should only consider pursuing psychiatric medication “[if a] good two, three months of quality therapy is not leading to change.” Though medications can be effective without therapy, Yann argues, there are often issues driving symptoms that are worth exploring first.
Many Yale students would consider themselves lucky to see a therapist for two to three months. For students like Robbie and David, psychiatry became an inadequate substitute for psychotherapy. Robbie’s psychiatrist doubled as an “awful” therapist, they recalled, who would “start meetings late, end them early, [and] open a can of worms.”
David never received a therapist, even while coping with his bipolar diagnosis. “It’s critical to see how far therapy can go before medication comes into play… even just dealing with the side effects of medication requires help,” he remarked. “That’s a journey in itself.”
For students like Claire ‘22, who spoke to the News on the condition of anonymity, who are fortunate enough to receive both a psychiatrist and a therapist, the two professionals often fail to work hand-in-hand, to the detriment of the patient. “Frankly, [it] seemed like my psychiatrist and my therapist weren’t in conversation with each other at all, at any point,” Claire recounted.
Research shows that collaboration among healthcare providers can improve patient outcomes and prevent adverse drug reactions. Some experts believe it is, in fact, essential. Dr. Linda Drozdowicz, a specialist in child and adolescent psychiatry at Yale-New Haven Hospital, said that collaboration “is something that all mental health professionals should strive to do, since not communicating well can lead to suboptimal care.”
In addition to reporting uninformed and disjointed treatment, some Yale students—such as Sasha Carney ‘23—felt that their providers were apathetic and uninvested. “He was very detached and removed. When he… tried to get me to talk about my feelings, I got the impression that he really did not want to care about them, and I felt no desire or comfort with sharing,” Sasha said of their first-year psychiatrist. “I would often miss my medication or fall behind on my medication because I hated spending time with him, I hated setting appointments with him.”
This sentiment between patient and mental health care provider can have disastrous consequences. The Family Institute at Northwestern University reported that patients who rate their relationship with their provider poorly are more likely to drop out of treatment.
Other students felt that their psychiatrists almost dehumanized them. “Yale psychiatry and medication in general was reductive and not too holistic and healthy in viewing me as a person. They kind of view you as a little chemistry equation,” Michael said.
Students, like Anna ‘24, who spoke to the News on the condition of anonymity, experienced suspicion and distrust from their psychiatrists, which prevented them from being transparent about their symptoms. “When I was trying to get accommodations for my classes, my psychiatrist told me that he wasn’t able to do that…because we could be lying about our symptoms. These were the same symptoms he was prescribing me medication for,” she said. “It was jarring to hear that I could get all these drugs from him, but I couldn’t get medical accommodations for my classes.”
Jaclyn Recktenwald, Program Coordinator of Student Wellness at the University of Pennsylvania, believes these concerns highlight a failure of one of the fundamentals of student psychiatry. “For folks to feel seen and heard, they have to feel like the person they are talking to respects them—trusts that their pain is real,” Recktenwald said.
When psychiatrists fail to listen to their patients, they place lives in danger. In the fall of their sophomore year, after experiencing a traumatic incident during a summer abroad, Robbie’s psychiatrist suggested Lexapro to address severe panic attacks. Almost immediately, Robbie began to feel unsettling symptoms. “I was struggling to swallow, and my tongue was swollen. I thought I was going crazy, but as I kept taking it more and more, it kept happening…and those symptoms were in addition to the rampant anxiety I was feeling from the meds,” Robbie recalled. Robbie’s psychiatrist refused to listen to them, dismissing their concerns and claiming that the medication just “wasn’t at a therapeutic dose.” With no support from their provider, Robbie’s anxiety continued to worsen.
Soon after, they ended up in the hospital.
“ONE OF THE WORST POSSIBLE MEDICATIONS”
Given his concerns about Lamictal’s potential side effects, David’s psychiatrist instead prescribed him Abilify in the spring of 2018. “That really messed me up,” David confessed. “It made it impossible for me to move my body.” Unable to function over his spring break, David called Yale Health, seeking approval to stop Abilify. He struggled to get a hold of a professional, in large part because his psychiatrist was only in-office three days a week. Eventually, after repeated attempts, the on-call psychiatrist authorized David to get off Abilify.
“The moment I got off, I was just unbelievably unstable. I was having the worst manias, the worst depressions of my life. I was in real danger,” he said. The on-call psychiatrist failed to tell David’s psychiatrist that he had been taken off Abilify, so David suffered through the effects of what he believes was withdrawal without an alternative medication.
Eventually, David’s psychiatrist prescribed him the antipsychotic Seroquel to address his paranoia. “The psychiatrist I saw later, after I went home, said that [Seroquel] was probably one of the worst possible medications he could’ve given me,” David recalls. “I was very unstable and the Seroquel probably made it worse,” David said, likely because it exacerbated his anxiety. As his condition worsened on Seroquel and psychotic symptoms emerged, David knew he had to be hospitalized, but was afraid to tell anyone—even his psychiatrist. He finally made the decision to withdraw from Yale.
Because of attention issues during ‘zoom-school’ her junior year at Yale, Claire ‘22, who spoke to the News on the condition of anonymity, reached out to her high school therapist, whom she had previously spoken with about her attention difficulties. Hoping to obtain medication to help her focus through Yale Health, Claire asked her former therapist to write her a letter confirming she had ADHD symptoms.
The letter was enough to get Claire a prescription for Adderall, which derailed her mental health completely. “There would be days where I just wouldn’t eat at all. And I was also having a ton of difficulty sleeping…sometimes I would go multiple days with a total of about six hours of sleep,” she said. “I would be taking two or three shots [of alcohol] a night in order to sleep.
Claire’s worsening symptoms eventually brought her to Yale-New Haven Hospital, where she was diagnosed with bipolar disorder. “They thought that a lot of the mental health crisis I was in was because I was being completely incorrectly medicated,” she remembers.
A private psychiatrist later told Claire that being placed on a stimulant like Adderall with bipolar disorder is very dangerous—which is why stimulants should never be prescribed without a psychiatric evaluation.“[A letter] doesn’t count,” Claire recalled her psychiatrist saying.
When asked to comment on Claire’s story, Dr. Victor Schwartz, Senior Associate Dean for Wellness and Student Life at CUNY School of Medicine and former chief psychiatrist at the NYU Student Counseling Service, wrote in a March 8th email that, while a new psychiatrist might feel comfortable relying on a patient’s history to continue a treatment, they should “still meet the student and do their own assessment.” The only exception, he continued, is if a patient has been prescribed a particular medication for a long time and is running out. But this was Claire’s first time on Adderall.
These dangerous errors and lack of standardized procedure may arise from the very structure of Yale’s student psychiatric services: providers are often residents—recent graduates of medical school— who are still in training. Dr. Schwartz wrote in a December 3rd email that “residents are trainees, so by definition less experienced, but often, they have more time to do in-depth assessments too.”
According to Paul Hoffman, Director of Yale Mental Health and Counseling, the program has 12 psychiatrists on staff and 5 advanced psychiatry residents. “MHC sees training the next generation of psychiatrists as vital to its core mission of helping our students,” he wrote in a March 10th email.
For Michael, however, the problem lies not in experience, but in residents’ shorter tenures and, thus, higher turnover. “[O]ver three years—my sophomore year to my senior year—I had four different psychiatrists,” Michael remarked. “With every replacement of a psychiatrist, you would sort of start over with this person and build a relationship.”
Paul Hoffman upholds that Yale’s psychiatrists undergo “weekly clinical supervision, clinical rounds, and clinical teams.” This brings into question, then, how David or Claire faced life-threatening emergencies due to errors their providers made—errors private psychiatrists could recognize immediately.
CHOOSE YOUR OWN ADVENTURE
With SSRIs—selective serotonin reuptake inhibitors, the most common class of antidepressant—the most precarious time for a patient is the first few weeks on the drug, also referred to as the initiation period. While antidepressants are associated with having a protective effect on suicide attempts overall, in younger people there can be an increased risk of suicidal thoughts or behaviors during initiation of the medication. Because of this risk, Dr. Drozdowicz says, “the standard of care is to check in…in some way at least weekly for the first month,” when adolescents and young adults are first prescribed SSRIs. But when Michael ‘20 was first prescribed Prozac in 2017—after a brief, 30-minute appointment—their Yale Health psychiatrist only checked in with them a month later. At that appointment, when Michael expressed that their symptoms had not improved, their psychiatrist upped the Prozac dose and added Wellbutrin. “From there, it just kept… incrementing upwards,” Michael recalled.
Dr. Schwartz considers this “incrementing” a common problem within psychiatry. “With SSRIs specifically… the therapeutic effects take a while to happen and there is a tendency to try and push the dose up in order to get it working. The problem with that is it can actually increase the risk of side effects as well,” he explained.
The incrementation Michael underwent made them feel emotionally blunted—flat. “I could actually wake up and go do things… but I’m not like ‘happy.’ I’m not, like, excited to wake up but I can exist, I can function,” they described. Michael conveyed these emotions to their psychiatrist, who dismissed them. “Apparently that was enough of a justification to keep upping the dosages basically… as long as I was a working subject within the university, I guess it was fine,” they recalled.
While hasty dosing can cause unnerving side-effects like emotional blunting, abruptly stopping antidepressant medication can make a student’s condition even worse. “Some medications I describe as… like wearing glasses. You can put them on, put them off—you see or don’t see,” Dr. Poncin explained. “Other medications [are] in your system to make changes, more like muscle building and to come off of them, you have to go more slowly.” Antidepressant withdrawal may lead to “Antidepressant Discontinuation Syndrome,” which causes flu-like symptoms, according to the American Academy of Family Physicians. Worse, withdrawal can cause a relapse—or even an escalation—of depression.
For some students, these dangerous withdrawal effects were not their doing—but the University’s. When Anna withdrew from Yale in 2019 on a medical leave to address her mental
health, she lost the insurance coverage that helped her pay for her psychiatric medication and the provider who prescribed it. At that time, students who withdrew were prohibited from enrolling in any affiliated healthcare. “I called [my psychiatrist], and I said, ‘I think I’m going to withdraw’ and he basically said ‘Yeah I think that’s a good idea.’ It was literally a two minute phone call. There was no discussion of how I was going to continue my medication or how I was going to phase them out,” Anna said. Without a new provider, Anna had to stop her medication.
“I noticed pretty immediately that I was having some sort of withdrawal… and a friend [said] ‘Yeah you’re not supposed to just stop Prozac’… and I was like ‘Oh, nobody told me about that,’” she explained. Her symptoms were severe. “It was a lot of suicidal ideation… very very different from how I’d experienced that kind of suicidal ideation in the past,” Anna described.
Yale has since altered its healthcare policy. “All students on medical leave may continue with Yale Health once they take a leave of absence if they have been on Yale Health Hospitalization/Specialty coverage,” Hoffman wrote on March 10th. The Yale Health Specialty Coverage plan starts at $2,756 a full term for enrolled students and skyrockets to nearly $8,000 for students on a leave of absence.
However, even when students are fully enrolled, they are often able to stop medication while flying completely under the radar of Yale’s psychiatric department. When Michael halted their medication cold-turkey, there was “just an assumption” that they were okay, they recalled. “I didn’t pick anything up from the pharmacy, I didn’t email my psychiatrist for refills. Obviously something was wrong. And I was on pretty high dosages. I was on 80-100 Prozac and 150 Wellbutrin… it was interesting that there was no contact,” they said.
The dire symptoms of sudden withdrawals also raise questions about the safety of students—particularly those who rely on the University for health insurance—once they graduate from Yale. “In the case of first-generation, low-income students or undocumented students… it’s kind of like a ‘Choose Your Own Adventure and Figure it Out’ after you graduate,” Michael said.
However, Paul Hoffman sees health care access as far less precarious. “If a student comes from an FGLI background, it is possible that their health insurance may be paid for by Yale College. If a student is newly graduated, they remain on Yale Health coverage through July 31st, ensuring [they have] ample time to arrange appropriate follow-up care,” he wrote.
Despite this safeguard, Michael has seen a number of friends panic about losing their prescription due to financial concerns or impending graduation. “Access to medication shouldn’t be confined to timetables or income brackets,” they said.
A HARD PILL TO SWALLOW
When he was hospitalized at Yale-New Haven for severe depression in 2017, Quinn ‘19, who spoke to the News on the condition of anonymity, was told he was “too much of a liability to the University” by the former director of Yale Mental Health and was asked to withdraw for a year. “She told me that verbatim. It was a two minute phone call,” he said. Within days, his ID was deactivated. Movers were hired to pack his stuff. His dean told him that if she saw him on campus, she would be forced to call the police on him for trespassing. For Quinn, the situation exemplified what is so wrong about Yale Mental Health and Counseling.
“They don’t actually care about making you feel better. They don’t care about making your life better. They just don’t want a liability on their hands. There is never a why that’s asked,” he said, referring to the roots of mental health conditions. “It [is] a very deterministic, chemical thinking.” In the eyes of Yale Mental Health and Counseling, Quinn argues, students are meant to be stabilized, not supported.
Students who struggle to connect with their psychiatrists, build trusting relationships, or receive adequate care deserve proper recourse—an avenue to voice their concerns about the performance of their psychiatrists, for example. But when Quinn met with a Yale College dean to discuss his complaints about Yale Mental Health and Counseling, the dean failed to follow up—or even take notes, he recalls. Paul Hoffman contends that feedback mechanisms are already in place, noting that “students may provide feedback by calling our main phone line and asking to speak to the clinical manager or by clicking on the ‘Provide Feedback’ link on the MHC website.” None of the Yale students interviewed knew these options were available.
Not all students who make use of Yale psychiatric services have negative experiences like Quinn’s or Michael’s, which is perhaps what is most frightening about the system. Desperate for relief, students must take a chance on an unreliable system that could just as easily fail them. “It really comes down to a coin toss of who you happen to get assigned to. Which is just depressing and weird,” Sasha said.
After Robbie was hospitalized, they received a new psychiatrist at Yale, who “went above and beyond” for their health, they said. She was responsive, attentive, and worked to get Robbie on the right medication. “If I didn’t find her I wouldn’t have graduated,” they admitted.
For Robbie, that coin toss worked out. For others, it won’t.