Nov. 15, 2006

CU seeks to change campus culture about mental health and to encourage more compassion for student problems

Giselle Vitaliti '07 began college excited and hopeful, but by the start of her second semester, pressures from her parents to do well at school, the workload and financial concerns resulted in physical illness and isolation.

"I just withdrew from everything," said the Spanish literature and government major. "I just wouldn't leave my room."

She vaguely recalled seeing flyers during orientation about Gannett Health Services' Counseling and Psychological Services (CAPS) and its help with such mental health issues as depression, anxiety disorders, alcohol problems, eating disorders, self-injury and suicide, but at the time, she never thought she would need it. But now that she needed help, Vitaliti said she could not overcome the stigmas about therapy from her Argentinean roots.

"The two worst things in my family's culture were to be a prostitute or to be crazy," she said. Instead of seeking professional help, she decided to "deal with it and just get through the semester"; over time her despondency lifted, and she adjusted to the stress. The experience made such a lasting impression on her, however, that she is now president of Cornell Minds Matter, a student-run mental health awareness and advocacy organization.

By coping on her own, Vitaliti echoed the way many students handle psychological distress. A National College Health Assessment of 1,902 Cornell undergraduates last spring revealed that in the previous year, 44 percent -- and an even higher percentage of students of color and international students -- had experienced moments when they were "so depressed it was difficult to function." Yet, only 13 percent of Cornell's student body had sought CAPS services.

Similarly, in a fall 2005 e-mail survey of 1,695 recent Cornell graduates, Jeff Haugaard, a former Cornell associate professor of human development, found that more than 20 percent reported they had been unable to attend classes for at least one week due to depression or anxiety. Of those severely depressed students, 60 to 70 percent had shared their problems with friends, far eclipsing the percentage who had sought professional help. Nearly one-fifth of the male respondents who had been severely depressed told no one about their struggles. Some 80 percent of the students who kept their problems to themselves did so because they felt they should be able to cope on their own.

Such student groups as Cornell Minds Matter have pushed hard to provide forums for students to talk with one another about their problems and to reduce stigmas. In the past month alone, open meetings have addressed mental health issues related to psychotropic medications, healthy relationships and families and friends with mental illness. Among those with a keen interest in next semester's meetings are members of a new CMM support group for students with depression, which Assistant Dean of Students Karen "Casey" Carr is helping to form.

"Stigma prevents people from not only seeking treatment but from recognizing signs in the first place," said Joey Notaro, a Cornell student currently on leave, whose suicidal feelings have resulted in two hospitalizations since starting high school. He pointed to American cultural idealizations of the rugged individualist. "Sometimes we don't need to be independent; sometimes we need help," he said.

Cultural differences, in particular, campus experts say, can lead to isolation and depression. Of the 16 confirmed suicides of Cornell students since 1996, nine of the students (56 percent) were born outside of the United States. People from some cultures, Cornell mental health experts say, often experience high familial pressures to succeed and have few references for openly expressing feelings.

The mental health professionals at CAPS are well aware of the stigmas and are making efforts to place counselors in those areas frequented by students considered "at risk," among them Asian-Americans and international and underrepresented minority students.

"We are trying to strategically spread counselors out around campus," said CAPS Director Greg Eells. For example, through the CAPS Let's Talk program, counselors offer walk-in advice in such places the Office of International Students and Scholars, the Colleges of Engineering and of Arts and Sciences, the Law School, the Graduate School and the Computing and Communications Center Building, where there is an English-language support office. There also have been efforts to educate faculty on mental health issues, hire more counselors who reflect the demographics of the student body and to integrate depression screening into primary health care at Gannett.

Gannett staff are also aware that their mental health services, which are already operating near to capacity, cannot meet all of the emotional needs of students. They can, however, try to shift the culture on campus to be more caring and compassionate.

"Everyone in the university community has a potential role to play," said Janet Corson-Rikert, executive director of Gannett. "Students often turn to friends for support, and faculty and staff may be the first to the see signs of a problem."

Cornell's campuswide mental health strategy has been shaped by participation in a pilot study with University of Rochester, Princeton, Harvard, Massachusetts Institute of Technology and Columbia to promote mental health and prevent suicide. Initiated three years ago by the Jed Foundation, a nonprofit suicide-prevention organization, the project has adapted the best practices from a U.S. Air Force suicide-prevention model and applied versions of those practices to each campus. The original model was developed in the mid-'90s and dramatically reduced not just suicides but also homicides among Air Force members.

The universities in the pilot study have begun to collect and share more research about students' mental health issues in order to better target resources and help. In spring 2006, for example, Cornell and several other universities in the Jed program administered the National College Health Assessment. This fall, Cornell Senior Research Associate Janice Whitlock collaborated with University of Rochester researchers to develop and administer a Survey of Student Mental Health and Well Being for all the institutions. Results will be available later this fall.

"These surveys enable us to understand in broad terms the epidemiology of mental health at Cornell," said Tim Marchell, director of mental health initiatives at Gannett.

As in the Air Force, where service men and women, and especially officers, are educated in suicide prevention, Cornell's CAPS professionals and others, led by Eells, Associate Dean of Students Tanni Hall and Cornell Dean of Students Kent Hubbell, are educating faculty and staff at department meetings and residence halls on how to recognize problems and be aware of campus resources for students in need.

"Faculty need to be educated about students who have psychological needs," said Notaro, the student on leave. "Students need to be able to approach faculty and say, 'I have this problem, and I need your help to finish this course.'"

As part of this effort, Marchell has promoted a "bystander gatekeeper model" that encourages faculty, staff and students to understand the important supportive role they can play and to be aware of such signs that may indicate a mental health problem -- absences, falling grades, disheveled appearance, crying, scars on forearms from cutting (which a recent Cornell and Princeton study found to be quite common) and students talking directly about their distress.

The aim is for faculty to engage troubled students, respond appropriately, make referrals and call and consult with their college's or school's advising office when necessary. Campus phone books this year will include a quick reference wallet card with key student-support health services and emergency phone numbers that faculty are encouraged to keep handy.

The university's Council on Mental Health and Welfare (initiated in 2004) fit well with the pilot study framework. Headed by Vice President for Student and Academic Services Susan Murphy, the council is a cross-campus group of faculty, staff and students that studies the campus environment in order to advise the provost and president on how to decrease risks and improve support for those in need. Also, a 10-member Alert Team meets weekly to discretely track specific students who display such risk signs as getting in trouble with the police. In some cases, the team may pre-emptively reach out with support.

Finally, a cornerstone of the Air Force model is that leadership needs to set a new tone to prompt culture changes regarding mental health. In the Air Force, a four-star general made public statements about the importance of mental health, that seeking help was a sign of strength, not weakness, and that such efforts would advance people's careers.

At Cornell, President David Skorton's Aug. 19 convocation address was peppered with messages about the need for compassion.

"I urge you to think about the person next to you, the person across the hall, the person in your class and to help us build an even more caring community," he said.

Cornell Minds Matter plans new events for spring semester

Cornell Minds Matter (CMM), a student-run mental health awareness and advocacy organization, has planned a few events for next semester for those interested in getting support and meeting fellow students.

Feb. 2: CMM will sponsor a dance/club event with nonalcoholic drinks, food and information about alcohol awareness and mental health.

Feb. 19-23: Minorities and Mental Health Awareness Week. Events include a mental health resource fair, mental health facts game night, and a panel of speakers, a discussion session and dinner.

CMM also will be starting a regular "Support Group" next semester for students dealing with depression or anxiety. This will not be a therapy or counseling group, just a support/discussion group where students can learn from each other, support each other and discuss topics of interest. Students interested can contact CMM adviser Casey Carr at or (607) 255-3897.

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