SHAWN CHENG/YH

Why do students slip through the cracks?

During the two months that Branford senior Greg Norris was missing, his friends, his professors, and even those who never knew him wondered what had become of him, hoping for the best. Those who knew him well were dreading the worst. Their fears were realized when the New York Police Department announced it had found Norris' body on Mon., Dec. 20. The New York City medical examiner confirmed on Mon., Jan. 10, that his death had been the result of a suicide. As the mystery surrounding Norris' disappearance dissipated, an uneasy sadness made its way to every corner of the Yale community. And with that disquiet came a lingering question: could anything have been done to avoid it?

Norris had been seeking counseling at University Health Services' department of Mental Hygiene—but the help he received there fell far short of what he needed, according to Norris' roommate Swami Kumaresan, BR '00. "Greg went in for weekly therapy and came home feeling terrible," Kumaresan said. "His therapist was listening but not helping him cope with anything. He went in, suffered through an hour of talking about his life, got his prescription and left. That's all. I don't think any progress was being made. From what he told me, his therapist wasn't too bothered by that either."

Was Norris' experience typical? Yale's Mental Hygiene program is one of the most highly regarded in the nation, according to psychiatrists around the Ivy League. Between 25 and 30 percent of Yale undergraduates seek counseling at Mental Hygiene during their four years at Yale, largely without incident or complaint. But an environment where seeking help is perceived as both acceptable and effective has yet to materialize.

Being a student at Yale is hard enough. But being a student trying to combat depression at Yale is even harder. Residential college deans are the first and most immediate people able to respond to struggling students. Mental Hygiene's psychological counseling services provide the most common forms of treatment. In the most serious of cases, hospitalization at facilities such as the Yale Psychiatric Institute (YPI) can become necessary. But does this combination of services truly amount to an effective safety net? When the system fails, as it seemed to in Norris' case, it prompts students and administrators alike to question whether the University is doing everything it could to help students who suffer from depression.

Navigating the system

In a number of ways, Norris was like many other students who seek counseling through Mental Hygiene, yet the tragic outcome of his case made him an exception. Did Yale's system ultimately fail Norris? Or does his case illustrate the limits of even the strongest mental hygiene programs? Alice Norris, Greg's mother, declined to comment on her feelings about how her son had been treated at Mental Hygiene. But according to Kumaresan, a psychiatrist Norris saw over the summer wrote a letter for Norris to show to his psychiatrist at Yale, emphasizing that Norris had suicidal tendencies. "I've read the letter— Greg showed it to me," Kumaresan said. "That he was potentially suicidal was made clear in the letter, and I know [Norris' doctor] read it."

Blake Hounshell, TD '00, who has suffered from depression for most of his life, went to Mental Hygiene in the spring of his junior year for help. "I was suicidal at the time, and I told them so," he said. "I should have been popped into a hospital. Instead, I was given a prescription for Paxil, an anti-depressant, and given counseling which made me feel like I needed to search for incidents in my past to explain my situation." Dr. Lorraine Siggins, chief psychiatrist at Mental Hygiene, defended this mode of treatment. "Students are so used to being able to control things in their lives that it's sometimes difficult for them to tolerate their feelings," she said. "We try to get them to come to terms with things from a longer perspective. Impulsivity is often one of the problems."

But Hounshell was unhappy with this approach, and soon stopped attending his twice-weekly therapy sessions. "When I stopped going to my appointments at Mental Hygiene, I got one call, and that was it," he said. "I wasn't really in shape to take care of myself at all. I'm surprised that I'm still alive."

When students go to Mental Hygiene for guidance, there are two ways they can be treated. If it is an emergency, they will almost always be seen that day. "Freshman year I was feeling really crazy," Steven,* a recent Yale graduate, said. "It was midnight, it was snowing and I wigged out; I was talking to myself, I walked down to Mental Hygiene, and they actually called up a psychiatrist who agreed to meet with me right then and for the next couple weeks."

But if the student is not in this sort of an urgent situation, he or she must arrange an "intake appointment," usually scheduled within two to three days of the student's initial call and intended to pair the student with an appropriate therapist, according to Siggins. Yet many Yale students agree that the

intake system often provides a bureaucratic obstacle to finding the right therapist. "It can take tons of time to find the person who you match up the best with," said Walter,* a Yale senior who has repeatedly sought counseling at Mental Hygiene. "I know that you can call up and say that it's an emergency and get help, but I don't think anybody knows about this. Otherwise, you go and they give you this completely worthless pre-interview. You can feel yourself being steered toward a classification because they desperately want to figure out what to do with you. I think their favorite one is manic depressive. I think manic depressive at Mental Hygiene is kind of the equivalent of them telling you you're pregnant when you go in if you're sick."

Siggins disagreed with this appraisal, saying Mental Hygiene tries to avoid such pigeonholing. "Sometimes students are concerned that you're going to try to fit them into a particular mold," she said. "We try to help the student to be who they want to be, and to lead a fulfilled life."

For some students, another obstacle to obtaining effective treatment at Mental Hygiene is the time they must wait between their intake appointment and their first session with their assigned therapist. Siggins said that this period is typically anywhere between seven and 14 days. Her department has a staff of approximately 20 psychiatrists, psychologists, and social workers to handle the many appointment requests. But even that many therapists simply may not be enough to meet the demand. "I was seen for an intake appointment after two weeks," Dixie,* who sought help at Mental Hygiene last year, said. "Then I didn't get a regular appointment for another eight weeks. I called at a busy time, but that was a significant amount of time to wait."

Having to wait this long for an appointment can itself be a potential risk to a student's mental health, according to independent psychologist Jeannette Gerzon. "When a student calls and asks for an appointment and they're told they have to wait for a month, that could be felt as devastating," she said. "Counselors care deeply about students, but it's important that somehow students make it clear when they need to be seen."

Once students are assigned to therapists, they may not always receive treatment appropriate to their problems. "The psychiatrist I saw at DUH would sit me down on a couch and take notes, and if I didn't talk he had no means of prompting me," Walter said. "The one thing he did do right off the bat was give me Prozac before he asked me what my name was."

But there are many success stories, and students clearly continue to make use of Mental Hygiene's services. After her initial setbacks, Dixie eventually found a therapist she loved. Though she said she has received top-notch treatment ever since, she added, "To do well at Mental Hygiene you have to know how to navigate the system instead of being tossed around in it."

Too little, too late?

ANDREW HEID/YH Students are often hospitalized at the Yale Psychiatric Institute (YPI) when their depression becomes life-threatening.

But when students are severely depressed, they often lack the energy or the will to take on the system themselves, and more serious treatment measures become necessary. Had Norris' doctor judged his life to be in danger, he might have placed him at the Yale Psychiatric Institute (YPI), a psychiatric hospital that treats patients from every walk of life who suffer from a wide variety of mental disorders. Dr. Robert Milstein, a psychiatrist at YPI who deals primarily with the Yale students staying there, said hospitalization of Yale students at YPI usually occurs "in a circumstance of extreme risk, where there's a real concern for the person's safety."

Hounshell ended up at YPI in November after he stopped seeing his Mental Hygiene therapist and stopped taking his anti-depressants. He insisted to therapists at Mental Hygiene that he was not suicidal, but they nevertheless concluded that he was and called an ambulance to take him to YPI. "I lost my choice in the matter," he said. "I'm not sure that at that particular time I needed to be at the hospital for a week. There were a few Yale students there when I was and we were all talking about how we thought Yale might have put us at YPI just to be safe because Greg had just disappeared. But how can you really blame Yale for that? I did have a history of suicide attempts and going off my treatment."

Is YPI the best option for students who have the potential to harm themselves? Would Norris have been safer if he had been hospitalized there? Rose,* another Yale student who spent time at YPI, had mixed feelings. "They didn't make it an environment that was specific to me being a student," she said. "It was never really acknowledged that I was going to be going back to school. I didn't think the specific questions that the therapists, the doctors, and the nurses gave me were helpful. But I give YPI a lot of credit for accomplishing what might not have been accomplished otherwise, which was that I became physically stabilized."

This physical stabilization is YPI's main aim, according to Milstein. "Our goals are short-term with a view toward the long term," he said. "The long-term goal is to help the person get well. The short term goal is to help them leave the hospital to safely continue their treatment on an outpatient basis and get well."

But Hounshell felt his time at YPI did little to initiate any permanent improvement. "There was no education, no treatment, basically all day you did nothing. They had groups, but they weren't relevant to the problems of Yale students. You were just kind of imprisoned." Ironically, it was this very sense of imprisonment that led Rose to commit to recovery. "I really did not have a good experience," she said. "But I thought, I'm going to be stuck here until I can figure out how to get better. And that was basically the impetus that made me realize I wanted to get well."

Jane,* a friend of Norris' who spent several days in YPI last year after a suicide attempt, felt its chaotic environment made her feel worse. "I think I definitely needed help, but if anything, personally, being in YPI depressed me even more." She added, "I don't think being in YPI helped me. I'm not going to say it wouldn't have helped Greg, but I don't think it's ever a surefire thing." Looking after our own Though Yale's Mental Hygiene program has often been regarded as the standard for other top institutions, Norris' case suggests the limitations even the best university counseling programs face. Some of the features in Yale's comprehensive counseling program include the training of residential college deans, professors, advisers, and coaches routinely on how to recognize troubled students and refer them to Mental Hygiene. In addition, each residential college has its own liaison to Mental Hygiene who is on call whenever he or she is needed in difficult situations.

Harvard appears to be following in Yale's footsteps in instituting many similar counseling policies. In September 1999, Harvard University Health services conducted a student poll in which 36 percent of those surveyed rated its mental health services fair or poor. After eight months of interviews, the committee made a series of recommendations. These included instructions to train resident advisers and professors on how to spot and help students suffering serious mental problems. The committee also recommended that Harvard set up "safe spaces" for stressed students with roommate problems in each of the residential houses, and appointed a Mental Health liaison to each residential house.

When informed of the changes Harvard was proposing, Walter said, "I think it looks really nice for Harvard but I don't think it addresses any of the central issues." He further questioned the potential of such changes to encourage students to seek help themselves. "The fact of the matter is that you're not going to change the stigma against seeking help for mental illness. If Yale had made it known that some of these services were available here, that would be a great help. I think deans should make speeches about the treatment that's available for depression."

Deans are indeed intended to be the linchpin of the residential college-mental hygiene connection. "This sounds basic, but the deans eat a lot of meals in the residential colleges and they can see who's not there, and when someone's not there for several meals in a row, they're concerned, just like in a family," Dean of Student Affairs Betty Trachtenberg said. "When somebody's not around, the ears begin to perk up. Students also become concerned. If the residential colleges function well as a community, then the community looks after its own."

Branford College Dean Nicole Parisier agreed with Trachtenberg. "I feel like it's actually not that hard to figure out who's not well," she said. "You have to be attentive, and you have to be present to be effective. You can figure out who's sad and who's lonely and who's isolated. You just have to try."

But the dual role of the dean as academic and emotional adviser is sometimes problematic. "Deans know everything about you, they're supposed to be writing recommendations for you, they decide on freshman counselorships, but they also play the role of a social adviser," Argyro Caminis, BR '00, said. "That can be difficult for students to understand because they risk getting a lousy recommendation."

ANDREW HEID/YH Twenty-five to thirty percent of Yale undergraduates seek counseling at University Health Services Department of Mental Hygiene during their four years at Yale.

Gerzon said that in her experience, students tend to distrust deans and administrators, despite their efforts and intentions to help. "It's easy to go after administrators as if they're the wrongdoers, but I think it's important to know how much these people care," she said.

Davenport Dean Susan Wennemyr said she did not view her dual role as academic and social adviser as conflicting. "I see mental illness as a sign of suffering, not of failure," she said. "If we dismissed the mentally ill as contributors to our culture, we would miss the brilliance of Van Gogh, of Poe, of Nietzsche, of Thoreau."

The Massachusetts Institute of Technology (MIT) has a unique way of maintaining the division between academic and social advisory roles. The school makes prominent use of four counseling deans who are the first place students can go before making the decision to see a therapist,according to Peter Reich, chief of mental health services at MIT.

Increased use of Mental Hygiene liaisons is one way some deans try to help their students cope with depression. Wennemyr had her liaison constantly available to Davenport students in the days after Suzanne Jovin's death.

"The liaison is not on duty all the time but is on call," Trachtenberg said. "Very often the liaison and the dean speak and they work together to solve a problem.They can also be used with freshmen working out roommate problems." Could the liaison's role ever be expanded to be the equivalent of a writing tutor—someone who is there when and if students need him or her? Both Trachtenberg and Siggins said it was an interesting idea, though they expressed concerns about the logistics of the situation. "Often the times don't work out—Yale students are very busy," Siggins said.

Hounshell feels that any improvement of on-campus awareness and treatment about depression would be helpful. The closest program to this right now is Walden, a student-run anonymous counseling service, which runs a hotline (2-4477) from 8 p.m. to 8 a.m. seven days a week.

"There is no program at Yale for the prevention of depression, there is no general outreach," Hounshell maintained. "I think there should be support groups sponsored at DUH or YPI. There needs to be a sense that you're not a failure if you need help. Yale is the place it is because it pushes people so hard, but it doesn't need to push too hard at the expense of people's health."

On a mission But in the end, no matter how much information is disseminated, no matter how many professors are trained, and no matter how many committees are made, when a depressed student is determined to commit suicide, most agree that little can be done to stop him or her. "Greg fell through every available crack," one Branford senior who was a friend of Norris', said. "I don't think Greg wanted anyone to know. In a sense, he got what he wanted."

Professionals around the Ivy League concurred. "When we know someone is suicidal then we can take actions," said Marvin Geller, director of the Princeton University Health Services Counseling Center. "But there are times when someone's masking that they're doing, or they're doing something impulsive where no one's had any warning. We've had students who are just hell-bent on killing themselves." Parisier added, "What can be frightening is that sometimes people don't know that you care, especially when someone is feeling depressed or isolated or alone."

Walter felt that the nature of Yale had much to do with the worsening of his own condition. "It is tremendously easy to get lost here, because so many people are—and have to be—so absorbed in their activities, that it's very easy to spend three weeks alone in your room and have nobody notice. That's when depression really gets out of control."

But Norris' friends seem to feel that nothing could have stopped him from taking his own life. "I don't know whether or not Greg ever would have gotten the adequate help that he needed," Jane said. "When someone is on a mission like that there's very little you can do."

Calhoun Dean Stephen Lassonde pointed out, "The thing with [the Norris incident] is that in the end, there is only so much you can do—you can't be responsible for every minute of a person's life." Kumaresan, despite his insistence that Norris' Mental Hygiene psychiatrist knew of his suicidal tendencies and was unresponsive to them, agreed. "If someone really wants to die, they'll probably find a way."

*Names have been changed to protect anonymity. Julia Paolitto contributed to this article. Discuss this article and the issue of student depression at Yale online at www.yaleherald.com.

Back to News...