Campus mental health (II)

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UC campuses received poor scores on the accessibility, diversity, and outreach of their mental health services

This is part two of a series on UC mental health and the campaign to reform it. A previous post outlining areas of concern is located here.

The UC Students Association (UCSA) has released their evaluation of campus mental health resources, part of a new reform campaign (#HowAreYou) which was adopted last August. Three areas were measured: accessibility of the system, diversity of current staff, and extent and quality of outreach.

Results: not good. UC students would be appalled if their own academic grades were this bad. Campuses scored best on outreach, which is the least important of the three criteria. The core issue is accessibility. Diversity among counselors is only meaningful if students can get appointments within a reasonable amount of time- and are allowed a sufficient number of sessions per term. Outreach is key- it destigmatizes mental illness, and plays a key role in the increasing number of college students looking for treatment in the last fifteen years. But effective outreach magnifies accessibility issues. The more students who seek Counseling and Psychological Services (CAPS) or an equivalent service, the more meaningful staff to student ratios become. It’s clear that the rise in demand for counseling and psychiatry is outpacing general student growth and funding allocations.

These issues aren’t new. A 2006 UC Office of the President report (PDF) outlined the same basic problems. Their findings summary stated:

The increased need by students for campus mental health services has resulted in an overtaxed delivery system at UC that falls significantly short of meeting the actual student demand and expectation for services

The cumulative toll of this shortfall in service capacity has had and continues to have a significant negative impact on all campus populations, including other students, faculty and staff; on the affected individual student’s academic performance; and on that student’s overall mental and physical well-being.

Further, it is the Committee’s considered view that this situation will not improve over time, and indeed given general societal trends can only further deteriorate, without aggressive intervention on the part of the institution. This intervention must include a systematic review of policy, enhanced communication mechanisms, and a renewed commitment to campus-wide collaboration along with an infusion of new resources commensurate with both the nature and magnitude of the challenge now facing the University.

As usual, the issue boils down to money. The reason is the corporate-like administrative structure that ties up over a billion dollars more than is needed to run the UC. A low-cost, high revenue structure will always underfund student services like counseling. This combines with the ‘progressive’ state government abdicating its duty to provide quality higher education. Thus we are told that any investment in students will raise tuition, because in 2016 there is increasingly little difference between private and public universities. Remember how K-12 is a right, but once you hit around 18 education becomes a paid-for privilege? Students and faculty are hostages of a mindset we see in corporations all the time, where investment in people makes the system uncompetitive.

With that out of the way, I’d like to talk about the disability services for students, in the context of mental health. There are several names for this office:
Office for Students with Disabilities at UC San Diego and UCLA;
Disabled Students’ Program at UC Berkeley and UC Santa Barbara;
Student Disability Center at UC Davis;
Student Special Services at UC Riverside;
Disability Resource Center at UC Santa Cruz;
Disability Services Center at UC Irvine; and the Disability Services Office at UC Merced.

When #HowAreYou was first presented in a public meeting at UCSD, I had issues with its depiction of a full coalition of groups and university services. I like the focus on collaboration- as improving mental health is not just about psychologists but peer mentors, wellness education, student groups, resource centers, etc. But mental illness as disability was never mentioned. Laws like 5150 involuntary commitment were mentioned, but the Americans with Disabilities Act (ADA) was conspicuous in its absence.

Updated design of the International Symbol of Access

Under the ADA, the definition of disability (Section 12102) is broad and non-exhaustive. In public perception, the term “disability” has been strongly tied to physical disability. The International Symbol of Access is the image most closely tied to the concept of disability- part of an inherent bias towards conditions that others can perceive and verify. Part of stigma is how people may not perceive psychological issues as potentially chronic or severe.

So let’s turn the three branches of #HowAreYou– accessibility, diversity, and outreach. All of this is based on my own experience, the experience of many friends and people I come across, and hour-long meetings with a case worker who deals with the largest portion of students seeking help with psychological conditions, dedicated to talking about the mental health system.

Accessibility: There are many different accessibility issues inherent in psychological conditions being the basis of disability accommodations. Here are some that come to mind initially:

  • Especially in cases of mental health, there are few connections between disabilities office and other parts of the university. Professors rarely, if ever, talk about it or put information on their syllabi. It’s seldom a topic of conversation in student groups.
  • Documentation is difficult for someone with no prior experience.
  • The ratio of case workers to students leads to logjams early in each term as everyone is trying to get their accommodations set and given to professors.
  • Faculty may block accommodation requests, which the student must then solve by going back and forth between the office and faculty.

Diversity: The same issues exist here, as it does when talking about CAPS.

  • Case workers and staff must be equipped to deal with a very broad spectrum of disabilities (movement, deafness, blindness, learning disabilities, anxiety, depression, mood disorders, PTSD)
  • Students may lack confidence in a staff member without shared experience (for instance, a deaf person may feel their obstacles can’t be fully experienced, or a depressed student may feel their issues are being devalued because it’s not visible)
  • Students may come from cultural backgrounds that don’t talk about mental illness, and may stigmatize those who have problems. This is brought up frequently by Asian Pacific Islander (API) students, and is relevant with both CAPS and disability services.

Outreach: Stigma is a big factor here, but I’m very insistent here- the stigma of having mental health problems is very different from the stigma of having a disability. So campaigns launched by #HowAreYou will have limited effect if they are only talking about the direct stigma of mental illness.

  • The disabilities office, like CAPS, is given a very limited slice of time in orientation. With so much information in a day-long event, students are unlikely to follow up with the office if they had heard about it for the first time.
  • Faculty aren’t trained at all about disability accommodations. Thus they often treat accommodations as guidelines rather than legal rights. If faculty have to go out of their way to meet standards, they will often refuse to honor entitlements.
    • Many faculty are new to teaching, or from countries that do not have an equivalent to the ADA. So a large chunk of teachers every year will have no prior experience with the system.
  • Because mental health is usually placed in a therapy/treatment rather than disability context, anti-stigma campaigns rarely address that there are two stages of stigma of mental illness.
  • The disabilities office rarely has a robust outreach component. They will table at resource fairs and present at orientation, but there is rarely a push to get staff and student mentors in club meetings, classes, and hold events specifically about disability.
    • It should be said that everything here applies more to psychological disabilities than other types. Many people have no idea psychological conditions are legally disabilities.

So this concludes my second post about mental health in the context of the UCs and the #HowAreYou campaign by the UC Students Association. I welcome any information by those that have experience with disability services and mental health, especially outside UCSD.

My next post will be about the structure of how students give accommodations. An exchange with someone at a community college in Northern California shows that there are multiple ways to go through the process, and I think some are superior to others.

First thoughts: campus mental health


This post is to mark the beginning of  How Are You at UC San Diego, a student mental health overhaul instigated system-wide by the UC Student Association (UCSA). Mental health for students, from elementary school on through graduate education, is in crisis on a structural level. The toll of mental illness has always been underestimated, and thus few schools have services to match need. Nationwide studies find sharp increases in college students seeking counseling.

Dr. Victor Schwartz in the linked article outlines two potential reasons that campus services are being overwhelmed. Number one, that college students as a population are having more issues than before. Number two, more people with existing issues are seeking treatment, so it’s not the density of the problem but the response rate.

I’m firmly in the camp that thinks reason two is the key issue. In my previous post on student health, “The fantasy of perfection,” I wrote about the crisis that appears when mental illness is viewed as weakness. Society waking to the reality that mental health problems, both acute and chronic, are common features of the human experience is a huge development. So while the present is a challenge on a resource level, it is at the same time an incredible opportunity.

So I’m just going to list nine things that should be considered by the How Are You campaign at the UC schools, and campus mental health campaigns in general.

The introduction of mental health resources to new freshman and transfer students. Existing orientations tend to lump all resources together- first-generation college students, sexual assault counseling, centers for racial and ethnic groups, reporting discrimination, with psychological services and disability services mixed in among them.

Identification of students who may need help. In particular, the training that RAs, graduate assistants, professors, and student leaders have, and the criteria by which they intervene.

Outreach to special groups. This can be split into vulnerable populations at risk of dropping out, and those coming from a culture where mental illness is a taboo subject. This includes having diversity in personnel, as in America counseling often defaults to white women.

Handling of acute crises. Some students need to see someone more or less now. There needs to be slack in the system to deal with an irregular number of special cases.

Handling of chronic cases. Each new person with a chronic need aren’t filling up one slot, but several each term. This leads to:

Referral. At some point, a delay for someone with chronic need becomes excessive, and off-campus help is preferable. The system needs to provide a sufficient variety of options- not only diversity of practitioners but choice easily accessible by students without a car. This includes student health insurance being accepted at most practices, and referrals being timely.

Connections with disability accommodations. Under the Americans with Disabilities Act, people with chronic psychological conditions have special rights and can qualify for accommodations to make academics easier. However, the stigma of mental illness is distinct from the stigma of having a disability. Thus additional outreach must be made. The counseling office and disability office need to be well-connected.

Faculty education. In particular, making sure that accommodations students receive for a psychological issue are respected. Professors may resist making changes to their routine, such as letting students take a test at a different time. This needs to be restated as a civil rights issue.


Letting peers tell their own stories. Having experience with a speaker’s bureau, I can attest to the power of having people with mental health issues open up. Having the ability to educate is empowering. People dealing with mental illness should be able to self-liberate.

Onwards and upwards.


Playgrounds as a civil rights struggle

There’s a nice three-minute video released today by Al Jazeera America, part of a much wider collection of material on the 25th anniversary of the Americans with Disabilities Act (ADA). It’s about playground accessibility, which is a struggle that has emerged largely in the aftermath of the ADA. Indeed, in the year I spent on a county disabilities commission, the ADA compliance committee (its most important part, since they decide how to spend limited grants from the state and federal governments) spent a huge chunk of time on playgrounds. Basically no playgrounds created prior to the ADA met code. Like all other structures, they have to evolve with the many amendments to the Act, which have made many new areas in violation.

Disability accommodation and accessibility are civil rights struggles. The failure of conservative lawmakers to pass the Convention on the Rights of Persons with Disabilities due to a series of vague, conspiratorial concerns is not the exception, but rather part of an ongoing undermining of a large, diverse group of oppressed people that was in no way ended when the ADA was signed.

How tax money is spent is a reflection of a society’s commitment to their ideals. The United States prioritizes defense spending above programs that would help implement what the Constitution and American idealism espouse. Indeed, how much time and attention is paid to playgrounds can tell us much about the larger social justice struggles of the 21st century.