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.

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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.

Open Mosque, and the not-quite Reformation

Vice writer Gavin Haynes has a new feature out about Open Mosque, an eclectic liberal mosque in Cape Town. I think he oversells the idea that Open Mosque is unprecedented in its views (the Alevi of Turkey are millions strong, largely secular, left-wing, and gender-equal). Otherwise, I found it interesting. The idea that Islam needs a Reformation like the one Luther kicked off in the 16th century has gained much currency recently with the rise of ISIS and their so-called ‘caliphate’. This is problematic- early Protestants were extreme theocrats (anyone living in Calvin’s Geneva would let you know that), the two religions are dissimilar in a lot of key areas, and since the Reformation global industry, culture, and politics has emerged that create complications. But taking the idea of the Reformation as a potential good, let’s go on.

Haynes gives an idea as to what a Martin Luther figure would look like- TV news tends to skimp on the details of how a Reformation would work, besides moderate Muslims creating new institutions that end the reign of hard-liners. Taj Hargey has a key thing in common with Luther- going back to the core text and using it as the moral guide to society. This is a lesson that all religious people can use- going back to scripture, what does it say, and what kind of society does it put forward? What is the gap between scripture and modern day religious authority? I don’t think Open Mosque will change the face of world history like Luther managed to, but it is offering a genuine alternative. What I worry is that violence against him and his congregation will prevent the spread of new ideas.

Despotic democracies

China focusing on environment, fighting corruption
The Chinese National People’s Congress, March 5th, 2013
credit: AP/Ng Han Guan

On March 9th, the Democratic People’s Republic of Korea (DPRK)- known as North Korea, though they don’t like a name that implies there’s more than one- held its latest parliamentary election. Elections have occurred throughout North Korea’s history, just as they once did in the Soviet Union and Nazi Germany, and continue in China, Laos, and many other countries that would be classified as non-democratic by most uses of the term. The result was unanimous- 100% support for Kim Jong-un and 100% turnout. Clearly my recent concerns about voter apathy don’t apply to the DPRK.

An elaborate sham, of course- a UK minister stated “our Pyongyang Embassy visited a polling station and, contrary to media reports, concluded there is no ‘D’ in ‘DPRK’”. No independent parties, no civil society, no free speech. You can vote against the one candidate provided in your district, but that requires going into a special booth to cross it out. So a show of opposition is sure suicide.

Why does the DPRK, or any other one-party state bother with an election that serves no governmental purpose? They could ban elections and not care- certainly Eritrea hasn’t held a national election since independence in 1993, and has about zero interest in holding one. You’ve got uncontested power, everyone knows it.

The makeup of the DPRK’s Supreme People’s Assembly.
Dark red: Worker’s Party. Other colors are puppets under the same front.

Several years ago I took an independent study in comparative government. I didn’t do all that much (it was my senior year of high school, what do you expect), but I did read a few interesting textbooks on the subject. One put forth the idea of the “democratic idea.” Not democratic ideals- values like equality, justice, and human rights we see as part and parcel with representative government. Rather the simple idea that a country is a democracy.

11th Congress of the Socialist Unity Party of East Germany (SED), 1986.

In the modern era- say, since the end of World War I, very few countries will openly state that they are anti-democratic. Germany under Nazi rule held an election in 1938. The year before the Soviet Union did the same. Even if the elections ain’t fooling anyone, there seems to be a need to use elections as a means to legitimacy. Often a regime supported by military force will switch to politics-  the Burmese junta held regular elections ( in 1981, for instance), before making the mistake of having a free election and losing. The trend indicates that democracy has an intrinsic attraction- it’s a matter of world consensus that democracy, at least the veneer and symbol of it, is a good thing. The United Nations is full of voting members who’d never conceive of an open debate on their own soil. If a nation can be a part of the General Assembly, yet not give up a smidgen of political power, they go for it.

There is also the idea of elections as a patronage system. From a Big Think piece of sham elections:

According to Bueno de Mesquita a dictator or autocrat can conduct a rigged election, not to confer legitimacy or choose the right person to govern the country’s affairs but to cultivate loyalty. Bueno de Mesquita argues that a ruler will let sham elections run in their country so that they can communicate to the politicians around them that they are expendable should they stray from the desired agenda.

If you have ultimate control over who gets elected, it’s a way of doling out bits of political prestige. With the North Korean election, it provides a more diplomatic way of moving to a new generation. Kim Jong-un certainly was fine with executing the old guard, but he doesn’t have to do that as his sole weapon.

These sham processes are not impervious to change. Currently the People’s Republic of China is holding its annual National People’s Congress. The NPC is becoming something new and different- more responsive to local concerns and increasingly willing to defy the official party line. Vietnam is on the same route. In many ways there isn’t a huge gap between the era of rubber-stamp parliaments and a new era where the democratic process actually shows up for some of the party- all the elections and meetings may ultimately have provided a platform for reform at a later time. Ludicrous as it sounds, authoritarian states practice many things that will be needed, in a similar form, if that state becomes democratic. It’s a dry run for a real, competitive election. Perhaps that redeems the farce. Perhaps not.

An interesting paper weighing democratic feeling among East Asian states can be found here, which debates how important democratic institutions are on a practical regime level.

 

 

 

May Day march, San Jose CA; May 1st, 2013

May Day march, San Jose CA; May 1st, 2013

I took the day off yesterday to march in one of the three major May Day marches in the Bay Area. The San Jose one was by far the largest- local news station KGO cited several thousand protestors. May 1st is International Workers’ Day, and has special importance to socialist and anarchist groups. After the splintering of large leftist groups in the decades after World War I, the holiday stopped being a major event in the United States

However, starting in 2006 in reaction to the caustic immigration debate in Washington D.C, immigrant groups have used the day to march in favor of immigration reform and against business exploitation of undocumented workers.