“Asking for help is taking action,” said Tori Gruber ’17 at “Reducing the Sigma,” a panel hosted by the MINDS foundation and Well-Being House last month to discuss mental health on campus. “That takes so much strength, more strength than relying on yourself.”
At Wesleyan, more students than ever before are seeking help through Counseling and Psychological Services (CAPS). During the 2013-14 school year, CAPS saw 724 students for a total of 3,364 visits. This marks an increase of about 30 percent from 2010-2011 in both number of students and visits to CAPS at the Davison Health Center.
“The demand has really gone through the roof, for sure,” said Director of CAPS Jennifer D’Andrea, the director of CAPS. “I would like us to keep our wait list for initial appointments to about a week and a half, and we’re not able to do that right now.”
CAPS was founded by Dr. Philippa Coughlan in 1971 and was initially based on a private practice model. In addition to Coughlan, the staff consisted of three full-time psychologists—one of whom, Psychotherapist Linda Russell, remains on staff today—who focused primarily on individual therapy. D’Andrea, who joined CAPS in 2009, was promoted to director in 2011 after Coughlan died.
“Even though the office is over 40 years old, I’m only the second director it’s ever had, which is kind of weird,” D’Andrea said.
Under D’Andrea’s direction, CAPS has expanded its staff and shifted toward a community mental health model with an emphasis on education and prevention as well as individual therapy.
“I’ve tried to really keep a focus on therapy, because there’s such a demand for it, but also integrate the office more into the University community,” D’Andrea said. “Which is hard, and it’s hard for two reasons: one is that every hour you’re devoting toward education and prevention is an hour you take away from therapy, and [the second is that] the more you’re out there in the community, the more people know about you, and the more the demand for therapy goes up. So it’s kind of tricky.”
The current staff consists of six therapists, with only two, Russell and Lisa Miceli, working full-time. The remainder of the staff work part-time: D’Andrea, Post-Doctoral Clinical/Counseling Psychologist Smith Kidkarndee, a fellow who also does outreach; Psychotherapist Anne Keating-Scherer, a social worker whose position was added this year; and Sexual Assault Resource Coordinator Alysha Warren.
Warren specializes in dealing with sexual violence, both with individual survivors and within the University community by organizing campus events geared toward education and prevention.
“I work to create a safe and supportive space for survivors of trauma that supports them in rebuilding their sense of safety and enables them to reconnect with their resilience,” Warren said. “Loss of power and control factors largely into sexual violence, and I work to help people rediscover their power.”
In recent years, Warren has introduced significant changes in the support services offered to survivors of sexual violence.
“Since the fall of 2011, with the exception of fall 2013 due to low interest, we’ve offered support groups for survivors of sexual assault each semester,” Warren said.
She has also organized groups and retreats that use art, writing, and yoga to aid survivors in the healing process.
Additionally, Warren has spearheaded campus education in order to prevent future sexual violence.
“In Fall 2013, we offered WEconsent, a seven-week sexual violence organizing training series that prepared students to organize and lead sustainable programming on campus,” Warren said. “The training provided an overview of sexual violence, effective organizing principles, best practices in sexual violence education and helped students build facilitation skills to navigate emotionally difficult conversations. The students were also trained in bystander intervention.”
Many CAPS initiatives, like WEconsent, aim to combat specific mental health-related issues. Despite the considerable variety of CAPS services, therapy—in the many forms it takes on campus—does not always sufficiently alleviate the struggles of students, particularly those who may suffer from mental illnesses.
When CAPS therapists suspect that their patients may need further mental health care, they refer them to Katina Varzos, CAPS’ Part-Time Psychiatric Advance Practice Registered Nurse. Varzos, who received her Master’s in Nursing at Yale, specializing in midwifery, assesses students’ mental health and in some cases, provides mental illness diagnoses.
Varzos deems whether CAPS patients require medical care and prescribes medication when it is necessary. However, she stressed that medication, unlike therapy, is not always a crucial aspect of recovery for those struggling with mental health.
“At CAPS, we believe that therapy is an important and essential aspect of treatment,” Varzos wrote in an email to The Argus. “Medication can sometimes enhance this modality, but it is not always indicated.”
Varzos works around 20 hours a week, usually split up between three days. She sees between 10 and 12 students each day she works. Because Varzos’ position is new this year, her role is still evolving. In addition to providing students with diagnostic and medication management, she refers CAPS patients to other mental health programs that may be better suited to their needs.
“CAPS may act as an intermediate crisis management service, ultimately providing referral and recommendation to a level of care that can better accommodate a student’s needs (such as biweekly therapy, intensive outpatient program, or hospital evaluation),” Varzos wrote.
One of Varzos’ main responsibilities has been to refer students with mental health struggles to community providers in Middletown. Currently, she is compiling a list of local providers, taking into consideration financial concerns, the limited coverage of some types of health insurance, and differences in student needs based on individual diagnoses and personal struggles.
Rachel Kaly ’17, who recently published an article in Method Magazine titled “I Am Not What I Am” about her battle with an eating disorder and bipolar disorder, was frustrated by the suggestion to see a local psychologist instead of a CAPS therapist.
“They…suggested I get a psychologist in Middletown,” Kaly recalled from her experience with CAPS last year. “Which is fine, but…if we have a mental health center on campus why [not] use that?”
Many students, like Kaly, are prescribed medication by doctors at home and must have either a CAPS professional or a psychiatrist in Middletown prescribe the medication again.
“This is actually a very common scenario,” D’Andrea explained. “They have a medication provider at home, but the doctor says, ‘Listen, I’m not going to be prescribing for you while you’re at Wesleyan. I can’t see you, I can’t monitor you; you’re in another state.’ So that’s fine, we can see that student, we can prescribe medication, as long as they’re willing to get hooked in with a therapist and come in at least a couple times a semester for check-ins. And then, over breaks, the student just goes back to their home person.”
Regulations like the aforementioned policy about check-ins mean that the student demand for time at CAPS is high, often too high for the regular staff to accommodate on its own. In addition to its core staff, CAPS employs four externs, students from the University of Hartford’s Doctor of Psychology program who are supervised by an outside psychologist. These externs have a limited caseload in individual therapy, typically between 6 and 10 students per week, and facilitate support groups on the side.
Although D’Andrea is optimistic about the overall role of group therapy among CAPS’ offerings, she notes that these therapist-led groups have had mixed results.
“I think that Wesleyan students in general are more comfortable going to groups when they’re not being run by a therapist,” D’Andrea said. “There have been times we’ve organized groups in the past, and nobody comes…even though I know that there’s a need for it.”
D’Andrea hopes that student-facilitated groups, which emerged for the first time last spring as part of the WeSupport program, will have more success. In WeSupport, a series of workshops taught by D’Andrea and Kidkarndee, students learn how to improve their interpersonal relationships and how to be a peer health advocate within the University community. The program has been incredibly popular, according to D’Andrea, with a wait list of 20-40 students each semester since it began in 2012.
“There seems to be a really strong interest by Wesleyan students in just supporting each other and being able to be present for each other,” D’Andrea said. “I think Wesleyan students really care about each other, and they want to learn about how to be more effective at supporting each other.”
Students who graduate from WeSupport can become eligible to facilitate some of CAPS’ mental health support groups, although they are not required to do so.
“[WeSupport] just helps people to become empathic and more effective at supporting people, but there are more opportunities for people who want to go on and become involved in the mental health community in a more formal way,” D’Andrea said. “So for those students, I do day-long trainings in active listening and in group facilitation.”
Gruber participated in a six week WeSupport program this fall and found the experience applicable to campus life as well as rewarding for her personal recovery.
“Every week we covered a different topic,” Gruber said. “We did disorder eating/eating disorder. We covered sexual assault, we covered drinking and drug abuse, we covered suicide fixation, we covered depression and anxiety. And they really went into sort of how these things manifest on campus…and how to deal with that if you start to see these things coming up in friends. It was one of the most helpful things, one of the most helpful tools that I found.”
Another popular service offered by CAPS is the crisis appointments, which last for 30 minutes and can be booked over the phone the day of. Currently, with demand for therapy far outpacing the number of clinicians available, these appointments have become one of the ways of accommodating student overflow.
“The [crisis appointments] are booked solid every day,” D’Andrea said. “And I think part of that is because of people experiencing crises, like true crises, and I think the other part is just the demand for our services.”
For those who do not use crisis hours, the wait time for a one-on-one therapy appointment at CAPS can be up to two weeks.
An anonymous Wesleyan student, who has been diagnosed with OCD and depressive disorder, described her experience with CAPS as positive despite long waiting periods, but believes this may be because of her improving condition.
“For me, it’s not that bad because I’ve been getting a lot better, so it isn’t a big deal,” the student said. “But I have friends who… made an appointment like two weeks ago [in November], and the only open slot [was] in December. So yeah, I do feel like it’s understaffed.”
The crisis appointments are also an important resource for the deans, who often reserve them on the spot for students who become distressed over the course of a meeting.
D’Andrea says she would like to see more involvement on the part of faculty, however, in steering students towards CAPS.
“Faculty do use us; I would like to see faculty use us more,” D’Andrea said. “Because faculty are in a position to see students all the time and have a sense of what’s typical and what’s not. They might be the first ones to notice when somebody’s struggling.”
Yet D’Andrea acknowledges that direct interactions between CAPS and faculty are not always in the best interest of the student. For example, negotiating academic accommodations with a student’s therapist may put professors in an awkward position.
“In the past, when we’ve tried to speak directly to faculty, [it] can be a little bit challenging, because sometimes a faculty member might…feel pressured, whether or not there’s any intention to pressure them,” D’Andrea said.
For this reason, CAPS now relies on the class deans as an intermediary in advocating for students’ academic success.
“What we find works the best is to get permission [from the student] to speak with the class dean, [and] we can have a really open discussion with the class dean about how the student’s emotional struggles are impacting their academic performance,” D’Andrea said. “And then the class dean reaches out and communicates directly with the faculty.”
CAPS is responsible for designating students’ mental illness as severe enough to merit disability accommodations. However, D’Andrea explained that since the threshold for ADA (Americans with Disabilities Act) recognition is very high, it’s rare for students to receive this designation.
“First, we would need an ongoing relationship with the student; we would need to know the student really well and have a history of seeing them,” D’Andrea said. “And then clinically, we would need to… strongly believe that three criteria are met: one, that the student’s struggle does rise to the level of disability as legally defined… [Two], we need to believe that that disability is causing severe impairment in an area of functioning… and then number three would be that we would need to believe that the proposed accommodation is the only remaining way to mitigate the impairment caused by the severe disability.”
For students who do meet these criteria, Laura Patey, the Associate Dean for Student Academic Resources who oversees Wesleyan’s Disability Resources and the Peer Advising and Tutoring programs, is a crucial resource.
While not every student seeking help will come into contact with her, she is a valuable starting point for many who do not know where to go first.
“Part of my job is helping students connect with the resources that are available on campus, and through that ultimately resources that are available in the community,” Patey said.
Patey works with students who seek her out, as well as ones who are referred to her by friends, faculty, and the class deans. She now works with over 300 students, more than 10 percent of the Wesleyan student body. On a case-by-case basis, she walks students through all possible options.
“I’m trying to empower students to make those decisions,” she said. “I think it’s really important to assess where a student is, and part of that assessment for me is to help that student identify who the particular supports are.”
In most cases, Patey poses speaking with a therapist at CAPS as a useful first step. To help with more difficult decisions, such as whether or not to take a medical leave, Dean Patey worked with the class deans last year to devise a detailed decision tree chart to help students more fully comprehend their options.
“I like to actually lay out for the student,” Patey said. “‘Well, you could do this. You could stay in all of your classes and continue with what you’re doing, and here are the risks and benefits of that. You could perhaps take a lighter course load and finish those courses successfully, but there are consequences related to that. Or you could take a medical leave.’ I’m laying out the range of options so that students feel that they are part of the decision making.”
The decision to take a medical leave is a collaboration between the student, CAPS, and hir class dean.
While the University has options and resources for students struggling with their mental health, such as CAPS therapy services and the medical leave process, the intricate nature of mental illness and its unique manifestation in each individual makes finding solutions difficult.
Gruber sees the option of medical leave as a chance for growth. She chose to take medical leave after struggling with an eating disorder and depression during her first year at Wesleyan.
“I think that’s sort of the problem around medical leave, there’s this big stigma that it’s forced upon you and it’s a bad thing,” Gruber said. “I don’t think it has to be that. I’m not trying to say like sometimes—yeah, sometimes it is necessary, and sometimes it should be forced. Because sometimes being here is going to be so detrimental to your health that you need to go home and take care of yourself.”
Kaly considered taking medical leave last year, but thought that the choice would create a false expectation that the campus climate she would return to after leave would be any different.
“I’m not sure how much [medical leave] would accomplish,” Kaly said. “Because it doesn’t feel like anything here is going to change, if that makes sense. I might go off and figure some shit out, but at the end of the day if I come back here and nothing has changed it could very well put me back where I started.”
Even after students take time away from Wesleyan to prioritize their mental health, the transition back to campus can be daunting. After completing a treatment program for an eating disorder this past summer, Kaly said that self-care remains a full-time job.
“People don’t understand how much energy goes into making sure that you’re OK when that’s never really been a part of your lifestyle,” Kaly said. “Once you’re out of treatment [that] doesn’t mean you’re cured. It means you still have a shit ton of work to do…. The amount of energy that it takes to make sure that you’re able to attend classes is outrageous. And people who don’t have to deal with that really don’t understand that at all.”
Gruber echoed the sentiment that self-care is full-time work for someone who struggles with mental health. She commented that Wesleyan’s campus culture does not foster lifestyles that prioritize self-care.
“I think there is a tremendous amount of pressure to be constantly busy, an overachiever at everything, both academically and socially,” Gruber said. “Finding that balance…was tremendously difficult because I thought that I had to be the top at all my classes and be a social butterfly every weekend. Because you look around and that’s what everybody’s doing. And people who aren’t doing that, you don’t really see.”
Adam Jacobs ’15 spoke to the inexorable pull to be in the swarm of busy-bee students. After withdrawing from the University and reapplying for the 2014-2015 school year, he immediately re-assumed the role of a high achieving student despite his expectation that he would feel detached from the University’s pace.
“Within a week, when it was like all these assignments, I want to do well,” Jacobs said. “I was like, ‘Shit. I’m just like everyone else.’ It was like a second. And now after a few weeks, I feel just like the old self. I’m churning out work, it’s like right back in that role.”
Kaly said that many students do not understand how detrimental Wesleyan’s high-stress environment can be for someone struggling with their mental health. Even when students are aware that mental health is campus concern, they are often not prepared to approach the topic in conversation.
“I also think that on this campus people are so afraid of saying the wrong thing, which can be good—people are definitely very PC,” Kaly said. “But that can also be a hindrance to open, honest dialogue when the people who want to be open and honest feel like no one is being open and honest with them.”
D’Andrea’s dual focus on therapy as well as outreach and education strives to end this stunted dialogue.
“I always want to look for ways we can be a resource for the whole campus community,” D’Andrea said.