Improving Care at Harvard

Every undergraduate commencing today has been at the University long enough to have experienced Harvard’s academic excellence firsthand. Each has also been here long enough to recognize that Harvard is a stressful place, fertile ground for mental health concerns to develop or worsen. The 2002 National College Health Assessment, which surveyed 930 Harvard students, found that 58.6 percent of undergraduates at the College felt things were hopeless during the previous year while 9.5 percent had been diagnosed with depression.

Numbers like these are bolstered by countless pieces of anecdotal evidence that I've heard and seen during my time at Harvard. I'd be surprised to meet a student who has made it through Harvard without suffering from a mental health concern or having felt the effects of one as a friend or roommate of someone who has.

In the battle to provide mental healthcare for students, a residential support system is the first line of defense. It is in the 12 upperclass Houses that students spend a majority of their waking hours, find academic and personal advisors, forge friendships and experience some of the most difficult struggles of their college careers.

This year, Harvard has made an effort to improve the quality of mental healthcare provided for its students, but it has failed to make a significant stride towards better care in the Houses. At the start of the fall semester, Harvard created the Student Mental Health Task Force to recommend ways to improve the system of mental healthcare at Harvard. Just last month, Harvard hired Paul J. Barreira, a psychiatrist at McLean Hospital and chair of the task force, to oversee mental health services at the University starting July 1. But while Barreira has said that students will see changes in residential support as early as the fall, the task force’s proposal to identify and provide additional training and continuing support for House tutors interested in becoming mental health advisors is severely inadequate. Graduate students, even ones with an extra week of training, cannot fully address the needs of students at the College. Full-time mental health professionals, trained therapists or psychiatrists, are required in each undergraduate House to bring Harvard’s residential mental health offerings in line with student need.

In the Houses, trained mental health professionals could identify students’ struggles, provide an outlet for students’ concerns, destigmatize seeking and receiving help, handle emergency mental health crises and, when necessary, ease students into longer-term mental health treatment. Just by living among students, they would become aware of the day-to-day pressures of the College and, if trained in the ways of Harvard’s bureaucracy and administration, they could help troubled students navigate them safely.

Right now, however, under-trained and over-worked House tutors and Allston Burr senior tutors are responsible for identifying and addressing their students’ mental health needs. Both receive inadequate training for the responsibilities of counseling upset students, handling mental health emergencies and directing students to care. House tutors undergo a three-day training before the start of each year, of which only a part is devoted to mental health. New senior tutors attend a five-day training program that focuses on mental health for only one day. Even with the improved tutor training that is proposed, tutors could not come close to providing the kind of care a professional who has undergone the years of school and practice necessary to become a therapist or psychiatrist can provide.

Senior tutors hold multiple jobs and often devote significant attention to research and teaching along with administrating, disciplining and providing mental health support for their hundreds of students. House tutors are almost all graduate school or professional school students with busy lives and commitments of their own. And students might feel conflicted when coming to a tutor or senior tutor with a mental health concern about themselves, friends or roommates since tutors and senior tutors have disciplinary responsibilities and can be called upon to write students’ letters of recommendation. Senior tutors help decide whether or not students need to take time off and House tutors often double as students’ academic advisors. A professional who is not involved with academic advising or discipline would be more approachable and free of these potential conflicts.

The resources necessary to hire and house a mental health professional could come from eliminating some of the many resident tutor positions in each House. Many schools, Yale prominently among them, operate with far fewer tutors in each of their residential colleges, and the benefits of having a mental health professional in a House would far surpass those of having another residential tutor.

In my four years at Harvard, I have been privy to horror stories about the mental health response of House tutors and senior tutors who have ignored cries for help, failed to uphold confidentiality and mistreated friends and roommates of students suffering from mental health problems. While I have to assume, and desperately hope, that these stories are not the norm, a mental health professional in each House would be far superior to what we have now. Anything else leaves students short changed.

Judd B. Kessler, an economics concentrator in Adams House, was editorial chair of The Crimson in 2003.