Calling for Consistency at CAMHS

Thoughtful opinion pieces in the past have disagreed persuasively with the claim that demographics do not matter in the design, delivery, and evaluation of Harvard's Counseling and Mental Health Services. Diversify CAMHS’s survey is a case in point: It suggests direct interventions CAMHS could roll out to address problems of inordinate attrition among non-white, foreign-born, first-time users of mental health services. Demographic factors such as nativity, ethnicity, and socioeconomic insecurity do contribute to the alarmingly high rates of attrition among first-time users of university-based mental health services. But, as is the case with far too many conversations about mental health, stakeholders have yet to think, talk, and write about mental health services comprehensively. Despite efforts to optimize front-end client flow at CAMHS, much less thought has touched on enhancing back-end flow.

A survey of the history of CAMHS’s back-end procedures displays troubling inconsistencies in its commitment to one of higher education's long-standing practices: Evaluation. Counseling and Mental Health Services, as its name indicates, is charged to provide services. But if the current design of its service delivery system is any indication, CAMHS has yet to meet the challenge of comprehensiveness of its charge to provide services.

CAMHS’s evaluation procedures leave much to be desired in two respects. First, they do not promptly invite students to reflect upon and assess the quality and effectiveness of the counseling session immediately afterwards. Second, they do not ask students whether demographic factors may have inflected their experience of the counseling session.

The University mandates evaluations by students for virtually all courses, workshops, and conferences. Moreover, University Health Services already sends student evaluations following ordinary visits. Why doesn’t UHS embed a similar evaluation system for mental health visits? We do not see any reason why CAMHS instead maintains a culture of inconsistent solicitation of student feedback, nor do we understand why UHS does not charge the firm contracted to design its electronic evaluation systems to incorporate a component for CAMHS.

When the University refuses to apply equal scrutiny to its mental and physical health services, it perpetuates the stigmatizing and harmful culture of disparate coverage of mental health. Additionally, it subjects many students to the risks of disengagement and withdrawal. As a custodian of the future, the University has the capacity—and, indeed, the responsibility—to interrogate and transform that culture of disparate coverage of mental health. We urge UHS to embed a procedure to solicit student feedback immediately following each CAMHS visit.

Why not design a check-out survey that offers each client quick and thoughtful closure while equipping providers with feedback on how to enhance the client experience at CAMHS? We designed such a survey for a Science and Religion course we took at the Divinity School last semester. In addition to being replicable and scalable, the survey is as rapid and indicator-friendly as the check-in every client has to complete before meeting a counselor at CAMHS. The survey’s 10 questions invite students to pause and reflect on how their demographics—and their assigned counselor’s—permeated the visit. Asking such questions with greater consistency would affirm CAMHS’ openness to learning from student responses and equip CAMHS to expand the relevance of its services to our increasingly diverse University community.

For many of us, college or graduate school is the first time we engage with our mental health. It should not be the last time. At present, the University’s message to students who seek help with mental health transitions is clear and bleak: Their views on the quality and impact of their experiences at CAMHS do not merit examination. This message reinforces the tacit and harmful assumption that mental health transitions are a form of deviance and failure. We do not and cannot subscribe to that view. Rather, we consider mental health transitions to be an expected dimension of many students' experiences and development within a highly competitive—and for some, culturally unfamiliar—environment.

Toni Morrison, this year’s Norton Professor of Poetry, has prophesied that, in the third millennium, “universities alone may very well be the last preserve of free thought, of independent inquiry, of simple caring for.”

Simple caring for.

The University fails to care for its own when it does not ask those entrusted in its care whether its providers have indeed provided care, safety, and healing. As long as CAMHS fails to solicit student feedback after each visit, it will deny its own care providers important opportunities to enhance and fine-tune their interventions and treatment frameworks; more importantly, it will deny students their right to effective and relevant care. Embedding an insightful, onsite, post-visit evaluation system for CAMHS visits is a matter of ethical and educational responsibility for the University.

Caring deeply about our University community requires questioning troubling inconsistencies in CAMHS’s solicitation of student evaluations, which in turn will help us take better care of the experiences of our students and future citizens. Asking CAMHS to be more prompt and consistent in soliciting feedback from students is about engendering a kinder, healthier, freer future—about simple caring for. The University’s capacity to harness the promise of 21st-century diversity is at stake.

Sitraka St. Michael is a second-year student at Harvard Divinity School. Mason S. Barnard ’16 is a Social Studies concentrator living in Quincy House. Nicole W. Bassoff ’16 is a History & Science concentrator living in Adams House.