If You Can’t Hire More Therapists, Make Them

Much ink has been spilled pointing out the sorry state of mental health on Harvard’s campus. Something clearly needs to change.

The problem is: This is far easier said than done. Expanding Harvard Counseling and Mental Health Services, though certainly necessary, is nowhere near sufficient. The shortage of psychotherapists is a national problem, as demand for therapy has skyrocketed post-pandemic; initiatives to hire more therapists at Harvard would face the same pitfalls of scarcity that the general public does. As it stands, even if CAMHS were to double in size, each CAMHS clinician would need to take on over 98 clients to support the bare minimum 25 percent of the undergraduate and graduate student body suffering from psychological distress — not counting the faculty and staff that also rely on CAMHS. All told, this adds up to what seems like a thoroughly unsustainable caseload.

So what’s a $50.9 billion institution to do?

Our best hope for providing care at the scale necessary to address the mental health crisis at Harvard (and possibly in the world at large) is layperson psychotherapists — that is, non-professionals who have been briefly trained in psychotherapy by a professional.

In other words, if you can’t hire more therapists, then make them.

At first glance, this seems like an insane idea, but I promise you that it is not. This concept is well-backed by scientific literature, and has been implemented, at scale, to successfully treat over a hundred thousand people for depression. It also pushes us to take a second glance at some of our deeply held beliefs about therapy — namely, the idea that struggles with mental health should be solved within the exclusive purview of medical professionals. Though treatments by psychiatrists and psychologists are clearly extremely effective, there are many ways to skin a psychological cat.

Take for example, StrongMinds, a non-governmental organization based out of Uganda and Zambia that uses peer-facilitated group interpersonal psychotherapy to provide care for women with depression. Over the last decade, they have helped over 210,000 women, accomplished entirely with trained members. StrongMinds prepares facilitators with a short course in interpersonal psychotherapy, then recruits former group members to coordinate future group therapy sessions. The result is an exponentially growing therapeutic capacity, at a lower price. In 2022, StrongMinds’s cost per patient was $79; contrast this to the average $100 to $200 cost per session of psychotherapy in the United States. Peer facilitation doesn’t come at the cost of efficacy either: Six months after the conclusion of treatment, 80 percent of StrongMinds patients are depression-free.

This sort of approach has been validated among American college students as well. In the 1970s, a pair of Vanderbilt researchers attempted to understand whether trained therapists produced better treatment outcomes. They selected one group of experienced psychotherapists and a second group of professors chosen for their ability to form warm and trustworthy relationships with students. The trained therapists and the untrained professors each provided between three and four months of therapy to a subset of students. In the end, all students demonstrated equivalent (and statistically significant) levels of psychological improvement — despite the differences in training and qualifications between their therapy providers.

This study should not be read as a refutation of the value of professional therapeutic training — these were, after all, specially selected professors — but rather should make it clear that there is a vast reservoir of therapeutic talent that remains untapped. By educating already compassionate individuals, we can create a highly effective group of lay therapists at Harvard, at a scale significant enough to change the mental health landscape on campus.

Harvard has no shortage of warm, kind, caring professionals throughout its facilities, including proctors, house tutors, professors, and staff. It seems eminently possible to train a group of selected such people in a form of therapy that has been clinically validated for layperson facilitation. The resulting therapy could be provided on a volunteer basis (though ideally volunteer therapists would be compensated for their time).

In any case, effective psychotherapy can be made available to Harvard students on short notice, rerouting CAMHS clinicians to focus on more complex cases. This creates a rapid pathway for referring those with severe depression or anxiety to a professional, allowing for significantly more proactive care. Layperson psychotherapists operate in a similar role to EMTs in hospital systems: They solve life-threatening health problems with relatively minimal training.

The effectiveness of layperson therapists hints at a deeper truth about psychotherapy: Therapy is not an arcane art, passed down through the hallowed guilds of Freud and Beck, but rather a structured human relationship. With this in mind, we can start to look past endless medicalization, and begin to think about solutions to mental illness that don’t cost up to $200 per hour. By leveraging Harvard’s considerable resources, this kind of therapy could grant far more students access to effective psychological care, reshaping the mental health landscape on campus with more scalable methods.

Suhaas M. Bhat ’23-’24 is a double concentrator in Social Studies and Physics in Mather House and a leader of Harvard Undergraduate Group Peer Therapy. His column, “Demystifying Therapy,” runs on alternate Wednesdays.