Town Hall: Is Stanford's counseling service failing students?


"It felt like Stanford was lying to me," said John-Lancaster Finley, a Stanford University undergraduate during a town hall in the Old Union Clubhouse Wednesday night. "Stanford told me that all this mental health care was readily available to me and that there are all these people who are going to be supportive. I would have much rather felt that no one here is going to help me and that I'm on my own. What is the purpose of CAPS? Why did you tell me CAPS was there for me when it just wasn't?"

The vast majority of the students at the moderated town-hall discussion, which was organized by the Associated Students of Stanford University (ASSU), had personal experiences with the university's Counseling and Psychological Services (CAPS). Their anecdotes revealed an administrative body woefully in need of additional space, staff and initiative. Because of the personal nature of the anecdotes most of the students spoke without providing their names.

CAPS Director Dr. Ronald Albucher sat in the front of the room quietly taking notes. 

Many of the students there were or still are suffering from depression, sometimes resulting from traumatic experiences like sexual assault. Admitting to having a problem is hard enough in a sunny environment where success and happiness seems to be both plentiful and expected of everyone, said several students, but CAPS seems to make getting help more difficult, and sometimes painful, than it should.

Students outlined a process exhibiting both the crassness and inefficiency of an impersonal, poorly supported bureaucracy. When students call CAPS, they are immediately subjected to a questionnaire by an anonymous staff person who asks them deeply uncomfortable personal questions including ones asking them to reveal their sexual orientation, if they've ever been sexually assaulted, and even if they are planning on harming themselves. The irony is that many of the students seeking help are calling because they want to talk to a psychiatrist about one or many of those sensitive topics.

"I did not feel comfortable talking on the phone primarily because it felt like they were trying to solicit information from me that I did not want to share. At the same time I wanted someone to know what I'm going through, but I know the person on the phone won't be the person I would most interact with so why would I tell you all these things?" Finley said.

"I felt I was being asked to self-diagnose," said another student about the phone call. "At that point I had never had any mental health issues in my life and I had no idea how to do that. I thought the reason I couldn't get any work done was ADHD (attention deficit hyperactivity disorder) so then they put me into this ADHD program. In reality if I had been able to sit down with a counselor they would have figured out it was depression about six months earlier than I did."

Most of the students reported that after they navigated the uncomfortable phone call they were then told to wait three weeks for an appointment. "If you built up the courage to actually call CAPS that means you need something right at that moment. Overcoming the huge stigma of admitting to a problem is hard enough, but then being told you have to wait three weeks before you can see someone is really unacceptable. It feels like my problem is being dismissed as not that important and I end up struggling with stigma again," said Nicole Doumeng, who was echoed by several others.

For the students who did see counselors, they reported their sessions were inconsistent in quality and frequency. Many students reported being assigned to "temporary staff" or "in-residence trainees" rather than fully qualified psychiatrists. The results for some were disastrous. 

"I had a really traumatic event happen to me, but was given a counselor who was in-training," a male student said. "We spent half the session just talking about other people who I would possibly work with, and I felt like we had a plan. Then she came back to me the next appointment and said she spoke with her supervisors and they felt I would be 'best for her,' and she made it seem like I would be a good case for her to 'train on.' It was really disempowering and awful." Then one appointment was dropped and weeks passed before his next, and what would be his final, session.

"She said something along the lines of how I should try to have more sex to feel control. I just walked out and never went back."

Another student had a similar anecdote. "When I finally met my counselor she told me she was in-residence and not an actual full-time employee. Nonetheless, I opened up and told the counselor I was depressed. I also told her something I never told anyone: I was sexually abused as a child. And it felt like she didn't get it. And then she went back to, 'OK, well it says here you are having adjustment issues so let's talk about your adjustment issues. Maybe you should consider taking less units next quarter.' I immediately ended the session and I left and never wanted to go back."

A small minority of the students present reported having good experiences with CAPS and were shocked by some of the anecdotes. "I shouldn't feel like I'm one of the lucky ones," said a student who was one of the few to report having a good experience. "I would love to see CAPS have its own building and its own system in place." Despite the opposite experiences everyone who spoke agreed that Stanford urgently needed to provide more mental health support.

Dr. Albucher remained silent for most of the town hall, only speaking to briefly walk through the current phone and appointment system in place and to agree with student suggestions for improvement.

"The primary goal was so that students knew they were being heard, so I really just wanted to listen," he said.

However, the issues facing CAPS can only be addressed by Stanford management: A bigger budget, a dedicated space (CAPS is currently relegated to part of the second floor of the Vaden Health Center) and more staff are things only Stanford leadership can provide.

"I have control over ground-level things like how we organize our services, but the only part I play in the budget is submitting requests to the Student Affairs Division of the university, which considers many other budget requests alongside it," Dr. Albucher said.

"I was not quite sure what to expect, but the students did a great job talking about their experiences. I was mostly unsurprised to hear about the wait times and the difficulties around engaging in longer-term care. I was happy to hear from students who did have a good experience and sung our praises," he said.

CAPS had a difficult year when it came to staffing, which made the spike in student demand harder to manage. "A lot of unexpected things like pregnancies, medical leaves, retirements, and we had a trainee we hoped would stay with us but decided to take a job elsewhere. All these things caught us by surprise to some extent.

"I did come away with a better appreciation for the difficulties students face in the phone triage process. It will give me and my staff something to think about. I want to work with students to look at our limitations and help come up with creative solutions to make it work better. The students are our customers, so to speak," he said. 

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15 people like this
Posted by parent
a resident of Another Palo Alto neighborhood
on Feb 27, 2015 at 4:25 pm

Stanford. If you are having trouble providing the services in house, you have the money to send the kids to professional services outside. No excuses. When people are having mental health crises, this is unacceptable.

How do you think, Mrs. Stanford, the woman who sold her jewels to keep the tuition free rebuilding after the earthquake, would feel about this, given the resources you have at your disposal now?

Like this comment
Posted by resident 1
a resident of Adobe-Meadow
on Feb 27, 2015 at 8:51 pm

These are very strange stories. Possibly some type of pamphlet given to/ available to all students that provides guidance on how to frame the problem, and how to ask the questions. People need to be able to state the problem and what the result is they want. They need to know before hand what personal information they need to provide to solve the problem so they can disregard questions that are not specific to the problem.

There needs to be some type of restriction on what type questions are being asked if those questions have nothing to do with the problem.

6 people like this
Posted by simply unacceptable
a resident of College Terrace
on Feb 27, 2015 at 10:11 pm

As a Stanford instructor who has directed a number of troubled students to contact CAPS, I find these anecdotes appalling. The primary purpose of CAPS should be to provide confidential and appropriate assistance for students in emotional distress, not to provide learning opportunities for counselors-in-training. I appreciate that these brave students have spoken out about their experiences and hope, for the benefit of future students that these concerns are heard. Our students deserve much better.

1 person likes this
Posted by Nora Charles
a resident of Stanford
on Feb 27, 2015 at 10:46 pm

A lot is asked of universities these days. Their main mission, to educate, almost seems eclipsed at times by other services and roles they are increasingly expected to provide. I can't help wondering if many of the students should be visiting doctors or psychologists for their issues.

2 people like this
Posted by Stanny Med School
a resident of Another Palo Alto neighborhood
on Feb 28, 2015 at 7:57 am

Reading this story reminds me of the Stanford Medical School and Hospital, where the same thing happens. For services paid for above the market rate, patients are subjected to being guinea pigs for doctors-in-training. As a result, severe injuries to the patient are charged. Doctors-to -be are often ill-supervised, or even totally UNsupervised.

Obviously this is unethical, as is what Stanford does with their counseling services-- it at least they don't charge for these unethicalities like the medical school/hospital so exorbitantly does.

The moral: it is criminal and immoral to hurt people by using unqualified services, either for money or for free!

Stanford, as a learned institution you are obligated not to do such things by using under-educated cheap labor!

9 people like this
Posted by Michele Dauber
a resident of Barron Park
on Feb 28, 2015 at 9:00 am

Victims of sexual assault have routinely reported to me a three week wait to see a counselor. Even with a call from a faculty member it is difficult and entails red tape to push the appointment sooner. Everytime I have raised this issue I have been told it is fixed, only to have another student contact me to tell me a similar story. I no longer believe it when I am told that this has been "fixed" because I have heard it so many times only to hear that it is not from students.

But one of the most serious issues with accessing psychiatric assistance at Stanford is in the area of obtaining inpatient care. Evidently the only way a student who is at risk for self-harm can access inpt services is through the emergency room, which involves a wait as long as 8 or 10 hours (and could be MORE) in the ER. Stanford's ER, if you have not been there, is not the high-touch Four Seasons feel that the rest of the hospital delivers. It is actually far less comfortable and calm than a lot of other ERs I have been to. It has a metal detector and an armed guard. It is cramped and feels claustrophobic. There is little or no privacy. The student who has been victimized by sexual assault has to tell triage nurses and others in a semi-public setting and then sit in a waiting room for hours and hours with no support.

I have recent personal experience assisting a student trying to be admitted inpatient in which I personally waited with the student for many hours in the ER and found this to be appalling. This is evidently the same treatment that every student in need of inpatient psych care receives even if they have a doctor at Stanford and even if they are a victim of sexual assault on campus. It felt completely unnecessary, and retraumatizing. I think that the university should take a serious look at fixing this process.

2 people like this
Posted by parent
a resident of Another Palo Alto neighborhood
on Feb 28, 2015 at 9:00 am

Although you have a point that patients are often put in a situation where they can't just know about and easily decline to be subjected to a training doctor if they don't wish to, and that's just wrong, our most recent visit to Stanford involved first a resident and then the supervising doctor.

While we had a lot of confidence in both, and the doctor was an experienced specialist, I was so impressed by the knowledge, manner, and approach of the resident, they seemed more like a team than us being subject to one after the other if you know what I mean. The resident had been so thoughtful and thorough in exam and answering our questions, we really didn't feel like the "in-training" part was an issue.

Students who are fragile from a potential mental health crisis are another issue. When students are in a high-pressure school environment and having any kind of medical issue, schools cause enormous stress if the delivery of care is so difficult or time-consuming it causes students to choose between failing at their schooling or getting the care. If Stanford was having staffing issues, they should simply have paid for seamless professional help.

Sorry, but further commenting on this topic has been closed.

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