"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.