Yale grad students say mental health care in ‘crisis’, university adds therapists University adds therapists to ease wait times

Yale University doctoral students Jennifer Axler, left, Alyssa Battistoni, center, and Shawn Ta say that the university does not give them adequate mental health services. Yale University doctoral students Jennifer Axler, left, Alyssa Battistoni, center, and Shawn Ta say that the university does not give them adequate mental health services. Photo: Peter Hvizdak — New Haven Register Photo: Peter Hvizdak — New Haven Register Image 1 of / 3 Caption Close Yale grad students say mental health care in ‘crisis’, university adds therapists 1 / 3 Back to Gallery

NEW HAVEN >> Alyssa Battistoni, a fourth-year doctoral student in political science at Yale University, felt depressed two years ago and went to Yale Health to seek out a therapist.

While mental health care is considered basic to the care offered by Yale Health, Battistoni said she waited weeks to sit down with her counselor, an experience she said is common among graduate students at Yale.

Battistoni said it took about a week to get an intake appointment for her depression, which she said was “exacerbated by the gender dynamics of grad school.” She decided that the male therapist she was assigned “wasn’t a good fit” and asked for a different counselor. She waited a month to be reassigned.

“Eventually I did start meeting with my therapist,” she said recently during a meeting with other graduate students.

“It was helpful,” she said. “But what’s been difficult is that has been consistently interrupted by the limited number of sessions I’ve been able to have each academic year.

“She was very clear: You have three sessions left, two sessions left,” Battistoni said of her therapist.

Shawn Ta, in his fourth year studying for a Ph.D. in the East Asian Language and Literatures Department, has been in counseling since sophomore year of high school. When he began his studies at Yale, he said it took him “about a month for an intake evaluation. … Then it took another month for them to pair me with someone.”

Since then, there have been long intervals between sessions. “Sometimes it’s five weeks, sometimes it’s seven,” Ta said.

Ta saw his therapist between February and November, when he was told “I had exhausted the programs at Yale Health.” He’s still waiting to be put into a long-term care program. “I’ll be waiting six months in total without consistent care,” he said.

Dr. Howard Blue, deputy director of mental health and counseling at Yale Health, the health care center on Lock Street for students, faculty and staff, said there is no set cap on the number of sessions — that it depends on the seriousness of the case — but that mental health care at Yale depends on a model of time-limited therapy, so that those who are in more extreme need receive longer-term treatment.

Union issue

Delays, irregularly scheduled sessions and the perception of caps on the number of sessions are frequent complaints of graduate students at Yale. The Graduate Employees and Students Organization has filed a grievance with Provost Ben Polak on the issue, and a group of East Asian students has filed a petition calling mental health care “a major concern especially for the diverse community of Asian and Asian American graduate students at Yale.”

It is a prime issue for GESO, which wants to negotiate health care coverage as part of a union contract. The university refuses to recognize GESO, maintaining that graduate students are not employees, and the administration will not sit down at the negotiating table. On March 9, GESO rebranded itself as Unite HERE Local 33, in an attempt to persuade the administration to negotiate.

“I think the university is hearing from all over the Yale community that mental health services are a crisis,” said Aaron Greenberg, chairman of GESO and the city alder representing Ward 8.

“By a wide consensus, mental health care has been one of the most important issues” for GESO, he said.

Battistoni said her experience is that mental health care at Yale is “intended to be a short-term use. That can make it into a crisis resource rather than an ongoing resource. … If there is in fact no session cap … then they need to hire enough people to meet that demand.”

Yale has added 2.5 positions to its mental health staff this academic year for a total of “25 to 26,” Blue said. “This year we already have about 2,400 students who have come in. This is up about 200 additional students” from 2014-15, he said.

“If you’re talking a ratio of one clinician per 100 students, most clinics would die for that kind of ratio,” he said.

The issues a student is dealing with “can deteriorate over that waiting time and you’re already at a point where you needed help in the first place,” said Jennifer Axler, a fifth-year doctoral student in geology. “It feels like the Yale mental health system is so overwhelmed they don’t have time to make you a priority.”

While undergraduates face similar issues of mental health, Blue said, “We have, at least for the undergraduates, the idea that they have a time-limited stay” of four years. Graduate students, on the other hand, may be on campus for up to 10 years, and the students say they are more isolated than undergraduates, who live in freshman dorms and residential colleges. Most graduate students live off-campus.

“A lot of the work is: You go through your day and you do your research,” Axler said.

Ta added, “It’s also very easy to internalize being ignored by the mental health system and say your symptoms are not valid or you’re just being lazy.”

“When you’re doing intellectual work all the time it’s important to feel like you’re at your best,” said Battistoni.

“The atmosphere at Yale is not conducive to creating a sense of community” among graduate students, Ta said. He knows the importance of mental health from a provider’s point of view as well. For three years, he was “a group facilitator for group therapy as an undergraduate” at the University of California at San Diego. “I have also worked as a social worker for senior citizens,” he said.

Axler “had to wait a month to get placed with a regular therapist,” which she believes is far too long.

“By the time you’re ready to ask for help, you’re already struggling,” Axler said. “That can make everything even worse for a person. … I shouldn’t have to wait for an emergency to happen to get an appointment.”

“You wind up relying on your friends and your family if you can. … I just had to lean on my family heavily for support,” Axler said.

Axler is no longer seeing a therapist at Yale Health but will graduate this May.

Ta said, “I think there’s a lot of worry and anxiety about not knowing where you’re going to find help.”

He said the pressures on foreign students are especially difficult. “It’s my understanding that Yale is not equipped” to care well for immigrants and minorities,” Ta said. “There’s still a lot of stigma in many communities. There’s some mistrust of the science of mental health. Even at Yale there are psychiatrists who disagree on whether some illnesses should be considered illnesses.”

Mental health and academics

One of the public faces of the issue for graduate students has been Grant Mao, who was dismissed from the Yale School of Management because he fell short of the required minimum academic credits. He believes his depression and his being Chinese — he is from Shanghai — contributed to his academic problems.

“I got overwhelmed because I had language difficulties and … my fiancée broke up with me and my mom was really ill,” he said. “My mental health definitely affected my academic performance,” which fell half a unit short of requirements.

When he was dismissed from the School of Management, Mao faced the threat of deportation. He is enrolled part time at the University of New Haven to maintain his visa status and is “trying different channels to stay in the U.S. and continue to fight this for my own dignity.”

During his meeting with university administrators, “they told me to leave the country within 15 days and stopped my insurance,” Mao said.

He said he is not allowed in the business school. “It’s clear they want to get rid of me,” he said.

He still hopes to return to Yale and has met with President Peter Salovey. So far, there has been no word on reinstatement.

Tif Shen moved from China to Canada when he was 9. He is a fourth-year graduate teacher and researcher in the Mathematics Department. He said that after going to Yale Health for depression, “It actually took 1½ months to see a therapist.”

Since then, his appointments have been irregular, partly because of his teaching schedule. “Basically every week it was just a struggle for the two of us to get a time for my therapy,” Shen said. He too said he was told there is a cap on the number of sessions allowed.

“I was going through a major depression and I was not getting the help and care that I needed,” he said.

Medical triage and risk assessment

Blue, who was appointed deputy director for mental health in December, said each student is evaluated as to the seriousness of his or her condition and that emergency cases are given top priority.

“I understand why people may feel that their particular concern is the most important thing,” he said. “But we do have to do medical triage.

“It’s a perennial issue on college campuses. It’s a perennial issue in medical systems,” Blue said. “Everyone does triage. Everyone does risk assessment. Everyone does an assessment of acuity.”

He said students are screened within a week of their coming to the Yale Health building and clinicians determine “whether or not this warrants immediate connection or whether this is something that is more routine and can wait.” He said “we have at least 100-plus appointments per week.”

“This is always a very difficult conversation to have with anyone because anyone will say the fact that they’re coming in for treatment means it’s urgent,” Blue said. However, complaints range broadly, from someone who had “a spat with a partner to someone with chronic, enduring mental illness.”

For “people who have chronic mental illness, you want to be available to them for the duration of their stint as a student,” Blue said. “Depression as a disease entity is a fairly well defined thing.

“We do want to reduce the amount of time people wait to begin treatment,” he said, and added that Yale’s mental health care will continue to expand as two new residential colleges open in 2017. But, he said it’s not reasonable “if you believe that people should have absolutely no wait time to start psychiatric treatment, which is not the standard anywhere in the world as far as I know.”

“I do think what we have is adequate. But we do want to become more efficient and more responsive,” Blue said.

As for a limit on appointments, Blue said, “I know very few medical systems that don’t have some kind of cap,” so those with less severe conditions will have treatment that is time-limited.

“This is part of the perennial problem, that you’re serving a large number of people. It’s always a balancing act. … If you have someone who has a parent dying, one person may react more than another.”

Limited resources and group sessions

Officials at other schools in Connecticut say they tend to see non-emergency students within one or two days of a self-referral, especially if the complaint is acute.

“For us, students typically are seen … that day,” said Jeff Van Lone, director of counseling services at Southern Connecticut State University, however, the time frame might lengthen because of the student’s schedule. “Our students tend to be very busy people” but “those students who need to be seen most immediately are seen.”

Because of limited resources — Southern has six full-time clinicians and four advanced graduate students to serve about 10,000 students — the university, like others, focuses on “time-limited work,” Van Lone said. “Most university counseling centers do not offer unlimited mental health services,” he said. And while “not all students can afford the deductibles to get services privately, we would never leave a student without care.”

About 6,000 of Southern’s 10,000 undergraduate and graduate students are commuters and use their family’s health care providers, Van Lone said. One way Southern is meeting the needs of students is through mindfulness groups and other forms of group therapy.

“Much research suggests that these groups are as effective, if not more effective, than individual therapy and they allow us to better manage our own resources to meet the needs of students,” Van Lone said.

He said anxiety and stress have become more common complaints than depression in recent years and the groups meet the needs of those students.

Kerry Patton, director of counseling at the Health and Wellness Center at Quinnipiac University, said students generally are seen quickly.

“If it’s urgent we’ll get them in that day,” she said, and students can file an intake form online 24 hours a day. But not all complaints are urgent, she said.

“Sometimes they’re transitioning, having a stress or managing academics,” she said. After the initial evaluation, “Usually they’ll come back the following week. Some might be recommended to see a psychiatrist for medication.”

When necessary, the students can go to the health center, where there is a nurse on duty 24 hours a day, “which is nice if they’re feeling a little homesick or anxious.” She too said anxiety has increased as an issue for students. Quinnipiac has five counselors available for almost 10,000 students, she said.

“I think we’re serving our students,” Patton said. “I think we always look for more resources but we’re able to handle the need.”

Stephanie Reitz, spokeswoman for the University of Connecticut, said in an email that “UConn’s Counseling and Mental Health Services served more than 2,100 individuals in academic year 2014-15, which is a 34 percent increase over the past five years.”

Reitz said UConn has 16 full-time and seven part-time mental health professionals, including two part-time psychiatrists, on staff, as well as eight advanced-level graduate trainees to serve 18,800 undergraduates and 6,000 graduate students.

“Students’ physical and mental health and safety is one of UConn’s very highest priorities, and we’ve been increasing our CMHS programs, services, and personnel to promote their emotional, relational and academic potential,” Streitz wrote.

UConn also offers group workshops, such as yoga and stress-reduction groups.

“We also recognize that our diverse student population has a variety of needs, and provide targeted outreach programming and support to specific student populations such as at our Cultural Centers, to athletes, and to survivors of sexual violence,” Streitz wrote.

“At the other end of the continuum, for students who present with significant functional impairment or crises, we help them, along with their families, identify appropriate treatment resources designed to restore safety and functioning.”

Like other schools, emergency and acute care is available 24 hours a day. Otherwise, Streitz said, “Wait times vary across the semester, and increase as we approach finals. The average wait for a routine, non-emergency intake is about 10 to 11 days (the number goes up when there’s a vacation break between the time of contact and the time of appointment).

Once a match is made with a therapist, appointments may be made weekly at first. “In the brief therapy model, we may accordion that schedule, beginning with weekly sessions for a brief time and then expanding time between sessions as the student stabilizes,” Streitz wrote.

Call Ed Stannard at 203-680-9382.