Dr. Paul Genecin, director of Yale Health, invited students to participate in this hour-long forum on mental health issues. On Wed., Feb. 25., Genecin fielded student concerns alongside Chief of Yale Mental Health and Counseling Dr. Lorraine Siggins, Dean of Yale College Jonathan Holloway, Clinician Dr. Howard Blue, and Professor John Rogers, chairman of a committee that is reviewing Yale College’s policies on withdrawal and readmission. Genecin and Siggins were contacted multiple times by phone and email, and I also spoke with their assistants for this article; both physicians declined to answer questions, citing unavailability. Multiple therapists were also contacted via email and phone, but none responded.
The forum is only a recent development in a discussion on Mental Health and Counseling (MHC) at Yale. A month prior, on Tuesday, January 27th, Holloway sent an email to Yale College students informing them that Luchang Wang, SM ’17, had died of an apparent suicide. The 20-year-old had posted on Facebook a few hours before her death. “Dear Yale: I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”
The tragedy of her death and the contents of what appears to be her suicide note set off a campus wide discussion about the issues Luchang mentioned, including mental health and the withdrawal and readmission policy. The conversation has expanded to national media outlets (including the Atlantic and Bloomberg), which have reprinted her note and commented on the state of mental health at Yale.
Students attending the forum voiced a range of grievances against the administration based on personal experiences and those of friends. If the forum meant to clarify Yale’s policies, it didn’t.
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“A tiny number [of students] must withdraw involuntarily when the risks to their health reach the level where staying in school is not possible,” Genecin wrote in an op-ed for the Yale Daily News published on March 2. In an interview with the Herald, Holloway offered furthered clarification on the policy: “An involuntary withdrawal is when they have no choice, the University takes action.” Yet Holloway explained that students and administrators still have different understandings of what constitutes involuntary withdrawal; some students believe they were forced to withdraw, but did so based on a suggestion and not university action, Holloway said. “Involuntary withdrawal is a very rare action, and it’s a last resort action, as well,” he added.
These inconsistent expectations explain the concern for involuntary withdrawals voiced by students during the forum. “In my own experience, I intentionally lied about the extremity of my condition” Korbin Richards, PC ’15, said. “There is a fear that we’ll be sent home if you approach Yale Mental Health and disclose your symptoms like a responsible patient to these medical professionals.” Adriana Miele, BK ’16, acknowledged that while her personal experiences were positive, a culture of distrust persists among students and MHC. Carlee Jensen, MC ’15, who has used MHC services, agreed that students don’t always feel safe expressing themselves to therapists.
In an open letter published in the Yale Daily News on March 5, 17 students requested clarification regarding involuntary withdrawals. “In particular, we request publication of the operative standards for involuntary withdrawal and an overview of the involuntary withdrawal process. This is absolutely necessary when Yale administrators, rather than clinical professionals, have the ultimate say in determining a student’s future,” the students wrote. In light of Holloway’s comments, this confusion is no surprise.
When Caroline Posner, BK ’17, asked for statistics on involuntary withdrawals at the forum, the panel members representing Yale Health said the Dean’s Office keeps this information. Holloway said this surprised him: “That was actually news to me, I didn’t know who kept that data,” he said in an interview with the Herald following the forum.
The Dean’s Office is currently debating whether to release the exact numbers of involuntary withdrawals while also respecting confidentiality. “The rationale is that the numbers are so low, that if you release the data, someone could say, ‘Wait you’re talking about me.’ It’s really as simple as that. Absolutely, our first priority is to protect the identity of students,” Holloway said. He added that this concern had made him initially hesitant to hold the forum.
Miele said she would like to see statistics released, but acknowledged the necessity that confidentiality must remain a top concern for the administration. “I know a number of people who have attempted suicide or have come very close to it, and I do not at all feel comfortable with Yale Health releasing details that would make it obvious who that person was. I think protecting identity in very certain cases is important,” Miele said.
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In the forum, Posner claimed her therapist is “willfully violating [Yale Health’s] rules” to give her proper treatment. Her therapist does not limit her to 12 visits in a school year, despite Yale Health’s suggestion to cap student visits at a dozen. “We don’t have an absolute number of sessions, what we do say, as all counseling services do, is that it’s roughly more of a short term model of treatment,” Siggins explained. Posner asked students to raise their hands if they were told about the 12-session policy. Nearly 50 hands rose.
“That was really exciting when [Siggins] said it but I don’t believe it’s true,” Posner told me in an interview.
In the week following the forum, I spoke to several students who have used Yale’s Mental Health and Counseling services, and many were familiar with the 12-session cap.
Richards was told about it in her first therapy session. “I took it in stride,” Richards wrote in an email. “But because of a lack of experience I didn’t understand that this was absurd. I called my other therapist, and she said never to go back.”
Posner added that the implications of such a limit are troubling, making students seem like a “logistical problem” and something of a burden. Both Jensen and Miele were also informed of the limit, though neither believed it is strictly imposed. The University has yet to clarify the extent to which the cap is meant to be enforced.
Corinne Ruth, SY ’15, a member of an MHC student advisory committee, explained that to the best of her knowledge, “As stated by Dr. Siggins at the recent forum, there is no hard limit as to the number of therapy sessions that a student can receive at MHC.” Ruth explained that if a student requires long-term care, MHC will work to provide that. However, they simply don’t have the resources to provide long-term treatment for every student who visits. Moreover, that level of treatment is not required for many students who seek help.
“I don’t think that the short term care model is necessarily a bad one for students seeking supportive counseling. For students experiencing chronic mental illness, long term care is often absolutely essential,” Jensen said. “I do think that Yale needs to be more explicit about these policies so students that do need longer term care feel safe going to Yale Health to pursue treatment.”
As of now, the University does not outline a clear distinction between short-term and long-term care plans for students. Rather, the two seem to be inappropriately lumped together under the broader umbrella of “MHC.”
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Holloway called sitting through the mental health forum “painful.”
“I walked away honestly feeling like I had made things worse, by suggesting we have the town hall, because it was so heated. I thought, ‘oh my God, I’ve just agitated people, and they couldn’t get answers.’ I just felt terrible,” Holloway explained.
But after the forum, his opinion began to change. Students emailed and told him in person that, while the forum was difficult, it was important that it occurred. He said he began to realize that the forum was, in the end, a good step forward in determining what the major complaints and confusions were on campus. Students seem to agree that the forum was a necessary step. The first line in the open letter in the YDN expressed gratitude for the forum and the opportunity it offered students.
However, many students were left unsatisfied. Posner believes the forum contained a large amount of diplomatic rhetoric that didn’t place blame on either side of the discussion. She also said that before that day, she had never seen Siggins or Genecin. “So these are people who are really never visible to students going through this process, and it kind of parallels how opaque the process is,” she said.
Still, the administration has begun to make changes. In an email sent to Yale College students, Genecin announced that the University is hiring more psychologists, psychiatrists, and clinical social workers. Yale Health is also hoping to expedite the transition from a patient’s first visit to the beginning of treatment.
“I want to believe everyone who is involved in this conversation has good intentions,” Jensen said.
An MHC advisory committee formed in spring 2014 to provide a student opinion on policies and practices to ultimately improve campus culture. The committee includes four students, Cory Myers, BK ’15, Olivia Pollak, DC ’16, Madeline Bauer, CC ’17, and Ruth, who was previously mentioned in response to Siggins’ claims on the 12-cap policy.
Myers stated in an email that he has seen a shift in campus discussion this semester, switching from a broad effort to raise awareness towards specific critiques. When asked why he thought the expectations are different between students and administrators, Myers wrote: “I think this problem, although real, is a misnomer. Students don’t experience policy, per se, which is general and abstract. Students have direct encounters with specific treatment and concrete administrative decisions. Both Yale Health and the administration can and should make their policies more transparent, but aspects of individual treatment will always be private.”
“I think we’re all confused,” Richards said in an email. “Our experiences say one thing and Dr. Siggins another. There is no reliable source of information, including the MHC website. Patients need to know their rights.”
Right now, students do not know what constitutes an involuntary withdrawal. Students do not know how Yale determines short or long term care plans for individual needs, and they fear a 12-session cap. Both Myers and Richards agree that students and the University approach these ideas from vastly different perspectives. The forum brought this mutual misunderstanding to light, but an hour wasn’t long enough to reconcile the two sides. In the meantime, Myers directed students in search of clarity to the Mental Health and Counseling section of Yale Health’s online FAQ.