Now is as good a time as any to remind ourselves about the state of the mental health crisis in higher education and what we can do about it. In particular, it’s important to recognize that we were living through a crisis before the pandemic, and the fear, isolation, insecurity, lost opportunities, and despair that followed have inflamed illnesses and made already-desparate situations unbearable for many.

Much has already been eloquently written about the crisis, so I won’t attempt to retred that ground.

Instead, I want to share my personal experience navigating this space and offer advice to friends and colleagues who are struggling or in a position of responsibility for folks that may be – particularly in the University environment. I have no relevant credentials, so this is purely anecdotal and should be regarded as such; in particular, this is not medical advice, and I encourage you to consult with a licensed mental health professional regarding your healthcare decisions. But I live with mental illness, so at least there’s that.

• signs that something is off
• having the Hard Conversation
• what can you do?
• services
• suicide (trigger warning)

signs that something is off

I’ll speak to what it can look like when something is off for yourself or someone else.

Regarding the former, let’s talk about anxiety and depression – the dynamic duo. If you lack prior experience (first- or second-hand), they’re both capable of knocking you flat on your ass. Anxiety can come on as a restless agitated fluttery nauseous feeling in your stomach or throughout your whole body. It can culminate in a full-blown panic attack where every piece of you wants to rip apart and be anywhere but here. Depression can creep in through the cracks in the door, make you feel like you’re getting over the flu, give you insomnia, or cause you to think The Crazy Thoughts. It does something funny (ha!) to your brain, where it directly makes you feel awful feelings – guilt, despair, self-loathing – that have no basis in reality. Your Big Brain then fills in the gaps, convincing you that you must in fact be a guilty desparate piece of shit.

Actually, the preceding is a description of how anxiety and depression manifest for me specifically – others may have completely different symptomology. For instance, anxiety can cause worrying, phobias, obsessive intrusive thoughts, or physiological symptoms like muscle pain or gastrointestinal problems. Depression can show up in all kinds of nebulous ways: eating too much – or too little; anhedonia; trouble concentrating; or physiological symptoms like back pain or headaches. So if you’re feeling bad for almost any reason, you’re probably anxious and/or depressed :) The dividing line between inconvenience and illness seems to be the level of impairment experienced. If your symptoms interfere with your ability to live your life or do your work, it’s risen to the level where you should talk with a clinician.

Regarding how these illnesses present in others, the good news / bad news is that they are obvious once they get bad enough. Someone may literally say “I feel anxious”. If they’ve never said that before, or if they’ve started saying it a half dozen times everytime you meet, you should infer that THEY ARE ON THE VERGE OF A PANIC ATTACK RIGHT NOW, or were last night, or over the weekend. Depression is more likely to manifest as a withdrawal or an absence. Someone who was formerly on top of their shit becomes scattered. The sparkling life of the party stops socializing. The razer-sharp intellectual gets dull. They stop making eye contact. Or ghost you.

having the Hard Conversation

So now that it’s become painfully obvious there’s a problem, what’s to be done?

Again, there are differences depending on whether you’re attending to your self or another’s.

I hope that you seek treatment for your self. There may be stigma to overcome, but the fact is that these are well-characterized illnesses that are every bit as real and serious and potentially lethal as so-called “physical” illnesses. Although there’s never certainty in any medical specialty about what you have or how you’ll respond to interventions, psychiatric diagnoses are valid and the treatments work if you stick with them.

For the other, I hope that you will have the Hard Conversation about how they’re doing and what support they need. There is no easy way out: asking someone about a deeply personal part of their identity that they themselves may not yet recognize is intimidating, fraught, scary, and more. I hope that you will dare be brave and just, like, ask: “Are you OK?” … “You seem stressed” … “I’ve noticed you’re withdrawn lately” … “How are things at home?” … “Anything bothering you?” … There are a million ways to open that door, and it pays to be persistent: “No, really: how are you doing?” … “I am here as an ally and advocate” … “I want to support you in any way I can” … Again, it’s tough work. But you could literally be performing a life-saving intervention.

what can you do?

You are ultimately not responsible for a mentee’s illness or for their pursuit of treatment – those hard roads are theirs to navigate. But you are well-positioned to connect them with services, which I’ll say more about in a sec. In terms of what you can do on the daily, some basic decency goes a long way to ensure you’re part of the solution rather than the alternative:

• be respectful – criticize the science, not the scientist;
• be friendly – get to know and value them as people, not just research automatons;
• be attentive – notice when something is off and follow up about it;
• be compassionate – your #1 priority is their safety and well-being, everything else comes second.

It is important to remember that the very best science occurs when one is safe, secure, and healthy. Giving a mentee support and encouragement through a difficult period is the most direct and least distressing path to productivity. Moreover, the trust built along this path forges lifelong loyalty. And there’s a multiplicative effect: modeling this behavior for your mentees means they can apply it to support their future mentees. Being a good ancestor pays dividends.

services

In addition to being rich, us faculty have extraordinarily good health insurance. As such, we can access the very best care available with few if any restrictions on provider, location, frequency, etc. So I’m not too worried about us: if we seek services, they will come.

Students, on the other hand, experience the same scarcity and precarity in healthcare that attends their professional and financial lives. Their health plan is likely to cover only a small subset of providers. And it almost certainly limits the number of appointments permitted with therapists or psychiatrists. Aaand the co-pays are a nonnegligible fraction of their disposable income. Nevertheless, it is possible to find good care – several students in my sphere have disclosed this to be the case for them. I want to talk through the process in some detail so mentors and mentees know what to expect.

Usually the journey begins at the campus clinic (at UW, the venerable Hall Health) with a mental health professional performing triage. A limited number of sessions may be available there, but generally there will be a referral to an outside provider. Finding the provider may be challenging, as there are a limited number that accept the health plan and few will be accepting new patients. But it pays to be persistent, and to document the persistence: if there is genuinely no one available, the insurer can be coerced to authorize someone out-of-network. All of the preceding is equally true of obtaining care from a therapist or psychiatrist.

It’s worth talking through the multiple modalities of therapy that are available. Psychoanalysis has fallen out of favor in recent decades, so is now mostly the stuff of New Yorker cartoons. Psychotherapy is a sort of catch-all term for things that are not psychoanalysis, and can be a good place to start if you want to talk a lot about your past. Cognitive Behavioral Therapy (CBT) focuses more on the present, creating concrete plans for behavior change that are expected to improve cognitive state; it can be particularly helpful for anxiety and obsessive-compulsive disorders. Dialectical Behavioral Therapy (DBT) is primarily used to treat personality disorders. But there’s also group therapy and support groups where multiple patients interact – with a therapist in the case of the former, or entirely on their own in the case of the latter.

Not that you asked, but I personally have availed myself of psychotherapy, psychiatry, and support groups on my Mental Health Journey. I had no hangups about the first two, but I resisted the third for many years. Why? I can’t say precisely (I’m working through it with my therapist). But part of it was surely that I wanted to avoid the vulnerability that attends exposing my most shameful and hated parts to a room of non-clinicians. I’ve been in two support groups for more than a year now, and have found them transformative. There is something profound and powerful about the collective experience.

suicide (trigger warning)

Call 988 or go to the emergency room if you are having persistent suicidal ideas, making a plan, or intend to kill yourself. The world is a better place with you in it <3

Although suicide rates of college students are less than half that of the general population of young adults and suicide rates of educators are lowest of all occupations, the rates are not zero, and there are evidence-based methods to prevent suicide. So it’s worth discussing.

If you’re worried that someone may hurt themselves, the most effective and compassionate thing you can do is talk to them directly about it. Contrary to what intuition might suggest, talking to someone about suicide decreases the chances of self-harm. If you are at a loss for what to say, I have good news for you: people more qualified than you or I have created a script. I can’t promise it will be easy to follow, but it is undoubtedly the most important work you will do in your career – I believe you have the ability and courage to take it on. In terms of services to connect the student with, at UW I suggest availing yourself of SafeCampus’s resources.

Without weighing into the perenially toxic debate on gun control, we can observe that firearms are used in more than half of suicides in the US and, therefore, anyone you interact with that owns or has access to a gun is at higher risk of dying by suicide. I don’t advise interrogating your colleagues or students about this aspect of their lives, but if they happen to share this information I do recommend noting it and taking it into account when you’re deciding whether and when to talk to them about self-harm.

It is not your “fault” if someone in your life decides to take theirs. But your actions can have an impact. And this can be particularly true in your role as mentor, as your opinions and dispositions may have outsized influence on someone’s sense of self-worth. I won’t pretend to have a comprehensive guide for how to interact with your trainees to protect them from themselves or others. But the “basic decency” points above seem germane.