Mental Heath Day

March 13, 2018 | Vanderbilt University

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1. A brief history of our union’s campaign to improve mental healthcare services for graduate workers at Vanderbilt

Our campaign started the first day of fall semester, when Graduate Workers United informed the graduate student body about policy changes at the Psychological Counseling Center that would subject clients to clinical review evaluations after just six individual therapy sessions. Following this news, we put together a petition to our administrators, signed by 355 graduate students, to guarantee us affordable, accessible, equitable, and on-campus mental health services through the PCC. This led to a Town Hall hosted by Graduate School and PCC administrators, to which dozens of graduate workers and professional students showed up to share our experiences and voice our concerns about the changes to the PCC’s policies. At the Town Hall, we discovered that there is no outlet for student input during the clinical review process, nor had the administration yet made an attempt to calculate the cost of off-campus care on our employee insurance plan. We responded to these concerns with a Mental Health Bill of Rights, a document originally drafted by our union and passed in December by the GSC, that sets down in clear, fair language our expectations for mental healthcare at Vanderbilt.

2. Graduate workers reply to the Graduate Workers United anonymous mental healthcare experience survey

“The PCC was integral to my success during my first two years at Vanderbilt. I had an amazing counselor who helped me identify and manage my lows before they became incapacitating, which allowed me to keep up with my studies, learn how to balance my personal life and my work, and flourish as an educator. Now I work with a new counselor and our limited sessions are goal-oriented, forcing me to rethink how to best manage my chronic depression. The thought of having to ration my visits (not only to save money on sessions outside of VU, but also for the cost of travel and irregular scheduling) is a source of worry and immense frustration, as if I'm not the right 'candidate' for mental health treatment since I don't have a problem which can be 'fixed.'”

“As a queer person I’m having a hard time finding an LGBT friendly therapist that is covered by insurance and isn’t too far from campus.”

“I was told my crippling anxiety, which I almost quit the grad program over, wasn’t “severe” enough to get treatment there. They said I could wait for about six month to get in to see someone but no sooner. I was given a list of community providers of which most were unavailable or did not take our insurance. I ended up having to pay so much out of pocket, it felt very unfair.”

3. The latest empirical data on mental health in the academic profession:

A 2015 study at the University of California, Berkeley found that 47% of graduate students suffer from depression.

A 2017 study at Ghent University in Belgium found that over half of PhD students in Flanders, Belgium reported at least two symptoms of poor mental health, and are at much greater risk of psychiatric disorders than highly educated employees in the general population.

A 2018 survey published in Nature Biotechnology looked at PhD candidates across 26 countries and 234 institutions and found that they are six times more likely to experience depression and anxiety than the general population.

4. Mental health issues in academia are rooted in workplace conditions.

As the above data show, graduate students suffer disproportionately from mental health issues and have unique mental health care needs. So how can we as graduate students work to ensure that those needs are met? Well that depends on how we understand the causes of mental well-being or illness among graduate students. More and more studies are showing that working conditions, and especially our degree of participation in organizing our working conditions, plays a fundamental role in our mental health.

Some have found, for example, that financial insecurity,  competitive atmospheres, work-life balance, and workload significantly contribute to mental illness among PhD students (Appel and Dahlgren, 2003; Kurtz-Costes et al., 2006; Stubb et al., 2011, 2012). Most recently, the above-mentioned Belgian study finds a strong connection between mental health issues and high job demands and low job control, uncertainties regarding funding, work-family conflict, and a closed decision making culture in the university.

These studies are confirming what has long been accepted in organizational health research: that high job demands and low job control significantly contribute to poor mental health outcomes. Low job control has also been shown to have significant emotional costs and to contribute significantly to stress (e.g.  De Lange et al., 2004; Vanroelen et al., 2009; Gillespie et al., 2001; Winefield et al., 2003; Kinman, 2001; Kinman et al., 2006; Tytherleigh et al., 2005; Biron et al., 2008; Sun et al., 2011; Mark and Smith, 2012; Boyd et al., 2011). When it comes to job control, university management strategies play a significant role. According to one study Kinman (2001), social interaction patterns between university staff have shifted from a culture of collegiality to a bureaucratic culture and a management style in which consultation and participation in decision making are given less importance (see also Biron et al., 2008). This means less participation in university decision-making processes, less job control, and more stress for everyone.

Given that our working conditions have such a significant impact on our mental health during graduate school, it’s imperative that we start thinking about our workplace and our mental health as intimately linked. Today we start that conversation on our campus. Having a share in determining our working conditions would not just be a formal change in our relationship to Vanderbilt’s administration. It would, we believe, bring tangible benefits to our mental wellbeing and productivity as a community of scholar-educators.

5. Highlights from graduate worker testimonies on Mental Health Day:

Charlie Geyer, Department of Spanish and Portuguese

  • Charlie expressed disappointment with the lack of transparency and communication regarding the policy change at the PCC.
  • Although Charlie was told that he would have unlimited access to the PCC, his access was gradually reduced. In the Fall of 2015, he was able to access the PCC every two weeks. As of the Fall of 2016, his access has been restricted to once a month. In the Fall of 2017, he was made aware that after 6 sessions his services may be discontinued pending clinical review.
  • “Given not only these changes, but also the denial on the part of the administration that there are any changes taking place at all, it’s hard to believe that the administration has our best interest at heart when it comes mental and emotional wellbeing.”
  • “This is why we are asking for student input into policy changes at the PCC, and a more transparent and democratic process regarding PCC policy in general.”

Elizabeth Barna, Department of Sociology

  • Elizabeth shared her experience of what many could reasonably consider to be a crisis situation requiring more frequent sessions. In July of 2016, her car was stolen at gunpoint and, approximately one week later, she had her first appointment with what she thought would be a long-term provider. During Elizabeth’s first two years at Vanderbilt, she had unlimited access to therapy to help manage her existing moderate-to-major depressive disorder and anxiety symptoms. She has fortunately had access to an excellent meds provider at the PCC throughout her time at Vanderbilt and has greatly benefited from the PCC’s group therapy services. However, she finds the phasing out of long-term care to be incredibly harmful to graduate workers with trauma histories and chronic mental illnesses. Based on her experiences, Elizabeth offered the following suggestions for improving mental health care on campus:
  • Be willing to provide long-term individual care to students with trauma histories or chronic mental health conditions.
  • Continue medical services with no co-pays.
  • Establish a transparent, easy-to-access/navigate network of community partners who accept Vanderbilt insurance AND are accepting new patients.
  • Vanderbilt University needs to be a leader in encouraging mental health providers to set up offices in Nashville; this is part of a larger problem of few providers in the area.  
  • More group therapy sessions—also, I noticed that both groups I attended were/are predominantly white and cisgender.  We need groups inclusive of people of color, first-generation college/grad students, and LGBTQIA students.
  • Hire more providers who are people of color, LGBTQIA, first-generation, and so on.  Having a lesbian therapist was critical to my personal development in college.  Having providers whose biographies are shaped by structural inequality will generate greater trust with diverse student populations.  People of color need and deserve competent care, including multiple group therapy session options for POC, led by POC providers.

Jesse McCarthy, Department of History

  • Jesse emphasized that our campaign for improved mental healthcare services needs to be about affordable mental health care on campus. He said that although the Center for Student Wellbeing (CSW) and other organizations are great parts of the on-campus healthcare network, they are meant to be a support mechanism, not a replacement for therapy.
  • Relatedly, he noted that the PCC offers professional services in medication management, alcohol and other drugs (AOD), and trauma therapy, while CSW does not. Moreover, CSW runs support groups for recovery, stress, and other vital things, but does not have licensed therapists and cannot provide complex treatments like eye movement desensitization and reprocessing (EMDR).
  • Overall, Jesse worries that the impression given from recent communications from the administration is that the CSW is supposed to be a replacement for PCC care, rather than the support mechanism it has been since its inception.

Jesse Berton, Department of English

  • “I started receiving individual therapy at the PCC at the beginning of 2017. I had bi-weekly sessions for the spring semester. Though I was working with an early-career therapist, I was happy with the counseling I received. At the beginning of the 2018 Fall semester, I was informed that the PCC was moving to a short-term care model. I was told that this probably wouldn’t work for me, and that I should find weekly talk therapy options in the community. My therapist attempted to help me find some resources in Nashville, but as someone who’d only been in town about a year, it wasn’t much help.”
  • “I used the resource page provided by Vanderbilt, as well as the directory on Psychology Today, to find a therapist who seemed like a good match. He didn’t work with Vanderbilt’s insurance, but suggested that it was going to be difficult to find a provider in Nashville who did. In light of my income as a graduate student, he offered me a sliding scale discount—sessions at half price. Which is a pretty good deal. But because of my limited income as a graduate student, at that time, paying half-price for weekly talk therapy—the extremely discounted sliding scale rate—that would have been almost twenty percent of my income. That’s just not possible for me. I’m not currently seeing a therapist.”
  • “In closing, I just want to say a quick word about the Center for Student Wellbeing, which has been billed as a resource for Graduate Students who are feeling the pinch of changes at the PCC. I have received several free ten-minute massages at the CSW. I enjoyed them! I am a satisfied customer! A free ten-minute massage is really different than regular sessions with a trained mental health professional. Look, both massages and mental health care are wonderful. But I appreciate massages. I need mental health care. I’m bummed that the mental health of its graduate students isn’t a priority for Vanderbilt.”

Sabeen Ahmed, Department of Philosophy

  • Sabeen acknowledged that the PCC offers group therapy options dedicated to the specific needs of graduate students and “a students of color affinity group series, composed of 4 different seminar series spread across 12 sessions in locations across campus, free for any and all students to attend.” However, would like to see “process groups specifically for students of color, that are closed groups and led by therapists trained in the specific needs of this demographic,” a process group led by therapists trained to address the specific needs of women of color, and multiple sessions of group therapy.

6. Reflecting on the common themes from graduate worker testimonies

Our colleagues’ testimonies make clear that the policies governing mental health care have changed in measurable ways since they started graduate school. And they also show how much information we still need about the future of our on-campus care and the financial consequences of having to seek care off-campus. Our speakers also testified eloquently, I think, to how much graduate workers value their care at the PCC. Individual therapy, group therapy, and access to emergency care are necessities without which we cannot thrive in our work. Equitability in care, such as having access to a well-trained, diverse team of providers and inclusive group therapy, is also a deeply felt need. Continuing the long-term care model on both the individual and group level is also a clear priority. Now is not the time for Vanderbilt to be shifting to a shorter-term care model, not when statistics are showing the increasing need for mental health services in academic workplaces.

These issues extend out into the wider community as well. Our undergraduate allies have many of the same concerns as we do, and whatever changes we are able to effect on the mental health infrastructure on our campus will affect them, too. So many of us teach undergraduates while in graduate school. These are wonderful learning experiences for them and for us. Our working conditions and overall mental health are their learning conditions. Our advocacy must therefore extend to consider their concerns and needs; we want them to get the mental healthcare they need as well.

7. What our administration has done so far

We want to recognize the administration’s efforts to improve mental health care at campus. At the town hall on September 11, 2017, the administration made a serious effort to hear our concerns. Since then, the administration has announced the creation of a University Counseling Center, which aims to a mix of direct access counseling, targeted wellness services, and referrals to community providers for specialized care. In addition, the administration has included graduate students on the hiring committee for UCC director. More recently, the administration has entered into negotiations with the GSC over the ratification of a Mental Health Bill of Rights, which originally came out of our union. Finally, this evening’s discussion between Chancellor Zeppos and former U.S. rep. Patrick Kennedy shows that the administration is aware of the need for improvements to mental health care options on campus.

We recognize and appreciate these efforts on the part of the administration. We also want to make sure that we as a community of Vanderbilt students and staff continue to have the conversation about what role we should have in the process of improving mental health care on campus and creating a more democratic work and study place for all. With that in mind, remember that Mental Health Day is just the beginning of this conversation.