This semester, the Office of the Provost convened a task force on managing student mental health to begin to assess and respond to significant increases in both student self-reports of mental health issues and the subsequent use of related services — an uptick that reflects a national trend in higher education over the past several years. The task force is charged with examining how Harvard can best address the mix of academic, social, and institutional issues that have the potential to influence student mental health, while looking beyond traditional services toward a more holistic model of care.
The Gazette sat down with the task force’s three chairs, Grafstein Family Professor of Sociology Mario Small, McLean Professor of Ancient and Modern History and of the Classics and Dean of the Graduate School of Arts and Sciences (GSAS) Emma Dench, and Edgar Pierce Professor of Psychology Matt Nock, to discuss what they hope to bring to the table in their respective leadership roles and how they believe the task force can quickly begin to improve mental health services at Harvard while also planning for long-term change.
Mario Small, Emma Dench, and Matt Nock
GAZETTE: Thank you all for taking the time to sit down with us today to discuss this exciting new initiative from the Office of the Provost. Each of you has a unique background to bring to your leadership role on the task force. Talk about what it means to you to be involved, and what you hope to be able to impart.
SMALL: When I was asked by the provost to join and chair this task force, I was very happy to participate for a number of reasons. For one, the work corresponds with my intellectual interests: I recently wrote a book, “Someone To Talk To,” which engages my field of sociology, to try to understand how people make decisions, specifically about whom they turn to when facing difficulties. The book is a combination case study and survey-based study, and I focused the qualitative section of the study on graduate students because of all the difficulties related to the fact they’re entering into a new environment and may also be facing serious life choices at the same time.
Most importantly, however, I’m hopeful that I can help to contribute to the quality of life at the University. It’s clear to me that universities in general, and this one in particular, are high-stress environments that attract people who are high-achieving and who often have become so at great personal sacrifice — often emotional or psychosocial in nature. This very ambitious task force, with dozens of people from across the entire University, has the opportunity to do something important and lasting to improve mental health on campus.
NOCK: I’m extremely excited about being involved in the task force, in large part because as a clinical psychologist who studies mental health and suicide, I know very well how serious this problem is. We know that mental health disorders often have an onset during the college years. Suicide, which is my primary area of study, is the second-leading cause of death among college students.
We’ve known as a society for decades that late adolescence/early adulthood is a time of high onset of mental disorders and suicidal behavior and alcohol and drug abuse. As higher education administrators, we have a captive audience. We have undergraduate students in the same place for four years with the same address and email; we have attachment and the opportunity to provide consistent, strong, coordinated support. The fact that Harvard is now making it a priority to figure out how we can best provide this support, across the University’s Schools and units, is very exciting.
DENCH: I’m really pleased to be a member of the task force steering group, and to be leading the working group on graduate and professional students, particularly as those enrolled at the GSAS make up a third of all students in this category. Our students are unique at the University in that it can take five years or more for them to earn their degrees; for some, it can be very challenging along the way. Over the past several years, we’ve partnered with Harvard University Health Services (HUHS) to conduct mental health surveys in a variety of programs, and thanks to very good response rates, we’re learning quite a bit about the scope of mental health problems throughout our student body. I know that the information-gathering we’ve already done will be crucial to the work of the task force.
Harvard, on the whole, is very atomized, so I’m really delighted that the task force is concentrating on mental health from a University-wide perspective. I’m hopeful that we can use what we’ve learned at GSAS to help with the development of a broad strategy, one that can effectively support all students at a time when requests for care are increasing. I know it can often be difficult to get together and share what we know with colleagues across Harvard; now we can build a collective process to address that.
GAZETTE: There is a real heterogeneity of voices on this task force, which is also quite large. How do you begin to think about incorporating the numerous and diverse perspectives of the task force’s membership, toward actually implementing real University-wide change?
DENCH: Harvard is a really complicated place, but our diversity is one of our greatest strengths. I’m a huge fan of getting everybody with different perspectives, experiences, and viewpoints around the same table. That always leads to something better, and I can already tell that we’re going to learn a great deal from one another. When I’ve been involved in similar groups in the past, I’ve noticed how we all realize that we’re each developing and implementing great ideas already, but that we don’t necessarily realize what others are doing. The task force will allow us to share our best practices and quickly provide opportunities to communicate them to our colleagues across Harvard.
We are also benefiting from the incredible work undertaken by the Harvard University Review Committee under Annette Gordon-Reed’s leadership. Their recommendations on student mental health inform our work as task force members and highlight the questions we’ve been asking at GSAS, particularly surrounding student challenges that are unique to specific populations. Asking questions, sharing solutions, and hearing where our students’ experiences diverge and intersect will help inform change for the benefit of all Harvard students.
NOCK: The diversity and heterogeneity of the committee is necessary and important and one of its greatest strengths. Mental health among students is not just a student issue, it’s a Harvard issue, a University issue. It’s one that affects, and is affected by, everyone on campus. Undergrads, graduate students, professional staff, tenure and tenure-track professors, other members of the teaching community, police, HUHS — everyone has a role to play in the environment that we create for our students, and it’s critically important to have everyone at the table. I’ve already seen the interest, investment, and passion on all sides.
SMALL: The size and composition of the task force is its biggest asset, and its greatest challenge.
The asset is very clear. We have an extraordinary amount of expertise and talent in the room both from Harvard and other universities — people who have particular skills and knowledge in terms of mental health. We have psychologists, psychiatrists, academics, experts on running institutions, people who have had one-to-one contact with students facing mental health issues; we have students grad and undergrad; we have regular faculty, people from all sorts of backgrounds; we have women and men; we have people from multiple backgrounds with regards to sexuality; we have people of diverse ethnic and racial backgrounds. In multiple ways, the diversity of the group reflects the diversity of our institutions.
The challenge is twofold: getting diverse sets of people on the same page as to what we should be doing, and determining what constitutes an effective process. Big groups — all else being equal — tend to move more slowly than small groups. We must work quickly to get people to understand the process, ensure that their voices are heard, and then move forward in a collaborative way. I think we can meet that challenge.
GAZETTE: It’s of course very early. The first task force meetings took place this February, and then the working groups convened in March, and I imagine that you want to guide a productive conversation, rather than make pre-emptive decisions about what Harvard needs vis-à-vis mental health. But how do you begin to think about what success would look like?
NOCK: I think the first thing that we have to do as a task force is get a good understanding of the nature of mental health concerns among students. The good news is that there are existing data to provide a baseline for our work. I am currently part of a team of cross-national researchers looking at mental health problems in college students in over a dozen schools worldwide (including Harvard), and we have learned that more than 20 percent of students have a mental disorder in a given year. We also know that in more than 50 percent of cases they had those disorders before they entered college, and only less than 20 percent of those students will seek mental health treatment while in college. This suggests to me that there are some clear things we could be doing differently, and others we should work to strengthen.
We need to work hard to identify the students who are coming into College with existing disorders, reach out to them, and better direct those who are struggling with mental health concerns into treatment. There are already excellent mental health resources at Harvard that aren’t being used as much as they perhaps should be. One easy thing we can do is to help better connect students with them. That might mean more active outreach, or that might mean trying to identify and remove existing barriers for students, including attitudinal barriers (thinking they might not need help, not trusting the help, or not trusting there’s not going to be forced mental health leave) and structural barriers — we’ve heard from students that it might be difficult to get to mental health services even on campus. When bottlenecks occur, can we take the lead as a university in bringing treatments to students so that they can use them where and when they need them?
Looking forward, what gives me hope is that there has been an explosion of new approaches to identifying and helping people to manage and overcome mental health challenges using things like new technologies. Harvard is already using some of these. There are online psych interventions for things like depression, insomnia, and anxiety that have been shown in randomized trials to be extremely effective.
SMALL: There are already great resources here at Harvard, but also aspects of mental health that require immediate attention, and we’re going to identify those and work on them as quickly as we can responsibly. For other aspects that cannot be met immediately, we will proceed thoughtfully.
The first thing we need to do is ensure that every member of the task force has a strong idea of exactly what we’re dealing with. We have some statistics. What do the numbers say about the incidence of loneliness and depression and anxiety and other indicators of mental health? We want to get a really concrete sense of what we know.
We also want to gain a better sense of what we don’t know. What are the important gaps in the statistics we collect? And thirdly, in terms of understanding the data, we need to be able to parse which issues are not general but specific to particular groups, subgroups, or units. What are the things only people in a given School or with a given background are facing? We need to know that as well. To my mind, one of the very first tasks is to get a very clear sense of the scope of the issue.
DENCH: In the short term, success means identifying the most challenging problems. I’m hoping this will happen reasonably efficiently so that, as both Matt and Mario mentioned, we can begin to determine where the gaps are. In the medium to long term, after conversation with, most importantly, students, but also with the faculty and staff who engage with them, I’m confident we’ll begin to identify precise deliverables that will have immediate impact on the student experience. I’m already thinking about one way to improve mental health access and care — the centralization of information. Something as simple as a one-stop source for information would be pretty revolutionary, as well as powerful and effective.
One of the reasons I am so energized by the work we are undertaking is that it isn’t simply about addressing problems that our students are having — it’s about improving their experience as students and as human beings. In thinking about this, I’m drawn to a sentence in the document that lays out the task force’s role: “Mental health is not a problem to address in a few students but an element of well-being to cultivate among all.” That is very well said and something we all should bear in mind.
This interview has been lightly edited for length and clarity.