Stanford enhances its focus on mental health

Mental health is a continuing priority at Stanford and many of its peer institutions. Three university health professionals describe how Stanford responds to people in distress and how the university is enhancing its services for those with urgent needs.

Jim Jacobs is executive director of Vaden Health Center.

Rosan Gomperts is director of the Faculty Staff Help Center.

Doug Noordsy is associate chair for clinical integration and coordination in the Department of Psychiatry and Behavioral Sciences.

Access to mental health services on college campuses has become a subject of concern nationwide. Some students at Stanford believe the university is not doing enough in this area. What is the status of mental health services at Stanford?

Jacobs: This is an area where there will always be more we can do to support our students, and the needs are indeed increasing, ranging from substance issues to the everyday stresses of university life. Stanford students do have broad access to licensed mental health staff through the Counseling and Psychological Services (CAPS) program, on the second floor of Vaden Health Center. In the fall we will also initiate some new services in the renovated Kingscote Gardens building. We also have a team of confidential counselors specifically to assist victims of sexual violence. We are also fortunate to leverage relationships with Stanford’s Department of Psychiatry and Behavioral Sciences and with many mental health professionals in the greater Palo Alto area to expand care options for students.

Gomperts: Faculty, staff and postdocs all have access to the Faculty Staff Help Center, which provides counseling and consultation services. The FSHC is available by appointment from 8 a.m. to 6 p.m. Monday through Friday. Main offices are located at 408 Panama Mall, with additional locations at SLAC, the medical school and an office in San Jose. Referrals are made for people who prefer to receive services in the community and/or are looking for services that the FSHC does not offer. As a confidential and no-cost resource, the FSHC works to support faculty, staff and postdocs to get support for any kinds of issues they are facing in their life. We can be reached at helpcenter.stanford.edu.

Students often say there are long wait times to see a CAPS counselor, and some say they don’t call at all because of the anticipated wait time. How are you addressing this?

Jacobs: Mental health resources, including those offered by most colleges and universities, are straining. CAPS includes a staff of more than 23 full-time equivalents of psychiatrists, psychologists, therapists and case managers, but there are times during each quarter when demand exceeds supply, especially for clinically non-acute services, and the wait time expands. Note that wait time refers to the time between an initial phone conversation with a CAPS counselor, which usually happens within 24 hours of a request, and the next available in-person appointment. For acute needs, we do have staff ready to meet with students on a same-day, urgent basis Monday through Friday during regular business hours. We also understand that crises can happen at any time. After hours, CAPS staff are available by phone to speak with students, faculty and staff – as well as parents and friends – about any mental health issues affecting our students.

CAPS also is trying to increase utilization of group therapy as an option to get students into care more rapidly.

There are others on campus also offering around-the-clock services, including Resident Education staff, Graduate Life Office deans, the Confidential Support Team for sexual assault and relationship violence issues, The Bridge Peer Counseling Center, Peer Health Educators and a large number of student groups. Together, we make up a safety net of people and services supporting students.

What happens when Vaden is closed?

Jacobs: Historically, CAPS staff have provided a robust after-hours on-call presence through a traditional answering service model. CAPS is currently finalizing an arrangement with ProtoCall, a national company that provides after-hours mental health coverage using licensed clinicians to more than 170 universities and colleges, including the entire University of California system and Columbia University. ProtoCall has multiple clinicians available at any one time for consultation by telephone. CAPS staff will still be on call, but leveraging ProtoCall for most after-hours responses will allow us to focus more CAPS staff on maximizing access to in-person services.

Noordsy: The Department of Psychiatry also maintains a 24-hour on-call system based at Stanford Hospital. We are able to respond to phone calls and see people who present to the Stanford Hospital Emergency Department for help. We are available at (650) 723-6661.

Many students are not aware of the services available to them. What are you doing to raise awareness?

Jacobs: This year, the ASSU (Associated Students) has made wellness one of its top priorities, and we appreciate the additional attention they have shed on this important issue and the awareness they have raised among students. We did a campus-wide survey in 2016 that showed some 87 percent of both graduate and undergraduate students knew about mental health resources available to them on campus. But we can do better. We are committed to continuing to work with faculty, staff and students on campus to identify the warning signs of mental health problems and how to access services.

The Wellness Information Network for Graduate Students (WINGS), which was recommended by the Mental Health and Wellbeing Advisory Board, is currently being piloted in several graduate school departments. Graduate students are more likely to feel isolated, so we see this as a way to help connect a graduate student to services.

Noordsy: In addition to CAPS and the Help Center, students, faculty and staff have access to care at the Stanford Department of Psychiatry and at a range of providers in the local community, many of whom trained at Stanford or serve as affiliated teaching faculty. The Department of Psychiatry offices are located on the north edge of campus at 401 Quarry Road and are reachable by walking trails off of Palm Drive or by the Marguerite shuttle. Our faculty and staff provide expert psychotherapy and psychopharmacology services for people experiencing a range of mental health problems, with a focus on integrating lifestyle and wellness interventions to empower people to achieve mastery over their disorder. Our faculty are also advancing science through research into more precise and effective interventions. You can learn more about the Department of Psychiatry at med.stanford.edu/psychiatry, and request an appointment by calling our Intake Department at (650) 498-9111.

For the last several years, students have been asking for outreach and support for their specific communities. How are you addressing this?

Noordsy: We realized that it’s not enough for us to provide support to students only at Vaden. We must go out onto campus, to traditionally underserved communities. CAPS has worked with many of the campus community centers to provide care specific to the Native American, African American, Asian American, Latino/a/x and LGBTQIA communities on campus. We have incorporated a psychologist in the Athletics Department to provide on-site support and problem solving for student athletes. We also have clinics in the School of Medicine, School of Engineering and most recently at The Markaz resource center for Muslim students and the Bechtel International Center. The latter two are recent additions given the stressful political issues facing many of our students.

Outside of CAPS, what resources are available to the campus community, including faculty and staff?

Gomperts: There are an abundance of professionals paying attention to student well-being, including resident fellows, resident assistants, resident deans and academic advisors. For employees, there is the Faculty Staff Help Center and the Office of the Ombuds. Both offices maintain confidentiality, except in case of legal reporting duties having to do with safety issues. All of these people are valuable parts of the Stanford safety net.

What this means is that there are a lot of people paying attention to how members of our community are doing. We’ve also been trying to include even more university faculty, staff and students into the effort of raising awareness of mental health issues and wellness on campus. It’s a big and important job, and we need everyone to advocate for care, decrease stigma and encourage healthy behaviors and self-care.

Noordsy: As mentioned above, the Stanford Department of Psychiatry provides outpatient, emergency and inpatient care to students, faculty and staff in need. We also provide training to a substantial cadre of psychiatrists and psychologists, many of whom stay in the area after graduation and form a robust community of private practice and adjunct faculty. Some students, faculty and staff prefer the additional separation of receiving care with a private practitioner, while others prefer the convenience of receiving care on campus. Our Intake Department can help with identifying a provider.

What happens if a student, or someone else on campus, is in extreme distress?

Jacobs: There are many people who can respond, and we are all trying to continually train the Stanford community about early warning signs and how to get the student in touch with the right people. CAPS, Residential Education, the Graduate Life Office deans, The Bridge – all are available 24/7. So, the last thing anyone should worry about is who to call. Many times, the residence deans are the key responders, and they quickly get the rest of the safety net involved, including CAPS.

Noordsy: Sometimes a call will come into the Dean of Students Office first. Sometimes a student comes to the attention of CAPS first, and then we quickly call together a support team for the student. That support can include receiving care at the Emergency Department or the psychiatry service at Stanford Hospital. No one should feel that they have to handle a situation alone. We encourage the community to reach out to us early and to have a low threshold of concern to call. We aim to offer a rapid appointment for evaluation for those in distress whenever possible.

There has been some concern expressed about the process of a 5150 on campus, and what is involved when the safety of a student is at risk. When and why do campus police become involved?

Noordsy: The abbreviation 5150 refers to a section of California code that allows a person to be held in a safe place when a dangerous mental health problem is present. A 5150 allows designated trained personnel – peace officers, emergency room physicians, psychiatrists or psychologists – to protect those who are in imminent danger of hurting themselves or others, or are unable to provide for their basic needs related to a psychiatric disorder. In the interest of safety, the law allows an evaluation for up to 72 hours whether or not the person agrees to the evaluation.

Circumstances when a 5150 may be considered include when someone presents to the Emergency Department because of suicide risk and then declines help, when someone is concerned enough about a student’s safety on campus to call the police, or a provider at CAPS is worried that someone is in imminent danger of suicide and requests that campus police bring the student to the Emergency Department for an evaluation. Adverse reaction to a substance of abuse may at times lead to a need to protect a student and those around them from untoward consequences were they to leave the care setting.

The 5150 is controversial precisely because it pits an individual’s civil rights against the societal goal to protect and provide for those at risk. Mental health professionals carefully consider these competing values with the individual at risk to help ensure that they get the care they need. In the rare circumstance where there is need for a 5150 to ensure someone’s safety and access to care, the individual at risk may either be evaluated and referred for outpatient care or hospitalized for further evaluation and treatment.

Jacobs: In Santa Clara County, where Stanford resides, only specially trained peace officers, emergency physicians and certain mental health professionals can invoke a 5150, and usually only when the distressed person is determined to pose danger to themselves or others.

What types of mental health issues do you see Stanford students struggle with?

Noordsy: Stanford students experience a wide range of challenges, from adjustment to being away from home, sharing living space and dating to depression, anxiety, eating disorders and substance abuse. University students are right in the middle of the age range when the initial signs of most psychiatric disorders become apparent. While having a mental health problem can feel scary, it is important to keep in mind that these issues are very common. One in four Americans will experience a mental health issue during their lifetime. Current treatments are effective, often allowing students to continue to fully enjoy and participate in their academic and social lives.

What advice do you have for faculty, staff and students who are worried about a student who seems to be in distress?

Jacobs: We have a website that outlines how to assist students in distress. It describes how you can involve residence deans, the Graduate Life Office, the Office of Sexual Assault and Relationship Abuse Office and all the other support services Stanford offers. It also talks about signs of behavior changes, from dramatic weight loss or gain, changes in personal hygiene, excessive absences, poor preparation –behaviors that should draw our attention.

Gomperts: The most important takeaway is to remember – whether you are struggling yourself or know someone who is – there is support. There are many dedicated individuals who are knowledgeable and compassionate, and want to see you thrive during your time at Stanford. Reach out to us, talk to us and take a step that is compassionate to yourself by getting care and support. The Help Center staff will always talk to those either in distress or who have people in their life they are worried about.