More than Just the Therapy

Pamphlets can make seeking mental health counseling at Harvard simple for students. Call a hotline, or just head on over to the Smith Campus Center, and go up to Counseling and Mental Health Services. But for students—especially from communities where seeking counseling is stigmatized or uncommon—dialing that phone number or pressing the 4th floor button on the Campus Center elevator can be harder than it seems. And as those students consider whether to seek help, a question persists; will the person on the other end be able to relate?

In recent years, diversifying the makeup of Harvard’s Counseling and Mental Health Services staff has become a pressing issue. Students have formed organizations to advocate for increased racial diversity among counselors, and the winning platform in last year’s Undergraduate Council presidential election also emphasized the need for diverse counselors.

Harvard University Health Services is aware of the importance of having a diverse counseling staff and is taking steps to recruit counselors from different backgrounds. But they face challenges in their recruitment, particularly a limited pool of minority candidates from which to hire. Currently, there are seven counselors of color who work for CAMHS, according to CAMHS Chief Barbara Lewis—representing roughly a quarter of CAMHS clinicians.

At a time when issues of mental health are prominent on campus, both students and health administrators understand the need for a diverse counseling staff, but recognize the difficulties of achieving that goal.

ORGANIZING FOR DIVERSITY

Across the country and at Harvard, students are increasingly seeking out mental health resources. While at Harvard, about 36 percent of last year’s graduating Class of 2016 who responded to The Crimson’s annual senior survey sought mental health support on campus from HUHS. This figure represents a seven percent increase from the same survey administered to the Class of 2013, the first year The Crimson began collecting data about whether students sought HUHS mental health resources.

In addition, the diversity of counselors and outreach to historically underserved populations has become even more important to students at Harvard.

In fall 2015, a small group of students met in Boylston Hall to talk about their experiences with CAMHS. Karla C. Mendoza, an undergraduate currently taking time off from Harvard, said the student organization that would later morph into Diversify CAMHS began very informally.

“It started over a Facebook Messenger group, people just kept adding people,” Mendoza said. “It was people who had been to CAMHS but were really dissatisfied with their services.”

The group circulated a survey over College email lists asking students about their experiences at CAMHS. They received almost 150 responses, and Mendoza noted that the survey showed a significant number of students were dissatisfied, especially BGLTQ students and students of color.

Following the survey, a few of those students penned an op-ed in The Crimson announcing their creation of a group known as Diversify CAMHS. With the goal of improving mental health services for “marginalized and minority Harvard students,” the coalition gained traction in spring 2016, hosting discussions about the intersection of identity and mental health, according to the group’s website.

Diversify CAMHS was not the first to advocate for a more diverse counseling staff. Their calls followed similar appeals during the 2015 Undergraduate Council presidential election to increase the diversity of CAMHS counselors. Two of the tickets included the issue as part of their campaign platforms, including that of the eventual victors, now-President Shaiba Rather ’17 and now- Vice President Daniel V. Banks ’17.

Campaigning on the promise to “Open Harvard,” Rather and Banks advocated for “[increasing] the racial diversity of the UHS counseling staff” as part of the mental health arm of their platform.

Mental health has since become one of the four “compelling interests” that the UC funds as part of its “Grant for an Open Harvard College” initiative, but aside from the grants, Rather said the UC has taken a more advisory role in advocating for student health issues, holding biweekly meetings to discuss student wellness with Kevin Wehmhoefer—a CAMHS social worker and supervisor of Student Mental Health Liaisons—and monthly meetings with Barreira.

While Diversify CAMHS as a group has largely gone silent this fall, and current members of the group did not respond to request for comment, a new peer counseling group addressing issues of diversity in mental health called Indigo was founded last spring. After offering counseling in spring 2016, Indigo has since seen staffing shortages this semester and is currently spending time training. The group plans to resume counseling next semester.

Other groups have also formed on campus to address issues of diversity and mental health— for example, the Asian American and Pacific Islander Mental Health Initiative.

Waverley Y. He ’18, a member of the AAPI Mental Health Initiative, said many Asian American youth are not used to admitting problems and seeking help—part of the reason for the group’s formation.

“Obviously, parents were more than happy to broadcast their children’s successes, but when anything goes wrong, if their child isn’t doing well in class, or if they’re having family struggles, that is something that’s very much kept between family members,” she said. “It’s just hard to imagine that [in college] you’d be able to tell those insecurities to somebody that you’ve never met before, that you don’t relate to.”

CHALLENGES NATIONALLY AND AT HARVARD

Earlier this semester, some students received communication through the secure message portal of Harvard University Health Services from B. Francis Chen, informing them that he would leave Harvard for Tufts University’s Counseling and Mental Health Service.

Chen, who declined to comment for this story, was the only Asian American counselor in CAMHS at the time of his departure. HUHS worked quickly to hire a new Asian American counselor, and Lewis said a Mandarin-speaking psychologist has accepted the job and is now undergoing the process of credentialing and obtaining a Massachusetts license.

“We were really lucky and we decided, if the [interviewing] group likes her, we’re offering her a job on the spot. And they did,” Lewis said.

However, Chen’s departure underscored the difficulties administrators face in hiring a diverse staff of counselors. According to Lewis, CAMHS’ goal of hiring more counselors of color is sometimes limited by the demographics of applicants. She described the tough decision her office faces when the pool of applicants is not as diverse as they hope it to be.

“Do we leave these positions open, and maybe have less access for a period of time, so we can wait in hopes that we can get someone who would add diversity to our staff?” Lewis asked.

In an interview last spring, HUHS Director Paul J. Barreira was more direct in acknowledging the challenges that come along with trying to hire a more diverse staff: “We would never be able to hire enough people of diversity to necessarily offer somebody of diversity to every student who wanted it.”

When the applicant pool does not reflect the desired diversity, the leadership of CAMHS sometimes resorts to alternate methods of finding candidates. Lewis said her office has reached out to alumni of the University and asked current staff members to make recommendations.

Barbara Lewis is the chief of Counseling and Mental Health Services at Harvard University Health Services. By Helen Y. Wu

The issues Harvard has faced in achieving a diverse counseling staff reflects broader national trends. The overwhelming majority—around 72 percent—of clinical counseling staff across the country identify as white, according to a 2015 survey conducted by the Association for University and College Counseling Center Directors. Harvard participated in the survey.

Additionally, 10.2 percent of counseling staff identified as black or African American, 7.4 percent as Asian or Asian American, 6.7 percent as Latino or Latina, 2 percent as multiracial, 1 percent marking “other,” and 0.5 percent as Indian or Native American in the survey.

Although university counseling centers have historically been predominantly staffed by professionals who identify as white, David R. Reetz, a Rochester Institute of Technology health administrator who coordinates the AUCCCD’s annual survey, said he has noticed trends that show an increase in underrepresented racial identities among new staffing hires.

“More centers are hiring more staff each of the last five years. So we’re hiring more, and we’re using those staff increases to expand the diversity of staff,” Reetz said.

Barreira also said counseling staff benefit from sharing knowledge to eliminate implicit biases they might have coming from different perspectives about issues related to identity.

“There’s a way that staff can learn from each other,” Barreira said. “So, there’s value not only to the students. There’s value to the staff to have diversity because you’re looking and saying, ‘I might be missing something.’”

He said that he thinks the training and collaboration within the staff makes a huge difference in the long run for students.

DIVERSITY OF IDENTITY, DIVERSITY OF EXPERIENCE

Students, administrators, and mental health professionals agree that having a diverse counseling staff is important for cultivating a resource best able to support the student body. However, students’ belief in the importance of counselors sharing similar backgrounds with students differs slightly from professionals’ opinions on the effects of “matching.”

Some students said it’s important not simply to match identifies with counselors, but also to have counselors who have a diversity of life experiences that can help them relate to students of all backgrounds

“I feel so much more comfortable sitting across a black authority or a queer authority and talking about my problems than a white straight person, just because I feel there’s such an experiential gap that you just can’t cross,” Nicholas P. Whittaker ’19 said.

Patrick Y. Xu ’16, a former president of the AAPI Mental Health Initiative, said having a counselor of Asian descent can be advantageous for students who may prefer not to have to explain the nuances of their upbringings, like cultural discrepancies in parenting.

“It’s way easier to have someone who understands that, rather than someone being like ‘Can you explain what is it like to have an immigrant parent?’” Xu said. “By no means for me is having an Asian clinician necessary, but I can definitely foresee situations in which it might help.”

Lewis and Barreira both said that, while they value a diverse counseling staff, it is the job of counselors to empathize with clients in all situations, regardless of whether or not can they personally relate to a given situation.

“I might not necessarily feel or understand because it’s not my experience, but I should still be able to hear what that person has struggled with and come to kind of a common understanding,” Lewis said. “I know sometimes students get frustrated with having to educate, but that’s what the process is in trying to understand.”

Additionally, Edward K.S. Wang, a Medical School professor of psychology who has developed programs targeted at treating racially diverse mental health patients, said matching clients and counselors on the basis of a particular identity may not solely guarantee good or better outcomes.

According to Wang, studies in the field have concluded that the ability for counselors to “understand and connect with [their] clients” is a more crucial influence on successful outcomes than sharing identity traits.

“Just because I can match you racially or ethnically, doesn’t mean that [necessarily] that’s everything,” Wang said. “Maybe, initially, racial matching can work well together for the first two or three situations. To Wang, it’s really about, ‘Hey can my therapist understand me?’”

The value of diversity within college counseling extends beyond one-to-one interactions that clients see in appointments. Wang said that having more diversity among counselors is an overall positive factor because it affects the workplace environment and outside perception for those potentially seeking help.

“I think the reason for that is it also creates an environment of sensitivity, of cultural respectfulness, and that also reflects the view of the counseling service,” Wang said. “It’s more than just the therapy itself, it’s also about the organizational environment.”

And with mental health professionals describing the organizational environment as an integral part of a counseling resource, Reetz also linked the diversity of a university’s mental health clinicians to a student body’s use of those services.

“We do recognize that the more diverse the staff is, the most diverse the student body is that utilizes certain services,” Reetz said.

Whether having a diverse mental health counseling staff improves the experience of patients, makes the resource present as more accessible, or encourages cultural competency among clinicians, HUHS administration is unequivocal in their support for a more diverse counseling staff.

“I think the face of CAMHS has to reflect some diversity, otherwise, students won’t find it attractive. It’s not the question of a diverse staff, it’s a question of how many of each type of diversity you can have in a group,” Barreira said. “So, it’s got to be diverse and it’s got to represent at least the diversity of the student body.”

—Staff writer Menaka V. Narayanan can be reached at menaka.narayanan@thecrimson.com. Follow her on Twitter @mnarayanan97.

—Staff writer Kenton K. Shimozaki can be reached at kenton.shimozaki@thecrimson.com. Follow him on Twitter @KentonShimozaki.