Content warning: This article contains references to suicide.
When James Hutchinson ’24 called Yale’s Acute Care Emergency Line and told the operator that he was considering suicide, he was told to expect a counselor assignment in a month. For now, however, he was advised to “go for a walk.” Hutchinson, who requested a pseudonym to remain anonymous, was assured that his counselor assignment process would be expedited, given the urgency of his situation. By the time Hutchinson spoke to The Politic in January, it had been over two months since Hutchinson first called the Acute Care Emergency Line. At the end of February, he still did not have a counselor.
“My personal experience with the Office of Counseling and Mental Health has shown me that even someone like me, that is, an at-risk student, can’t get help,” Hutchinson told The Politic. He worries about what this means for others in crisis. “It’s making me a little bit scared that other students aren’t getting the help that they need. It’s scary to me because it might be indicative of a larger problem,” he said.
Students have been drawing attention to experiences like Hutchinson’s increasingly over the past three years. In 2019, Molly Shapiro ’21 wrote an article for The Politic that highlighted similar problems: Students seeking mental health services at Yale often had to wait months to receive support, and the Yale College Council Mental Health Report found that only 31.5% of students agreed that the length of time they waited before receiving help was reasonable. Shapiro’s article also documented that there were insufficient resources to meet students’ increased demand for counseling and called attention to a lack of published data from Yale Health about student wait times. These problems linger to this day.
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“There’s something dehumanizing about the fact that you can say, ‘Hello, I am in need of help,’ and the system won’t get back to you for months,” said Joe Brown ’24, who requested a pseudonym. Brown has used Yale’s mental health services in the past, and he wondered, “How much could the system possibly care about me, if they’re not going to take the time to reach out?”
Yale University’s student body is made up of over 12,000 people, all of whom are entitled to mental health care from Yale under free Yale Health Basic Coverage. Yet the Yale Mental Health & Counseling website only lists 50 full-time providers — one provider for every 240 students. While Yale’s mental health resources were strained before the COVID-19 pandemic, the stressors of the last two years have prompted more students to seek out help, according to Hoffman.
While Yale’s mental health resources already lagged behind student need before the onset of COVID-19, universities across America are experiencing the same COVID-19 induced surge in demand as Yale is now. Amy Biancolli, a staff reporter for “Mad in America,” recently documented this crisis in college and university counseling services, finding that the wait time for a session can be as much as six weeks in many schools. Though as the third-wealthiest university in America, Yale’s resources greatly outpace almost all other schools, this wait time is typical at Yale too.
“Yale is facing the same problem that so many colleges and universities are facing, which is that we’re in the middle of a mental health crisis,” said Laurie Santos, a professor of psychology at Yale, the head of Silliman College, and the director of The Good Life Center. As mental health staffers seek to accommodate as many students as possible throughout the pandemic, the mental wellness of mental health providers has taken a hit as well. “The resources available really are outstripped by the demand,” she concluded.
Yale Mental Health and Counseling is actively working to increase its number of counselors. In an interview with The Politic, Paul Hoffman, the Director of Yale Mental Health and Counseling (YMHC), said it has been a “challenge” to keep up with the year-after-year volume increases along with the increase in students due to higher enrollment this year. YMHC has seen in excess of 800 more students this year than during the same period of time last year. It is in year one of a three-year hiring plan intended to correlate staffing levels to demand.
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Citing early research that the pandemic has particularly impacted the mental health of high school and college-aged people, including increases in depression, anxiety, eating disorders, and substance abuse, Hoffman suggested several reasons why this may be the case: Greater social isolation during a critical period of social development, as well as constant changes to the learning environment as students switch between online and in-person instruction, are two significant factors he points out.
In order to address this problem at the onset of the pandemic, the YMHC immediately switched to virtual therapy and was able to continue seeing many students while they were at home and in different states. The YMHC was able to do so because of emergency orders allowing out-of-state treatment. In states where this was not possible, YMHC created an out-of-state benefit so that no student would be without access to mental health treatment.
In response to high demand, Hoffman explained that YMHC is in year one of three of a planned increase in the number of clinicians, and that YMHC opened a second location at 205 Whitney Avenue to accommodate the new therapists. Furthermore, YMHC expanded their group therapy program and now allows students to participate in individual and group therapy simultaneously.
“The biggest change that will be noticeable to students is the increase in the number of clinicians,” Hoffman said.“It may take time for the full effects of the increase to be felt, but our aim is to decrease the amount of time some students may have to wait for treatment and to increase the amount of time each student would have in therapy.”
While changes are underway, many undergraduate students continue to complain about long wait times to be matched with a YMHC clinician. If and when students finally overcome the long wait times, they often remain unsatisfied with their care, due to issues such as short session times and being matched with the wrong type of mental healthcare provider.
Evelyn Brooks ’24 initially reached out to the YMHC on October 12, 2021, to request an appointment with a therapist, and completed her initial intake on October 20. But it wasn’t until January 27 that her current therapist reached out and informed her that his next available spot was February 18.
“That’s over four months that I had to wait just to get a single session. And all that I got was a 30 minute zoom call,” Brooks, who requested a pseudonym, told The Politic.
During those four months of radio silence from YMHC, Brooks’ mental health worsened. Shortly after reaching out to the YMHC, she was sexually assaulted. A professional not affiliated with Yale diagnosed her with post traumatic stress disorder.
“Obviously, I know that I can’t change the past or say for certain whether or not things would turn out differently,” Brooks explained. “But I’m sure having a therapist during that time as I went through that traumatizing experience probably would have changed the trajectory of my healing process and made things significantly easier. I suffered in silence, shame, and self-blame for so long, and I felt like I had no one to turn to. And perhaps, things would have been different if I could have seen someone at Yale Mental Health and Counseling Center. I think about this a lot.”
Hutchinson finally heard back from the YMHC, and learned that he was assigned to a psychiatrist. However, it was not the assignment he had asked for.
“I was assigned a psychiatrist, but I had already communicated to [YMHC] that I was taking prescribed medication from a doctor back home. Essentially, I already have a psychiatrist. I didn’t really need another one. I wanted talk therapy from a different provider,” Hutchinson explained.
Eric Moore ’24, who requested a pseudonym, had a similarly frustrating experience. When he initially reached out to the YMHC back in September, he informed them multiple times that he was running low on his ADHD and anxiety medication. After a month passed with no response, Moore called the clinicians on their mobile number to ask them if he had been matched with a clinician yet. He was told that, although they didn’t have a psychiatrist for Moore yet, they could provide a temporary person to prescribe his medication.
In his initial intake interview, Moore remembers, he informed the YMHC that a temporary clinician prescribed him medication for his ADHD, which is a short term release — meaning that, for two to three hours, the medications help him to study and focus. However, Moore wanted to try an extended-release medication for ADHD under the long-term guidance of a psychiatrist.
“So I decided to go back to the same person who gave me the short-term medicine last time from Yale and explain to them the situation,” he told The Politic. “Their response was that my question was more for a psychiatrist. And I was like, ‘Okay, I know it is, but I haven’t been matched with a psychiatrist yet. So, what do I do?’ And so it has just been like back and forth like that.”
Even when students are finally assigned to a professional through YMHC and find a time slot that works for both them and their therapist, students report that the duration of their therapy of 30 minutes isn’t often enough time.
“I’m not blaming this on the individuals, I blame this on the system. You could be in the middle of talking about a very serious and emotional topic, and crying,” said Brooks, who had waited four months to talk to a Yale therapist. “But, at the end of your 30 minutes, they have someone else they need to see. So you’re kind of out of luck at that point.” According to Moore, the natural consequence of shorter sessions is the risk of decreasing their quality, despite individual efforts by therapists and psychiatrists to improve the experience.
Leila Abbott ’24, who requested a pseudonym to remain anonymous, echoed these sentiments. In the second semester of her first year, Abbott had her first session with a Yale therapist. Abbott saw her therapist until March, but eventually stopped attending, frustrated by the way her overworked therapist would be five minutes late for an appointment, let her talk for about 20 minutes, and then would suddenly interrupt her just to schedule their next appointment. “At the peak of my vulnerability, she would just cut me off and send me home,” Abbott recalled.
Experiences such as this, Hoffman suggested in a follow-up email to The Politic, are a function of YMHC’s policy to accept new clients at all times, which differs from mental healthcare practices outside of Yale. Students often come to YMHC expecting the same exact experience they have had when they have sought treatment through clinicians in private practice without realizing that they are completely different systems. Clinicians in private practice only take new patients when they have dedicated space to offer them. When they do not have the time, they simply do not take new patients and are “full,” Hoffman explained.
YMHC, however, is never “full” and will take new patients regardless of how many students are currently being seen, according to Hoffman. “Because of this, clinician’s time at YMHC is a resource that is shared among all Yale students, and when there is a rapid increase in the number of students seeking treatment, some students will be seen less often and some students will need to wait to receive individual therapy. The first priority is to see the students with the greatest need.” In this way, “one of the greatest strengths of YMHC” — their commitment to seeing all patients — “also creates challenges,” wrote Hoffman.
Hoffman also emphasized that YMHC offers more short-term and long-term treatment options than most college counseling centers in the country. Most counseling centers only offer short-term treatment, group therapy, or case management. YMHC offers “much more” to its students, but “in the process can become more vulnerable to large surges in utilization or significant increases in acuity.”
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Other than the increase in the number of providers from 34 to 50 since 2019, the most significant change in Yale’s mental health services for undergraduates is the Yale College Community Care (YC3) program that launched in the spring of 2021, which is co-led by Mental Health and Counseling and Student Affairs. The new program, staffed by eight full-time mental health practitioners, is meant specifically for undergraduate students, as opposed to the traditional YMHC resources which serve the entire university. Each Yale student is entitled to four 30-minute sessions with a YC3 clinician.
According to Nicole Taylor, a college care clinician at YC3, YC3 is a program that integrates mental health and wellness services. While the clinicians on the YC3 team are also Mental Health and Counseling staff, the wellness specialists on the YC3 team are part of Yale College Student Affairs.
YC3 was created to give students easy access to short-term therapy appointments that can be scheduled online, part of the clinician increase Hoffman described. The YC3 staff members are trained clinicians and community wellness specialists, and can act as a temporary alternative while students wait to receive more permanent care. Beyond one-on-one therapy sessions conducted by clinicians, community wellness specialists offer virtual workshops on sleep, mindfulness, and stress management, which Brooks found “super helpful.” While YC3 is not a replacement for YMHC services, students have found it an effective form of stop-gap mental health care.
Santos was pleased that Yale College’s expanded mental health offerings coincided with the COVID-19 pandemic, when students had even more need for support than in the past.
“While it’s not necessarily fixing all the problems that we have at Yale mental health and counseling, I think the new YC3 program is an excellent step in the right direction in devoting staff members particularly to the needs of Yale College students,” Santos explained. “And in some ways this is unprecedented in terms of what Yale has done for mental health support for students so far.”
Taylor of YC3 also echoed Santos’s sentiments, encouraging students to utilize the mental health resources that are available to them. “Yale offers a significant amount of mental health resources compared to other colleges, but during a time when there is unprecedented demand for mental health treatment, it is important for students to remember all the resources that are available to them,” Taylor said in an interview with The Politic. She emphasized that YC3 is designed to work in conjunction with Mental Health and Counseling to meet the demands of students who need wellness resources or quick access to short mental health counseling. “While it may take time to get connected to an individual counselor at YMHC for some students, YC3 is always an option for students even if they are waiting to see someone at MHC. Through YC3, Yale has taken the approach of building different types of mental health and wellness resources that can meet different student needs.”
Taylor also suggested that YC3 remains “adaptable” — meaning that the team is offering several virtual programs and short-term therapy groups in response to the topics students are raising during individual sessions.
“This serves as an excellent support for students who may not be able to immediately get individual therapy within MHC or as an additional support to students who may not see a therapist as often as they wish,” Hoffman said.
Back in summer of 2021, Brown used YC3 while he was living on campus. Initially, he reached out to receive an intake appointment with YMHC. However, because he had taken a leave of absence during the 2020-21 school year, his Yale Health Basic Coverage — which allows all Yale undergraduates to take advantage of YMHC services free of charge — had been paused, and his request was denied. After contending with the administration about the lack of mental health services available to students who had taken leaves of absence, the administration recommended he try using YC3.
“I was screaming from the rooftops that I needed help. And like, the best I can get was like a 20 minute session,” Brown explained in an interview with The Politic. After two sessions, Brown stopped using the YC3 services.
Brown did not have a negative experience with YC3, he emphasized, but he still “would not sing its praises,” he said. “It served the function I needed it to serve.” Brown said that he had recommended YC3 to other Yale students who needed immediate care. “If you are currently in crisis and need someone to talk to, it’s not perfect, but it’s better than nothing.”
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“I bet the things you write about in this article will be jarring to some, but surprising to none,” Abbott, who had withdrawn from counseling because of her negative experience with short therapy sessions, said.
For Abbott, the issues within the YMHC system expose a problematic reality within the student body — that “good mental health care is becoming the privilege of the few, or rather, the privilege of the wealthy.” Abbott noted that, in her conversations with friends, she has observed that students, not satisfied with YMHC, often seek out mental health care with therapists or psychiatrists outside of Yale. This outside therapy is usually not covered by health insurance and can cost hundreds of dollars a session. Thus, quality mental health care becomes an issue of socioeconomic and financial inequity — while some students who are stuck using the Yale Mental Health Care, others’ families can afford therapy outside of Yale.
For years, students have been documenting dire mental health needs and deficiencies within YMHC. Now, we’re two years into a pandemic that has exacerbated mental health issues to an extreme degree. Yale has recognized these persisting problems to some degree and has introduced new programs in response, yet core issues such as inappropriate wait times and short therapy sessions remain the same. Shapiro’s 2019 Politic article and others since then chronicle similar complaints among the student body, prompting the student body and administration to take stock of where we are amid a period of increasing attention toward and exacerbation of student mental health challenges.
Because this is no abstract problem. “Every Yale student is either going through something like this, or knows someone who is,” Abbott said.