REPORT OF THE TASK FORCE

ON MANAGING STUDENT

MENTAL HEALTH

July 2020

CONTENTS

EXECUTIVE SUMMARY ....................................................................................................3

INTRODUCTION ................................................................................................................4

MEMBERSHIP ...................................................................................................................6

State of graduate and professional student mental health ....................................18

RECOMMENDATIONS ....................................................................................................29

APPENDICES ..................................................................................................................37

Appendix B: Unedited list of suggestions received by the Task Force ..................40

Appendix C: List of focus groups interviewed .........................................................46

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

Cover photo credit: Stephanie Mitchell/Harvard University

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

for how Harvard can improve its support of student mental health.

The Task Force first met in February 2019. Over the following 15 months, we analyzed surveys that have been

fielded across Harvard’s Schools, looked to national surveys for comparative numbers, examined institutional

data on mental health services at the University, and convened focus groups to hear directly from undergrad-

uate, graduate, and professional students, faculty members across multiple Schools, and sta at all levels of

the institution. Our investigation confirmed that Harvard students are experiencing rising levels of depression

and anxiety disorders, and high and widespread levels of anxiety, depression, loneliness, and other conditions.

In addition, undergraduates reported high levels of stress, overwork, concern about measuring up to peers,

and inability to maintain healthy coping strategies. Extracurricular activities, rather than providing unquali-

fied relief, often represented another source of competition and stress. Graduate and professional students

an emphasis on mental health and flourishing

2. We recommend launching a one-year campaign focused on mental health awareness and culture

change

3. We recommend instituting a yearly messaging program focused on core elements of the first cam-

paign

4. We recommend creating a small committee to explore ways to make Counseling and Mental Health

Services more accessible

5. We recommend that the Provost examine how to address mental health, sexual climate, inclusiveness,

isolation, and sense of belonging holistically

6. We recommend addressing any potential institutional service gaps that may have been created by

The Task Force was inspired by the dedication of students, faculty, and sta of the University to cultivate an

environment in which all students can thrive and flourish. We recommend that, three years from the inception

of the recommendations, an independent evaluation be performed to report on the progress made. This form

of accountability will help maximize the benefits from our eorts.

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

think they may have depression increased from 22% to 31%, and the percentage reporting that they have

or think they may have an anxiety disorder increased from 19% to 30%. In recent surveys of graduate and

professional students at Harvard, almost a quarter of respondents exhibited symptoms of moderate to

severe depression at the time of the survey, with a similar rate for moderate to severe generalized anxiety.

Accordingly, student demand for mental health services had risen.

The Task Force on Managing Student Mental Health was composed of 46 undergraduates, graduate students,

faculty members, mental health practitioners, administrators, and others of varying economic, gender, race,

national, and ethnic backgrounds. In our various roles, we had all seen students grapple with emotional

and psychosocial distress, in many and complex forms and across a variety of contexts. It was evident to

us and to the University that the situation could not be addressed solely by the University’s Counseling

address three questions: (1) What is the current state of student mental health at Harvard? (2) What are

mental health? We understood that fulfilling our charge would require understanding students holistically,

of dierent cultural approaches to addressing mental health.

The entire Task Force first met in February of 2019. We then divided into two working groups, one focused

on undergraduate students and another focused on graduate and professional students, and a steering

committee comprised largely of members of each group. Members were provided with extensive information to

review between meetings and were consulted for advice and input at various points along the way. Subgroups

were convened on an ad hoc basis to discuss specific topics as the Task Force proceeded with its work.

Meetings in the spring of 2019 focused on reviewing the available survey and institutional data related to

student mental health and mental health services and discussing where more information was needed. The

sta with the goal of hearing their thoughts about the mental health challenges faced by students at Harvard,

the resources they were aware of, and the obstacles to accessing them. The Task Force also solicited their

ideas about what changes could have a positive impact on students’ well-being. We convened approximately

20 focus groups in late spring and early fall of 2019.

The sessions were led by professional facilitators from

the Derek Bok Center for Teaching and Learning and the Organizational Development consulting team from

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

clinicians at CAMHS; spoke with several clinicians in the local community who regularly see Harvard students

in their practices; and held individual meetings with others across Harvard’s campus. We continued to work

with the University and College institutional research oces to further analyze the data available from

student surveys.

Our findings and recommendations are summarized in the document that follows. While our charge was to

investigate the mental health of students, we note that Harvard should examine the mental health of its sta

and faculty. Students learn habits of work, thought, and balance from faculty, and student mental health has

clearly been aected by the practices and visible stresses of their professors. In addition, we note that while

we focus largely on the environment for students at Harvard, we do so with full awareness that Harvard does

not exist in a vacuum. Rates of anxiety, depression, and other mental health conditions are rising nationally,

has shrunk.

students and their families. And students were facing all these conditions before the world was forced to

confront its worst pandemic nearly a century.

We had concluded most of our work, and were drafting our recommendations, when COVID-19 hit. It is clear to

us that the dramatic disruptions to social life created by the pandemic will aect, and in some cases worsen,

the problems we have identified. Economic stress, high unemployment, social isolation, loss of life, and many

other conditions produce grief, stress, loneliness, despair, and more. The University has and must continue to

respond, both in the short term and in the long term. At the same time, changing the work of this Task Force

to address the specific impacts of COVID-19 would not be sensible. Our Task Force is ill-equipped for that

and among graduate students and professional students. In both cases, we summarize what we learned

about the basic state of aairs, including recent changes in mental health indicators, the range of issues

that students are facing, and the conditions that seem to be aecting mental health. Next, we describe in

more detail the clinical resources available at Harvard, including how much students know about—and what

they think of—these resources. Finally, we list our recommendations for action. Our recommendations were

culled from a large set of ideas generated by the many constituents we spoke to, after extensive discussions

of feasibility, likely impact, and possible unintended consequences. Several ideas that appeared to be

promising did not make the final cut, as they required further study.

addressing student mental health requires a more sustained eort than a task force can undertake, and our

can help the Harvard community build on that enthusiasm and resolve for years to come.

3 Carey, Kevin. “The Bleak Job Landscape of Adjunctopia for PhDs” New York Times. March, 2020. https://www.nytimes.

com/2020/03/05/upshot/academic-job-crisis-phd.html

4 These ideas are listed in Appendix A

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Grafstein Family Professor of Sociology, Faculty of

Arts and Sciences

Deputy Provost, Harvard University

Executive Director, Harvard University Health

Services; Henry K. Oliver Chair of Hygiene

Edgar Pierce Professor of Psychology, Faculty of

Arts and Sciences

Dean of Students, Harvard College

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

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6 American College Health Association Data: American College Health Association-National College Health Assessment II: Undergradu-

ate Student Reference Group Data Report Spring 2018. Silver Spring, MD: American College Health Association; 2018.

7 In 2014 and 2016, the HUHS survey question read “Do you currently have, or think you may have, any of the following conditions?”

and the choices were “No, Not sure/Don’t know, Yes.” In 2018, the question remained the same but the choices changed to “No, Have

concerns, Diagnosed.”

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

I’ve heard from people who go visit them that the peer counselor they saw knows them. This raises

privacy concerns. – Undergraduate student focus group participant

Many students also rely on friends for support. While this is generally a positive practice, the focus

overreliance on friends, as it places additional burdens on the peers and may further result in “circuits of

distress” whereby the mental health of an entire friend group suers. Others expressed a reluctance to be

vulnerable with peers. While anxiety is everywhere, some believed that being frank about their troubles to

peers could be perilous.

I’ve seen a lot of weight being put on friends in terms of mental health concerns, and the friends

are you doing?” is “great, how are you doing?” You have anxiety but you feel like you’re the only one

because people don’t talk about it. – Undergraduate student focus group participant

Family. For students from stable, supportive families, calling home and having parents visit campus can be

a welcome relief. For those from less financially or emotionally stable backgrounds, family may be not only

less accessible, but also itself a source of stress. Family figured prominently among students’ sources of

stress, including worries about an inability to send money home, about parents’ undocumented status and

deportation, and about the implications of newly discovered or newly declared identities.

One resource that helps me a lot is calling home […] Not a resource that Harvard supplies but it

more and more often. – Focus group participant

I have family problems all the time that I feel like other people don’t have and I don’t know who can

relate to what I’m going through. I don’t feel like I have the support and I don’t know where to get it

from. – Undergraduate student focus group participant

Academic accommodations. The Accessible Education Oce (AEO) works with many students who have

mental health issues, reporting that this category makes up more than 300 of its 900 registered students.

While the oce reports a sense that an increasing number of students are starting to self-identify as needing

accommodations for mental health issues, it also notes the possibility that some students who could benefit

from accommodations for mental health issues still may not be connecting with the oce or are doing so only

echoed this concern. The issue was lack of awareness – not merely about the existence of the AEO, but also,

more generous with accommodations, while faculty in the sciences are more strict […] it can be scary

Focus group participant

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emotional well-being. Harvard College also has several Equity, Diversity, and Inclusion Oces, including the

Oce of Diversity Education and Support, the Oce of BGLTQ Student Life, and the Harvard Foundation

for Intercultural and Race Relations. For issues of sexual or gender-based harassment or assault, the

University has a Title IX Oce, Title IX Coordinators for Harvard College students, and an Oce for Sexual

Assault Prevention and Response (OSAPR). Examining the quality of student interaction with each of these

oces was beyond the scope of our work. However, we note that students who participated in focus groups

repeatedly cited the Oce of BGLTQ Student Life as a trusted resource.

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

STATE OF AFFAIRS: GRADUATE AND PROFESSIONAL

STUDENTS

Through these eorts, 6,811 graduate and professional students have been surveyed. The findings listed

below are based on survey results from 11 programs:

• Institutional survey data using the PHQ-9 screening tool for depression suggests that approximately

23.6% of graduate students responding to the survey exhibited symptoms of moderate to severe

depression at the time of the survey.

• The prevalence rate of generalized anxiety, using the GAD-7 screening tool, is similar to the rate of

depression. Institutional data collection suggests that approximately 23.1% of graduate students who

responded to the survey exhibited symptoms of moderate to severe generalized anxiety at the time of

the survey.

• Underrepresented minority students, first generation students, low income students, and students

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

students, and existing studies are mostly small in scale.

Because of sampling dierences and low response

rates, caution should be exercised in using some of the published literature as benchmarks to contextualize

the prevalence of student mental health issues at Harvard.

9 Flaherty, Colleen. “A Very Mixed Record on Grad Student Mental Health” Inside Higher Ed. December, 2018. https://www.insidehigh-

ered.com/news/2018/12/06/new-research-graduate-student-mental-well-being-says-departments-have-important

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

mental health of their students in specific ways. For example, in Schools with a strong ethos of caregiving,

students can find themselves taking on the troubles of their peers at the expense of their own mental health.

In Schools or programs where research and classroom discussions focus frequently on places or populations

– particularly low-income communities or communities of color – with which some students identify, some

diversity among faculty seemed to exacerbate this issue.

In some cases, a School’s institutional environment is closely connected to the culture of the profession

for which students are being trained. Some students in the Graduate School of Design (GSD) reported that

studio culture within the School – most notably the practice of sacrificing sleep for longer work hours – is

seen by many in the profession as a rite of passage and is directly linked to what will be asked of them when

examples of balancing work with life.

10 McLellan, Lizzy. “Lawyers Reveal True Depth of Mental Health Struggles” Law.com. February 2020. https://www.law.

com/2020/02/19/lawyers-reveal-true-depth-of-the-mental-health-struggles/?slreturn=20200405092036#

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

The lack of certainty or control over whether they will find a position and where they will end up

geographically was stressful to students and placed stress on their relationships with spouses and partners.

Students hoping to pursue a career outside of the typical path for their program at times faced additional

challenges. Several reported not feeling that they could be open with faculty about their career goals. Some

worried that their advisor would not devote as much time to their research or professional development if

the advisor knew the student was not planning a career in academia. Some students reported being actively

discouraged from seeking out opportunities that would prepare them for a non-traditional career path. Even

when faculty are supportive of alternative career paths, students may find it dicult to get informed guidance

about how to best prepare themselves for and pursue those paths. Students from several Schools reported

that their career services oces are only helpful for those seeking traditional career paths – even in programs

participant

knowledge of their peers, others do not want to reveal their struggles to others in their program. Students

reported concerns about displaying weakness or vulnerability in front of both peers and faculty in their

Schools. While student well-being can be bolstered by relationships with faculty that are both personally and

professionally supportive, students worry about opening up to faculty who may be in a position to evaluate

them either now or in the future.

There’s tension between people being your classmates and social support but also your future

colleagues. You don’t want to admit failures or weaknesses to them. – Professional student focus

group participant

Imposter syndrome. Imposter syndrome has emerged through surveys and Task Force conversations as a

major factor in graduate students’ mental health, and is likely both a cause and an eect of loneliness and

11 Moore, Monika. “The Changing Landscape of Tenure-Track Positions” Higher Ed Jobs. May, 2019. https://www.higheredjobs.com/Arti-

cles/articleDisplay.cfm?ID=1952

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isolation among students. Graduate and professional students have largely experienced success in their

academic lives before coming to Harvard, but they face new challenges in their graduate programs where

they are surrounded by similarly successful peers. For some students, the first year can be a major shock and

may be the first time they experience the feeling of being “behind” their peers. Embarrassed by the fact that

students each get the impression that they are the only one having a hard time. It is easy for them to draw the

conclusion that they must not be good enough, smart enough, hardworking enough, or creative enough for

their program. Reports of this issue were frequent.

For me the first year was a really big shock to my self-esteem. […] Makes you question whether or not

you belong. Everyone tells you it’s going to be dicult but you don’t really know what that’s like. A lot of

and professional programs face challenges in building and sustaining communities. Some master’s degree

students spoke about the challenge of building strong community bonds in programs that last only one or

two years, also noting that the overall high rate of turnover can make it dicult to sustain the groups and

communities that are established.

The structure of some programs also can impede a strong sense of connection or community. For example,

and then subdivided again on clinical rotations. At the GSD, some students report that they feel divided by

what they see as an unocial hierarchy among their respective programs. Even Ph.D. students note that their

ability to be part of a community – both in terms of time and physical presence in Cambridge – changes as

though they could be a wealth of knowledge and advice. They don’t feel like they can. No access to the

In conversations with the Task Force, graduate students identified institutional support as vital in sustaining

communities and student-led initiatives. Without this support, innovative and successful student-led

programs can disappear when the students behind those eorts graduate or are otherwise unable to

continue leading them. Students reported that the creation of community spaces can be a particularly

impactful way for faculty and administrators to improve the climate and foster a sense of community among

graduate students. For example, students in one department reported feelings of isolation, noting that they

would return to their apartments rather than staying on campus after class because they had no designated

space to relax, convene with other students, or study. In response, the chair of that department began

encourage socialization, and transformed the space into a more welcoming, social environment. Students

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Graduate student surveys revealed a strong correlation between the relationship between a Ph.D. student and

their advisor and scores on screening tools for depression, anxiety, self-esteem, and imposter phenomenon.

Issues in this area range from an absence of connection with one’s advisor, because the advisor is either

physically absent or is not available for check-ins, to advisors whose behavior is actively harmful to students’

struggle with these skills or do not view them as a priority. Students and faculty alike noted the challenges

of identifying ahead of time which faculty were likely to serve students well as mentors. While students

sometimes share information informally amongst themselves, they regretted that there is no systematic way

to provide feedback on advisors – either to the advisors themselves, or to potential future students.

The relationship between advisors and their students also involves a significant power dierential, which

they ever felt that they were experiencing issues with advising, 44.8% of students who participated in the

GSMHSI responded they would not.

There are some faculty who are not available physically, not responsive, not around. This is not

unrewarded if they’re productive. – Focus group participant

For doctoral students, the relationship with your advisor is a big factor. if there’s a problem, you can’t

really go to anyone for help. You can’t get away from that relationship. Changing advisors is really risky.

– Graduate student focus group participant

task force interview

[The] advisor relationship can either make or break mental health issues. In some cases, advisors

cause the mental health issues. But I have also seen advisors who are key in helping students make it

through. That resource is critical. – Focus group participant

Students whose advisors leave Harvard during the course of their graduate program are placed in a

particularly stressful situation. Some students choose to follow their advisors to new institutions or continue

working with them remotely, underlining how integral advisors are to their students’ academic experience.

Other students may have no choice but to search for a faculty member whose academic focus aligns with

their own and who has the capacity to take on a new advisee. They are then left with the challenge of building

HMS, medical students have identified mentoring on wellness, careers, and work-life balance as a priority.

12 Chuang, Callia. “‘Derailed’: When Graduate Students’ Mentors Leave Harvard” The Harvard Crimson. March 2020. https://www.the-

crimson.com/article/2020/3/2/grad-student-mentorship/

13 Barreira, P., Basilico, M., & Bolotnyy, V. (2018). Graduate Student Mental Health: Lessons from American Economics Departments.

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And while there are thousands of HMS faculty working in Harvard’s aliated hospitals, it can be challenging

for students to identify and connect with doctors who are interested in mentoring them in their chosen fields

of medicine and who have time to devote to this pursuit. GSAS students in terminal master’s programs noted

that they sometimes find it challenging to get time or attention from faculty advisors, given the pressures on

The Task Force has identified several positive eorts related to graduate student mentoring. Mentorship

is one of the topics addressed through the FAS New Faculty Institute, a two-day orientation for all new

ladder and senior faculty in the FAS. Demonstration of eective mentorship is also a factor in FAS tenure

decisions. The GSAS recently launched The Advising Project, a two-year initiative to identity and promote

best practice in advising structures and relationships.

The Government Department’s Committee on

agree on a “management plan” with their mentor to avoid either neglect or micromanagement. At HMS, MD

students have developed a web platform to help match students with faculty mentors interested in providing

personal or professional guidance.

Finally, growing numbers of faculty in the sciences are beginning to

outline their expectations of graduate students in writing. These documents can give students a better sense

of the environment that will be entering and can reduce the anxiety that results from uncertainty around

things like sick days and vacation time.

become things. – Graduate student focus group participant

undergraduate experience involves frequent feedback via graded assignments and exams, graduate research

16 Langin, Katie. “Why some professors welcome new lab members with clear expectations—in writing” Science. August, 2019. https://

www.sciencemag.org/careers/2019/08/why-some-professors-welcome-new-lab-members-clear-expectations-writing

17 In recognition of these issues, GSAS recently launched a new course titled “Introduction to Graduate School: Skills and Practices for

Scholarly Success,” which oers training in many fundamental aspects of graduate school, including clear and persuasive writing, eec-

tive teaching, and identifying and applying for grants. Other schools also report that they are considering adding more information about

these topics based on feedback from students.

REPORT OF THE TASK FORCE ON MANAGING STUDENT MENTAL HEALTH | JULY 2020 | HARVARD UNIVERSITY

be a struggle for many students, and, according to survey data, can exacerbate imposter syndrome. One

focus group participant emphasized that not providing students with support and guidance on navigating

this transition equates to “dumping them into the abyss.” Another participant shared that their department