For many at Stanford, seeking mental health services means finding their way to the second floor of Vaden Health Center with its the towering windows and modern décor.
The past few years, however, have marked a shift towards a more decentralized approach towards psychological health. University officials have sought to make mental health services more accessible to on-campus communities that have traditionally underutilized them.
In 2011, Counseling and Psychological Services (CAPS) began offering clinical services at El Centro Chicano, based out of a former storage closet that was renovated into a beach-themed wellness room.
“To introduce CAPS services in El Centro, we had a town hall meeting with students, because it was a new initiative,” said Frances Morales, associate dean and director of El Centro Chicano. “We wanted to make sure students knew that coming here and receiving services didn’t mean that there was a stigma; we were trying to work to decrease the stigma of seeking help.”
According to Morales, offering clinical services in El Centro was just one such step: CAPS has been making an active effort in recent years to address varying cultural attitudes towards mental health treatment, she said.
Approaches and barriers to mental health care
“One of the things we learned early on is that a single approach won’t work,” CAPS Director Ronald Albucher said. “Because of the different cultures, languages, treatment of mental health issues within the culture, even religious concerns around mental health issues — is this more of a spiritual issue versus a mental health issue?”
The stigmatization of mental health issues can be more prevalent within some cultural groups on campus, making them less likely to seek out traditional psychological services, according to Cindy Ng, associate dean of students and Asian American Activities Center director. Ng brought up the example of a cultural stigma to mental health issues impacting whether Asian American students seek help.
“I believe that Asian American undergrads are still one of the few populations that underutilize CAPS, and I think it’s because of that cultural stigma to help-seeking,” Ng said. “And when they do go, they’re often sicker, rather than seeking help early.”
More practical difficulties can also arise for international students, whose insurance plans often include few or no provisions for mental health care. This was addressed in 2010, when the University began requiring all international students to enroll in the Stanford-run insurance plan Cardinal Care. Stanford gives exceptions to students whose insurance meets minimum standards.
“Insisting that all international students have Cardinal Care coverage was a major step forward in our ability to work with those students,” Albucher said. “A lot of them came here with minimal insurance coverage to begin with, and certainly within the mental health area.”
“So if we ever had to hospitalize a student in the past, there would be no coverage for that — or if we wanted to just see them in weekly psychotherapy, there was no coverage for that. It was a financial burden on the student,” he added.
The lack of proper mental health coverage was especially prevalent in the graduate student population, where around one in three are international students. Given these numbers, CAPS worked to reach out to this community through programs hosted in areas of campus frequented by graduate students, such as the School of Engineering and the School of Medicine. There are also two clinicians who work at the Graduate Community Center, Albucher said.
“People may be more comfortable going there to see a clinician or even to drop in and talk to somebody because I think graduate students tend not to utilize the community centers nearly as much,” Albucher said.
Increasing community mental health care
Many undergraduates, however, do take advantage of services offered at the community centers.
To address cultural factors that may serve as obstacles to providing proper mental health treatments, the University has focused on incorporating psychological services into existing community structures. The hope is to increase the accessibility of these services, particularly for students who may be uncomfortable signing up for an appointment at Vaden.
“We have a number of programs that we work in collaboration with the community centers to bring,” said Alejandro Martinez, senior associate director for consultation and liaison at CAPS. “The goal there is, instead of always coming to us, we want to make sure students can get some of these resources where they are, where they study, where they live, where they socialize.”
At El Centro Chicano and the Black Community Services Center (BCSC), this effort has taken the form of on-site clinical services as well as additional programs that promote mental health, such as workshops and discussions about stress and other student issues.
Similar programs have been introduced at the Native American Cultural Center (NACC), focusing on addressing mental health issues within the broader framework of Native American culture.
In addition to hosting their own on-site counseling, the NACC has created a three-course sequence on Native American mental health geared towards students with an interest in peer counseling and has introduced a talking circle for students.
“We started a talking circle in the afternoon, which is sort of a Native version of a group wellness dynamic,” said Karen Biestman, associate dean and director of the NACC. “That draws, of course, on tribal principles of a talking circle and the symbolism of a talking circle.”
Martinez said that overall CAPS has made a dedicated effort to allocate resources across communities on campus.
“For a service like CAPS to be effective, we need to have a good sense of where students are,” Martinez said. “That sometimes really requires that we be out in the community, that we don’t just simply wait for students to come to us.”
Contact Sabelle Smythe at issmythe ‘at’ stanford.edu.