“If something doesn’t work, up the ante and provide more of the same.” That is the conclusion of an exhaustive Report of the Task Force on Student Psychological Health and Welfare at the University of Pennsylvania.
The Task Force was deployed by the university in February 2014 after four students committed suicide since August 2013, three of them in the early months of 2014. Mass student outcry followed, demanding shorter waiting times and more caring clinicians from the University’s Counseling and Psychological Services (CAPS).
While the task force was working on its report, two more students committed suicide, bringing to a total of six suicides in a year and a half, making the rate about five times higher than the national average.
The takeaway from the Task Force Report places the blame mostly on student anxiety and depression carried over from childhood, and excessive stress due to the student need for academic perfection. The report recommends a single unified website pointing to available mental health services, university-wide recognition and reporting of students suspected of having mental issues, and additional CAPS staff to limit intake waiting to seven days for first-time non-emergency appointments.
Although the Report successfully brings to light much-needed outreach and education of students, it fails to mention how many of the suicide victims were in communication with or receiving treatment from CAPS staff. Nor did it address the CAPS treatment protocol which is operating from an antiquated 40-year-old model of diagnosing mental disorders, based upon symptoms categorized into 157 mental disorders.
The National Institute of Mental Health (NIMH), noting the lack of significant improvement in public mental health over the past 40 years compared with breakthroughs in medical health, recently abandoned this symptomatic model. NIMH is looking to understand mental illness from basic biological mechanisms, such as genes, cells, and brain circuits—but it also supports trans-diagnostic psychotherapies that target common factors underlying extraneous diagnoses.
The American Psychological Association has discouraged implementation of the NIMH approach by continuing to focus on symptoms with its Diagnostic Statistical Manual-5. Since many DSM symptoms overlap, the diagnoses are not necessarily valid. The diagnoses also are not reliable, as evidenced by poor interrater consensus.
Possibly the biggest barrier for student mental health at Penn is that over the past 30 years, and in spite of fairly high rates of treatment failure and relapse, Cognitive Behavioral Therapy (CBT) has increasingly become embedded in the minds of clinical counselors. If 70 percent of students respond with partial reduction of depressive symptoms, CBT is considered effective, without mention of the other 30 percent.
CBT holds that depression can be attributed to self-defeating negative cognitions, which are sustained inaccurate and often negative thoughts about the self. These negative cognitions are measured by negative symptoms, which are the negative thoughts believed to be the cause of depression. The problem is that these negative cognitions are seen as both the symptoms and the cause of depression, in a circuitous cause-effect relationship.
According to a 2012 meta-study undertaken by Health and Human Services, the pooled response rate for treating anger and aggression with Cognitive Behavioral Therapy versus other psychotherapies was virtually identical (66 to 69 percent vs. 65 to 70 percent). The response rates for depression were a little better at 51 to 87 percent vs. 45 to 70 percent. And the response rate for anxiety was only 46 percent, without another therapy for comparison.
What is needed at Penn is competent and caring staff that can empower students with emotional issues to take charge of their lives and become their own persons. This means focusing more on therapies that provide a theory of problem formation and change that can be empirically validated (not just hyped as “evidenced-based,” whatever that means).
The Task Force was deployed by the university in February 2014 after four students committed suicide since August 2013, three of them in the early months of 2014. Mass student outcry followed, demanding shorter waiting times and more caring clinicians from the University’s Counseling and Psychological Services (CAPS).
While the task force was working on its report, two more students committed suicide, bringing to a total of six suicides in a year and a half, making the rate about five times higher than the national average.
The takeaway from the Task Force Report places the blame mostly on student anxiety and depression carried over from childhood, and excessive stress due to the student need for academic perfection. The report recommends a single unified website pointing to available mental health services, university-wide recognition and reporting of students suspected of having mental issues, and additional CAPS staff to limit intake waiting to seven days for first-time non-emergency appointments.
Although the Report successfully brings to light much-needed outreach and education of students, it fails to mention how many of the suicide victims were in communication with or receiving treatment from CAPS staff. Nor did it address the CAPS treatment protocol which is operating from an antiquated 40-year-old model of diagnosing mental disorders, based upon symptoms categorized into 157 mental disorders.
The National Institute of Mental Health (NIMH), noting the lack of significant improvement in public mental health over the past 40 years compared with breakthroughs in medical health, recently abandoned this symptomatic model. NIMH is looking to understand mental illness from basic biological mechanisms, such as genes, cells, and brain circuits—but it also supports trans-diagnostic psychotherapies that target common factors underlying extraneous diagnoses.
The American Psychological Association has discouraged implementation of the NIMH approach by continuing to focus on symptoms with its Diagnostic Statistical Manual-5. Since many DSM symptoms overlap, the diagnoses are not necessarily valid. The diagnoses also are not reliable, as evidenced by poor interrater consensus.
Possibly the biggest barrier for student mental health at Penn is that over the past 30 years, and in spite of fairly high rates of treatment failure and relapse, Cognitive Behavioral Therapy (CBT) has increasingly become embedded in the minds of clinical counselors. If 70 percent of students respond with partial reduction of depressive symptoms, CBT is considered effective, without mention of the other 30 percent.
CBT holds that depression can be attributed to self-defeating negative cognitions, which are sustained inaccurate and often negative thoughts about the self. These negative cognitions are measured by negative symptoms, which are the negative thoughts believed to be the cause of depression. The problem is that these negative cognitions are seen as both the symptoms and the cause of depression, in a circuitous cause-effect relationship.
According to a 2012 meta-study undertaken by Health and Human Services, the pooled response rate for treating anger and aggression with Cognitive Behavioral Therapy versus other psychotherapies was virtually identical (66 to 69 percent vs. 65 to 70 percent). The response rates for depression were a little better at 51 to 87 percent vs. 45 to 70 percent. And the response rate for anxiety was only 46 percent, without another therapy for comparison.
What is needed at Penn is competent and caring staff that can empower students with emotional issues to take charge of their lives and become their own persons. This means focusing more on therapies that provide a theory of problem formation and change that can be empirically validated (not just hyped as “evidenced-based,” whatever that means).
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