Silently Struggling

How students navigate the barriers and doors to mental health access at the University

Words by Molly Wright. Photos and Illustration by Max Patten.

*The names in this story have been changed to protect the sources’ privacy.

A picture-perfect image of a student at the University exists within the minds of other students as someone they constantly have to live up to or strive to become — a student who is double-majoring in rewarding and rigorous subjects, excelling in their classes, leading on-Grounds organizations, having fun every weekend and making it all look easy.

“I definitely think there is an unspoken level of success,” said third year College student Sarah Nolan. “I feel like you’ve made it [as a University student] when you are involved in at least two organizations and you’re on the executive board for at least one of those. You’re on the Dean’s List the whole year. You probably have a job or some way to get money and you also have a great job or internship lined up.”

This desire to be perfectly well-rounded usually leaves students feeling overwhelmed, stressed and confused as to why they’re not keeping up with their peers, when their peers may very well be struggling as well.

Illustration by Max Patten.

“U.Va. is a highly-ranked institution, and students get here because they’ve been extremely successful for all of their academic careers and especially in high school, having been involved in lots of things,” said Nicole Ruzek, the Director of Counseling and Psychological Services at the University. “So what we tend to see is a lot of students coming in and striving still to be the best and to get into all the different clubs and majors that they want to be in and not always being successful like they were in high school. That can create some identity confusion and just kind of a re-evaluation of you know, ‘Who am I?’ ‘What do I really want?’ and ‘What’s important to me?’”

Ruzek said that while this “process of self-reflection” often goes well, in other cases these questions lead students to a lower sense of self-efficacy and self-esteem that can then trigger mental illness. The effects of mental illness and the nastier side of the University’s culture of competition and perfection is something that Alex* has seen more than once as a first year Resident Advisor at the University.  

“Around exams, one girl did not get into a leadership position for First Year Council, and she was threatening to throw herself in front of a bus,” Alex said. “Her friends found me, and we ran over there. She was sitting on the side of the street, and I ended up talking to her for 30 minutes with those girls.”

What Alex saw from this girl, they said, was the need to be perfect and the desire to fit the “U.Va. mold” that they have recognized many more times in other first-years who were also struggling.

“It’s usually about fitting in at U.Va, not feeling like they belong,” Alex said. “I don’t know how to correct that at U.Va, but I do think that there’s a lot that can be done about changing what we perceive as success and perfection. I try to tell people that you can be successful in so many different ways.”

The pressures of success ride on the backs of University students almost every day because, as Ruzek mentioned earlier, many students have already been successful for most of their lives. The idea of not being the best or even failing once in a while seems detrimental.

“There is an atmosphere at U.Va that discourages acknowledging [anxiety, depression and stress],” said an anonymous student survey respondent conducted by abcd magazine over Google form to which 29 students responded. “At U.Va, it seems as though every student is expected to have it all together all the time — make the best grades, be the most social, and be the most involved. In reality, no one has it all together, but no one ever dares express that. U.Va students hide behind a facade of perfection. I don’t think it’s only students’ faults though, I think the University in general doesn’t want to admit any kind of fault, or instance where we aren’t the best. They don’t want to compromise U.Va.’s reputation.”

So what do students do when they feel they can no longer handle being under constant stress or sense that their struggles might be the beginnings of a mental illness like anxiety or depression? The University offers free therapy sessions for students with Counseling and Psychological Services at the Elson Student Health Center, yet gaining access to the mental health resources at CAPS has proved difficult for many students.

Each year, CAPS sees approximately 2,000 students and has around 13,000 in-house appointments, but these numbers do not account for the amount of brief screening phone calls CAPs makes, which Ruzek cited as the way most students enter their services.

“Most of the students, they do an initial phone call, and it’s a script that we follow,” Ruzek said. “We know it’s not that fun for students to do because it’s you know very scripted, but it’s the best way for us to kind of look at everyone and see what level of functioning they’re at — get a sense of if they’re eating, if they’re sleeping, are they going to classes, are they using substances, are they having any thoughts of self-harm — that kind of thing.”

During the phone call, CAPS employees determine if the specific student fits into one of four categories, according to Ruzek. The first category is for students during an emergency or crisis, and CAPS will ask them to come into the center right away. A student may not be immediately in crisis, but is still not functioning well, and as CAPS’ second category, they are asked to do an “urgent intake.” For an ugent intake, although the student might not be seen by CAPS the day they call or even the day after, they will not have to wait more than five to seven days to be seen by CAPS.

A student who has a “standard issue” for CAPS falls into their third category. This might be a relationship breakup or “having some anxiety maybe having a few depressive symptoms but they’re still going to class and doing O.K.,” Ruzek said. The wait time for an appointment at CAPS for students like these during the middle of the semester can be up to three weeks before they are seen.

About 2,000 students use CAPS each year. Photo by Max Patten.

The last category that CAPS assesses is a student who either does not want to wait for an appointment at CAPS. Some students already know they have a mental health issue that they had been treated for at home by a psychologist or therapist and would like a similar kind of treatment. Others may complete a mental health screening and realize they want a therapist faster than CAPS can provide. For these students, CAPS tries to give them referrals for other psychologists or psychiatrists in the community.

As a precedent, CAPS also tells students that it can only offer up to eight sessions because of the high demand for appointments and there only being 18 counselors working for the 2,000 students they see each year.  This is a higher ratio of counselors to students than the one to 1000 ratio the International Association of Counseling Services recommends. However, the brevity of sessions, along with a lack of available appointments, has made many students upset with their services.

“I have a friend and she went to CAPS five or six times and she really liked the person that she worked with — she felt like it was helping,” Lanier* said. “Then they told her, ‘O.K, we can’t really help you anymore.” They tried to find her someplace else to go and they actually did find her someplace, but like she doesn’t have a car, she has to take three buses to get there and she just doesn’t click with the person. She just feels like she wasted all that time getting to know the other person at CAPS, so it’s just problematic.”

Even in times of crisis, the resources at CAPS have fallen short for students.

“I remember one time this girl was really struggling, and we were on the phone with her parents because she was going to spend the night in the E.R.” Alex* said. “A person from CAPS wasn’t available so the police escorted her to the E.R., and she was trying to make an appointment for CAPS just after, but they were like, ‘We won’t be able to see you for a week because we’re overpacked.’ I feel like they’re understaffed.”

Other students voiced their concerns and complaints about a disconnect between the brief screening phone call and the follow up in-person appointment that can happen weeks later.

“I wasn’t seen in an actual session, but I did the process of being screened to be seen twice,” said an anonymous student who voluntarily answered a survey posted on Facebook by the reporter. “Both times, it took two weeks to schedule a phone call for them to see what type of service would be best. Then it was two further weeks until they could get me in. The first time I did the process I convinced myself I was fine and just overreacting in the two weeks between me scheduling the call and actually doing it so I canceled it. The second time I did the same but after having the diagnosing call. I definitely needed help both times and the waiting periods created such a barrier to seeking help.”

Other students reported that they have benefited from seeking help and using the resources at CAPS.

“I gained a lot of skills and new ways to manage my anxiety,” said one anonymous student respondent. “My therapist was very intentional and seemed very proud to see my improvement. I greatly appreciated my sessions at CAPS.”

CAPS also has more than 12 group therapy classes in an effort to expand the number of students that can be seen by their services. Some of these offerings include a mindfulness meditation hour each week, a “Hoos Stress Less” group and groups for those needing support with substance abuse or eating disorders. However, students like Emma* have commented that the dynamic is different in group therapy compared to individual sessions.

“I’m going in for group therapy this semester, but it’s very odd just because they recommend that you do it for eight sessions and you’re not allowed to talk with the people that you see in group outside of group,” Emma said. “They don’t want you to develop extremely close relationships with anyone and then for that to effect the group dynamic — for them to feel like they’re getting more support from another peer. It’s just very odd — the fact that you can’t discuss everything that’s said in group because it involves other people’s lives and issues is just very strange because I was personally seeking out one-on-one treatment with a professional at the same time. Though it’s understandable that their  resources are very much strained — it’s not necessarily therapy in the same way that we think of therapy.”

CAPS is attempting to expand, but the details of expansion may not be clear for the next two years. Photo by Max Patten.

According to Ruzek, CAPS is currently trying to expand its resources for students with the construction of a new student health and wellness center on Brandon Avenue in the next two years, and do not have a budget yet. They hope to hire more therapists, but do not know how many, and have more wellness focused offerings, even a contemplative space with relaxation and mindfulness resources. Ruzek said she would like CAPS to focus more on helping promote students’ well-beings at the University so that fewer students would reach the breaking point of needing urgent care at CAPS.

“I think what we would all like to do is more prevention-type work and more wellness focused work, so instead of waiting until someone’s developed anxiety or depression,” Ruzek said. “We have a group called Enhance that’s based more on positive psychology and really helping people to build on their resilience. We’d like to be doing more of that kind of work to keep people healthy versus just addressing them when they’re not healthy.”

Student groups such as the University’s chapter of the National Mental Health Alliance, a national grassroots mental health organization, the website group and Peer Health Educators also provide resources and safe spaces for those struggling with mental health to find a community and share their stories.

“As of right now we are mainly just doing activities, trying to get people together so they can share their story, talk about this and find a group where they can feel comfortable sharing and having a dialogue,” said Wendy Wang, second-year College student and president of National Alliance on Mental Illnesses.

Wang also mentioned how NAMI is planning a panel on the topic of minority students and mental health stigma and said that she personally hopes to have a resources panel for first-years and exchange students next fall with representatives from CAPS, Madison House and the Maxine Platzer Lynn Women’s Center.

“NAMI is trying to fill a lot of gaps,” said Grace Leffler, second-year College student and NAMI member. “We’re trying to re-group and really look at how we can be advocates for mental health. We’re going to try to pair with IfYoureReadingThis and potentially other mental health-based groups to bring more awareness and also strengthen the ties between these different advocacy groups. If we’re all on the same page and aware of what everyone else is doing then we can better focus on our side of the court.”

Expansion is a common theme among the mental health resources at the University. The website, founded by first-year graduate student of Medicine Alexandra Pental, plans to not only develop its presence at the University more but also expand to other universities such as the University of Florida and Northwestern University. These plans are being enacted by the current president of, fourth-year College Student Alexander Hyldmar.  

Pentel started during her years as an undergraduate student to provide students with letters from their peers about mental health, stigmas, substance abuse or anything else people would like to write. She said the idea behind the website came from the need to have a support system of friends who were comfortable sharing their struggles and stories together. Pentel also stressed her excitement over having faculty members write letters as well to break down the barriers between students and the administration.

“I think it’s really great that Dean Groves and President Ryan wrote letters,” Pentel said. “Dean Groves’ was a lot more personal than I expected, being like, ‘hey I’ve struggled with this, I went here too, just know you’re not alone and just because I’m Dean Groves doesn’t mean that I’m immune to that.’”

While the student team behind cannot provide professional help, they have been trained and started a peer counseling group for students who may not be comfortable enough to talk to CAPS yet or just want to talk to a friend, according to Hyldmar. Pentel also said CAPS refers students to their website, and then helps students get connected with resources at CAPS.

“We want to create less of mental health resource nodes around U.Va and more like a net that can hopefully catch everyone,” Pentel said.

The word has spread around Grounds about as Hyldmar says they are seeing more and more submissions for letters from people the team does not know. The group also provides its subscribers with a mental health newsletter every so often and has a list of resources at the University and in the Charlottesville community on their website. Pentel said they have had conversations with Dean Groves about expanding the conversation surrounding mental health at first year orientation, seeing as discussions and modules about sexual abuse and drug and alcohol abuse are already included in the first year education process.

“Our first aim is to have a newsletter, like an email that’s sent out to all first-years or all undergrads,” Hyldmar said. “Then next step is maybe integrating a mental health module at orientation.”

“We want to let first-years know that U.Va cares about this and just let them know what’s there,” Pentel said. “I think a lot of times the only thing people know about is CAPS but there’s a lot in Charlottesville specifically for U.Va students.”

The hope from organizations like NAMI and is that those struggling at U.Va will not feel like they are struggling alone — that students will know about the vast array of sources available to them and see that many students at the University struggle with stress, anxiety and depression. In the Google form survey conducted by abcd magazine, 100 percent of its responders said that they thought anxiety, stress and depression were problems at the University.

“Honestly before like three years ago when I arrived at the University, mental health was not spoken about,” Hyldmar said. “I just remember that so clearly and over time, not only, but just like everything — other students, other organizations have created this community where people are more comfortable. I think we want to reach this level where everyone, not only a certain group of students, but everyone can be comfortable talking about it.”

*Names have been changed for anonymity

If you or anyone else you know is struggling with anxiety, depression or any other mental health concerns please call CAPS at 434-924-5556, the UVA HelpLine at 434-295-TALK, or dial 911 for emergency situations.

For more resources see: IfYoureReadingThis.orgStudent Health Links, NAMI

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