Mental Health on Campus

Mental Health on Campus

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Sylvia Mathews Burwell, president of American University, discusses mental health on campus and offers advice for universities and students to better cope with these challenges.

​​​​​​Learn more about CFR’s resources for the classroom at CFR Campus.

Speaker

Sylvia Mathews Burwell

President, American University

Presider

Irina A. Faskianos

Vice President, National Program and Outreach, Council on Foreign Relations

FASKIANOS: Good afternoon from New York, and welcome to the CFR Academic Conference Call Series. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. Thank you all for joining us for the first call of the Winter-Spring semester.

Today’s discussion is on the record, and the audio and transcript will be available on our website at CFR.org/Campus if you would like to share it with your colleagues or classmates.

We’re delighted to have Sylvia Mathews Burwell with us today to talk about mental health on campuses and how we can better cope with these challenges. President Burwell is American University’s fifteenth president and the first woman to serve as its president. She has held two Cabinet positions in the U.S. government. From 2014 to 2017, she served as the twenty-second secretary of the U.S. Department of Health and Human Services. During her tenure there she managed the department, including the National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration; oversaw the implementation of the Affordable Care Act; and led the department’s responses to the Ebola and Zika outbreaks. Prior to this role, President Burwell had served as director of the Office of Management and Budget, negotiating a budget deal following the 2013 government shutdown. She has held leadership positions at foundations, serving as chief operating officer and president of the Global Development Program at the Bill and Melinda Gates Foundation; and as president of the Walmart Foundation, where she ran its global women’s economic empowerment efforts. President Burwell is also a member of the Council on Foreign Relations Board of Directors.

President Burwell, we’re delighted to have you with us today. You recently authored an article in Foreign Affairs entitled Generation Stress. It would be great if you could talk about why you wrote this article about mental health on campus, as well as the cause and challenges that you’ve seen in your different capacities.

BURWELL: Thank you so much, Irina, and thanks for the introduction. Also, thanks for inviting me to join everyone this afternoon on this topic that I think is pretty important. And that leads me to a little bit about how and why I wrote the piece, which—I’ll start there.

And, as you mentioned, following the Obama administration I had the opportunity to join American University. And a little bit about American, as it gives context, I think, for the piece. American University is a private university located in Washington, D.C. We’re a student-centered research university, meaning that we focus deeply both on research and scholarship, but also on the student experience in terms of teaching, learning, and experiential learning. We are a university that’s about thirteen thousand students, about eight thousand undergraduates, and five thousand graduate students; 143 countries, fifty states; 14 percent international students; five hundred military-affiliated students, so military-friendly; our diversity in terms of 31 percent students of color. Eighty percent of our students receive financial aid and more than 16 percent have Pell grants. And so it’s a very diverse student body.

But one of the things in all of my conversations with students in the first year I was here—and I’m now at about a year and a half in terms of the length of time I’ve been here—the conversations reflected a similarity in this very diverse group of people, and it was one that troubled me. And it was—it came out as I would chat with students in formal settings—I have a regular breakfast—or informal settings like when I would host a study break or walk across campus or be at athletic events. And what came about was a familiar refrain, which is the students would express that they’re stressed. And what happened was at part of one of the Council on Foreign Relations board meetings I was asked: What should folks in the room know about higher education that they may not otherwise know? And what I said is it would be great if people outside the field of higher education could be more aware of the stress and anxiety that students face, and so out of that conversation I wrote the piece.

And so, as I started writing the piece and discussing this issue, I would ask questions of the students. And while both the piece and this conversation won’t allow me to get to the many nuances of this issue, there were some themes that resulted and came out. And one of the things, if you look at national statistics you see 39 percent of college students reporting experiencing symptoms of depression or anxiety in the 2016-2017 academic year. And the percentage of students who receive therapy has jumped from 13 to 24 percent from 2007 to 2017. And so hearing the students describe you could see that was happening, but then trying to understand why.

And at first, because college is a stressful experience in a sense of you’re making a transition in your life, you’re learning new things, there are pressures, and so there is a natural stress that is a stress that’s sometimes about learning. But clearly, there was something more and something different, perhaps, from what we’ve historically seen. And I would group the three largest areas—as I said, there are bigger nuances—in three different areas in terms of what is different about the stress that students are facing today. And this would be how they would articulate it, three areas: economics, safety, and technology.

With regard to economics, the students that we have on our campuses today have all experienced the Great Recession. They have lived through a serious economic downturn. And many of these students also recognize what is true when we look at economic statistics, which is the percentage likelihood that you will do better economically than your parents has gone down over a period of time. So the ease with which people will have economic success has gone down. In addition, when one looks at wages over a period of twenty, thirty years, you see wage stagnation; in other words, wages haven’t been necessarily growing, except in the upper, upper quintiles, at the same rates of inflation over time. And when you add that to the fact that universities have had inflation in terms of their cost that’s greater than core inflation, you see a mismatch and part of what makes many students nervous. In addition, for students who are first generation, taking on debt and seeing how this will work is something that is new and they don’t have models that they can see how it works, and that also increases anxiety. So the economics of higher education and economics in general are a place that make students have a greater sense of stress.

Second is the issue of safety. And for this generation of students, we see a generation of students that really have not grown up in a world where we haven’t had magnetometers at our airports, where they have not grown up in a world where we haven’t had a terrorist attack on the homeland from a foreign source. They have grown up in a world where, from the earlier shootings in schools in Colorado, Virginia Tech, Parkland, the list continues, even into elementary schools as we saw in Connecticut, and so their concepts of safety are different. And when you ask the students and say, well, students of another generation had to go into bomb shelters—you know, the threat of nuclear—and what many of our students, some of those that go to our School of International Service, say is it was a deterrent. And so they’re differentiating between nuclear happenings on our—you know, nuclear events in the United States versus shootings that are a regular occurrence. So safety is another area. That safety is sometimes built on, in addition, with issues like some of the issues of sexual harassment and race for certain populations in terms of some of the events like Charlottesville and other things exacerbate that for particular populations.

The third area that students articulate that’s different is technology. And technology has many different pieces and parts, but in the piece and now I’ll just focus on one particular area that the students articulate a lot in terms of what causes stress, and that is the—what I refer to as the curated life. And the curated life has two elements to it that are stressful. It has others, but two very, I think, telling elements.

One is, for those of us who are of a different generation than our students, if I asked—who are on the call—if I asked you to update your resume every day, that you as a tenured faculty member have to produce what you produce to go to a different university or for tenure every day, making it updated, that idea of curating and every day presenting yourself to an outside world that you feel is judging you is a very challenging thing and adds stress.

The second part of the curated world that they articulate that is stressful is the idea that you are observing others’ lives in a curated way, so much of what you see is very positive. You think, oh, wow, that person’s going to all the right parties, that person has more internships, that person has a better job, and that adds another element of stress.

So those are the elements that they are articulate. The context is a little different, too. And when we talk about that context in which all this occurs, it’s how both society and parents have—how we teach our young people and our students to cope with stress and anxiety. And in the piece I touch on the fact that sometimes rather than focusing on resiliency we often focus on prevention of stress and anxiety, so then when they get to situations where there’s stress and anxiety they have—we haven’t given them as many fuels as we might.

I think it’s important to recognize in that particular vein and context that different students face different challenges. Some of our students, such as our first-generation students, are some of the most resilient you’re going to find. Others, you know, some of those students may be facing financial challenges that cause stress. For other students, it’s a sense of belonging.

So from the problem to the question of the solution. Universities, I think, are at the earliest stages of working on this issue, and society, I think, is, too. When one thinks about how mental health and behavioral health is treated in society, while we’re making progress on those issues, whether that’s in the form of coverage—health coverage for mental health or the Mental Health Parity Act, which actually occurred not even fifteen years ago, there are steps that are helping with that. But as universities approach this, one of the things that I suggest in the piece is it would be helpful to think about these issues in the context of a public health approach.

Part of the reason that I think a public health approach is helpful is the public health approach is more all-encompassing in terms of thinking about all of the parts of society that contribute and can help make this better. The other part of a public health approach is the idea of framing how you go about the solution in the form of prevention, detection, and response.

Things like in the prevention space, whether that’s promoting a sense of community on campuses or even using curricular approaches—here at American University we have a course called AUX I and II, American University I and II, for all of our first years, so that they learn about what are the resources on campus, how should they think about financial management, how should they think about issues of freedom of expression and inclusion, and so trying to do it in a curricular fashion.

With regard to detection, that, from a public health perspective, it is—everyone needs to be a part of that. And so whether it’s faculty or other students, helping other students by recognizing if there are things that they’re seeing that students may need help, and that is then about the response, ensuring that there are things like counseling resources available and other resources to work on the issue.

So I think that gives you a broad sense of the—of the piece, the issue. And as we turn to questions, one of the things that—there were two issues that I thought might be interesting for us to talk about as part of this conversation. And one is: How do we take some of those things that we are seeing in our most resilient students and use those to help us with this issue on campus? What are the learnings from the resiliency that we do see that we can then spread across campuses more broadly?

And then a second question that I think is a helpful and important one is: How does one think about the role of universities relative to other parts of society in terms of this challenge that we face?

So, with that, I will stop so we can get to your questions.

FASKIANOS: Wonderful. Thank so much, Sylvia.

Let’s open it up to the group for questions and comments.

OPERATOR: Thank you. At this time we will open the floor for questions.

(Gives queuing instructions.)

Our first question will come from Ohio State University.

Q: Hi, Sylvia and Irina. It’s great to be on the call today. Thank you so much for bringing attention to this very important problem.

I’m on the implementation team at Ohio State, where we’re putting in place a whole new package for suicide prevention and mental health, and I have a question. I know one of the things we are doing, in fact, is copying American’s Morm (ph) Line concept, which is a wonderful idea where we have an ability for students to just call someone or text someone if they’re having a problem and need to talk it over with someone. We would also like to find ways to involve faculty. And I know, of course, it’s hard to ask faculty to do more things. They already have many, many jobs. And so I’m wondering, Sylvia, if you could give an idea of how you involve faculty. Is there any special training? Are there any incentives for them to participate and any kind of programmed activity? Are there any curricular add-ons that you provide in classes that faculty can use in terms of helping with this—with this problem and issue I think that many of us are seeing on campuses? Thanks.

BURWELL: So here we are using a curricular approach in the sense of the course that I described—AUX I and AUX II—which is a—it is unique in that we are actually doing a curricular approach where advisors—we’ve increased the ratio of our advisors and we’re now at—you know, it’s—it’s under one to a hundred in terms of number of advisors that teach these courses that are co-taught with students that are a part of helping students have some coping mechanisms and know where to turn. And so it is about actual things that are some of things that we know or some of the challenges that students are a part of. And these advisors are also connected into our actual systems in terms of helping flag for others if there are challenges that need to be addressed more fully than they can do.

With regard to the faculty more broadly, I agree with you that the question of adding to faculty is one of the challenges in terms of all the work that our faculty does. But actually, we’re finding that our faculty is seeking the knowledge to be able to do this right. And so just recently we had our largest faculty—annual faculty gathering, which was focused on teaching and research, as I’m sure you can imagine. But the faculty and the panel I ran wanted to talk about this issue and wanted to talk about the training. And so we are working to do actually some very specific training in the suicide prevention space. But we are finding that our faculty are actually anxious to have the right tools, because I think they sometimes—and I find this in my faculty breakfasts—they don’t feel that they have the tools. So I think training and education is an important part of engaging the faculty as well and having the conversations and being open that this is something that’s extremely important to the university.

Q: If I might follow up.

FASKIANOS: Yes, sure.

Q: Do you have a training that—do you have a training program that you buy? I mean, we—one thing we do use, Cognito (sp), are you developing it campus? Then I will pass so that others can join in. Thanks.

BURWELL: We are using others, but in that particular space the piece that we’re looking at now is an external piece. With regard to some of the other pieces that we do in the inclusive excellence space, we are working with some of the designers because we are using their products, but actually working with them for changes. But in this particular area, we are looking at some of the pieces that have already been produced by others.

Q: Thank you.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from Northfeld (ph) College. Your line is open.

FASKIANOS: Maybe we should take the next question and then come back.

OPERATOR: Our next question will come from Virginia Commonwealth University.

Q: Oh, hello. My name is Lizz Stoke and I’m a student from VCU.

And I was wondering, when you were looking at these problems in universities, did you see a difference between, like, smaller universities versus larger universities in these public health problems?

BURWELL: So having not spent a lot of time doing comparative analysis in terms of—as I started with a piece, this was mainly based on my experience and what I’m seeing at American University. But in my conversations with other university presidents in different types of universities and looking at the national statistics as part of the piece, what one sees is national trends that are similar with regard to increasing need for counseling. However, what I would say—and this, having talked to another university president who’s in a more rural setting—some of the challenges in terms of working on the problem, and some of what are the drivers—the percentage of drivers changes. The drivers I think are very similar, but in some settings—different settings—the problems are weighted differently, is what I would say.

And the other thing is that the solution spaces are different. In a place like Washington, D.C., where we are, one of the challenges about counseling is there is huge competition for hiring counselors. And so that’s one of the things. In some of our more rural schools, there are—in the nation—there are challenges with regard to hiring counselors and counselors that might come to rural places. The other thing that’s extremely important, and one of the challenges that one needs to think through that vary from different institution to different institution based on location and other things, is ensuring that your population of counselors has appropriate diversity in terms of working with different student populations in ways that can be most helpful.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from Fordham University.

Q: Hello. My name is Robert Brent. I’m a professor of economics at Fordham University in New York.

And I just wanted to point out that there’s a very obvious category of stress that you haven’t addressed so far, and that’s the stresses that students have as students in terms of exams, for example. They have various expectations, or their parents give them expectations of performance. And that leads to a lot of stress. And as a—as a teacher, I would like some sort of assistance in what sorts of exams would reduce stress? So we got various categories. We’ve got take-home exams, or we have in-person exams. We have the types of questions in terms of critical thinking. We have the length of exams. We have the frequency of exams. And we have class participation being part of an assessment. So what sorts of guidelines can you give to teachers when students are obviously stressed in many different ways outside their student life, but also that the exam process generates a lot of stress?

BURWELL: So with regard to—I think you—a couple of things in your comment and question I think are—you’ve highlighted some very important things. And one is that inherent tension in what we are doing in the university. Some of it is about stress that is appropriate and good. Sometimes learning is hard. And sometimes learning new things and stretching yourself can be stressful. But how do we get it—and I think that’s the point of your question—how do we get it to the right balance of those things in terms of what is needed and what is appropriate for the students.

And I think there are tools, like exams, that are going to be and are an important part for how we help students to learn and make sure that there is mastery as they move forward in different areas. And I think this question of which of the tools pedagogically, you know, are the best ones from the perspective of getting what you were trying to do in terms of accomplishing your goal in the classroom and reducing stress. Not a place that I have spent enough time to weigh in on take-homes versus others. But the one thing that we have started to do that I think is important is helping faculty be able to recognize in individual cases how they can, perhaps, help and support students. And I know there’s a question of does that scale.

The other thing that we’re trying to do in a more scalable way is making sure around those peak points of stress—and you have nailed what is one of the biggest ones. And it’s worse for us in the fall semester versus the spring semester in terms of the pressure of exams is actually the things that we do to bring them together as a community to create a sense of belonging and to put some relaxation into what is going on. And that’s not always as much faculty’s responsibility as it is the broader community. I’ll be specific: Every year now I do what are called pop-up study breaks. And so during that period right as exams are staring and during exams, we will have study breaks on our campus. It creates a sense of community. It creates a sense of relaxation. I am there, greet the students. The students have a break and have a social time. And there’s also a place where, you know, the students do express the anxiety, but there’s something to kind of break it. And so some is what happens in the classroom, but it’s also how we create an environment to help them get through that stressful time.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you.

(Gives queuing instructions.)

Our next question will come from American University.

Q: Hi. My name is Marissa Ditkowsky. I’m a law student at American.

So I just have a question about resources and tapping into those. I know obviously all of the social model things are extremely important, because not everything can be resolved by counseling or things like that. Sometimes all you need is community, et cetera. But at the same time, you know, the need for counseling is also pretty heavy. And it is extremely expensive in terms of health care, another huge stressor in terms of economics that a lot of us are dealing with. So in terms of other schools that I’m sure are experiencing similar issues in terms of trying to figure out where to get resources from and how to sort of re-budget, do you have suggestions as to how to, you know, fundraise, how to get funds, how to re-appropriate funds and resources to invest in not only counseling but also other services and events and things like that to, you know, focus on mental health?

BURWELL: So I think in two different categories. One is the actual counseling where it is just—it becomes a question of you do have to prioritize these resources. And at American, and I know most other universities, we all continue to add additional counselors. The other thing, in that particular space, in terms of the question of resources, is being nimble to change how you’re doing you’re—how you use your resources, what are scheduled appointments, what are the open hours? Because differing student groups have differing needs. And how are you meeting those? So the resources in the counseling space one needs to add, one also needs to be nimble in terms of that feedback of the student loop in terms of what are the largest demands at various points of time, harkening back to the professor’s question about that exam period and how you prepare for that period.

So that is about adding resources and managing resources. With regard to the fundraising towards those things, I think we’re now at a place—and that’s a part of why I felt it was important for Foreign Affairs to have a piece. I think broader populations need to know that this is a need on campuses that needs to be met so that we can actually have external support to do that because, as you appropriately reflect, both the cost and the wait time in the private market outside of universities are both challenging issues.

With regard to the question of the resources about the other things, I think about how one thinks about our commitment to having our students come here, retain, graduate, and thrive, and how we think about our student and campus life resources aligned against those things. And so then it does become an issue of how are those resources, what are the events that the students are participating in, are not participating in? Again, being nimble, listening to both informal and data and analytics, so that you’re putting the dollars against those things that are most important to the students in this way.

And so that takes a constant assessment of do you have it right or not. We’ve redone our orientation. I’ve been here for two rounds, and we continue to try and refine that, incorporating the things that we’re hearing from students that are a part of this coming and settling in. And then our graduate community, of which you are a part of, making sure that we are creating more connection with our graduate community. The Washington College of Law, where you are, but our other graduate schools as well.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from Northfeld (ph) College. Northfeld (ph) College, your line is open. Please make sure your phone’s not on mute. Again, your line is open. You may ask your question. OK, I—

FASKIANOS: Yes, I think we should pass and try again later.

OPERATOR: Our next question will come from Washington and Lee University.

Q: Hi, how are you? My name is Anton Livshin. I’m an undergraduate student at Washington and Lee. I’m really grateful to be on this call and the issues that are being discussed.

Being a first-generation student, I’m wondering about what resilient characteristics you’ve identified from these kinds of students. And how can these characteristics be widely expressed and taught on campus in an effective way, and in a way that will see a long-lasting change with each incoming class?

BURWELL: So I think that some of our first-generation students, with regard to this question of resiliency, they have experienced having to figure things out on their own in terms of how they—their support systems—so many of these students have incredible support from their families, but they don’t have the experiential support, by definition, in terms of their families are doing this for the first time. And so what that creates is many of these students are students who know how to speak out and find resources and get answers. And so in certain ways, the students who come from our first-generation students have had to already seek out financers, get solutions in ways that perhaps other students who come from differing backgrounds have not.

The other thing I will say about often—not all of our first-generation students, but many of our first-generation students also have a—have also experience with balancing things like efforts outside—whether that’s work, and other things—in terms of trying to balance. And so I think there are a number of things, but part of why I posed the question was understanding how others on the call think about this issue of how should we draw from the resiliency, and understanding that different students have different types of challenges.

And as I said, some of the challenges are financial. Some of the challenges are, as the professor mentioned, there’s pressure—academic pressure, and pressure that students have not had challenges academically. And now, whether it’s you failed a midterm and you’ve never failed anything in your life and you feel pressure from your parents. Or for others, it is about a community and a sense of belonging, that you came from one and now you are in a place where you are having challenges coming in. So I think it’s learning from each of the communities where their strength is, and what we can do to help with what is creating their stress and anxiety.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from the Pennsylvania College of Technology.

Q: Hi. My name is Alaina Shableski from Pennsylvania College of Technology.

And my question is, are you planning on not only training faculty in detection and prevention of mental health struggles, but also how to act and cope with a suicide on campus? Mainly because grief from suicide is so unique and can truly challenge other suffering from mental illness struggles, both students and faculty.

BURWELL: So thank you for the question. And I actually would extend your question to not just suicide but other incidents that occur. And often they’re incidents that don’t occur on your own campus. For instance, when Parkland occurred, we very quickly went through and figured out how many of our students—we actually had a student from Parkland. We had students from, you know, that area in Florida, or students that would relate to something that has happened, and then putting in place a system. And we build on the backbone of our campus life structure so that an RA might know. And if there is a suicide, there is an entire protocol that is put in place for those students that have been—known that student.

And it’s not just suicide. If for some other reason the student became ill and passed, or an accident happened, or something else happened to the student. The students that are around, it is very, very important, because sometimes those can be triggering events. And so we use both faculty, faculty is part of the suite, but we use the tools of campus life. And whether that’s ensuring that counseling is available, and direct outreach and meetings. What we find—it’s an important thing and it gets to this technology point, is to get students together so that people have an opportunity to talk about these issues face-to-face, if they want to. Some students may not process that way, so you have to have ability for them to process in other ways.

So we alert faculty. When we have an incident or something we go to our deans, and then deans go to the appropriate faculty in their schools to engage the faculty on these issues specifically. And as you suggested, some are like suicide, where a select group of people know. But then there are issues that have—that affect the campus more broadly. And so then we need everyone to engage.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from Case Western Reserve University.

Q: Hi. So I’m an undergraduate student at the student newspaper for Case Western Reserve. And something that our campus has been dealing with a lot is our university has over-admitted students the past two years. And a lot of our campus community is now—like, all the resources that we have are quickly exhausted for all the students, since there are more than we can really handle. So I’m just curious what your thoughts are about how to balance the admitting the students with the campus resources, and if you’ve seen this on other campuses as well.

BURWELL: So, you know, I think your question—part of the root of your question is actually related to the economics of higher education. And by the economics of higher education, it is that ability to articulate what is the value that’s being provided, what does it cost to provide that, how do you price for that, how do you then create the system and the students coming in? And obviously we all want to create more—not obviously—but we do want to create more access. Or, at least that is a—something that I think is particularly important in higher education. And so how you bring all of those pieces together is something that has to be done on a strategic basis over, you know, five-year plans, but on an annual basis.

And I’m not familiar with the issue that you have described in terms of other campuses. I think the one thing that I would just say is the idea of ensuring that you have nimbleness and know how to execute against that. In other words, I’m sure for you all then that you’ve had large admitted classes, I don’t know if it’s called expository writing or what it’s called, but just like you need additional resources for—in the health space, you probably need additional resources there. And so how one, at the university, has that flex capability is something I think we all need to focus on. And I think universities more broadly need to work toward being more nimble, able to adjust for the kinds of things that you’re talking about—whether that’s when you have an influx or a larger group of students coming in, or there are changes that you need to make such as we all need to take into account mental health perhaps in a different way than we historically have.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from Pepperdine University.

Q: This is Dan Caldwell from Pepperdine.

And I work very closely with student veterans. And the sort of problem facing the country is rather daunting, because of the three million Americans who’ve served in Iraq or Afghanistan in the last seventeen years, about a million are in college or universities now. And I’m wondering if you could give some ideas about how the special needs of student veterans can be met, and what should be done on campuses.

BURWELL: So I’m glad you work with those students. We think this is an incredible population, and a population that is a very important one, which is why I think you probably heard me mention it even in the beginning, when I was talking about what our student body looks like. We think this is a population that’s important to have and be a part of our university community. And as we try and work, some of the issues that you are raising I think, and this topic raises, for some of our students who are veterans, those that are combat veterans that are here with us right now, that is a place where sometimes there are particular and specialized needs for those who have been that experience in terms of making sure we’re supporting them as we transition.

And I think the transition overall for any veteran, because they have come from a highly structured and disciplined environment with a lot more clarity often in terms of goals and objectives and structure than they are in a university setting. So how we help them translate that experience. And there are a couple things that—in our campus—that we are working on and continuing to improve. One of the things is making sure that there is a special actual place for the veteran students, because one of the things often is that your veteran students may not be people—if you have a campus where people live on campus a lot, these are often students, because they are often older or have differing experiences, that don’t. So creating that space is actually just an important thing in making them feel welcome and having a place to go.

It also creates something else that we’ve found to be helpful and important, and that is mentoring and support from other veterans. So sometimes it is another veteran who is best able to help do that translation of here’s what you were doing before, here’s how it works in this newer context. And so those are some of the tools that we’ve been working on. The other thing that we’re doing is trying to make sure that American participates in some of the national organizations that support veterans. So some of our veterans are part of programs where folks are awarded and recognized for their scholarship or their work on campus. And so building that sense too of pride in this particular community. So a series of steps that we continue to work on and try and listen to our veterans.

I mean, one of the—I meet with our veterans groups. This year when we did our service project at American University, when all of our first-years come we do a large service project as part of our orientation week, where people go out all over the District. And this year, the piece of work I did, I did with our first-years. And it wasn’t just our first-year veterans. They joined with other people of our military community, and we did a service project together. And so trying to do things that create that sense of community. Where we did that service project with, now our veterans have, and our veteran-related communities have, the relationship with that organization. So those are just tactical suggestions.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from Columbia University.

Q: Hi. This is Miriam Laugesen from the School of Public Health.

And I guess one thing that I would say is that I think faculty needs scripts and kind of things to say to students, perhaps on the syllabus or on the first day of class, that, yes, it might be hard, it may be stressful, but there’s sort of a difference between stress and mental illness. But it’s OK to fail. And I think that, you know, that modeling that is really important. The second—or, not fail, but, you know—(laughs)—not get an A-plus or an A. The second thing is, did you talk about sort of incomplete and other policies that allow students to sort of take a break. You know, you have leave policies. It seems that they don’t really think sometimes that there’s a way out. And that would be—and making that sort of available and user-friendly and OK would be one strategy, perhaps. So I’d like to hear your thoughts on that, thanks.

BURWELL: Thank you. And I think you’re absolutely right that for a core group of people—and I touch on that a little bit in the piece, that issue of failing and, you know, it also relates to risk taking. That for so many of our students, we’re all so fortunate, our students come with so much. They’ve done so much. They’ve done so well. They have great academic records. But then coming to a situation where they haven’t failed before, and what that feels like. And so talking about that issue of—and failure’s a strong word, because what happens is they, and you see in the piece—I can’t even remember what number it was, but it was, like, in the 80s, a student, you know, gets something in the 80s, and they consider that a failure versus you just didn’t get an A—you know, the A that you usually do. And that happens to all of us. We all have times. And that happens to all of us. We all have times. And that’s part of learning. That’s also part of life. And how one works through, and accepts, and has that. And so I think that was—your point there was a very important one as we think through which kinds of stress are affecting which students.

With regard to the question of the script and having people do that early on, I think that is something that could be very helpful. And that, I think, is part of us getting to where the faculty is trained. On the idea of withdraws, we actually talk about good retention and bad retention because for some students, I think as you’re appropriately reflecting, whether it’s retention in a class or retention overall, when something gets to a particular point in time from the student’s health, that’s not—what’s in the best interest of the student is sometimes for that student to go and take the time that they need. You want to be able to do that. So that is an effort that we kind of work through, both our provost office and our vice president of campus life, working together in terms of how we’re supporting the students. I don’t know that we have gotten it to the level—I think faculty were starting in that space—but I don’t know that we’re at a place where we have advanced it where faculty know exactly all of the tools and how to exercise those. So I think that’s a place where we need growth.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from San Diego State University.

Q: Hi. My name is Rachel. I’m a student her at San Diego State University.

And I have a question. Is there anything you want to tell students on how we can help? I understand that for all universities that there are limited resources, and you’ve touched on that today. But is there any general advice you can tell students that are—that have come out for having stress and anxiety? Like, any calls to action that we can do to help?

BURWELL: Yes, there are a couple things that I—thank you for asking, and thanks for raising what I think is an important part of the solution. Because I think why I suggest it’s a public health issue is I think we all have to play. And whether that’s all of us on a university community, in a university community, or community writ large. So some of the things that I think are most important for students are peer-to-peer conversations are some of the most important conversations that can occur.

And often, you, as students, are going to see when a friend is struggling faster than anyone else. And so making sure that—a couple things. One, making sure you’re educated about the resources that are available on your campus so that you can, in turn, be a resource for your fellow students in terms of saying, hey, you’re having a hard time, you might want to think about going here, or doing this, or here are different options that you can do. You become a part of those, in a sense, the prevention, detection, and the response, based on your level of knowledge.

The other thing that I think that’s pretty important for students is the question and the role you all play in reducing issues of stigma related to mental health issues. And I think the students that we have are so much better than perhaps generations before who have not talked about these issues or focused on these issues. But one of the things that I think is sometimes a barrier for people to seeking help is, oh, I can do this on my own. It’s OK. I don’t want anybody to know, that would produce some sort of stigma. And you all being a part of making sure people know no, not at all. You know, how people speak out, what they need, that sort of thing we should be more encouraging of, because that helps us get in front of, as someone suggested—I think it was our colleague from Columbia was suggesting—you know, this is a wide spectrum of stress and anxiety, depression, you know, to very acute situations such as suicidal ideation or even beyond that. And so the role that students can play in keeping things on a different end of the spectrum and helping when there are students who are moving along that spectrum I think is very important to the knowledge they have and how they interact with their peers. The other thing is we have so many students who are great about participating in any number of our groups that are about these issues and supporting people when they have either an acute situation that might be causing this problem or in general.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from American University.

Q: Hi. My name is Julia Gagnon. I’m a senior and a reporter with the Eagle.

And I just wanted to ask if there were any program changes that you are implementing or planning to implement, and if so what the timeline of those would look like.

BURWELL: So many of the program changes—and we should—(laughs)—since you are from the Eagle I’ll—we will follow up in terms of some of the more specific things, making sure that you get—but a number of things.

One is the changes that we’ve done in terms of the numbers of counselors that we’ve added. Also, some of the changes in terms of how we’ve done office hours are another part of the work that we’ve done. You’re probably familiar with the work that we’ve done in sort of specialized areas that sometimes lead to some of these challenges, and whether that—the work that we’ve done in the Title IX space over the last two to three years in terms of changing the way that investigations occur, how folks come through those processes. The work that we’re doing on inclusive excellence here at American is also a part of it. So there are the specific things that are a part of what I would put in the treatment area around counseling and specific things there, but there’s a lot that’s going on also in the area of prevention, and whether that’s a policy change and the decision to make a curricular engagement with AUX I and II, the changes in orientation. So it goes across the spectrum in terms of the things that we’ve been changing.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. Our next question will come from the Pennsylvania College of Technology.

Q: Hi. My name’s Alexis Medero. I’m a civil engineering technology student here at Penn College, and I had a question.

Besides the faculty that at most times have connections with our students, do you think student leaders like residents’ assistants can also have a major impact on students and how they battle their mental health issues? And if that’s the case, do you think it’s also reliable for those student leaders to have training like QPR suicide prevention or active bystander intervention to better assist those students to understand and maintain positive mental health?

BURWELL: So, yes, I think that the role of RAs and student leaders—I think you were speaking to RAs, but also more broadly our student leaders being a part of both the communication and the doing in this space is very important, and student leaders across all kinds of organizations. So RAs, completely frontline in terms of the importance of the training that they’re doing, whether that’s the training that—many of our RAs are also some of our orientation leaders and so, you know, there’s overlap sometimes in those groups of people. So making sure that they have appropriate training.

And as I think you’re reflecting, they are some of our best implementers of prevention, and so them having knowledge about both prevention and also recognizing things is extremely important in terms of helping students get the assistance and support other students that they’re with, get the assistance that they need. RAs are particularly important because they’re in people’s homes, basically. They’re, you know, with you in your home, and so that’s frontline in a different way.

But I think your question also gets to there are lots of other different places and pieces and parts that are a part of this, and that includes things like your student government leaders, things like your organization leaders, things like the questions for students who belong to different types of student organizations. I’m sure on this call I’ve heard from a number of universities where I know there is Greek life, and the question of making sure that that is something that those leaders are ensuring. But that is something about promotion of community as part of the prevention. So I do think that the student leaders are a very important part of how we do this.

And again, it gets back to why I think this is like a public health issue. It needs to be a holistic approach where difference pieces and parts—why public health works, whether it was—and I used the example of Ebola in terms of the framing, but part of how we controlled and contained Ebola on the homeland here is that people in community health centers across the country were taking folks’ temperatures. And so it took everyone doing different pieces and parts. And similarly, in a university community, I think that is what it will take for us to be able to make some progress against this problem that we continue to see grow in terms of the numbers.

FASKIANOS: I’m going to try to squeeze in one last question.

OPERATOR: Thank you. Our last question will come from Johns Hopkins.

Q: Hello. We have a question here at Johns Hopkins at the Carey Business School.

What, if anything, are you doing to also engage non-campus stakeholders such as parents, friends, and family, or maybe even employers?

BURWELL: So with regard to parents and family, that is a place where engaging them—one of the things, obviously, because our students are adults, and how we engage in some of the mental health issues is something we want to always make sure we’re respecting the privacy of our students. But we engage with the parents on a regular basis, and even more the engagement with parents for us continues to increase.

And let me relate it to a point that another person raised on the call, which was the person—I think it was even a student who—it was a student, I think, who raised the issue of how are we helping students when a suicide occurs. Similarly, we need to engage the parents when that happens so that they know that their child could be—their own student may be suffering and they may not know all that’s going on. And so when there are incidents on campus—and our communication with parents is going up. How we engage parents in orientations, we’re increasing that because we think that’s an important part of the community, too, because they are supporting students. From when I was younger, the amount of time that you would engage with your parents—so many of our students, because of phones and how, you know, it’s pretty simple to text or call, their ability to do that, so parents become a part of the solution.

In terms of employers, it’s interesting that you raised that one because it’s very related to why I wrote the piece. When I brought up this issue in the Council on Foreign Relations board meeting, the people who most engaged were the CEOs. There are CEOs of companies. And what they said was the problems that you’re facing on campus, it’s not like they walk across the stage, you hand them a degree, and these issues go away. And so our work with employers is growing and is an important part of why I wrote the piece, is because I think we need to think about how we work hand in glove so the support systems that we’re building on university campuses and the things that we’re trying to do are reinforced when students go to that next step of employment.

FASKIANOS: Wonderful. Well, Sylvia, thank you very much for this insightful call. We really appreciate your giving us your best practices and your thought on it, as well as your leadership at American University, your service to this country, and as well as on our Board of Directors. We’re all very fortunate to have you in these different capacities, so thank you very much.

BURWELL: Well, Irina, I just want to thank everyone who joined this call because, to the last question, this kind of engagement is why I wrote the piece, because I think talking about the issues with the great questions that came from everyone that are so focused on getting us to solution spaces. And you can see people trying different things, focusing on different elements of the problem. That’s exactly why I wrote the piece, because I’m hopeful that this type of engagement will lead to improvements across the nation, both in terms of how universities handle it but also our broader society. So thanks to everybody who joined the call.

FASKIANOS: Wonderful.

Our next call will be on Wednesday, February 13, at 1:00 p.m. Eastern time. Dalia Dassa Kaye, director of the Center for Middle Eastern Public Policy and senior political scientist at the RAND Corporation, will lead a conversation on “U.S. Relations in the Persian Gulf.” So in the meantime I encourage you to visit CFR.org/Campus, follow us on Twitter at @CFR_Campus for information on new CFR resources and upcoming events, and continue to follow the content in Foreign Affairs through a subscription or the online content that they publish daily at ForeignAffairs.com.

So thank you all for being with us today. Thanks to Sylvia Mathews Burwell. And we look forward to a really wonderful semester.

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