TRIGGER WARNING: This article contains descriptions of sexual violence.
During an alumna’s second year at UCLA, she was sexually assaulted.
The recent graduate, who requested to be anonymous for this story, had a midterm the next day, but the incident absorbed all her attention – she struggled to focus and couldn’t retain information like she could before.
Over time, she avoided leaving her apartment – she couldn’t risk seeing any male who resembled the person who assaulted her. If she did see a man who looked even vaguely similar, it would trigger panic, tears and vomiting. So she resorted to practically hiding in her room for the remainder of the school year.
She knew the deep, emotional impact of the assault on her psyche meant she needed to take action. After calling a nurse hotline, she decided to seek help from UCLA’s Counseling and Psychological Services. With more midterms approaching, she was desperate for a psychiatrist to sign the Center for Accessible Education forms that would grant her disability-based accommodation, which can extend assignment deadlines and grant students breaks during exams.
When she went to CAPS for her prescreening, the waiting room felt daunting. She was afraid she would see someone she knew and that they would ask her questions about her trauma.
After her name was called and the prescreening was complete, the CAPS staff told her she would have to wait a month and a half for an appointment. In the meantime, they suggested off-campus resources. But the assault took place outside UCLA, and she was too frightened to venture off campus again.
“I could barely get myself to leave my apartment to go to class, let alone go outside of campus,” she said. “I was not able to physically bring myself to get anywhere outside of like Ralphs, which was pushing it.”
She expressed these concerns to the CAPS staff, but they didn’t offer a solution, she said. When she was finally able to see a therapist at CAPS nearly two months later, midterm season was long gone.
This alumna’s experience is not isolated – CAPS is notorious among students for lengthy wait times and limited resources.
CAPS’ infamous reputation reaches as far as the UCLA meme page on Facebook, on which a recent meme about the long wait times garnered over a thousand likes and nearly a hundred comments including “These are the actual facts” and “CAPS = 100% trash.”
UCLA’s student body is in the midst of a mental health crisis. On the Monday of zero week of fall quarter, 90 students came into the counseling facility, said CAPS Executive Director Nicole Green. On average, CAPS sees about 1,550 students per quarter, Green said.
“The crisis that we’re in is ... worldwide,” Green said. “We're looking at mental health being so underserved for so long and so much stigma attached, and now that people are raising issues, we're just bombarded. The demand for services is just far outpaced.”
And while CAPS’ limited resources play a significant role in the crisis at UCLA, decreasing stigma and increasing pressure on students have heightened the demand for mental health services nationally. A recent study found that 35% of first-year college students from eight different countries including the United States reported symptoms indicative of a mental health disorder. Moreover, the rate of individuals aged 18 to 25 who reported symptoms in line with major depression in the last year increased by 63% from 2009-2017.
There is no single explanation for such findings, said Dori Hutchinson, the director of services and an associate clinical professor at Sargent College of Health & Rehabilitation Sciences at Boston University. But one contributing factor, Hutchinson said, is the academic pressure on students, which gives rise to the mentality that straight A’s are the only path to success later in life.
“The academic culture is high stakes, ... and we've made it all about the grades because that's a good business model for the school,” Hutchinson said. “The more competitive you are, the more people apply, the more you charge, the higher your rankings.”
With an understaffed department and increasing demand for its services, CAPS has struggled to keep up. Green said the program has had difficulty hiring and maintaining mental health professionals largely because of the high volume of cases with an at-risk population.
In 2014, Green said CAPS adopted a triage system, in which the wait times for each student were based on the severity of their symptoms. The triage team was originally comprised of three triage clinicians, but has since expanded to seven members, Green said. The average wait time to receive a routine intake appointment has dropped from fall 2018’s average of five weeks to two and a half weeks this year, she said.
Green credits the improvement to the department being fully staffed.
CAPS hired seven new full-time therapists over the summer. From 2018 to 2019, the number of staff clinicians increased from between 24 and 27 to 33, which allowed CAPS to increase the number of intake appointments per week from 2018’s average of 100 to about 140, Green said.
Nevertheless, Green said CAPS still gets backed up, as do the off-campus facilities CAPS refers people to.
CAPS has a large triage team compared to other University of California schools, Green said, but it is still not enough to eliminate wait times for students. Even if CAPS had the funds to double its staff, Green said she thinks more people would feel encouraged to seek treatment, and the wait times would be largely unimproved.
Triage is intended to reduce wait times, but without sufficient staffing and resources, it can lead to significant wait times for people who require less urgent treatment, said Alexa Wesley, an associate director for research and policy at the National Association of Student Personnel Administrators – Student Affairs Administrators in Higher Education.
Further, while providing small improvements, it doesn’t directly address the issue of limited sessions. While it largely depends on the individual, Raphael Rose, the associate director of UCLA’s Anxiety and Depression Research Center, said the effects of cognitive behavioral therapy are generally assessed after 12 weekly sessions. CBT is a common technique employed by therapists at CAPS, but the six-session limit prevents it from being carried out to its full potential.
Glynnis McNamara, a third-year global jazz studies student, said her anxiety and depression led her to seek help from CAPS in late November 2018. She had not been to therapy since she struggled with similar mental health issues in high school, and she hoped CAPS would provide some novel solutions and coping mechanisms. But when the CAPS staff said the soonest a therapist could see her was February, she broke down in tears on the spot.
After her CAPS prescreening, McNamara said her emotions and mood swings became increasingly difficult to manage. Once her scheduled session rolled around nearly three months later, she said she missed the appointment because she was too depressed to get out of bed.
“You're trying to address issues before they worsen,” McNamara said. “The longer your mental health issues go on, your baseline and your tolerance for coping with things gets lower and lower, and eventually you're scraping rock bottom.”
Even if she had gone to her appointment, McNamara didn’t have the UC Student Health Insurance Plan, so she would only be offered three appointments. McNamara said she thought the touch-and-go treatment that CAPS offers would ultimately not be worth her time.
Similarly to McNamara, the recent graduate said the three-session limit prevented effective care and led to less individualized therapy. The graduate felt dehumanized after her assault, she said, and was hoping the sessions with CAPS would be tailored to her feelings and trauma. But during her appointments, her therapist gave her general advice rather than a personalized perspective.
The graduate said she wanted her therapist to validate her feelings, to tell her it’s normal to lose the ability to focus after being raped, to tell her she had PTSD and was not overreacting.
Instead, her therapist reiterated empty statements about how hard it must be for her. She resorted to reading people’s stories through online forums like Reddit to find comfort, the graduate said.
Her GPA also took a major hit after the assault, and the competitive environment of UCLA gave rise to feelings of inadequacy. She had to seek out articles online to understand how common it is for rape victims to struggle academically following their assaults.
At such a large, reputable university like UCLA, a robust counseling center seems like a necessity. But McNamara said UCLA advertises other, more outwardly appealing assets of the school, rather than putting full emphasis on its lacking mental health resources.
Publically, UCLA is investing in movements like its Depression Grand Challenge, a series of research studies aimed at cutting the burden of depression in half by 2050. But despite UCLA’s efforts to improve mental health 30 years from now, McNamara said UCLA needs to make an effort to provide more immediate mental health resources today.
“Other things are more attractive to UCLA,” McNamara said. “I think (athletics and research) are critical to UCLA's existence and the student body, but, ultimately, you're not going to have a student body unless you take care of them.”
Even when students are allotted the full six sessions, CAPS still comes up short. During Alexxa Vasquez’s first year of college at UCLA, the combination of high-pressure classes and intense sleep deprivation culminated in her having a panic attack on the floor of her dorm room. The episode prompted Vasquez, a fourth-year cognitive science student, to seek help from CAPS. She has UC SHIP and therefore has access to six sessions per year.
After the notoriously long wait before her intake, Vasquez said her therapist helped her address her anxiety, including the many “what if” concerns about how people might perceive her. But despite the sessions’ positive effects, she wishes the resources were more accessible on a weekly basis. She said the two- to three-week waits in between appointments made consistent help virtually impossible.
The resources are even less accessible to those without UC SHIP, with appointments at Westwood mental health clinic Acacia Counseling and Wellness costing up to $150 for people with out-of-network insurance. But, in addition to the cost of therapy, Hutchinson said the overall price of education also plays a role in the increasing amount of mental health issues college students experience. Hutchinson said steep tuition costs often force students to take out thousands of dollars in loans. And when students don’t rely on loans, their families carry the financial burden, Hutchinson said.
B. Janet Hibbs, psychologist and co-author of “The Stressed Years of Their Lives: Helping Your Kid Survive and Thrive During Their College Years,” said the cost of college pressures students to be perfect in school to avoid wasting their parents’ money.
People in the late adolescence to early adulthood age range are at the highest risk for the onset of many mental disorders, said Danielle Keenan-Miller, director of the UCLA Psychology Clinic. But since many students experience these issues for the first time, they don’t know when or how to seek help, and ultimately do not get treatment.
Ultimately, Green said CAPS is a short-term therapy provider. The best course of action for the 20% to 30% of students who want long-term therapy is to get a referral to an off-campus facility, she said.
But for students like the recent graduate, an off-campus referral is not enough. Even if she had been able to leave campus, she said the expensive Uber cost from UCLA to the Rape Treatment Center at UCLA Medical Center, Santa Monica, which CAPS referred her to, wasn’t feasible.
With CAPS’ current funding, Green said longer-term therapy would only create longer wait times. But Wesley said transparency is crucial to an effective mental health resource, so college counseling centers like CAPS should be upfront about the limitations of their services.
Green said UCLA as a university is making an effort to better publicize the mental health resources available and respond to student concerns. Staff from the Resilience in Your Student Experience hub – which was created in response to student feedback – gave a 30-minute presentation at orientation this year, Green said.
RISE offers group meditation, yoga and educational presentations among other resources beyond the scope of CAPS, she said. CAPS also created a community relations and outreach coordinator to help students with community referrals, and brought the copay of outside services from $25 down in past years to $5 this year.
But students are constantly – and understandably – asking for more effective mental health services, Green said. With CAPS’ current funding and physical size, she said its goal is to utilize as many resources from the surrounding community as possible to assist those with mental health issues nationwide.
For college campuses, there’s no one-size-fits-all treatment for mental health, Keenan-Miller said. Moving forward, an interdisciplinary approach is necessary to holistically address the issue.
Although clinical services are a major part of mental health treatment, mental health education also plays a significant role, said Sara Abelson, a co-investigator and lead for Diversity, Equity and Inclusion projects with the Healthy Minds Network.
At Boston University, Hutchinson said the school has begun training upperclassmen who identify as having a mental health condition to serve as peer mentors, a method she said has been validated by research. Although UCLA has a similar peer mentoring program to that of Boston University, its resources should, with the help of CAPS, be better publicized.
Hibbs said even parents could potentially be a crucial part of prevention. Parents can encourage their children to speak about mental health before it feels like too big a burden to address and provide a safety net of support, Hibbs said. Green added that staff from the RISE center gave presentations to emphasize the importance of monitoring mental health in the same way we monitor physical health.
“Students ... are expected to manage their physical health on a daily basis,” Green said. “Are students sleeping? Are students drinking a whole lot of energy drinks? Are they binging on the weekends? Are they really engaged in things that are going to take care of their mental health?”
But as students learn to track their mental health, campuses must find a way to facilitate access to mental health resources. Hibbs said some schools like University of Florida have implemented 24/7 teletherapy – a cheaper alternative to face-to-face therapy – which would be a potentially cost-effective way for CAPS to treat more students and reduce wait times.
Another option is online do-it-yourself therapy, with educational videos to help those with less pressing issues cope, Rose said. Data-driven measures like how often a student is missing class, or even how often they’re not using their dining hall swipes, might also help identify which students need help, Hibbs said.
Ultimately, Hutchinson said there is still an enormous amount of cultural shame, prejudice and discrimination that surrounds mental health issues in today’s society. But Hibbs said mental health disorders are nearly as prevalent as the common cold – and with the help of parents, peers and faculty, the crisis can be solved.
Both CAPS and UCLA have a long way to go before they’re part of the solution. And in the meantime, students like the recent graduate are forced to seek outside sources to bridge the treatment gap.
The alumna said she was finally able to travel far enough off campus for outside treatment spring quarter of her fourth year. Her best friend accompanied her for support, but she said it was still an extremely difficult process that she couldn’t imagine doing any sooner. The staff at the Rape Treatment Center – which she said offered 10 free sessions – were more understanding of her trauma and the sessions were more personalized than those at CAPS, she said.
But by this point, two years had elapsed since her assault. She said CAPS needs to find a way to make its services more available, perhaps by hiring more staff clinicians, so that it is not a last-resort resource for students in crisis.
“I was suicidal,” she said. “I don’t really need an outside place right now. Can I just have help, like, immediately?”