UP CLOSE | “Cold, institutional, transactional”
A look back on four decades of mental healthcare at Yale
Nicolette Mantica saw a therapist for the first time in 2017, during her junior year at Yale.
Mantica, who was slated to graduate in 2019, was depressed. She struggled with self-harm and abused over-the-counter medication. When she opened up to her close friends, they insisted she see a therapist — a step that Mantica by that point knew she needed to take. On her friends’ advice, she signed up for therapy through Yale Mental Health and Counseling.
“I was like, ‘I’m going to sign up. It’ll get better. I won’t have to worry about this anymore,’” Mantica recalled. “I started seeing a therapist who I really didn’t like that much, but because I’d never done it before and this was my first time ever seeing a therapist, I thought, ‘Well, this is just me. This is what therapy is like, and this is just me.’”
The treatment Mantica received from Yale Mental Health and Counseling, or MHC, continued to disappoint her. She pointed specifically to one incident, when she described the anxiety she felt about never being in a relationship and her therapist told her to “try harder.” That therapist referred her to a psychiatrist, who prescribed a medication that Mantica could not afford.
“I definitely felt like neither of them were ever listening to me,” Mantica said. “And because I didn’t think they were helping, I didn’t always tell the truth. I would lie about self-harming. Like, ‘They’re not doing anything for me, why would I tell them when I feel this way?’”
The emotions Mantica associated with MHC — feelings of betrayal, anger and shame — resonated with six other alumni who spoke to the News, who graduated between 1988 and 2019. The past year has seen renewed conversations surrounding the structural failings of Yale’s mental health resources, but Yale students have long felt underserved by the services and policies ingrained within YMHC. Concerns about the ability of MHC services to meet student needs are particularly pressing given a recent demand for counseling services — this year, MHC director Paul Hoffman said, saw the largest single-year utilization increase in the department’s near-century of operation.
The collective memories of alumni reflect that the critical student perception of MHC has remained virtually unchanged over the past 30 years. Paul Mange Johansen ’88 is an organizer for Elis for Rachael, a mental health advocacy group composed of alumni, current students and many of those who knew Rachael Shaw-Rosenbaum ’24, who died by suicide last year. One of the group’s first initiatives was conducting a survey of alumni encounters with MHC, which Johansen, a statistician, analyzed.
“The results are incredibly consistent over time,” Johansen said. “The complaints that people had when I was a student in the 80s … are almost identical to the problems that people are having today.”
The treatment Mantica received from Yale in 2017 continued to prove unsatisfying. Her mental health worsened to the point where her dean intervened, and she was involuntarily hospitalized. She spent ten days at various wings of Yale New Haven Hospital, taking three finals as she completed the semester. During that time, she received no communication from her therapist or psychiatrist, but she did receive a visit from a MHC representative, who stood in her doorway and told her she would need to take a medical withdrawal from Yale.
Withdrawals can occur for academic, medical, personal, disciplinary or financial reasons, and withdrawn students are barred from campus without permission from either their residential college dean or the dean of student affairs. Withdrawals are unique from leaves of absences in that those who withdraw are not automatically granted a place at the University upon their return and must instead meet certain requirements for reinstatement.
This month, Yale relaxed numerous reinstatement requirements. However, in Mantica’s time, requirements for reinstatement included an application form, two letters of support, a personal statement, interviews with members of the reinstatement committee, the equivalent of two term courses at an accredited four-year university or Yale-sanctioned community college and, in the case of students on medical withdrawal, documented treatment from a clinician.
“I felt so betrayed, because this message was, ‘We’re a family,’” Mantica said. “This constant message of, ‘We’re here to take care of you, if there’s anything that you need, come to us.’ And yet, every step of the way, every person that I tried to rely on for help just told me, ‘Well, we can’t have you here. We don’t want you here. We’re not going to help you.’”
“Every step of the way, every person that I tried to rely on for help just told me, ‘Well, we can’t have you here. We don’t want you here. We’re not going to help you.’”
—Nicolette Mantica
Mantica never returned to Yale. She began the reinstatement application but felt so alienated by the process that she decided to transfer to Northwestern University, in part because she felt the mental health care offered there was more comprehensive than at Yale.
Currently, MHC offers individual, group and couples therapy with licensed clinicians. After attending an initial intake session, the department provides students with clinicians to determine the length and regularity of their treatment.
The department was founded in 1925, and in its near-century of operation, has been headed by six people — Arthur Ruggles, Clements Fry, Bryant Wedge, Robert Arnstein, Lorraine Siggins and Hoffman. When Hoffman took over in 2020, Siggins had been in the position for 30 years. Siggins did not respond to multiple requests for comment.
(Yale School of Medicine)
“I think that I have the same goals as my predecessors as far as providing exceptional mental health treatment, but I think that the pandemic along with the large surge in mental health utilization have created an urgency to solve some of the challenges that have existed in the department for a number of years,” Hoffman wrote in an email to the News. “This has led to a period of significant change in the department.”
Last year has seen reforms such as the relaxing of reinstatement requirements, the creation of the Yale College Community Care program and additions to MHC clinical staff. But as student demand for mental healthcare grows, a culture of student mistrust lingers around MHC. In interviews with the News, experts, alumni and administrators recalled the fraught history of mental health care at Yale and looked ahead to avenues for change.
Shared experiences
Similar experiences and emotions recur throughout alumni recollections of MHC, regardless of the year they graduated.
Johansen never used MHC services during his time at Yale — other students, he said, warned him away.
“I heard rumors about, ‘Oh, don’t go to Yale psychiatric service, they’re terrible,’” Johansen said. “I was there ’84 to ’88, and that was sort of the word on the street.”
Lisa Marie Bronson ’88, who was on campus during the same window as Johansen, was one of the students who made use of MHC counseling. The experience left her unsatisfied.
Mental health was rarely discussed on campus, Bronson explained, but it was something that she talked about often with her parents. When she felt her mental health deteriorating during her time at Yale, she sought out therapy on her own, without guidance or intervention from anyone else at the University.
“I didn’t have any type of internalized stigma about it coming in that I brought with me, but I think if I had, I certainly wouldn’t have received any messaging or information to make me think differently,” Bronson said. “I also didn’t have anyone who would have been aware of or in touch with my mental state. I went to find counseling because I was concerned about how depressed and nonfunctional I was.”
When Bronson began the process of finding a therapist through University services, she asked to be assigned to someone with whom she shared experiences, specifically requesting a therapist who was young, a woman and, if possible, a person of color.
At the time, Bronson said, she had never heard of a non-white therapist, but she wanted to be able to talk to somebody about her experiences in the predominantly white environment of the University, where she often felt particularly targeted as a Black woman and an activist.
But the therapist Bronson was assigned to, she said, was a “very, very old, very, very white man,” with whom she did not feel comfortable talking about many of her experiences. When she was reassigned to another counselor, this time a middle-aged woman, the experience was not much better.
The new therapist referred her to a psychiatrist, who prescribed her medication. When the medication did not initially have an effect, the psychiatrist accused her of lying about taking it.
“Outraged,” Bronson returned to tell her therapist about what had happened in the hopes that she could help find a resolution to the situation and get her the medication she needed. But apart from asking her how she felt about being accused of lying, Bronson said that her therapist had almost “no reaction” when she described the interaction with the psychiatrist.
“When she did not advocate for me in that instance, I just said, ‘Okay, this isn’t going to work,’” Bronson said. “So, I stopped seeing her, but I was very depressed, and I definitely needed to be under care. It absolutely impacted my academic performance.”
Bronson was ultimately forced to take a withdrawal — not for mental health reasons but for academic ones.
She fulfilled the necessary requirements for reinstatement and eventually returned to Yale. But throughout the process, she recalled, no one from the University expressed concern for how she was, or if she had the necessary support to facilitate her return.
“I wanted to finish and graduate from Yale, but my support was not coming from there,” Bronson said.
Alicia Floyd ’03 graduated almost two decades later, but her experience applying for reinstatement to Yale left her with a similar sense of detachment from the mental health resources in place to support her.
Floyd struggled with depression throughout her time at Yale but did not initially pursue therapy. She said her first meaningful interaction with MHC came after an attempted overdose — “calm, but kind of bewildered,” she was taken from Yale Health to the emergency room and finally to a psychiatric institute. Like Mantica, she was asked by the University to take a medical withdrawal a week into her stay there.
As she went through the motions of withdrawing and completing reinstatement requirements, Floyd said the University’s handling of the process felt “harsh and liability-driven.” Although Floyd said that while the immediate aftermath of her overdose was traumatic in its own right, it was the reinstatement process that has stayed with her — it gave her nightmares, she said, for eight years after that. She felt “very betrayed” by a University she thought would support her regardless of her mental health.
“I think if I had perceived Yale as being a cold, institutional, transactional sort of place to begin with, my expectations and the reality would have matched up a lot better,” Floyd said.
Although Mantica’s interaction with MHC came another decade after Floyd’s, she described a similar feeling of betrayal.
“I did feel such a betrayal, and it made me feel like a criminal, too,” Mantica said. “When I got that reinstatement letter, for a long time, I wanted to go back because I loved my communities. I was involved with Glee Club; I was involved with some other clubs; I loved my friends; I loved Silliman. I wanted to be there. But the more I thought about it, I was like, ‘These people did not care about me when I was at my most vulnerable state. They didn’t want to take care of me because it was easier for me to just leave.’”
More than 30 years after graduating from Yale, Bronson has come to find fault with how her mental health crisis was handled by the University. She now provides professional wellness coaching to medical students. If she saw a student in the state that she was in at Yale, she explained, it would raise immediate alarms — “just kind of letting it ride” would not be an option.
But when she was a student, Bronson said that it did not occur to her to blame the University for the inadequate care she received.
“I internalized it, and I felt ashamed,” Bronson said. “I felt like it was my fault. I didn’t put that at the feet of the institution at the time at all. I felt like I had this wonderful opportunity and experience and I messed it up.”
“I internalized it, and I felt ashamed. I felt like it was my fault. I didn’t put that at the feet of the institution at the time at all. I felt like I had this wonderful opportunity and experience and I messed it up.”
—Lisa Marie Bronson ’88
“Incremental changes”
Recent changes to the University’s mental health care resources have come slowly, often in gradual policy amendments rather than sweeping reforms.
A buzz of dissatisfaction with Yale’s policies on mental health — and with its reinstatement and readmission practices in particular — has pervaded campus throughout the past two decades.
The News reported on the limitations of the University’s therapy offerings in 2002, quoting students who raised the same issues, like long wait times and underwhelming treatment, that are often brought up in discussions of MHC today. In 2007, students spoke against withdrawal and reinstatement policies, specifically criticizing Yale’s practice of sending students on involuntary withdrawals.
In January 2015, campus dissatisfaction with the University’s policies on mental health rose to a fever pitch after Luchang Wang ’17 died by suicide, citing Yale’s policies on readmission in a Facebook status posted hours before her death.
The next month, members of the Yale College Withdrawal and Readmission Review Committee, which had been commissioned by then-Dean Jonathan Holloway in fall 2014, attended a town hall meeting with students and administrators, where students aired their grievances with the policies as they stood.
In April 2014, the committee published a report including a series of recommendations to Holloway on how to improve the withdrawal process, all of which he accepted. The reforms, which Holloway committed to enacting for all students applying for reinstatement in 2016 and beyond, included the change of the term “readmission” to “reinstatement,” as well as changes to reinstatement application deadlines, an elimination of the application fee for reinstatement and changes to financial aid for students who take medical withdrawals.
Since then, the requirements for reinstatement remained the same — despite renewed criticism of the policies in the wake of Shaw-Rosenbaum’s passing — until a host of reforms were announced this April.
Dean of Yale College Marvin Chun, who will conclude his term at the end of June, told the News that student mental health had been a “priority area” during his time as dean and that he thought Yale had made important progress on this issue.
“The Yale College Community Care program is something I’m very proud of, and I really love my colleagues who are serving with it, and I’m very proud that they’re affiliated with the Yale College Dean’s Office,” Chun told the News. “That’s a program that did not exist, and it now exists. I think it’s going to continue to have a great impact on campus.”
Chun announced the establishment of Yale College Community Care, or YC3, in April last year. The program provides short-term clinical care and wellness advising, intended to help students work through short-term issues and ease the strain on the central branch of MHC.
Through YC3 in particular, Hoffman said, he has seen increased student engagement with mental health services over the past year.
“The major priority has been to add staff and find space, to modernize our department, to increase the diversity of staff and to increase the outreach to students,” Hoffman said. “All these efforts are aimed at decreasing the wait time for treatment, providing students with high quality treatment and decreasing barriers for students.”
Among the other developments that Hoffman recalled from his term as chief of MHC were new partnerships with the Yale Law School, the Yale School of the Environment and the Medical School, and the addition of a second location at 205 Whitney Avenue to accommodate the addition of “a significant number of clinicians.”
MHC, Hoffman added, has also adapted to a hybrid treatment model developed during the pandemic, the flexibility of which he said has received positive student feedback.
“We have changed our policy so that students can utilize both individual therapy and group therapy simultaneously to allow students access to more intensive treatment,” Hoffman explained. “In the next few months, we will be allowing students to use MyChart to communicate with their clinicians at MHC. We expect that the staff additions will begin to decrease wait times next year.”
But some advocates — including groups like Elis for Rachael — have argued that a meaningful overhaul of Yale’s mental health structures can only be achieved with the counsel of an outside perspective. In particular, Elis for Rachael has suggested that the University employ the services of the Jed Foundation, a nonprofit that focuses on suicide prevention and mental health care.
The Jed Foundation offers a four-year program that assesses mental health policies in place on college campuses and guides administrators through the process of policy development with the help of a dedicated campus advisor.
Nance Roy, the Jed Foundation’s chief clinical officer, told the News that she often proactively makes contact with university administrators. In 2020, she said, she met with Yale administrators to discuss a potential involvement with the four-year program.
“We met to talk about Jed campus and them joining and, you know, they never did,” Roy said. “I don’t know what factored into their decision. They are positive about Jed — they always applaud our work and think we do great work, but for whatever reason have chosen not to join the Jed campus program. I will say that Yale and Brown are the only two Ivies so far that are not part of our program. So of course, we’d love to have them, but I can’t tell you what the obstacle is.”
Hoffman told the News that the meeting with the Jed Foundation took place in the early days of the COVID-19 pandemic, when it was not “the right time to take on a project of that nature.” At the time, he explained, MHC was focused on the pivot to online counseling as the broader University responded to the pandemic.
“Everyone’s effort was being diverted to the pandemic response,” Hoffman said. “I would not say that partnering with either Jed or a different third-party consultant is a closed question.”
Even as change comes to Yale’s mental health policies, Floyd said, it can feel insignificant when compared to student calls for more major reform.
“Over and over and over again, you see these little incremental changes being made in response to pretty large outcries,” Floyd said. “You see what came out of that and it’s like, ‘Well, we created an FAQ page,’ or ‘We changed the name from readmission to reinstatement’ … It doesn’t add up.”
(Lily Colby)
Hoffman, for his part, noted that the University has made more significant changes in the last year, but recognized that these may take some time to have a tangible and widespread effect.
“We have made an enormous number of changes in a short period of time, but it may take some time for students to feel the full effects of the changes,” Hoffman said. “We are always looking for different ways to meet the needs of students and to evolve as we see generational shifts in mental health trends.”
Demand for treatment
Amid the push for reforms to the department, an increased demand for counseling services has placed a unique strain on MHC.
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“I think that many students who receive treatment in our clinic have a very positive relationship with MHC, but I do think that the public perception of our clinic is often shaped by our wait times and limits on our clinicians’ availability due to the extraordinary demand,” Hoffman explained.
Hoffman noted the positive “significant decrease in stigma around mental health” that is in part driving up demand for mental health care. But at Yale and across the country, he added, students are also facing more significant mental health challenges than they have in the past.
On Dec. 3, U.S. Surgeon General Vivek Murthy MED ’02 SOM ’02 released a public health advisory which warned of the “devastating” effect that modern challenges have on the mental health of youth in the United States. In particular, Murthy warned of issues like the COVID-19 pandemic, climate change, income inequality, racial injustice and the adverse effects of social media.
“These past few years, we’ve seen a lot of really major stressors at the community level,” Sarah Lowe, a clinical psychologist and an assistant professor of social and behavioral sciences at the Yale School of Public Health, told the News.
Lowe made specific reference to “the COVID-19 pandemic and all that comes with that in terms of bereavement, disruptions to routines, social isolation and so on.” Like Murthy, she also pointed to political tensions, the severity of climate change and an increased awareness of race-based violence as contributors to an “undercurrent of stress.”
But at Yale in particular, alumni have described a pervasive unhealthy student culture as yet another cause of mental health challenges — one that not only exerts pressure on students to succeed but casts shame on them for admitting to vulnerability.
(Anasthasia Shilov)
During their time at Yale, Sean Moundas ’03 said, the culture among the student body was one that rewarded engagement, encouraging students to be as involved with as many activities as possible.
“The downsides were that there was this pressure to be quite busy,” Moundas said. “I think there was a culture with the academic rigor and the work volume of, like, ‘I stayed up x-number of hours just to get this done,’ and pushing through and pushing through.”
The effect of this culture on student mental health, Moundas said, was not broadly acknowledged by students or the University’s faculty and staff.
“It seemed like mental health was something to be managed more privately, and that there wasn’t a ton of space to talk about experiences with mental health and seeking support,” Moundas said.
Mantica recalled a similar culture among the student body during her time at Yale, over a decade after Moundas. The attitude towards mental health on campus, Mantica said, could be exemplified by a Facebook meme page that took off while she was on campus, where much of the humor relied on playing student unhappiness and exhaustion for laughs.
Party culture on campus is similarly demonstrative of a cultural unwillingness among the student body to confront their mental health challenges head-on, Mantica added.
“The culture at Yale was very much work hard, play hard,” Mantica said. “Like, ‘You can’t show any weakness. It doesn’t matter if you think you’re sad or struggling because everyone’s struggling.’”
The force of this culture, Mantica explained, delayed her decision to seek mental health care from the University. Students talked so casually about the pressures they were under, she explained, that she wrote off her own concerns about her mental health when she began to lose a sense of stability.
“The thought process during my time was, ‘I’m not bad enough,’” Mantica said. “Like, ‘I’m not actually having suicidal thoughts, so I’m not bad enough.’ But at the same time, I’m saying that and really, really needing help and not recognizing that, because I just thought, ‘Oh, everybody does that.’”
“Cautiously optimistic”: Moving forward
Looking ahead, Bronson hopes the University will continue to treat the gap between student demand for mental health care and the services currently available with the urgency it deserves.
The current approach to mental health reform at Yale, she said, seems to prioritize institutional preservation above the immediate needs of students. But when the University has existed for over 300 years, she said, concern for the institution itself should pale in comparison to concern for the students within it.
“I think the institution is going to be alright,” Bronson said. “Are the kids alright? That’s what I want to know.”
Hoffman emphasized that MHC is always open to student feedback as the department continues to develop, lauding the “extremely dedicated and diverse” teams of clinicians within the department, which he said was one of the most talented groups in any university mental health department.
As he prepares to depart his deanship, Chun said that he has been pleased to see the stigma surrounding mental health on campus decrease during his time at Yale.
“I think there’s a better understanding that we need to manage our expectations,” Chun said. “It’s not healthy for oneself, and it’s not healthy for others, if someone drives themselves so hard for superficial reasons. What’s most important is that students learn and enjoy learning here. To work against that defeats the purpose of their time here.”
Floyd recognized some of the recent progress made but said that the historical pervasiveness of Yale’s inadequate mental health resources means that even if administrators seem to be moving in the right direction, there is far more that can be done.
“Regardless of whether they’re moving in the right direction or not, I think this is a long enough-standing problem that has been so chronically under-addressed,” Floyd said. “I think extra pressure is a good idea to keep them on the right track … I hope that they’re sincere. I do see some good movements.”
“Regardless of whether they’re moving in the right direction or not, I think this is a long enough-standing problem that has been so chronically under-addressed. I think extra pressure is a good idea to keep them on the right track… I hope that they’re sincere. I do see some good movements.”
—Alicia Floyd ’03
Floyd added that she was “cautiously optimistic” that the attitude of the current administration could be conducive to making substantive changes to some of the University’s current policies surrounding mental health — particularly regarding access to affordable mental health care.
In November 2021, Elis for Rachael circulated a petition demanding specific changes to the University’s current mental health care resources. In particular, they called on administrators to enact additional reforms to the reinstatement process — some of which were reflected in the changes announced in April — to add an affordable Preferred Provider Organization, or PPO, option to University health insurance that would allow students to see providers outside Yale and to allow withdrawn students access to campus.
“It boggles my mind [that] these changes haven’t been made, because some of them are free,” Johansen said. “There’s some things that they could do immediately. These reinstatement policies — just change your policy. That’s free. You can design what you need.”
Until these changes occur, Johansen, like Floyd, emphasized the importance of keeping up pressure on the University. Alumni advocacy, he suggested, could be uniquely powerful in its ability to sustain a movement, even if the turnover of current students every four years limits the broader memory of the student body.
Since Johansen and Bronson graduated in 1988, the University has increased the size of its student body, with the class of 2025 setting new records for the largest class size in history. That expansion could be a positive development, Bronson said, but only if the University has structures in place to make sure none of those students fall through the cracks.
“It shouldn’t be possible for a student to be in a state of extreme distress or having a mental health crisis, and have that be a complete surprise to the people around them,” Bronson said. “There needs to be a structure within which people are known.”
MHC was founded in 1925.
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