As colleges reopen, they should recognize that COVID-19 will collide with the campus mental health crisis (opinion)

You hug your mom and dad goodbye as they drop you off for your first day of college, and turn quickly toward your room; you know your parents will start crying anytime, and you don’t want them to embarrass you. You’re so antsy and excited to finally “leave the nest” that you fumble with your room key on the brand-new university lanyard looped proudly around your neck — you haven’t made older friends yet who would advise you that this universal sign screams “freshman!”

You’ve spent months, maybe years, dreaming about this day: you picked out the perfect, color-coordinated bedding and dorm supplies that will make the best impression; you’ve imagined every possible scenario for ensuring your roommate situation turns into a lifelong friendship; you’ve anticipated the freedom of the first night of college, informed by every decent coming-of-age story.

The room you enter is nothing like you imagined. As the door automatically locks behind you, you find yourself standing in a dark, stale hotel room in the middle of nowhere. You’re immediately shrouded in loneliness and homesickness. As you pick up the TV channel guide to search for a familiar distraction, you begin to realize this feeling isn’t going away anytime soon.

For the next 14 days, it’s just you, the two stuffed suitcases you were permitted to bring, the prepared food that gets delivered to your door daily, and the overly happy strangers in the virtual orientation programming you’re required to stream on your laptop.

You’ve never been away from home for longer than a few days of sleepaway camp as a kid, and that was much different than this. No one treated you like you were contaminated, and you didn’t spend every waking hour worrying that you might be.

For the past several months, I have served as the graduate student representative on Cornell University’s Teaching Reactivation Committee. We were tasked with providing recommendations to the university’s leadership for safely reopening our rural upstate New York campus amid the SARS-CoV-2 pandemic. We convened some of the brightest minds in public health, immunology, social psychology, operations research and engineering. We spent countless hours poring over the quickly evolving literature and state and federal guidelines regarding virus mitigation, meeting with different constituency groups around campus, and debating recommendations for our comprehensive report.

But in the furor of containing this virus, one hugely important factor has been largely absent from not only Cornell’s reopening conversations but also far too many other academic institutions’ planning: the campus mental health crisis that existed in 2019 did not simply get replaced. It bubbles quietly underneath our attention to a more visible virus. It waits, ready to capitalize on the far-from-ideal living and learning environments that college campuses have actively designed for themselves this fall.

In September 2019, I wrote a Letter to the Editor to The Cornell Daily Sun, criticizing the university for failing to acknowledge that the institution itself is at the heart of the stigma around mental health and resiliency on a campus notorious for high-profile deaths by suicide. This was in direct response to the university’s purposeful silence around the tragic loss of our recently departed counseling and psychological services director, Greg Eells, to suicide, at the start of the semester. At the time, I wrote that, “When I moved to Ithaca as a freshman in fall 2010, Cornell’s response to multiple deaths by suicide the semester before was both swift and controversial yet undeniable: fences on the bridges. Today? It’s deafening silence.”

Eells had left Cornell for a position at the University of Pennsylvania. His expertise in resilience and suicide prevention made the silence and denial in Ithaca even more palpable following his passing — and the lack of attention to the mental health of students, staff and (especially contingent) faculty in the university’s fall 2020 reopening plans today even more noticeable.

I take this silence as my starting place. We’re facing multiple interrelated, overlapping national crises as we seek to reopen college campuses. We are suffering not only from a poorly controlled pandemic but also one that disproportionately impacts low-income families and Black, Indigenous, People of Color, bringing longtime tensions related to systemic racism to the fore. Many undergraduates, graduate students, administrators and faculty members recognize that mental health will be more challenging to maintain than before; many are taking it upon themselves to prepare Band-Aid fixes they anticipate needing. Yet university administrations at Cornell and across the country have voiced little if any acknowledgment of the impending collision of the mental health epidemic with the COVID-19 pandemic as students return to campuses.

The lack of mental health expertise I’ve found in Cornell’s Teaching Reactivation Committee membership is striking, especially among the members of the subcommittee on “Health Considerations.” When I raised that as an early concern, I was astonished that no one provided a rationale for the clear oversight. It was a “Great question,” I was told. When I offered to initiate the organization of a group of experts from our counseling and psychological services center to inform reopening plans from their conception, committee leaders instead encouraged me to put together a working group of fellow students. Already balancing the Reopening Committee’s work with my obligations as a graduate student, I declined to do so; I told them explicitly that my fellow undergraduate and graduate student leaders and I are exhausted from doing this free emotional labor repeatedly, often at the expense of our own well-being.

Unanswered Questions

Since May, I’ve scrolled the pages of this publication and others in higher education regularly, anxiously waiting for someone to highlight this unacceptable and irresponsible silence across college campuses. I’ve seen surveys about the difficulty of accessing mental health care during the pandemic and one-off essays like that from JED Foundation CEO John MacPhee on ways to promote student mental health during this particularly difficult time. However, it seems to me that the solution here is far more complex than reminding young adults that physical distance does not have to mean absence of social connectedness, reassuring them that increases in anxiety and depression are common right now, and encouraging them to ask for help.

By not centering mental health as a fundamental aspect of the public health response to COVID-19 on college campuses, we are engineering unprecedented mental health challenges into reopening design. I don’t mean to minimize the work of individuals who have been focusing their energy on this topic. Within health centers, orientation programming committees and even among organized students, some people are working hard to fill in these gaps. I see you. But where are our university leaders as we embark on reopening plans and public health messaging campaigns?

Moreover, it is fundamentally irresponsible for universities to invite students to return without, at a minimum, frankly addressing student questions regarding the institutional capacity to manage the mental health impacts of coronavirus on both undergraduate and graduate students. Students keep asking, but no one answers — probably because such questions force us to think about the most negative potential consequences of reopening, and therefore challenge the idea of reopening campuses at all. For example:

What structures are in place to support the bereavement of the hundreds more students than normal who will inevitably find themselves struggling with the death of a parent or other loved one(s) during this time? The loss of classmates and professors? Will mental health services be available remotely to everyone if universities are forced into an online learning modality?

What policies are in place to ensure adequate access to counseling services for international students who might be unable to return to campus, but who also find themselves unable to legally continue the virtual care they would otherwise receive? In what ways have the already-exhausted and over-extended resources of counseling and psychological services on many campuses been increased to accommodate growing demand — especially considering the hiring freezes at many institutions?

What consequences will quarantining in isolated hotel rooms or in small, inadequately air-conditioned dorm rooms have on student well-being? This applies not only to quarantine upon move-in in the heat of summer but also when close contacts become infected. For students who serve in residential life capacities, what protections (and increased compensation) will they be provided as they become the first-responders for their distressed residents — heightening their own mental and physical health risks?

What is the anticipated impact of eliminating breaks from academic calendars, limiting in-person student activities or group dining opportunities, canceling sports, and/or closing other outlets for stress relief and recreation on student body stress and anxiety? On academic performance? Why are the same universities that modified their spring 2020 grading policies explicitly because of inequities and anxieties resulting from the pandemic so unwilling to do the same this fall, when the situation is arguably even worse?

In what ways do graduate students’ mental health needs differ from those of the undergraduates who are often the focus of university initiatives? As graduate students face increasingly unprecedented precarity, what impact does this have on our own mental health? As graduate students worry about the health of their own advisers? What additional services will be available to support graduate students with childcare or elder care responsibilities, which are at present causing tremendous stress and uncertainty? Graduate students serve as course instructors, teaching assistants, residential staff and research mentors for undergraduates; how can we ensure graduate students do not pick up additional emotional labor associated with filling in where our students lack access to appropriate mental health care?

I want to suggest that, had mental health considerations been shamelessly discussed and prioritized from the very beginning of the process to imagine the fall 2020 academic semester, reopening would look very different for many campuses than it does today. Dormitories would be viewed not just as coronavirus vectors or “petri dishes,” but also in terms of the alarming degrees of isolation they will create as locations for intermittent quarantine, for taking online courses, for studying, for virtual social activities, for eating, for attending telehealth appointments and for sleep.

If student mental health were truly prioritized, the solution to New York’s mandated two-week quarantine for travelers from a growing list of “hotspot” states would not be as simple as locking students in as many hotel rooms as they can possibly rent. We’d instead be considering seriously the deleterious psychological burden of confined, solitary isolation on the brain of an 18-year-old undergoing significant life changes — not to mention the health risk quarantined students present to hotel staff, restaurant delivery workers and others in the local college towns thoroughly unprepared for the dramatic influx of increased viral load into their communities.&

For now, the vignette I open this essay with is an example of a good scenario. It portrays a student whose family hasn’t suffered from the immediate effects of the pandemic and who still has an idealized vision of the semester their elite four-year university is marketing to them. It portrays a student whose university has provided them with a space to quarantine and probably free re-entry virus testing following the quarantine period. It portrays a student attending a university that, despite the inevitable upcoming financial challenges, will still exist in five years. This is certainly not representative of all colleges and universities, but it is alarming that this is an example from one with such tremendous resources.

All of this, and we have not even considered the mental health challenges that will come with actually testing positive.