Content Warning: The following article includes mention of student death and suicide. University Counseling services are available at 609-258-3141, and the Suicide Prevention Lifeline is available 24/7 at 988 or +1 (800) 273-TALK (8255). A Crisis Text Line is also available in the United States; text HOME to 741741. Students can contact residential college staff and the Office of Religious Life for other support and resources.
Our community has suffered too many tragedies. In the past year, we have lost five members of the campus community, four students and one staff member. If Princeton had the U.S. average rate of suicide deaths among 15- to 24- year-olds, there would be about one each year. One death would be too many — but four is a disturbing indictment of the way that Princeton University addresses student mental health.
Suicide is the second-highest cause of death for young adults aged 20–24. Princeton students, who often feel pressure to achieve, are a particularly at-risk group. Other risk factors for suicide, including hopelessness, anxiety, and substance use, are also common on college campuses. The University can and must take a much more robust approach to mental health care, starting with a more effective specific program to prevent suicide. Our goal should be zero suicides on campus. This can only be done by re-envisioning Princeton as the primary mental health care provider for students, moving away from the current broken model of referring students to scarce and expensive community providers who are unable to meet student needs.
Community and Psychological Services’s (CPS) current model relies on referring students out to counselors in the community, a system riddled with problems. For one, there is a shortage of mental health care providers willing to provide long-term support. The University also can’t ensure external care is high quality nor that the care can provide the full range of treatment options, including the evidence-based care offered at CPS. And the referral model can make CPS itself less effective — if the CPS counselor’s end goal is to refer you to an outside provider, it’s difficult to build a trusting therapeutic relationship. Reliance on outside providers also adds a financial barrier to care: the cost of treatment plus transportation is likely unaffordable for many students on the Student Health Plan.
Director Chin said that students on the plan pay a $20 copay per session to see a non-University provider on the Exclusive Provider Network, or $480 per year for 24 weeks of therapy. Even for in-network care, co-insurance is 10% of the cost of care. Although students can apply for the possibility of financial assistance with these costs, this adds yet another barrier to care, making it harder to get mental health help.
There’s a reason why off-campus mental health care is expensive — basic microeconomics: fewer people try to access care when it costs money compared to when it’s free, even when they really need it. Fewer people accessing care reduces strain on the system. But there’s a better way to reduce strain than preventing people from getting care: increasing treatment capacity.
CPS currently has only 29 care providers and, given our student population of about 8,600 graduate and undergraduate students, our counselor-to-student ratio is about 1:300. Although this is better than many other schools, Princeton’s average wait time for a mental health intake screening is nearly five days, and the wait for an actual appointment is another 14 days. And many students are soon referred to off-campus care, where they must start treatment again with a new counselor. This delay is unacceptable and potentially lethal. CPS only somewhat acknowledges the treatment gap: Director Calvin Chin told the ‘Prince’ recently that CPS has hired new counselors, but these counselors are “temporary.”
It’s a major perspective change to envision the university as a mental health provider -- traditionally, universities haven’t been responsible for that. That doesn’t mean they shouldn’t be. The University needs to take over providing mental health care for students and at least double the number of mental health care providers at CPS. This probably means substantially increasing the salaries of these coveted providers, especially those who can provide culturally and linguistically effective care for our diverse student body. This will be expensive, but with the University’s astonishingly excessive wealth, it’s well within reach for Princeton to pay in full to make this high-quality care free for students.
Princeton is doing some things right: CPS offers dialectical behavior therapy (DBT), a type of talk therapy used to treat suicidality, which is widely considered to be effective in treating suicidality among young people, as well as the highly successful cognitive behavioral therapy (CBT). Centering mental health resources on campus would also allow Princeton to provide universal, standardized screening for suicide risk, ensure timely follow-up care, and offer the highest quality care, including the most promising advances in treating mental health issues, such as ketamine and folic acid to address severe suicidal ideation. It would also give Princeton the opportunity to provide culturally and linguistically effective care, including more diverse providers from a broader range of backgrounds, that student groups such as Princeton Ethiopian and Eritrean Student Association (PEESA) have been calling for.
Princeton can’t expect students to fight mental health problems alone. The past year has shown us that, despite some high-quality care being offered, the status quo is not enough. So here’s an idea for what Princeton should do with its exponentially growing endowment: transform CPS into a primary, centralized mental health system by doubling the number of psychologists and psychiatrists in CPS, moving away from its current referral system, prioritizing the hiring of diverse providers with cultural and linguistic skills to match student needs, and investing in cutting-edge, culturally effective therapies. To inform and monitor our progress, Princeton can hire independent researchers and conduct surveys to understand unmet student needs, barriers to care, and to collect detailed information about the medical and cultural preferences of students.
Princeton has the financial resources, administrative capacity, and expertise to achieve a zero-suicide campus. Let’s do this.
Eleanor Clemans-Cope (she/her) is a first-year from Rockville, Md. intending to study economics. She spends her time making music with Princeton University Orchestra and good trouble with Divest Princeton. She is an associate Opinion editor. She can be reached on Twitter at @eleanorjcc or by email at email@example.com.