MIT's Mental Health Blind Spot

WARNING: This is an opinionated article.

The Massachusetts Institute of Technology (MIT) has a peculiar blind spot when it comes to mental health. In an environment long known as one with high-stress and an above-average suicide rate, effective delivery of mental health services at top universities such as MIT is a widely discussed problem.

MIT has it especially tough, with its strong scientific focus, where the cold, hard reality of "it either works or it doesn't" rules the day, and where both students and faculty are inclined to think with ruthless logic, without much patience for the "irrational."

It is instructive, then, to observe what happens when, in the name of supporting mental well-being, MIT attempts to summon the strength to point its high-powered perception at itself—to look at itself and write down what it sees. Alas, one gets the impression that maybe MIT is afraid to, as MIT seems to see very little.

A Promising Survey

To try to get a handle on how it was doing, MIT in 2015 ran the University of Michigan's Healthy Minds Study (HMS) on all 10,700 of its undergraduate and graduate students, about 3,000 of whom (28%) participated. In September, 2015 MIT published the results gathered from this extensive 18-page questionnaire, which asks a large number of highly personal questions.

The HMS advertises itself as unique in having "a special emphasis on understanding service utilization and help-seeking behavior, including factors such as stigma, knowledge, and the role of peers and other potential gatekeepers." In other words, it attempts to measure a very thorny problem with mental health service delivery: getting those who need help to seek it out and apply it to their problems. At MIT, the go-it-alone, figure-it-out-for-yourself attitude would be expected to undermine help-seeking, so it makes perfect sense to get a thorough measurement and analysis on this behavior, and to use this particular survey.

To that end, the HMS survey on p. 16 asks:

E21. In the past 12 months, which of the following factors have caused you to receive fewer services (counseling, therapy, or medications) for your mental or emotional health than you would have otherwise received? (Select all that apply)

It presents for selection any number of 24 reasons, plus "Other" and "None." These reasons are of two general types. Fourteen relate directly to MIT's service delivery: logistics like location, hours, wait time, and more managerial issues like handling of privacy and cultural differences. The other ten are what MIT called "personal" reasons such as "I prefer to deal with issues on my own," and these are more perceptual, often quite intractable.

MIT Service Delivery Reasons

There are financial reasons (too expensive, no insurance).

The location is inconvenient.

The hours are inconvenient.

The number of sessions is too limited.

The waiting time until I can get an appointment is too long.

I am concerned about privacy.

I worry that my actions will be documented in my academic record.

I worry that my actions will be documented in my medical record.

I worry that someone will notify my parents.

I fear being hospitalized.

People providing services aren't sensitive enough to cultural issues.

People providing services aren't sensitive enough to sexual identity issues.

I have a hard time communicating in English.

I question the quality of my options.

Personal Reasons

I don't have enough time.

I worry what others will think of me.

I question whether medication or therapy is helpful.

I have had bad experiences with medication and/or therapy.

The problem will get better by itself.

I question how serious my needs are.

I don't think anyone can understand my problems.

Stress is normal in college/graduate school.

I get a lot of support from other sources, such as friends and family.

I prefer to deal with issues on my own.

A key difference between these two sets of issues is that the first are directly addressable by improvements made by and at MIT, while the more "personal" reasons reflect attitudes toward mental health service that can be extremely difficult to change.

A Failed Analysis that Blames the User

In the published results, MIT discussed what they learned about barriers to help-seeking, near the end of the report on page 11 of 13:

Barriers to Help Seeking
When asked "In the past 12 months, which of the following factors have caused you to receive fewer services (counseling, therapy, or medications) for your mental or emotional health than you would have otherwise received?", the top factors were generally personal in nature, with some barriers—such as "I prefer to deal with issues on my own," "I question how serious my needs are," and "I don't have enough time"—selected more often by MIT respondents than respondents in the national sample.

And that's it. Nothing more. MIT analysts summarized and sorted the responses by top reason given, then noted the top three were the (not surprisingly) "personal reasons," and went home for the day. There was not a peep about any one of the fourteen actionable issues MIT could address to improve things. No mention of whether any of these more fixable problems were also "selected more often by MIT respondents than respondents in the national sample." All the reasons seen by MIT as worth noting come from within the help seeker, the failure to seek help his or her fault.

What MIT Failed to See

What would MIT have seen if they had looked for patterns in the addressable concerns? A lot of room for improvement. Below are comparisons, drawn directly from the published results of the HMS study, between MIT undergrads and the U.S. average for two groups of the addressable issues: privacy concerns, and five of the service delivery problems.

Privacy Concerns - MIT vs. U.S. Undergrads

As an example, fear of the ultimate loss of privacy—hospitalization—occurs at MIT at a rate double the U.S. average. MIT could work to allay this fear by educating students about options for anonymous assistance where unwanted hospitalization is less of a risk.

Service Delivery Issues - MIT vs. U.S. Undergrads

As an example, hours of operation is more than double the problem at MIT vs. the U.S. overall. Expanded hours of service is an obvious recommendation.

A Waste of Students' Time and Effort

With 2,973 students each taking the estimated 20 minutes to answer the 18-page survey, MIT had 53,514 pages of information from 1,000 student-hours of effort to work with, yet failed entirely to identify even one area of service improvement. MIT would appear not only to have opportunities for improvement of mental health service, but also the prerequisite problem of recognizing the existence of these opportunities, through the most rudimentary analysis of an expensive survey.

MIT would apparently need to learn how to do simple research.

A Punitive Opportunity Not Missed

It would be enough that the HMS survey was not used effectively for its intended purpose. But there are also concerns that MIT may have used the highly sensitive data for punitive measures in an ugly gesture to shut down access to an "alternative" residence. MIT clearly needs to open its eyes and take a look at its priorities, to at last honestly point its high-powered perception at itself.

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