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Doctor's Orders: Take Care of Your Mental Health

January 16-In an interview with The Harbus, Dr. Richard Kadison, Chief of Mental Health for all of Harvard University Health Services expressed concern for the mental health of business school students and urged students to seek care if they think they may need it.

Dr. Kadison emphasized that mental health services are part of an overall improvement plan currently being implemented throughout the University Health Service, and he encouraged Harvard Business School students in particular to take advantage of the services offered.

“What we’ve tried to do,” says Dr. Kadison, “is to get the focus on mental health instead of mental illness.” He added, “The comparison I like to make is that if you had diabetes, you wouldn’t just sit down and try to think your way into producing more insulin.” Many mental illnesses, even if emotionally triggered, are a result of hormonal imbalances, and such conditions are imminently treatable, says Dr. Kadison.

Dr. Kadison showed an impressive familiarity with the mental stresses HBS students currently face. “I’ve been here seven years now,” he says, “and I’ve never heard of so many people with so much frustration about the recruiting situation.”

Dr. Kadison also spoke with an intimate familiarity of the general environment at HBS, “It’s like taking a final exam every day for two years.” He described a “rut” that is very easy for students to fall into. “Students come here and they worry about the cold calls, so they stay up at night and lose sleep, and then they have a hard time making comments in class, so they lose more sleep the next week, and they become very anxious, performance can decline, they have a harder time making comments, self-esteem declines, and then depression can set in,” he says. “It’s a vicious cycle.”

Dr. Kadison says few people in this environment are willing to acknowledge depression. He says a person has a 20-25% average chance of experiencing depression in her or his lifetime, and he suspects the figure to be higher at a school like HBS. “Many people come here and have their first major incident of depression.”

Several factors contribute to the mental health risks at HBS in particular, says Dr. Kadison. “First of all, there are many people here from international cultures where there is no word for depression. Plus many come from very conservative business cultures,” where discussion of mental health is presumably taboo. And many people make the mistake of “thinking that it’s a matter of will-power,” said Dr. Kadison.
Prevention efforts are advisable, such as routine exercise, eating well, getting enough sleep, being careful with caffeine, and limiting use of alcohol, which can cause sleep but actually disrupt it. “But in an environment like this,” says Dr. Kadison, “many people don’t make time to do these things.”

Privacy Concerns Addressed: Not Even the CIA Gets the File
One of the main obstacles to people seeking care is a fear of privacy and that treatment records will become a part of a permanent medical record. But Dr. Kadison explained how these fears are mostly unfounded. When a primary care physician (PCP) makes a mental health recommendation to a patient, the PCP does not know whether or how the person follows through with the recommendation. No record is made in the permanent, regular healthcare record of the patient. A student can also seek care on his or her own.

When a person seeks treatment for mental health, an entirely separate file is created and stored separately and securely. If a patient requests his or her PCP to transfer a medical record, only the main medical record is released. The patient must follow an entirely separate consent process before his or her mental healthcare file can be released or transferred.
“Even the FBI and the CIA don’t see these records,” says Dr. Kadison. When these agencies call to inquire about an individual who is being put on assignment, “and I’ve got one of these files on my desk right now,” says Dr. Kadison, “they can only ask me two questions.” First, they want to know if a person has a condition that could present a national security risk, and second, they want to know if there is anything about the person’s mental health that would impair him or her from performing assigned duties.

“That’s it,” says Dr. Kadison, who makes the determination for the agencies in his professional opinion. Impeding responses are rare. An example of a person declined for an assignment might be someone who would need access to special medicine that is not available in the region of the assignment.

Many Resources Available
Dr. Kadison estimates that between 10% and 15% of HBS students use the University Mental Health Services. The Mental Health staff at Harvard includes about thirty therapists, an even distribution of psychiatrists (MD), psychologists (PhD), Licensed Social Workers (LICSW), and clinical nurse specialists (CNS). Four people are on staff at the HBS Health Center in the evenings, and more are on duty at the Holyoke Center, a place that Dr. Kadison says students should feel welcome. “You should never feel stranded.”

In addition, new efforts to increase access to mental health services include five hours per day of urgent care walk-in appointments at the Holyoke Center, 4th Floor. There is also a new “same-day triage” system that provides students with a fifteen-minute phone consultation with a senior clinician to help direct students to the best care as quickly as possible.

Twenty-four hour urgent care is available at 617-495-5711. Regular calls for appointments or information can be made to 617-495-2042. The University Health Services Website also contains more information about group support and other services at ush.harvard.edu Dr. Kadison also recommends that students contact Pat Light, a psychologist and Director of MBA Support Services in Spangler 461 at plight@hbs.edu or 617-495-6785. Pat can also help direct students to appropriate resources.

Said Dr. Kadison, “I personally think there needs to be a cultural change here, and that change should start with the faculty, who often have the same problems the students have. The pressures here are profound. There is very little wiggle room.”

January 22, 2002
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