Month: January 2024

Around the turn of the century, psychiatrist Holly Rogers noticed an emerging trend among her student clients at Duke University. Many of them were coming into the student counseling center with a variety of mental health problems driven by what seemed to be a lack of resilience; an inability to sit with discomfort, distress or disappointment. She concluded that helping her students develop the coping skills needed to confront these emotions would lead to a myriad of benefits, including alleviating what would soon grow to be a capacity crisis at college counseling centers across the country. 

Nearly a quarter century later, Rogers’ professional observation has become a personal mandate to help address some of what today’s college students are struggling with – including anxiety, depression and loneliness. She is even more convinced today that practices such as mindfulness can help many college students regulate their own wellbeing in a world that has only become more stressful. She and her colleague, Libby Webb, the former associate director of counseling and psychological services at Duke, founded the Mindfulness Institute for Emerging Adults (MIEA) to bring the evidence-based program in contemplative practices developed at Duke to colleges and universities around the country.

“Something more has got to be done,” said Rogers, MD. “There needs to be a top-level paradigm shift to change the culture on our campuses so we don’t have academic success over here with all its metrics and then ‘here’s a few things we do for wellness.’”  

Rates of anxiety and depression reported by college students have been on the rise for more than a decade, and the responsibility of addressing the crisis has been largely laid at the door of college counseling centers. But capacity problems have coincided with a growing recognition that subclinical emotional issues can and should be addressed by opening up the circle of care on campus, and that combatting the college mental health crisis requires adding a preventative, public health approach, along with a treatment response. Enter mindfulness. 

“Mindfulness is the skill and capacity to bring our minds to the present as opposed to galloping towards the future or dwelling in the past,” said Webb, MSW. “And doing so with a non-judgmental awareness of where our minds tend to go. You just notice it and bring your attention back to the present.”

Mindfulness has become a big business, complete with YouTube channels and celebrity endorsements, and it is clear the practice can work for people of any age. But Rogers and Webb believe it is particularly beneficial for emerging adults: traditional college-age students who are navigating emotional land mines such as test anxiety, social media-induced self-doubt, and vulnerability to substance use. “What we know about this developmental stage is that it is filled with ambiguity,” said Webb. “‘Who am I? What do I care about? Who am I going to love?’ And we know that the brain doesn’t like ambiguity. It detects a threat, so it’s a time of high unease.” 

Webb says that because their brains are still fluid, young people are more adept at flexing into other patterned behaviors if exposed to them. Skills-based practices like mindfulness can calm their brains, which helps them make better choices, examine their purpose, and identify what is important to them. In 2023, the American Council on Education strongly endorsed mindfulness programs with supervised practice in its report, “What Works for Improving Mental Health in Higher Education,” adding to a strong body of evidence already in the literature.

“Research is showing us more and more that this capacity to be in the moment reduces suffering and improves attention,” said Webb.

For several years, Duke offered the program developed by Rogers and her colleague Margaret Maytan, MD, in the form of a four-week, opt-in course, involving a teacher and group discussion.  While it was slow to catch on, it eventually took on waiting lists. They called it Koru, a Maori word used for an unfurling fern frond symbolizing stability in the center of unfolding growth. With refinements to the curriculum over the years, they began an effort to assess its effectiveness in 2012. The results of its randomized controlled trial were published in the Journal of American College Health and became that publication’s most downloaded article in 2014, around the same time the Healthy Minds survey showed a solid upward trend in mental health problems among college students. In the trial, students who had taken Koru reported a reduction in stress, an increase in restfulness, and a greater sense of self-compassion, among other findings.  

Skills-based practices like mindfulness can calm their brains, which helps them make better choices, examine their purpose, and identify what is important to them.

Interest in practices like Koru on college campuses has grown steadily since then, motivating Rogers and Webb to leave their positions at Duke to focus full-time on expanding the program through a “train the trainer” model. Individuals from other universities began coming to the center, recently renamed MIEA, in Durham, NC, where they receive training to become MIEA-certified teachers and then go back to their campuses and offer the courses in a variety of forms. 

Since the pandemic, MIEA has offered the certification program online, which has accelerated the number of schools and individuals participating in the program. Rogers said that MIEA has now trained 1,500 teachers in 14 different countries and taught over 70,000 students. Institutions range from the Ivies to community colleges. You don’t have to have a clinical background to become a MIEA teacher, only some background in contemplative practices. If you don’t, they will help you cultivate one.  

MIEA’s first non-Duke client was Harvard University, which continues to offer a variety of classes each semester and has 12 MIEA-certified teachers within its Center for Wellness and Health Promotion. “I have been teaching MIEA classes for over 10 years,” said Amanda Ayers, MPH, Harvard’s Director of Health Promotion. “It is such a joy to see the changes that students make in just four weeks. They are able to be more present in their everyday lives, spend less time on social media, and are kinder to themselves.” 

How mindfulness practices are taught and who chooses to teach them illustrates their versatility and low barrier to access. In an environment as siloed as a college campus, mindfulness curriculum like that offered through MIEA can weave through departments and requirements – a credit-bearing course here, an elective there. Mindfulness teachers are often connected to traditional fields like health promotion but can include anyone in any discipline who sees the value of improving student wellbeing. Evidence on the connection between mindfulness and attention attracts professors and academic advisors worried about student disengagement and burnout.

“You can embed this curriculum into your first-year seminars, your physical education classes, or as an extra credit elective,” said Rogers. “We have faculty in business schools who are offering the curriculum in conjunction with their academic material.”

The individualized nature of the MIEA program is both an advantage and a challenge. The curriculum, which comes with an app and a teacher dashboard, takes different forms at different price points. To date, MIEA’s business model is to sell the program to individuals within schools such as faculty or staff working in the wellness center who might use professional development funds to pay for it. Rogers points out that this case-by-case model lacks the consistency and traction needed to make mindfulness a universal benefit. Professors get busy. Funds dry up. The team is now offering the MIEA program directly to institutions at a much larger scale, hoping the urgency of student mental health will spur a university-wide commitment to wellbeing.  

“We’re asking universities to make a commitment both to us and to their teachers if they want to really make a difference on their campus,” said Rogers.  

Mindfulness in Action

Eric Teske directs the Office of Health and Wellness Promotion at Indiana University, Indianapolis. His interest in the MIEA program came from his desire to “take pressure off of the counseling center” by offering a program that could be taught by trained teachers to students who could be helped in non-clinical contexts. After hearing a presentation by Libby Webb during the pandemic, Teske was determined to get a number of people on campus trained and certified through MIEA. Making it a free professional development opportunity was an added incentive. He funded the trainings through a grant from the state’s Division of Mental Health and Addiction.  

“In helping students understand their own thoughts and feelings, we are equipping them with self-regulatory skills, self-management, and that is all part of alcohol and drug prevention,” said Teske, MS, CHWC, who urges institutions in other states to explore the use of similar public funding.

The person who brought Libby Webb to IU was Nancy Barton, MS, a senior lecturer in the School of Health and Human Sciences’ Department of Kinesiology. With a background in meditation, Barton had been interested in becoming MIEA certified but didn’t find the time to pursue it until the pandemic,when the online option provided an opportunity — and even more students were reaching out for help. 

“Once I got it [the certification], I really wanted to work with my university to see it take off,” she said.  “So many people would say to me, ‘I am really worried about the mental health of my students, but I don’t know what to do.’ Now I could say,‘here’s something you can do.’”

Teske and Barton were part of the university’s Wellness Coalition, an ad hoc group of wellness enthusiasts who informally met to strategize about tactics to use on campus. Another member was Lisa Angermeier, PhD, MCHES, a senior faculty fellow in the Institute for Engaged Learning, which focuses on first-year experience and high impact practices. Together, they led an effort to embed the MIEA curriculum as a pilot program into selected sections of the first-year seminar. Now, the course is not just a credit-bearing option in the Department of Kinesiology, but a required course for first-year students.

“We wanted to offer students more tools, right from the beginning of their college experience to help them deal with the stress they will encounter,” said Angermeier. “But we also see this as something they can take with them and use for the rest of their lives.” 

An assessment of the program indicates that 62% of the first-year students found the program to be valuable. The team considers this statistic a positive outcome, considering that students do not opt-in to the program. Requiring mindfulness courses is a matter of debate among experts, with some saying it takes away from the self-agency of the practice, but Angermeierviews it as a way to plant a seed of self-care, even for those students who may be reluctant. Equity was another driver. 

“Oftentimes with opt-in programs, we see that the students that get there first come in with more social capital while those who lag behind lose out,” she said. “These are the students who often need it the most.”  

Valencia College in Orlando, Florida is also utilizing the MIEA curriculum. One of the largest, multi-campus community colleges in the country, Valencia is diverse, both in terms of its students and in the broad range of developmental stages in which they come to campus. Marcia Roman, EdD, ThM, is a counselor and faculty member at Valencia, where she and her colleagues do case management-type work, connecting students to clinicians when necessary and providing workshops and skills-based training. She said the MIEA curriculum “blended beautifully” with their model.  

“Our students can learn basic skills that you might even describe as mechanical – like how to breathe in a way that activates the parasympathetic nervous system, which will calm them down – but it’s more than that. For some, it has been life-changing. With mindfulness, they can move through the difficulty in their lives as opposed to all the manner of ways we try to bypass it. And they can do so without tremendous cost and with little risk.”  

The accessibility of mindfulness is one of its biggest selling points and something Rogers and Webb are promoting before potential higher education clients. Vivien Roman-Hampton, MSW, LICSW, is MIEA’s new Director of Outreach and Teacher Development. Part of her job is encouraging MIEA teachers to become trainers with a particular focus on bringing in people with diverse backgrounds.  

Roman-Hampton believes that when colleges and universities offer these services to students of all backgrounds and abilities, it says to them, “We see you and we want to support you.”

“My focus is on ensuring that the practices are accessible to anyone who isn’t what we would call ‘mainstream,’” she said.

Her interest in MIEA is personal. A clinician who works with clients from marginalized communities and is from one herself, Roman-Hampton was drawn to MIEA’s work because of its low cost and long-term benefit. “So much about self-care costs money, and that becomes a barrier to people,” she said. But Roman-Hampton initially questioned the lack of diversity among the training staff, which she said would be an issue for her clients. When she expressed her concern to Rogers and Webb, they encouraged her to help diversify the practice, and she joined them officially two years ago.    

Roman-Hampton believes that when colleges and universities offer these services to students of all backgrounds and abilities, it says to students, “We see you and we want to support you.”

Asked if mindfulness programs offer a particular benefit for marginalized groups, she said, “I think the practice allows us to sit with things that might be really difficult — like how the world sees us versus how we really are. And while we can most definitely work to create change, it is also exhausting, and not everyone will change as a result. But that doesn’t mean we have to keep absorbing it the way we have historically. Mindfulness is a way to sit with suffering but not let it destroy you.”

Listen to this story:

When Joey left his hometown to attend a prestigious out-of-state university, his mother was in hospice care for a rare sarcoma, a terminal cancer affecting the body’s soft tissues and bones. Two weeks into his freshman year, her nurses warned the family that Joey’s mother was in the final days of her life. Joey returned home, and his mother died the next day.

Joey’s mom had encouraged him to go to college, find community, and engage academically and socially with his campus. In the wake of her death, he no longer knew what that looked like. Joey went back to school one week after losing his mother, uncertain of his options and fearing the academic consequences of missing classes. When he emailed a dean at his university to explain his weeklong absence, an administrative assistant wrote back, asking Joey to provide a copy of his mother’s obituary.

“I didn’t want to dig myself into a deep hole in my first semester,” Joey says. “My university didn’t really know what to do with me, so I went back after a week. That’s when things really started to go downhill.” He describes feeling “indirectly rushed” to return to campus, having no knowledge of the university’s academic accommodations or leave policies. No one from his university’s administration reached out to make Joey aware of his options for support in or out of the classroom. He did not know until his second semester, after months of depression and isolation had taken a toll on his transcript, that he could have been graded on a Pass/Fail basis, allowing him to proceed with a clean slate. 

“My grades were very poor,” he recalls. “I had no study habits whatsoever. Seeing my GPA, seeing that it didn’t reflect the kind of student I am, it just made me more depressed. And then socially, it also took a huge toll. I was living in my dorm room most of the time.” Watching his grades drop over the course of his first semester, Joey says, compounded the cycle of anxiety, overwhelm, and pain—but what choice did he have? Without clarity on his university’s policies on grief and bereavement, Joey believed his only option was to keep going, soldiering on through the daily slog of academia, held to the same standard as his peers.

Death is a sensitive subject even for family and close friends, often leaving us at a loss for words, choosing to say nothing for fear of saying the wrong thing—so how should a college or university respond when a student loses a loved one? That question, at once ethical and practical, is the driving force behind UGrieve, a new initiative by the Parmenter Foundation designed to help colleges support students as they navigate the loss of a loved one while balancing academic and social commitments at a time when they may be living away from home for the first time. 

Established in 1949 as a provider of medical care in MetroWest Massachusetts, the Parmenter Foundation offers end-of-life and bereavement programs, resources and education, as well as grant funding for other nonprofits that provide services such as grief support groups for all ages, guidance for educators, and hospice care. The foundation launched UGrieve with interviews of three college students who describe feeling isolated, disoriented, and unsupported while grieving on campus.

“Our understanding, based on anecdotes from bereaved students, parents, and also counselors and administrators, is that higher education institutions do not have systems, policies or protocols in place to support students who have experienced a death in their family,” says Angela Crocker, Executive Director of the Parmenter Foundation. “It seems colleges and universities can be accommodating to students who are grieving, but only if the students know what to ask for and whom to ask.” 

The confusion and ambiguity that accompanies students reentering campus life after losing a loved one is an additional stressor for grieving families. “We’ve talked to moms who have lost a husband who say, ‘I’m grieving. I’m in shock. And then my son needs to go back to school, and I feel like I’m sending him into a black hole, and nobody’s looking out for him,’” says Jennifer Siegal, Communications and Programs Manager at the Parmenter Foundation.

The fear of sending a student back into a “black hole” of grief and bereavement protocol is far from unfounded, as Joey’s experience lays bare. Colleges tend to be pro-active only when a death (usually of a student) occurs on campus, assuming that what happens at home falls outside their institutional responsibility. As a result, according to Crocker, bereaved students are not only emotionally gutted, but often left feeling pulled between family and school obligations. 

“Colleges and universities can be accommodating to students who are grieving, but only if the students know what to ask for and whom to ask.” 

Joey’s older sister was their mother’s primary caretaker while their dad worked, he says. She made the preemptive decision to take the entire fall semester off from school, because she did not know when her mother would pass away. Joey describes feeling torn, longing to be at home to grieve with his loved ones but fearing falling behind in his academics. He reminded himself that his mother had encouraged him to make friends and “make his mark” on campus, something that seemed impossible as he struggled just to stay afloat.

“When college students have to confront the loss of a family member, they are immediately pulled between their two worlds of school and family life,” said Crocker, who noted the chasm is even wider for international students. “This pull is aggravated by geographic factors, multi-faceted academic demands, and oftentimes by the uncertain timeline at the end of their loved one’s life. No one is prepared for this. Colleges and universities need to understand this painful dynamic and provide balance and support—not demands—to students who are grieving.” 

Another barrier is the disconnect around bereavement and mental health support on campus. Siegal and Crocker emphasize that bereavement is a component of mental health, yet as colleges have increased cultural awareness and attention to mental health, grief and bereavement have been largely excluded from the conversation—despite the fact that the death of a loved one is correlated with a higher risk of depression, anxiety, post-traumatic stress disorder, and compromised physical health due to chronic stress.

How to Help

Colleges and universities do recognize the need. According to Siegal, administrators and decision-makers in higher education have expressed uncertainty surrounding best practices—they, too, operate in the dark, without a clear, universal protocol for students. “We saw that there was a demand for support in this area,” Siegal says, “so we started to put a program and initiative together. We interviewed students and created the video just so people could see that there really is a case for this work, and data show there are hundreds of thousands of students losing a loved one each year. This is not a small problem.”

“When college students have to confront the loss of a family member, they are immediately pulled between their two worlds of school and family life. Colleges and universities need to understand this painful dynamic and provide balance and support—not demands—to students who are grieving.”

The UGrieve program provides data and information about bereavement and makes recommendations to colleges on how to “build compassionate campuses” through policy changes. The UGrieve program urges colleges and universities to implement a “point person” to inform students of their options, communicate with professors, and coordinate accommodations as needed. The point person, she says, would ensure that grieving students will not be forced to make hurried decisions about their academic futures without full knowledge of the school’s policies and the resources available to them. “College students who have suffered a loss experience a sense of grief and isolation that inhibits them from navigating their classwork, effectively communicating with professors and accessing even the resources that are readily available on campus,” says Crocker. “Colleges and universities can overcome this disconnect by assigning a single point of contact to guide a grieving student on every accommodation available to them.”

Additionally, Siegal says, universities can implement training programs for faculty, staff, and students to make it easier for them to approach conversations with people who have lost loved ones. “It can be awkward,” Siegal acknowledges. “If someone brings up the death of a loved one, a roommate or professor won’t always know what to say.” Trainings and educational resources, she says, can create a grief-ready campus. The UGrieve mission is to “build compassionate campuses” where bereaved students are not neglected as they struggle to navigate classwork and social lives in a time of grief. On a compassionate campus, faculty will be better prepared to accommodate students who lose a parent, caregiver, or sibling. Bereaved students will have a point person to direct them to campus resources. Roommates and friends will be better equipped to recognize signs of isolation and depression.

UGrieve suggests that the first step to creating compassionate and informed campuses is to include grief and bereavement in conversations about mental health, including legal conversations. In 2023, several U.S. senators, including Massachusetts’ Edward Markey, introduced the Student Mental Health Rights Act, which would require the Department of Education to issue guidance to institutions of higher education to ensure compliance with federal law on mental health disabilities. But for some students, there is a glaring gap in the legislation: “It mandates colleges to provide accommodations for students who have anxiety, depression, substance use disorder, and they don’t include bereavement,” says Siegal. “So we’re working to compel them to include bereavement in the legislation. The accommodations they are proposing for supporting students with mental health struggles are very similar to what we are recommending for students who are grieving.”

With advocacy and hands-on resources, the Parmenter Foundation hopes all colleges and universities will examine the strength of their bereavement programs and consider them an important part of creating compassionate campuses.

After his mother was diagnosed with cancer, Joey says, “She fought till the very end. She wasn’t willing to give up or back down without a fight. It’s still a huge inspiration. When I’m thinking about giving up, or when I’m at my lowest point, I always think: What would my mom say? What would my mom do?”

When Joey returned to school for the second semester of his freshman year, he arranged a meeting with the dean of students and the dean of the business school. He described his experience, telling them that it was the experience of many students who were suffering in silence, not knowing where to turn for help. He says the deans listened: they wanted to do better. They listened to a student who had felt neglected, left to fend for himself—and they took his suggestions seriously, proposing new protocols for grief support with the goal of making campus resources clear and accessible to all students.

Now a finance major with a minor in economics, Joey has cultivated a sense of belonging and hope on campus, living a life beyond his dorm room. “I don’t hate this school,” he says. “I love being here. It’s a great fit for me. I just wanted to make it better.” He has worked with UGrieve to build a compassionate campus for future students, who he says he hopes “will be treated the exact opposite” of how he was. For Joey, a compassionate campus is one where students can spend time at home to grieve with their families, knowing that they will be accommodated and welcomed back to campus; where students know who to reach out to and where to go for help; where professors have built-in procedures to grant extensions and forgive missed work when a student loses a family member or caregiver. And a place where an administrator will be less likely to ask a student for his mother’s obituary as proof of death.

To learn more about UGrieve, visit https://parmenterfoundation.org/ugrieve/.