Q&A: Dr. Anthony Monaco

Marjorie Malpiede / December 21, 2017

The president of Tufts University on student mental health, from his Task Force and beyond

Anthony Monaco is a medical doctor and a Ph.D as well as a distinguished geneticist whose doctoral work led to landmark discoveries recognized throughout the world. His role as President of Tufts University, where he presides over the often-unpredictable behaviors of young adults, has taken him in less methodical directions. But Monaco is an adept listener whose penchant for observation and problem-solving extends to every facet of university life, particularly student success.

In 2012, after students brought concerns about the way the university was handling sexual assault claims, Monaco put the school’s entire leadership team behind it. The sexual misconduct prevention task force, now a steering committee, brought major changes in education, resources, and reporting, which increased the number of people who have come forward.

In the fall of last year, Monaco announced another task force after seeing trends indicating sharp increases in usage at the school’s counseling center. He appointed renowned psychiatrist Paul Summergrad to serve as his co-chair in the effort to examine the university’s infrastructure around student emotional and behavioral health, including its policies, practices, and culture.

As the Mental Health Task Force enters the final phase of its effort, we spoke with President Monaco about what motivated such a sweeping effort and what the university hopes to gain from it. We also learned more about the students themselves — “Jumbos,” as they are called, after their elephant mascot.

Mary Christie Quarterly: What motivated you to take on a comprehensive effort like the Mental Health Task Force?
Dr. Anthony Monaco: About four years ago, we started to document increasing numbers of students visiting our Counseling and Mental Health Service. And that has gone unabated. We had a 25 percent increase last year in students accessing our mental health services; currently about 25 percent of our undergraduate students utilize our mental health services. We conduct a survey of students every two years called the Healthy Minds Survey (out of the University of Michigan), and that data was also indicating increased need.

It was clear from the survey work that a large percentage of students say that their academics are impaired by mental health issues. The biggest two are anxiety and depression. They make up 50 percent of the cases we see. Either of those can impair academic performance in the short or long term.

That’s why I think this is our issue to solve — because our main educational mission is to ensure that students are successful, that they are educated while they’re here, and graduate to successful careers. If mental health or substance use issues prevent them from being successful, we must provide a network of support in various avenues so that students can try to overcome those challenges.

MCQ: Beyond eliminating barriers to success, why is this something colleges should care about?
AM: Intellectual development of students is only one part of our mission. Students’ personal and social development are also a big part of the college experience. College students are still developing on a range of fronts. One of the best parts of my job is watching how students arrive here at age 18 or 19 and how they’ve changed and matured by the time they graduate.

It’s not just what happens in the classroom. They benefit from residential life and the entire community experience — all the clubs and co-curricular activities in which they’re involved. Mental health issues, substance abuse, and sexual misconduct are risks that exist in this environment, so we need to make sure that we are providing the right support to reduce those risks.

MCQ: What has the Task Force been working on? Did you identify specific areas of focus?

AM: We’ve tried to frame this by looking at three areas: our policies and practices; our services and resources; and then education, outreach, and health promotion. We’ve had a several different working groups. One focused on undergraduates and, for the first time, we’ve been looking comprehensively at graduate and professional students. (Tufts has eight graduate schools.)

We know from our data that although the largest area of growth in utilization was in undergraduates, 20 percent of the clients served at the mental health counseling center on our Medford/Somerville campus are graduate students. And we’ve had evidence from our professional schools of significant numbers of students having to take leave for mental health issues, so it’s really important that we support this group.

We are now completing the first university-wide survey of graduate and professional students.

MCQ: How is the Task Force going about this work?
AM: The work of the task force is very data-driven in terms of understanding how our services work, the resources we’re putting in, and how they’re being managed, given the more acute cases we’re seeing as well as the rising volume of cases.

We’re also comparing data across the country to understand Tufts’ experience relative to other schools. Our surveys and focus groups are showing how people perceive the services, how they perceive the supportive environment, and ways in which they think we could provide better outcomes for students. We are also talking to other schools and attending national conferences.

MCQ: What are you looking at specifically in terms of models of care and policy?
AM: Right now, we have a traditional short-term care model within the counseling center. We’re examining how that is working relative to the volume and some of our more acute cases.

One issue we’re looking at is supporting students who require chronic care. Besides the fact that this age cohort is when many mental health issues emerge, we are seeing a lot more students arriving having been in counseling and/or on medication in high school. We need to consider how we support the full range of students.

On policy, we are looking at medical and personal leave issues, privacy concerns, and substance abuse. We’re also examining how we can improve the environment here so that students may feel better-supported up front — within residential life, say — and how we can build support within the faculty and staff to help students who present with early warning signs.

When students are struggling with mental health issues, it is really important for people who are interacting with them frequently to help them get to the counseling center if they’re not able to advocate for themselves. If a student has not shown up for several lectures in a row, there should be some alarm bells that indicate he or she needs a wellness check.

MCQ: What are you looking at in terms of student life?
AM: Creating a better student life experience is part of our approach, and we’re doing a number of things on this front in addition to a more stringent oversight of Greek life. I formed a student life review committee last year, which met regularly from January to May, had significant outreach to students, alumni and others, and generated a thoughtful report.

The recommendations of the report covered safety issues related to fraternities and sororities as well as diversity and inclusion, and the ability for all students on campus to participate in robust, positive social activity. The implementation of the report involves student affairs, student leaders, and our operations team thinking about how we can open up social spaces available to students.

One strategy for upperclassmen is the “villages” concept. A lot of students study abroad their junior year, and when they come back, they often live off campus and may not feel as connected to the Tufts community as they did in their first two years. We own a number of wood-framed houses on campus that we’re going to renovate for upper class housing, so there will be a more connected social life for these students.

MCQ: Is the school looking to do more in the wellness/health promotion area?
AM: Yes. This is part of the remit of the Task Force. Whenever we promote meditation or yoga classes, they rapidly become booked. The students appreciate ways to reduce stress, and we need to do more in this area to provide positive activities in their everyday life to deal with stress. When I was in medical school, they taught us all how to meditate, and I found it to be incredibly useful.

MCQ: Do you think that there’s something about highly competitive schools that may drive some of the stress?
AM: Perhaps in the sense that the academic rigor is high here, and students want to perform well. They strive to do well on their papers, their problem sets, their exams. To get to Tufts, you’re most likely an A student in high school and you are used to being at the top of your class. Many students arrive here and deal with struggling academically for the first time in comparison to their peers. That’s probably generating a lot of stress. One of the things we need to help students overcome is that failure is actually part of normal life. That you actually make personal progress through becoming resilient to failures.

We are striving to provide a network of support at various places where the students live, work, and study — whether it’s the residence halls or the organizations in which they are involved, or through health services — to help them cope better.

MCQ: Do you anticipate the Task Force will recommend major changes?
AM: Our number one goal at the moment is to assess what we’re currently providing and understand whether our model of care can continue to function well with increasing need. After that, we will consider what changes need to be made.

MCQ: Finally, tell us what kind of students come to Tufts?
AM: Our students are looking for academic rigor and engagement in a vibrant residential community. Fifty percent of undergraduates are doing independent research or scholarship with faculty members. That is part of the transformative experience and intellectual and personal development.

We also have about 50 percent of our students involved in civic engagement. We’re one of the unique universities with a college totally dedicated to civic life — the Jonathan M. Tisch College of Civic Life. Tisch College is very much focused on political and civic life: Getting students to vote, getting them involved in elections, bringing different politicians to campus to provide different views. Students are also very much involved in community partnership projects and volunteering.

Overall, our students are very engaged not only in the academic experience but also in co-curricular activities.