From 2012-2013, one-third of college students in the United States suffered from symptoms of depression. Among students who seek help, almost half received counseling for mental health reasons. One-third of students who received counselling have considered suicide. Of the 125,000 students asked, in 150 different colleges across the U.S., about half admitted to feeling “overwhelming anxiety”. If we applied those statistics to our small community at NYU Shanghai, it would seem that around 300 students are currently suffering from symptoms of depression. Potentially, only 150 of these students have sought out counseling for mental health, and over 50 students have seriously considered suicide. About 450 of us could have felt unbearable anxiety. Even writing this, these numbers seem unrealistic -- and you start to think one of two things. First, ‘how I have I not noticed?’, and second, ‘I’m not the only one.’ It’s harrowing to think that as I sit in any of my classes, one in three of my fellow students is hurting. I will not attempt to describe their pain, their agony, their numbness, their loneliness, or their sadness. My words could not do justice to how these individuals feel. Instead, let me turn to another statistics: those who have actively received help. Based off these statistics, it’s impossible for colleges to ignore the fact that mental health is prevalent across college campuses. But, how do colleges even start to tackle this issue? How do you get across to not only the suffering one-third but also prevent others from feeling the same way? How do you make the university available to every issue, every concern, every emergency, and every student? For universities, the obvious solution is to provide resources - and many of them. From professional psychiatrists, to social workers, to counselors, to hotlines, to off-campus emergency support. New York University, with its Global Network campuses, is no exception. The Associate Vice Director of Student Mental Health at NYU New York, Zoe Ragouzeos, stated that “Students at our portal campuses in Shanghai and Abu Dhabi are offered both psychological and medical support on campus. Students at the majority of our study away sites (Paris, London, Florence, etc.) have access to a counselor who can offer psychological support on campus, but we refer to providers in the community for medical services.” In addition, the NYU Wellness Exchange is a 24-hour hotline providing over the phone counselling to any student at any campus. In particular, the areas of concerns that the Wellness Exchange address include “medical issues, academic stress, depression, sexual assault, anxiety, alcohol and other drug dependence, sexually transmitted infections, eating disorders” and any other personal issues. The hotline is completely private, and can refer you to medical professionals, if the student desires, or if they believe that the student is at risk.At NYU Shanghai specifically, there are two counsellors open to students; Madeleine Dupre and Yirui Wang. Both counsellors are experienced professionals and have practiced clinical psychology. On the receptiveness of the counselors, Sophomore Allison Chesky, who was looking to transfer in the middle of her freshman year, commented positively: “Rather than encouraging me to transfer or take medical leave, Madeleine helped me decide to stay at school, with the knowledge that I could always go to her for support when necessary.” However, with a student population of around 750 in Shanghai at any given point, two counsellors is perhaps not adequate. Sophomore Lillian Korinek commented on this issue, saying “You know there is a need [for an increase in counselling services] when you go to the Health and Wellness center, and you need immediate attention and you’re told that you have to wait a week for an appointment. I mean I didn’t look that severe, but I was dying on the inside.” Another Sophomore student, when attempting to make an appointment, was told to “only make an appointment if absolutely necessary.” “I was hurt; it made me seem like my issues weren’t as important as other people’s”, said the student. Psychological associations have also identified that there is a correlation between the stresses and tribulations students have to undergo to make an appointment, and the desire to obtain help. The University of Texas at Austin’s Counseling and Mental Health Center, for example, created a “Brief Assessment and Referral Team”, which attempts to provide an alternative to drawn out and prolonged initial consultations. Instead, each student is provided with a brief assessment conducted by a professional and trained counselor, and is then referred to an “appropriate level of care”. At NYU Shanghai, the Health and Wellness counsellors can recommend that a student turn to off-campus resources in the case that the student needs emergency care or medication. However, for some students, in the case that medication or psychiatric management is needed, “referrals are provided to outside psychiatrists affiliated with local hospitals and covered by your insurance.” However, for international students, while professional management is necessary for many disorders, entering into a health system that is different from one’s own may be challenging. NYU Shanghai’s Dean of Students Charlene Visconti commented on the availability of off-campus resources, stating, “The level of care is not always a Western model. We have to figure out how to cater this to such a unique population.” For students coming from the United States, the standard of resources that they’re used to may be different. In the United States, mental health medications are prevalent and counselors have the same certifications -- every licensed practitioner must hold a doctorate in Psychology -- and similar levels of education. However, international clinics in Shanghai hire professionals from all over the world, and therefore, health care procedures and standard of care may differ from what some students are used to.However, this is not necessarily the fault of NYU Shanghai, but rather a side effect of our location. NYU Gallatin Junior Natalie Soloperto, who transferred from NYU Shanghai at the end of her Sophomore year, commented on students’ complaints of NYU Shanghai’s mental health resources, stating that, “There’s a sense of rejection of facilities available [on-campus] because they feel as though they’re in need for more advanced mental health care which isn't really available in China altogether, so they assume it's the fault of the school.”In New York, resources available range from group counseling to short-term counseling, to other long-term psychiatric programs. In this way, students can access psychiatric, psychological, and short-term counseling all on site. As Ragouzeos commented, “We are happy to provide students with referrals to providers in the community if they wish to access services externally.” However, it depends on each student and their specific needs. Soloperto also expressed her concern with sending students off campus, and believes that there is “a tendency to overmedicate students by United Health and that referrals/prescriptions are incredibly under regulated”. Although students are referred to certain international and Chinese clinics, there is no specific regulation that requires a follow up. In this way, students accessing off-campus medical resources are not required to follow up with an on-campus counselor, who is specifically trained in dealing with the pressures of college. However, despite having on-campus or off-campus resources available, students still have to be willing to actively seek help. Looking back at the statistics, only potentially half of students suffering from symptoms of depression are actually receiving help. But what about the other half? During one of NYU Shanghai’s Health and Wellness Lunch and Learn seminars, a counsellor at Health and Wellness Yirui Wang said, “The mentality is that if you seek out a psychiatrist, you are accepting that you have a problem. So if you don’t see a psychiatrist, you don’t have a problem. But think about having a broken leg. If you have a broken leg but do not do something about it, does it mean that you don’t have a broken leg? Mental health is the same thing”. So, how do universities help students who are simply unwilling? As another anonymous student stated, “To be honest, I haven’t shared my stress with anyone. I just feel like nobody here would understand how much pressure and stress I have.”Students not “sharing” stress with anyone is perhaps an example what experts at Stanford University, in California, call the “The Duck Syndrome”. Essentially, on the water’s surface, you see a duck gliding smoothly, with grace. However, underneath the water, the duck is the rapid movement of the duck’s feet, to keep itself elevated above water.This metaphor attempts to describe the pressure that college students are under. It’s the desire to be perfect, both socially or academically, and doing anything to seem like you are. It’s the ‘fake it til you make it’ mentality. It’s the students overloading on classes, pushing for that extra internship, or sacrificing that extra hour of sleep. Freshman Andy Qiheng Feng, indirectly referenced another reason for this aspiration for perfection, stating that “China is a country that attaches great significance to personal privacy. And if anyone suspects that a person is inclined to psychological problems, it is a source of shame.” There is more pressure to hold up appearances if one believes there is a cultural stigma attached to the idea of “mental health”. The Chinese concept of “面子” (mianzi, face) alludes to the individual presentation of prestige, and the ability to uphold appearances. If a lack of ‘face’ is presented, one is shamed within society.For Chinese students at NYU Shanghai, this pressure is felt even before college. Prior to admissions, Chinese student applications must partake in Candidate Weekend. Sophomore Yining Lang describes the process as a “24-hour interview, where students are tested in all aspects. If you do well, you don’t have to do as well in the Gaokao. If you don’t do as well, your Gaokao admittance score will be much higher.” Suddenly, top-achievers are being placed in an even more competitive environment, and the stakes are higher. This phenomenon of “small fish in a big pond” was described by renowned journalist Malcolm Gladwell in his book David and Goliath. In short, the theory describes the circumstances where students who were the top of their class in high school, are suddenly put in a seriously competitive environment, and fail. He uses the example of “Caroline Sacks”, who was set on attending Brown University to study science. Until she started obtaining B’s in comparison to straight-A classmates.This places larger pressure on university resources to combat not only psychological disorders, but also the general, yet constant, demands of college, and the cultural stigmas around mental health. New York Magazine recently published an article entitled “The Myth of the Fragile College Student”, which discussed the pressures that a 21st Century college student faces daily: “academic pressure to hook-up culture to social media to the prevalence of binge-drinking on campus.”Ultimately, this is something that NYU Shanghai administration has attempted to address. Dean Visconti acknowledged that college students face specific issues, and NYU Shanghai Student Life attempts to recognize these issues through “holistic approaches”. “From Health and Wellness to the Athletics department, to different clubs, it’s all to provide students with a healthy environment,” stated Visconti. This is method is supported by the American Psychological Association, who published a cover story in 2014, following their statistical findings. The author, Amy Novotney, stated that, “For students to be able to learn at their peak capacity, they need to be physically, emotionally, intellectually and spiritually well.” Branches of Student Life, such as Athletics, Clubs and Organizations, and Residential Life, are also ways in which NYU Shanghai has addressed the issue of mental health with a holistic approach. “We have sports clubs, interest clubs, excursions with your floormates -- but it all relies on student participation,” said David Pe. However, for some events, attendance remains incredibly low, suggesting that students do not necessarily take advantage of the resources offered.But the struggles of being a modern-day college student border on infinite, and the struggles of being a modern-day college student abroad are even greater. Not only do students have to deal with academics, relationships, social pressures, sex, drinking, psychological disorders, and family, but also the issues that come with moving to China. Suddenly, students have to cope with pollution, navigating a new language, homesickness, cultural differences, eating habits, and so much more. With all of this, students are going to struggle even more to keep their heads above water: the Duck Syndrome worsens, and it becomes harder to tackle. For Sophomore Richard Awuku-Aboagye, mental health is a topic that should be discussed at any University, “as it is a very stressful environment.” However, issues of mental health must be addressed “especially NYU Shanghai since 49% of the population is studying abroad.”With a student population hailing from over 60 countries, it becomes difficult to pinpoint exactly what issues are troubling the students. Regarding their attempt at providing resources, without adequate communication between students and the administration, the school is left guessing what students want. “We start with traditional needs of college students. From there, an area we do need to improve on is better communication, and we need to hear from students [on what their concerns are].” In a small community, it’s easy to become the duck. It’s easy to succumb to the pressure, and it’s easy to think it’s normal. But, it doesn’t have to be. You don’t have to be the one in three suffering, and or the one in two overwhelmed. Rest your legs, and come up for air. You are not alone. If you are struggling to keep your head above water, please do reach out to any one of the following resources. They are here to help you.

To make an appointment with a counselor at Health and Wellness, click here.

To call the Wellness Exchange, dial +86-21-2059-9999. If you don’t have a Chinese phone number, my phone is at your disposal.

If you are in need of assistance, contact your RA.

If you believe there is another student in need of assistance, contact your RA, Health and Wellness, or the Wellness Exchange.

If you have suggestions about resources either Student Life or Health and Wellness should implement, please visit Charlene Visconti at her office in 1431.

In addition, tomorrow, there will be a school-wide discussion on mental health, sexual health, and general health policies at NYU Shanghai. If you wish to continue this conversation and have constructive suggestions, please come along. Be aware, NYU Shanghai's administration and faculty will be present, and we do not intend for this forum to be an attack on policies, but merely want this forum to be an extension of the conversation around mental health stigma and policies.This article was written by Isabella Farr. Research was also contributed by Savannah Billman and Joanne Chun. Please send an email to [email protected] to get in touch. Photo Credit: Arshaun Darabnia.