Well before the media coined it “the college mental health crisis,” Nicholas Zeppos made student mental health one of his key priorities at Vanderbilt. By the time he retired as Chancellor in 2019, Zeppos had incorporated this into every facet of university life, having come to believe that the emotional wellbeing of his students was perhaps the larger goal.
Zeppos’ resolution to embrace mental health at Vanderbilt was driven by both a deep frustration at how society continued to treat mental illness and a strong empathy for other people’s children. In 2010, he had delivered the eulogy of a friend and colleague who died by suicide, a physician at Vanderbilt’s Medical Center, who had died alone, among a community of colleagues who knew little or nothing of his suffering.
Bewildered and profoundly saddened by the experience, Zeppos took an even greater responsibility for the mental health struggles of his students – be it mental illness or stress and loneliness. He believed most colleges and universities, particularly those with high-achieving students like Vanderbilt, had sidelined or ignored the growing problem of student mental health. Zeppos vowed to make Vanderbilt “the most supportive, compassionate university among its peers.” How he went about this is instructive for other leaders dedicated to student flourishing and was the focal point of our interview.
Zeppos has since returned to the classroom to teach law at Vanderbilt and continues his work in mental health as a trustee at McLean Hospital, the Harvard-affiliated psychiatric institute and research center in Belmont, Massachusetts. He is reflective, earnest, and candid as he speaks of the need to offer a culture of healing and acceptance amidst powerful counter forces like discrimination, alienation, and fear, all of which he believes have been exacerbated by COVID-19.
MCI: Your approach to mental health at Vanderbilt was very intentional and comprehensive. Can you talk more about that?
Zeppos: For me, it was very personal. I had experienced it in my family going back generations and I had lost a friend to suicide. Throughout, I was struck by the ways that the health care system marginalized and then really ignored, even suppressed, discussions about the advancement in treatment for mental illness.
I also viewed the children coming to my campus as the children of families who loved them as much as I love my own sons. And so I had a great sense of empathy and reciprocity as I looked at these young people coming here and struggling and I thought, “Yes, I really care that the academics are great but if we’re not taking care of these students in a way that’s honest and embracing, I feel like I’m failing.”
My philosophy at Vanderbilt was always “I want to be the most supportive and compassionate university among my peer group.” This was something that I just thought was missing in really profoundly concerning, if not dangerous, ways at almost all universities, particularly at places that were highly selective. I didn’t want a school that was all academics and all brain and no soul and no heart.
MCI: How do you go about that kind of change?
Zeppos: I learned early on if I cared about something and I could move resources and use my voice and my office, I was going to do that. Sometimes I’m early, sometimes I’m late, but the timing on this was right. I started with a lot of listening sessions. I am a lawyer by training, so I needed to learn a lot about the development of young people. The manifestation of mental illness and the symptoms and the correct or incorrect diagnosis is squarely in the time period when these young people come into my community.
In many ways, this year has challenged schools to meet mission but paradoxically has given schools a free pass on truly caring in a personal way for each and everyone on campus – faculty, staff, and students.
This is someone’s child and I know that our system is not always working for him or her. I’ve seen it myself. And I know there are misinterpreted symptoms and terrible misdiagnoses. I’ve seen kids being moved into conduct, being marginalizing or expelled without really understanding what’s going on. We know there’s all these co-morbidities with drinking and substance use.
I developed what I call a “bench to bedside approach.” We are really good at neuroscience and we had our academic medical center right here on campus, so I invested heavily in neuroscience, neurobiology, and drug discovery. I thought that whatever the complexities of these diseases and the manifestations of them, we have got to have better ways of treating them. I wanted to make a promise to those families – those children – that I’m going to do the best that I can – I’m going to put a lot of money into something that in 10, 15, or 20 years is going to give you a better life.
On student health on campus, I knew from all of my work that even if I got on my soap box and gave speeches, I needed to do much, much more. I needed to be much more deeply engaged with the offices that were driving the strategy and tactics. I needed to better understand the conditions, the real conditions these students were facing. And then build up – not just from the top down, but from the bottom up, exercises that I thought were critical to begin to move the needle. So I tried to build new things and I tried to be really proximate and engaged.
I found the stigma part of it particularly vexing, going back to my experience with my good friend who couldn’t reach out. We started a campaign called “Go There.” It was a marketing campaign that encouraged students to come forward. There was a very sincere, consistent, deep, and broad willingness to have the students really own this. And I did see our students come forward and talk more and demand more as a result – tying it to important initiatives around gender, race, and thriving. I was really pleased with how our young people embraced this.
But we needed to make other changes for this to be effective. What do we mean when we say “Go There.” Go where? And who is going to be there?
I came to realize we needed to tier care and we needed to make the entry point a much less stigmatizing doorway, so we created the Center for Wellness, a little house that we put right in the middle of campus where you could go if you’re stressed out. It’s not at the counseling center seven blocks away next to the disabilities center which we all know has so much stigma and discrimination attached to it. In many cases, it was a first step for someone who may say “I have serious problems, too. I’m really anxious. Where do I go?”
The tiered approach, and the multi-entry points, I thought were really helpful because the capacity issues and the queuing issues and the access issues were simply brutally frank manifestations of societal shortcomings and the limited way we treat mental illness. We have a psychiatric hospital on our campus. When I looked at the data, I realized I would have to have one of the largest multi-specialty psychiatric practice groups in the country to meet this level of demand.
And we had to educate the students about that. I would say to my students who demanded care within 24 hours, “This is going to break my heart and upset you but I have to tell you your goal should be for only a very sick person to get immediate care or care within 24 hours. Not everyone needs to see a doctor immediately. And it doesn’t happen anywhere in the country. We all have to work together to understand these illnesses and these conditions so that everyone has access at the right time, at the right point, at the right level.”
At the same time, I think it’s wrong for universities to say we can’t provide these services. That’s not an adequate answer. We might not be able to provide them directly, but what is the network of care for people who are suffering? For people on the onset of a disease? If we know how to do it with every other [physical] disease, why can’t we do it with [mental health]?
So there were a lot of interesting conversations with a lot of student groups and a lot of good people on how we do this. How do we handle urgent cases? How do we handle entry points? How do we create systems and networks of care that are here on campus, that are in the Vanderbilt Medical Center in Nashville, and even around the country? I think psychiatry and therapeutic services off the campus grew and we just became much better and much more purposeful about the choices people had.
MCI: What about environmental strategies? How can campus cultures change to help address the mental health of their students – and their community members?
Zeppos: For me, it was profoundly important in the obvious way that a great university should have a set of overarching values and they had to be about healing and caring, both individually and collectively. The university should have an obligation to say if someone enters at this point and leaves at this point, do they have an empty soul? Do we have a wounded person? Do we have a sick person? We can’t bring people into a diverse, caring community and say, ‘We just won’t deal with that.’
I thought that was a big missing ingredient of education at Vanderbilt, so I worked hard on that and everything I did had a link back to this set of values. I got rid of student debt because I could see kids stressed out about money and if they have a mental health issue, this is really unhealthy. My view of retention was that people were suffering. They were unhappy for some reason and I thought, “If there’s someone living as a freshman, and they’re sad and depressed and they don’t have anyone to talk to – how do I make sure that child has friends? How do I make sure that child has connections?” So we built a whole new freshman campus where all of the first-year students would be together. There are ways to attract a diverse, interesting, talented group of people and we know how to do that.
I did a lot with architecture to inspire something bigger and beyond. I’d ask, “Why does that dome or spire make you look up? Why were they built that way? To inspire, to reflect, to be meditative.” We really focused on those things that would counter the stress the students were feeling, but it wasn’t easy. I used to say to the Dean’s office, “You’ve got to deal with these faculty. If a kid who is struggling has a paper due, I don’t want to hear ‘too bad.’ If the kid was just diagnosed with a serious debilitating physical illness we wouldn’t treat it this way. So we involved the whole community. We set up what I would call “care teams,” because when a child is struggling with a mental illness there’s going to be signs – he or she is going to miss class, they are going to disengage socially. I always said, “We’re small enough not to miss those. And if someone comes to me and says, ‘I’m worried about their grade in chemistry, I’d say ‘Give me a break.’”
MCI: Do you think higher ed has become too grade-conscious? Too focused on college as a means to a salary?
Zeppos: Yes. I saw it and I fought it hard – this obsession with vocationalism and this obsession with skills and narrowing the curriculum and this anti-humanistic approach. Look, we’re all humanists. Someone who is working to come up with a treatment for Alzheimer’s or autism, they’re doing it to improve humanity. I think this obsession with job skills and placement, it’s almost like giving up on college.
I used to really push back on parents and board members who would constantly say, “Yes, but are they going to get a job?” and I’d say, “They’re all going to be okay.” It’s insensitive and parochial and it’s getting worse. It’s great to see really successful students at Vanderbilt who go on to do amazing things and know that we contributed to the development of that young person. But I would say to parents, “Judge me on my hardest cases. Kids hit bumps – psychologically, spiritually, emotionally. I will deal with those bumps and judge me on that. Don’t judge me solely on the kids waltzing across the stage with Summa this and Phi Beta that. I am very proud to see those. But everyone should be supported and celebrated.”
MCI: Are colleges becoming more embracing of students with mental health challenges?
Zeppos: In some ways, yes. In others, no. We’re getting more kids who can make it to college with more therapy, maybe medication, and good care. I always got nervous when I’d hear people saying, “We have so many students with mental health problems, I wonder if it’s our admissions process?” And I thought, “Oh God. What do you want to screen them for? Is this eugenics?” So there continues to be pushback that takes the form of discrimination and stereotyping people.
It all goes back to a failure to acknowledge these issues as chronic illnesses. I remember one particularly powerful conversation I had with a young man who was in a wheelchair because of his physical disability. Despite challenges, he was excelling at Vanderbilt. But in a meeting with other students who suffered a range of disabilities he said, “I tell people I’m a philosophy major and they look at me in my wheelchair and it hurts; but I also look at so many of the people who have hidden disabilities and I wonder how much they suffer when they tell people that they’re sick and struggling, that they can’t do something that day, and people look at them and say, ‘You look great. What’s your problem?’”
MCI: Do you feel as though you achieved your agenda at Vanderbilt? What still needs to happen – particularly after this tumultuous year?
I am proud of what we achieved at Vanderbilt but, like every school in the country right now, we need to do much, much more. I gave a talk recently on what the biggest challenges are for universities after COVID. For a lot of schools, it will be financial. Fortunately, it won’t be for us. What I said was, “Your real top worry is the mental health of your faculty, staff, and students.” People are really suffering. And I don’t see enough work going on to address that anywhere.
This last year was just this powerful, twofold shock to the welfare of everyone; Covid and efforts at reconciliation and inclusion that fell far short on campuses devoid of community and belonging. We see people of color, trans individuals, and other marginalized groups struggling with a sense of alienation and fear. And then you have these moments of reckoning in the time of COVID, in the time of social dislocation, with the internet and our political sphere. I think there’s going to be a lot more reckoning and there needs to be a lot more difficult conversations, but also action to address the psychological pain that is real and constant for too many.
In many ways, this year has challenged schools to meet their missions but paradoxically has given schools a free pass on truly caring in a personal way for each and every person on campus – faculty, staff, and students. Schools and leaders that were neither committed nor engaged on mental health pre-Covid certainly went into the crisis oblivious to heightened needs. I’m listening and learning – there is pain here. University leaders need to be consistently proactive on this front on a daily basis. It’s wonderful to do “virtual town halls and healing circles,” but I think people are way past that. I think we need to see real change and we need to see real resources and we need to see real action on all levels.