McNabb: A tough day for me, especially a tough pandemic day has been like a day that begins with apathy that's just sustained [chuckles] and there are those days where I don't turn a corner.

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Moore: Welcome to the podcast, Top of Mind, promoting mental health at the University of Minnesota. I'm Rick Moore reporting.

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In this episode, we talk with some students who share how COVID-19 has affected their well-being in the hopes that others will recognize similar thoughts and feelings. We'll also explore what a couple of schools and departments at U of M have been doing to improve the landscape for student mental health.

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Another semester has passed, one marked with unprecedented online learning and decidedly less social interaction, and the mental toll on students certainly hasn't lessened. If anything, it's intensified. In a survey of college students completed this past spring, the percentage of students reporting unmanaged stress was at 51%, up nearly 10% from two years earlier. The sweep of the pandemic has affected everyone and most assuredly students at the University of Minnesota, Twin Cities.

Alex Rich: Oh, it's been quite a year. Living in Minneapolis this year, too, has been really difficult but also really impactful.

Moore: Alex Rich is a senior neuroscience major in the College of Biological Sciences. She's also a health promotions student assistance and has given presentations on stress management. Rich is keenly aware of her own mental health as well as the struggles of others and how COVID 19 and the other happenings of 2020 have taken a toll.

Rich: Starting in the spring, we were hit with it and everyone I think, was on the same page of like, "Okay, the world needs to stop for a second" but then over the summer, that started to shift because we're adjusting to, "Oh, this is how it's going to be." In terms of my mental health, things coming back into play but the workload of that not being acknowledged, I think of-- Everyone I think, still feels the world needs to pause a [chuckles] little bit. I felt burnt out going into this semester so to have the presidential election and conversations around that on top of it, that's just been a lot.

Moore: Rich and other students talk a lot about overload and burnout during the pandemic-- A problem that may not be apparent from the outside, looking in

Rich: Compassity is not the same. People are already hard on themselves sometimes right now for like, "I'm not at the same level of productivity that I usually am." We live in like this, yes, society of [chuckles] we're expected to say, yes, to any opportunity that comes our way and achievement is a huge mark of our culture. When we applaud working over full time, especially in people within our generation, it's really hard to feel you can't even work full time right now because there's a worldwide pandemic [chuckles] and still have the narrative that it's business as usual.

Moore: There's Pete McNabb whose words of struggle led off this episode.

Pete McNabb: A big part of my mental health has to do with my recovery as well. I've been in recovery from substance abuse, alcoholism, and addiction for the last five years.

Moore: McNabb was finishing up the last semester of his bachelor's degree in English in the fall, and talks about what it's like trying to get a degree while in a pandemic and in recovery.

McNabb: A big part of that process is the time you spend with other people. Recovery is a super social activity. It's really founded on the fellowship of other men and women who are trying to walk that path with one another and being in a situation where I couldn't be near people who are working on the same things as I was all the time, was a major shock.

It definitely left me with too much time on my hands to think about other things that I was upset about with my life, the things that I would change about myself if I could. Although the fellowship of others is very positive, confronting myself on my own terms and in my own spaces, I think, has shown me the ways that I can self-soothe and come back here to the present moment, without being over-reliant on the distraction of other people,

Moore: McNabb's thoughts are measured and deeply personal, and he lays bare what he faces during his toughest days and times.

McNabb: There are those days where I don't turn a corner in which I'm disengaged with my responsibilities. I'm disengaged with people who might be trying to reach out to me. It's very easy to ignore the people that are trying to get ahold of you when their only access to you is through your phone.

A lot of those days, they've been interrupted by self-care and other people's positivity. I haven't had to fall into a deep, deep trough, I guess, with my mental health throughout this pandemic, but I know a lot of people have. It's very difficult, I think, to gather the momentum to get out of these depressive bouts when we're left to our own devices.

Moore: Fortunately, McNabb find solace and support in his network of friends, even if it's not as feasible to get together in person because as someone in recovery, the stakes are high.

McNabb: When I'm experiencing extreme stress-- I'm a person in recovery, I will crave drugs and alcohol, and my go-to solution in my life before recovery was to self-medicate. There's been various times throughout the pandemic where relapsing has seemed attractive to me. I know there's a lot of people with long-term sobriety who have not been able to resist that urge.

A lot of people have lost a lot of ground that they've fought hard to earn before this quarantine started. That's really tragic, too because without the accountability we receive from other people, it is easy to regress into the most negative coping habits. I've really depended on the confidence of others to resist the urge to do that. For as many people as I know who have had to take a few steps back with their recovery in their mental health, so, too, do I know many people who have really maintained in a superheroic way. It's their examples that I think, keep me sober.

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Manos Hudson: COVID has really impacted my mental health.

Moore: Manos Hudson Malano is yet another student with multiple perspectives on mental health. He's a grad student in the U of M's counselor of education program in the College of Education and Human Development. He's also an international student and he was more or less marooned in Greece for most of 2020.

Hudson: In one word, I could explain it as burnout, feeling detached.

Moore: He says that being a counseling student, you think he'd be able to anticipate all of the struggles headed his way and cope with them perfectly using, he says dryly, evidenced informed approaches, but then there's the reality of online learning, Zoom fatigue, and the inability to connect with his cohorts in the ways he'd like, despite the best efforts of his college.

Hudson: There's an element of dissociation where you mostly want to be engaged, namely academic life, academic work, the feeling of community within my cohort. The uncertainty that has played everyone, the uncertainty would look up and then throw me off emotional balance.

Moore: Not only has Hudson Malano's experiencing the tribulations of studying in America from Greece, he's seen the toll it's taking on others. For his counselor education program, he has an internship working with international students and they share some of the same issues he talks about

Hudson: People are struggling, I think. The uncertainty and the fact that they've put everything behind their goal of being students in the US but in studying is not just fulfilling pedagogical goals or going through classes, getting grades, that sort of thing, it's half of the story. The other half is being physically there, obviously, engaging the student life, especially for undergraduate, the diluting experience of being abroad and not having the fullness of being a student. What's your executive function says when you sit in front of a laptop? There's something that revolts inside you and says that that's not how it should be.

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Moore: The students point out that the pandemic struggles are widespread, if not universal, which makes them all the more important to recognize and label.

McNabb: The biggest thing people share is just this profound sense of loneliness. It's just very difficult to feel that things are worth it, that their academic pursuits are worth it because it feels that the whole context for which we work and behave. The students and people and friends has just been stripped from us. That normal world that we were all trying to manifest in, just feels it got shattered. Yes, there's a great discouragement and a cynicism, too, I think, among a lot of people.

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Moore: For Rich and McNabb, relief can come in self-care and honest communication, even if that has to be modified to some extent.

Rich: Caring for yourself during this time is essential to get through it obviously but there's a ton of misconceptions about what that means, who is that for? I think being able to say like, "Okay, literally, I got dressed today, I nourished my body, I showered" tasks of daily living, seeing that as self-care during this time because I just maybe don't have the energy to sit and do a whole yoga exercise. I can't get myself to do it." I think just making time for something I enjoy every day and giving myself the grace for that not to be something that has to be productive, it's just something that's good for my mind and my body. That's definitely been a huge focus for me in coping with this.

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McNabb: I think people have this idea that reaching out to other people means finding a tangible solution with other people. It's not always about that. I never expect that the person, who I get honest with, is going to be able to fix my life or understand exactly what I need to feel, mentally fit and capable. It's something about the action itself of just entering that space, honestly, that is so therapeutic and makes changing so possible. It never boils down to any particular thing that anyone says. I think it's just speaking and knowing you're being heard, for some reason is just amazingly medicinal.

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Moore: Long before the COVID 19 pandemic struck, schools and departments around the University of Minnesota, Twin Cities, had already begun making tangible, substantial moves to become more mental health-friendly. Here, we highlight two of those efforts. Kaz Nelson is a psychiatrist and an associate professor at the University of Minnesota Medical School. She was part of the mental health panel discussion during President Joan Gabel's inauguration week.

Nelson wants to ensure that the next generation of medical students gets through its training stronger and healthier than the previous generation, which she would argue had a more negative, sometimes even toxic experience. That hit home locally a couple of years ago when a second-year med student and then a graduate who went off to residency, both took their lives. In her words, "We've got to flip the script and do better."

Nelson has witnessed a movement in medicine over the years with physicians being burdened by additions to their workload caused by electronic medical records and insurance requirements, burdened and increasingly burned out.

Nelson: I had a front-row seat to this whole saga within medicine, and I could see it playing out in a parallel way for the students' lack of clarity about, what is going to be on the exam? Do I really need to click and memorize everything on the other side of all these links? You can really sum it up as a cognitive load or cognitive overload.

At the height of this problem in a medical school, I will share with you because I think, we need to talk about this transparently, but there was a point where our first and second-year medical students were exposed to 27,000 PowerPoint slides in the course of their first two years of training.

There's no way that any person could absorb and integrate the amount of content contained within 27,000 PowerPoint slides but the cumulative effect of this cognitive overload is a setup for failure and it's not okay and no amount of yoga is going to make it okay. It's our responsibility as educators, to zoom out in partnership with the students, co-produce solutions that are achievable, that are navigable

Moore: To that end, she says the med school embarked on a strategic planning initiative to revamp the educational process and empower rather than pressure students. Students were included on committees at every level to help drive improvements while taking into account, diversity, equity, and inclusion. The school put in place a policy that limited how many hour should go into a workweek, including home study, move to a pass, fail grading system, and implemented a house system to foster relationships and a better sense of community. Nelson is adamant about debunking the notion that med students shouldn't be cuddled any more now than they were in the past.

Nelson: That's the point, we cannot compare our experience from 2 years ago, 4 years ago, 7 years ago, 10, 20 years ago. There's no comparison to what the students of today are dealing with at this moment. This is something we haven't seen in history, this explosion of information, explosion of technology. We must not assume we know what they're experiencing or what's best for them. We must ask them, "What is it like for you? What do you need? How can we do this better? How can we streamline things? How can we make this doable? How can we make this effective?"

If they say, "I need less time in class. I need more clarity on what's being assessed on the exam. I need to know exactly what the learning objectives are," we must not look back at them and say, "Oh, how dare you wish to be spoon-fed this information? How dare you wish to know what's on the exam? When I was a student, we never knew what was on the exam. It was our responsibility to learn the material and take the exam."

No, it's different now. It's totally different. Our job is to curate information for them, help them learn, broad learning frameworks. Later on, they're going to plug in details and plugin information. What is the learning objective?-- Becoming very clear about that, teaching it, and then fairly assessing it, and then not shaming people for not have memorized what's on the other end of 27,000 slides because it's inhumane?

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Moore: It's not just the medical school that's been proactively prioritizing student mental welfare. In the Department of Chemistry, Phil Bowman took on mental health as soon as he took over as Director of Graduate Studies in 2012. He had seen and heard stories before that, going back to his native Switzerland. When he was in high school, he had a teacher who committed suicide over Christmas break.

As an undergrad, a professor in the middle of a lecture suddenly looked out into the crowd said, "I can't do this anymore," and walked out. Bowman began working together with grad students who decided that to better determine where students struggled most, they should develop a survey. They collaborated with Boynton Mental Health and modified an existing survey to fit the needs of chemistry graduate students.

Phil Bowman: Other departments have heard about this and they've adapted our survey. They also have worked with Boynton Health. Now, actually, we do have departments all across our campus who have been using that same type of approach.

One thing that became very clear from our survey was that students, particularly, in their third and fourth year for added studies had fewer means to assess if they did well, whether they progressed well. Once we understood that, we completely change our annual progress report in the department. Actually, the students who recognized that, they went ahead and they made their own version of manual progress report.

Moore: The report is now filled out first by students who have the chance to self-evaluate before meeting with their advisors, a process that sometimes shows that students are too hard on themselves. An additional question asks if students are struggling with mental health. There are now four trained mental health advocates in the departments and students have also formed the Community of Chemistry Graduate Students.

The CCGS focuses on issues of stress and mental health, organizes workshops with topic experts, and offers weekly socializing opportunities centered around coffee, grafting, puzzles, and the like. The CCGS also has a website featuring events, resources, and a robust video series.

Claire Site Singer, a chemistry graduate student, and a PhD candidate has been involved with the group for about two years and became one of its co-presidents. She talks about how it has become a model for other colleges around the country.

Claire: We are at the leading edge. We have other groups at other universities who contact us about what we're doing and how they can do better. Before Zoom was really common, I would have Zoom meetings basically, talking about what do we do, how do we interface with faculty? A few questions that we get are, how do you approach faculty about mental health? That's a big question and we try to hope that faculty are open to that discussion.

A lot of faculty have struggled with mental health in the past, especially, in graduate school and it's can be good to go and talk to them and say, "This is what I'm struggling with" and have them say, "I struggled with that, too." I think in the chemistry department at Minnesota, faculty are willing to have that conversation.

Bowman: There have been numerous students who've told me specifically, "I've come to the University of Minnesota because I saw that you are doing this in this department and this is really something that I think, is very valuable. This is a place where I can see myself being a graduate student because you are doing this."

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Moore: The conversations and work on mental health continue at the University of Minnesota. In October, President Gabel co-hosted a mental health summit in conjunction with partners at Minnesota state. Faculty are participating in workshops and trainings on topics like trauma, informed teaching, and learning in higher education.

Look for more details soon on the University of Minnesota mental health initiative. If you're a student and you find yourself feeling you might need any help at all, please take advantage of the University of Minnesota's many resources, including Boynton Health and student counseling services. A great landing page is mental health.umn.edu.

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Our next episode, we'll explore other resources and initiatives at the U of M including the popular PAWS program, Pet Away Worry and Stress. We hope you'll tune in. Until then, please take care of yourself and ask for help if you need it.

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This is a production of University Relations

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