In the last five years, two members of Penn track and field, Madison Holleran and Timothy Hamlett, have died by suicide — events that spawned dozens of national headlines and in Holleran’s case, a recent New York Times bestselling book. 

Despite these high-profile tragedies, the University has not introduced any substantial reforms to the way athletes receive and request mental health care, either from Counseling and Psychological Services or through Penn Athletics, according to more than half a dozen athletes who spoke with The Daily Pennsylvanian. 

The vast majority of athletes see staffers from CAPS at introductory team meetings, where counselors regularly make an appearance. Over the past four years, Penn Athletics has extended that relationship with CAPS through I CARE training, a workshop that helps peers understand and respond to signs of mental illness. Since I CARE was introduced, more than 100 coaches, administrators, and staffers within the Athletics Department have received it, according to Associate Athletic Director Matt Valenti. 

Outside of these scheduled events, most athletes complete a mental health questionnaire or survey as part of their regularly scheduled physical. They also have the ability to schedule appointments with Dr. Joel Fish, a nationally-renowned sports psychologist who serves as a consultant for Penn Athletics.

These initiatives, current and former athletes said, have spread awareness for CAPS among athletes and ensured coaches are more sensitive to noticing signs of mental illness, but fail to target the main problem impeding athletes from seeking treatment: accessibility.

This past fall, one student leader came up with a proposal to target that very problem.

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Senior fencer Ashley Marcus has lobbied administrators before to produce change, having successfully pushed Penn last year to become the first Ivy League athletic program to join the “It’s On Us” pledge against sexual violence, a campaign started by the Obama administration. 

She became passionate about reforming the way athletes access mental health resources after a meeting last October with fellow members of the Student-Athlete Advisory Committee, which convenes representatives across Penn’s 33 varsity teams. Before arriving at a set policy recommendation, Marcus decided to create a survey to solicit feedback directly from athletes on the type of mental health resources and counseling they need.

With the help of Marian Reiff, an assessment specialist with CAPS, Marcus created a Qualtrics survey that aimed to uncover obstacles for athletes to obtain treatment. Two respondents from each sport filled out the survey on behalf of their teammates and Marcus said the results, while specific in desire and need to each particular team, were unanimous in their call for a deep change in the ways athletes accessed mental health resources at Penn.

“It’s not a question of, ‘Do we know about it?’ It’s a question of, 'How can we access it?'” Marcus said. 

Using the survey as an internal mandate to act, Marcus developed a proposal with Valenti that she ultimately presented to her other SAAC members: CAPS would allot one of the five therapists it plans to hire this year to work strictly out of a Penn Athletics building, ideally in a space shared with other staffers like nutritionists and compliance officers that student-athletes have reason to frequently visit. As part of the proposal, Penn Athletics would hire an additional therapist out of its own budget.

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If the proposal passed, it would have been one of the most significant steps Penn has publicly taken to expand mental health counseling for athletes in recent memory. 

Instead, Marcus says she has been given no indication whether her proposal is even still being considered and, given her impending graduation in May, considers the idea all but dead. 

“I don’t want this to be a situation where they wait us out.” 

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In interviews with Marcus and other athletes and administrators, a picture emerges of Penn’s sluggish policy formation process, where not all sides have access to the same information and a yearly turnover of graduating seniors makes consistent lobbying from students almost impossible. 

After organizing their schedules around practices, weightlifting sessions, team meetings, classes, and travel, athletes barely have time to make it to CAPS before the main Market Street office closes, Marcus said. On Mondays and Fridays, CAPS closes at 5 p.m. For the remaining weekdays, CAPS stays open until 7 p.m.

Athletes who responded to Marcus’ survey overwhelmingly said that the best time for them to schedule CAPS appointments was in the late evening, often past 7 p.m. 

“Their hours are not very conducive to an athletic schedule,” Marcus said. 

In response to similar complaints from graduate students, who tend to also keep highly irregular schedules, CAPS embedded four counselors inside the Penn Law School, Perelman School of Medicine, School of Dental Medicine, and School of Veterinary Medicine for six-to-10 hours a week. A year after that model took off, 17 percent of graduate students used CAPS’ services, a 5 percent increase. (Student usage of CAPS as a whole increased by just 5 percent from 2007 to 2016.)

Marcus believes the same impact could happen within Penn Athletics if CAPS were willing to relocate just one staffer.

“If we have psychologists housed in the athletic department, then it becomes easier to access them. They’re ingrained in the culture of Penn Athletics,” she said. “And they become a familiar face around athletes.”

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She said the issue received wide support from other SAAC representatives, all of whom received the survey.

“The consensus that I got from the women’s rowing team is that people were very, very excited about the idea of getting both a specific CAPS representative for Athletics and also having one on site,” said senior Regina Salmons, a co-captain of the women’s rowing team who solicited feedback from her teammates to complete Marcus’ survey. 

Despite CAPS receiving an additional $860,000 in funding between 2014 and 2016, officials have had to keep up with increasing student demand from all sectors of the University. Most of that funding has been directed toward hiring new staffers in an attempt to offset one of CAPS’ most persistent problems: long wait times for new arrivals. 

CAPS Director of Outreach and Prevention Meeta Kumar acknowledged in January that the average wait time for appointments is seven to 10 days. In 2016, CAPS Director Bill Alexander said the office serves about 20 percent of the undergraduate population each year, an amount that has only increased. In September alone, CAPS held 1,000 more sessions than it had the year before during that timespan.

As a byproduct of CAPS' expansion, its office on Market Street — despite offering 25 percent more space than the division's previous office — will no longer be able to host all necessary staffers. In an interview with the DP in February, Kumar said of the space, "We are pretty maxed out."  

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From the beginning of November to late January, Alexander and other administrators from the Division of the Vice Provost for University Life met with Marcus and other SAAC representatives to discuss her proposal and the relationship between Penn Athletics and CAPS more generally. 

As Marcus began collecting information for her survey, she held two meetings at CAPS, including one with Alexander and Max King, the associate vice provost for Health and Academic Services. Alexander and King later spoke to all SAAC representatives on Jan. 31 with Valarie Swain-Cade McCoullum, the vice provost for University Life, for over an hour in Huntsman Hall. 

At the meeting, SAAC representatives reiterated Marcus’ call for a CAPS representative within a Penn Athletics building with the justification that for athletes, “accessibility is often a priority over privacy,” according to a copy of the meeting minutes provided to the DP.

Marcus and Salmons said the administrators were dismissive of the idea of shifting a counselor to an Athletics building despite CAPS' own problems with finding enough space for its staffers in the main office. 

“It felt like they were giving excuses for why Penn Athletics doesn’t need these resources that we’re asking for,” Marcus said.

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When asked about the meeting and Marcus’ proposal in general, Cade replied in an emailed statement, “The Athletics Department is considering this proposal with our support. We won’t know more about this suggestion until the summer for the next academic year as we evaluate this idea with a number of additional, excellent recommendations from students, faculty, and staff that we have received over the last few months as well.”

Alexander, also in an emailed statement, said, “There [is] much more we need to learn about the needs of athletic students.”

He added, “There are still unanswered questions: What is the need? How will the need be addressed by the CAPS on site? What is the optimal time for CAPS staff on site? Is the proposed position within the mission and scope of practice of CAPS vs Student affairs?  Who will fund the athletic department placement? Will the Provost office approve hiring additional staff to support this position?”

The issues Alexander raised are indicative of the difficulty in establishing any stable working relationship across two disparate wings of the University. Despite both technically reporting up to Provost Wendell Pritchett, CAPS and Penn Athletics operate in practice under entirely separate chains of command. 

At Cornell University, the wellness and athletics divisions have forged a stronger working relationship, largely due to Cornell’s Counseling and Psychological Services program being integrated with the university’s other primary care providers. 

“At some point or another, I’ve talked to coaches in every [sport],” said Gregory Eells, the director of Cornell’s CAPS. “We have some eating disorder therapists who will work with them if a coach has a gymnast who has some eating issues or body image issues. We’ll do some trainings on some of those issues, as well.”

Because Cornell's CAPS is integrated with Cornell Health as a whole, Eells has a strong working relationship with the trainers and medical staffers who primarily work with athletes. Penn has physicians, nutritionists, strength and conditioning coaches, and trainers on staff, but CAPS is run separately. The only psychologist affiliated with Penn Athletics is Fish, who is on staff as a consultant, not a primary care provider. 

What relationship Penn Athletics and CAPS will develop in the years ahead has yet to be seen. 

In Athletics’ strategic plan for 2017-2022, mental wellness efforts are mentioned just once: “The Division is committed to becoming more involved in campus wellness initiatives by forging partnerships with the Office of the Vice Provost for University Life.”

Matt Valenti, the associate athletic director who helped Marcus develop the proposal, said in a statement on behalf of the department:

"Our staff incorporated feedback from Ashley and her peers on the Student-Athlete Advisory Committee in creating the Penn Athletics proposal that was submitted to VPUL. That proposal is currently under consideration, along with recommendations from a number of other schools and centers on campus, and we look forward to receiving feedback in the coming months."

No students interviewed for this piece believed Penn Athletics had the budgetary space to hire two full-time counselors. CAPS, whose budget has already been stretched to its limit year after year, might not hold Athletics’ proposal as a priority among competing concerns from across the University. 

The answer to whether Marcus’ idea will ever see the light of day may be intertwined ultimately with the question Alexander raised: Who will fund it? 

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Administrators did not delve into any of these concerns during their meeting with SAAC representatives. In fact, students said the two sides were unable to even reach a central point of agreement about the need for such an arrangement. 

“At no point during the meeting we had was CAPS receptive in any ways to anything that we said,” Salmons said. “In no way were they ever really acknowledging our points or agreeing with us.”

She left the meeting frustrated with Cade and Alexander’s suggestions that CAPS just needed to brand itself better to athletes and was especially annoyed at an administrator’s idea for CAPS to give away merchandise at SAAC’s beginning-of-the-year event.

“It’s not an advertising issue,” she said. 

“Handing out pencils at our annual picnic is not going to solve everyone’s problems.”

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News Editor Kelly Heinzerling, Sports Editor Yosef Weitzman, and Associate Sports Editor Will DiGrande contributed reporting. 

This is the first in a series of stories The Daily Pennsylvanian is reporting about the intersection of mental health and athletics. If you would like to share a comment or add to our reporting, please contact Senior Sports Editor Jonathan Pollack at pollack@thedp.com.