Dr. Estevan Garcia is at the Table

Given his background, Dr. Estevan Garcia might be considered an unusual member of a college president’s cabinet. But as Dartmouth’s new Chief Health and Wellness Officer, the physician and public health expert works directly with President Sian Beilock on an issue she has made a well-publicized priority in her first year in office – protecting the mental health of students, faculty and staff. Garcia, who is a pediatrician specializing in emergency medicine, came to Dartmouth from the Massachusetts Department of Public Health where he helped led the effort to address the behavioral health crisis in emergency departments during the pandemic.

It is now Garcia’s job to lead Beilock’s health and wellbeing agenda, most specifically through the implementation of the school’s comprehensive strategic mental health plan called the “Commitment to Care.”  The origins of the plan predate Garcia’s arrival and was informed by a collaboration with the Jed Foundation, a non-profit organization dedicated to protecting emotional health and preventing suicide in young people. Beginning in 2020, the Dartmouth community lost several students, including by suicide, as the pandemic eclipsed college life.

Four years later, the Jed Foundation featured Dartmouth as a success story in its impact report and Garcia is now focused on the longer term outcome data that will provide a more precise evaluation of their recent work.  He views the plan as a pathway to a wellness culture at Dartmouth that prioritizes self-care, community care and mental health innovation. With an increased staff and budget behind him, Garcia is addressing a number of wellbeing issues often associated with elite institutions, particularly ones like Dartmouth, located in remote areas with less community resources.  These include the stress of perfectionism among high-performing students and the lingering lack of belonging many students feel, particularly those with mental health issues and/or those with diverse identities. As the fall semester brings new and familiar challenges to students’ wellbeing, Dr. Garcia is ready and at the table.

LW: What was the thinking behind having a new position in this area reporting directly to President Beilock?

EG: I think her vision for the role was to elevate student mental health and wellness as a high priority but also to bring under one umbrella campus-wide health and wellbeing. Part of my portfolio is faculty and staff health and wellness so it was important to President Beilock to have that direct communication on all of the activities in this area across campus.

LW: How has your background in public health prepared you and/or motivated you to take on the position of Chief Health and Wellness officer at a college? 

EG: What brought me to this work came from what I saw in emergency departments during, and predating COVID, with adolescents and young adults in crisis. To me, that was really shocking.  When I started in the Department of Public Health {in Massachusetts} I partnered with the Mass Department of Mental Health through the community behavioral health programs, providing options that would divert the mental health crisis from emergency departments when appropriate.  I spent those two years heavily involved in the work we were doing to create an actual road map for behavioral health in Massachusetts. 

My background is in emergency medicine.  I useasthma as an example of the way we look at illness in the emergency department.  You would come to the emergency department after you had gone through your asthma action plan – “I'm a green, I'm a yellow, I'm a red,” -- here's how I step up my care so by the time you came to us, you had exhausted your plan.  Westarted to view behavioral health in the same way.  “I'm at home fighting with my parents, or “I'm depressed, I can't leave my room” or “I'm in crisis, potentially I'm suicidal” – all of those scenarios have varying degrees of illness and severity.  Ifwe treated them all as emergencies, we would be failing our patientsand our ability to manage true crisis and emergencies.

LW: Do you have a similar strategy around health and wellbeing that you are utilizing at Dartmouth?

EG: When I first came here, it was important to explain to my colleagues what we mean by health and wellness because not everyone understands this. One of the things I did was develop a pyramid that shows the different degrees of mental health needs. The base of the pyramid is the 70% of the students we have here – very successful, high achieving – experiencing the stress that comes with that.  There’s another 20 to 25% who could use some clinical support.  The final piece at the top of the pyramid is the group of students who were most clinically concerning, potentially suicidal, and these are the student we need to act quickly to support and get into the appropriatesetting. 

The goal of this kind of structure is to understand that much of what we do is at the base – that 70% of our students need easy access to services and almost no barriers to the many wellness activities we should be providing across campus. The idea is that college is the right timeto experiment with wellness and to build your portfolio of activities and support strategieswhen you are successful – when you are at the base - so you can manage the challenges that will come your way.  You will be more prepared when you fail a test, or break up with your girlfriend, or have other challenges– all the things that challenge yourequilibrium andcould push you into crisis.

For the 20 to 25% in the middle, we have clinical  supports that help themmanage their illness, while also providing access to wellness activities.  With the smaller group, my job is to really help identify them as their situation evolves and get them the support that they need, and this can be a protective setting in a hospital if that’s necessary.  And it is really important that we don’t make them feel that they are alone.  You have to care enough about the students that require services outside of the college to partner with them – to give them time away, with support, and then bring them back with the appropriate accommodations. This is how I see my job.

LW: What have been some of your early priorities?

EG: President Beilock has recently completedher first year as presidentbut was very involved in the creation of the strategic plan for mental health and wellness before that. I would say the majority ofmy work since I came to Dartmouthhas been to implement that plan.  It has multipledeliverables and my job was to take that on and run with it, delivering on health and wellness as a priority for the president and for the campus.

Part of those deliverables involved new permanent staffpositions – across ourstudent health and wellness divisions.  It was really a huge investment by the college and we had to make sure those were the right positions and we were utilizing them in the right way.  

The Dartmouth community has faced several challenges since I arrived.  I think it is helpful to have a clinician at the table.  Health and wellness staff arenot enforcers, but supporters.  We arevery much there to support students, and help them engage in tough conversations. I think partnering with students has been one of the strongest game changers for me personally. I worked with them before as patients but now they are really partners to me in the work we are doing around health and wellness.

LW: What was the history behind the Commitment to Care plan?

EG: When Covid started, we (in reference to Dartmouth) were doing the best we could, but clearly it was very isolating on this campus and colleges across the country. It was not your normal college experience by far here and of course everywhere.  Beginningin 2020, we had several student deaths including bysuicide, and it was clear they needed to address what was happening.  In the summer of 2021, they brought the Jed Foundation in and that led to a major mental health review -  campus visits, survey data, all of that.  Additionally, the provost at the time set up a steering committee to work on an all-Dartmouth strategic plan on health and wellbeing from May 2023 to September 2023, that was the foundation of the Commitment to Care. It was across all campuses – undergrad, grad schools, professional schools. 

What makes it unique is that it is very stakeholder-driven, very student-driven and the result is this multi-year, campus-wide engagement with actual deliverables. What I found interesting when I first came to campus, folks would introduce themselves – students, staff, faculty – and they would say “I was on the committee for mental health” or “I was on the committee for health promotion.”

LW: What are the elements of the plan?  

There are five pillars to the plan which drive the many activities and initiatives that we are working on.  (From materials): Center wellbeing in all we do both inside and outside of academics; Create an inclusive community to foster mental health and well-being for students with diverse lived experiences; Equip students with the resources and skills to navigate both success and failure with strength and confidence; Proactively address mental illness to aid students in reaching their goals; Invest in innovative applications of evidence-based approaches to respond to changing environments and needs.

It is a very broad approach involving all aspects of the college.  Regarding the second pillar, we pride ourselves on attracting first generation students and students with diverse lived experiences, and it is important for us to center those lived experiences in what happens on campus, particularly here in rural New Hampshire. This includes how we address mental health and wellness and creating a sense of belonging.

President Beilock was clear that focusing on wellbeing is critical to a successfulacademic career. One of the key pillars for us is helping students navigate success and failure, this is number three.  There is an understanding that our students are incredibly driven. They are gifted and they are used to being at the top. They are not used to failure. But failure is part of succeeding and it is how you pick yourself up and move forward that is important.  We call it normalizing life.

Regarding wellness services, we have made significant gains here.  One of the first things I did was to move wellness to be a separate divisionwith a director reporting to me.  Our health services are really top notch and I wanted wellness to be on equal footing.  Additionally, we are arural community sometimes makingrecruitment difficult.  To better meet the needs of our students, we needed to find ways of extending and diversifying our services.  We partnered with a tele therapycompany, that gives us 24/7 behavioral health support for students and that made a big difference in accessibility when our team was not in the office.  We have several hundred students who have engaged with the service.  We have unlimited access to 30 minutes therapy slots any time of day or night and will beexpanding that to 50 minutes for those who need it.

The addition of the tele service didn’t lower our need for in-person services but it enabled other students to access therapy who might have been uncomfortable doing so before.  We know that a quarter of our students utilize our mental health services and that is similar across our student groups.  That is a significant point since historically, underrepresented students seek help less frequently. 

And the other piece – which I think is one of the harder ones – is thinking about data analysis and evidence-based approaches to make sure that what we are doing is impactful. This is really important because as we are delivering on a lot of these initiatives, we need to know what is helpful and not helpful and then redirect our time, energy and resources accordingly.

LW: You have said that some of your work is inside as well as outside the classroom.  What has been your experience there?

EG: There are a few tracks to this work, one involving academic policies and calendars that students have said would be meaningful to them in terms of reducing their stress levels over academics.  There’s also some interesting things faculty are doing in their classrooms by integrating mindfulness techniques in their academic disciplines including physiology and languages.   These are just some of the ways we are partnering with academic leadership, and I will say it does make a difference now that we are at the table.