The Bureau of Study Counsel resides in a white, wood frame building on Linden Street. The bureau’s inconspicuous headquarters parallels its mental health care, which escapes many students’ notice.

D. almost didn’t get help.

It was his first year at Harvard and he couldn’t sleep well, he constantly felt anxious and college life seemed too overwhelming to deal with.

When he finally worked up the courage to go to University Health Services (UHS) mental health service, he says he was disappointed with the care he received.

“The psychologist was like, ‘You’re a worrier, aren’t you?,’” says D., who was later diagnosed with anxiety disorder. “She didn’t take me seriously.”

She then sent him to a psychiatrist who prescribed Valium, which was ineffective. D., a Harvard senior who asked that his full name not be used, stopped taking the drug.

It took more than a year for him to return to UHS.

“I thought maybe there was some hope,” he says. “But it was the same terrible result. They didn’t say anything helpful to me—I went to two appointments and stopped.”

Another year passed before D. decided to look for help again, this time at the Bureau of Study Counsel. Up until this point, he hadn’t known that the bureau provided therapy.

“The moment you step in, it’s an entirely different place,” he says. “This woman sat down with me and said, ‘Let’s talk,’ and we spent the next eight months talking.” She later referred him to a UHS prescriber and D. began taking Zoloft.

“The drug and the talk at the Bureau of Study Counsel has completely changed my life,” he says.

D. says that even after four years of experiences with the bureau and UHS, he’s unclear about the distinction between the two services.

“I still don’t know what is for what—no one knows,” he says. “I think it’s atrocious. If I had found out about the bureau freshman year, I would have been so much happier and more successful at college.”

D.’s experience underscores the confusion—and potential for a breakdown in the system—that results from Harvard’s decentralized approach to mental health care.

There is no office at Harvard responsible for coordinating mental health services across the University.

“Mental health services at Harvard resemble a symphony orchestra of talented performers, but without a clear conductor and with all musicians playing different music,” concluded the 1999 Provost’s Committee on Student Mental Health Services.