On March 4, Dr. Estevan Garcia — a lifelong clinician with extensive expertise in both public health and pediatric medicine — will begin his role as the College’s inaugural Chief Health and Wellness Officer. The College previously announced his appointment on Feb. 8, according to Dartmouth News. In his previous role as Chief Medical Officer for the Massachusetts Department of Public Health, Garcia played a pivotal part in managing the state’s COVID-19 crisis. The Dartmouth spoke to Garcia about his background and plans for mental health on campus.
In her inaugural address, College President Sian Beilock promised a “holistic approach to mental health and wellness.” What are your general plans regarding mental health at Dartmouth?
EG: Part of it is the work that’s already been done, which is understanding the current environment at Dartmouth, and then really centering wellness, especially mental health, in everything that we do — in academics, social interactions and all of those different areas. It is going to be important to make sure that wellness is not secondary, but that it has its place at the table and should be supported.
In the past, you’ve served as Chief Medical Officer of the Massachusetts Department of Public Health. What did you take away from your time in that position, and what aspects of your experience there will help you in your new role?
EG: One is the approach at the state level to thinking about our population health. At the state level, I worked on a couple of different areas that directly impact the work that I’ll be doing at Dartmouth, and one of those was our behavioral health roadmap. The state had developed a roadmap through the Department of Mental Health, not within my department, but I was the representative from my department to the Department of Mental Health and their roadmap. That was important for me to understand not only what the needs were within the different communities across the state, but also how to begin to address those needs.
We have work to do at the state level, but much has been accomplished over the course of the last couple of years as we initiated this. I can bring that kind of population-based approach to mental health to Dartmouth. It’s a community. A community of learners, a community of teachers and a community of staff. And even more broadly, it’s all of the families that support all of our communities, too.
You’ve noted how COVID-19 has played a significant role in shaping your mindset surrounding mental health and wellness. What do you think have been the largest long-term impacts of COVID-19 on health and wellness on college campuses?
EG: There are certainly multiple. The primary impact that I see in general, but specifically as we go to college campuses, is the exacerbation of underlying mental health concerns. It’s clear — and President Beilock has mentioned this — that mental health had already been declining for quite some time on college campuses before the pandemic. And you then superimpose COVID and the stress of a pandemic on an already difficult situation, and it made it that much worse.
I’m a pediatric emergency medicine doctor, so I work in emergency departments that do care for college students, up to age 25 in many of them. And what we saw was an exponential increase in crisis evaluations and young adults in crisis to the point where we didn’t have the capacity to manage them — to the point that we were managing them in hallways. That is not something prior to COVID that I saw treated in the same way; they were maybe one-off isolated cases. When you have 15, 20 patients at the same time, it really did challenge our ability to support those patients and our emergency departments. With the abatement of COVID, that number has decreased, but we are still seeing a significant increase over pre-COVID times of young adults and children in crisis. That has changed, and I don’t think we’ll ever go back to being where it was before.
On a similar note, are there any other broader trends in health or wellness that you’ve noticed in the past few years?
EG: I think we’ve seen the acknowledgment that wellness is not a separate entity from physical health. For quite some time, we’ve been talking about integrating behavioral health into your healthcare. We are normalizing the idea that wellness is important, wellness is holistic, and that we need to support that.
We need to continue to move forward and understand that student success is dependent on wellness. It’s really important for us to continue to be advocates for that perspective. It’s not an added responsibility for faculty or staff, and it’s not something students need to see as a burden. It’s actually a requirement for success.
President Beilock noted in Dartmouth News that aside from your extensive background in public health, you also bring to your role “the deep experience of a lifelong clinician.” How do you feel that your career in pediatric emergency medicine will contribute to your role as Chief Health and Wellness Officer?
EG: I see patients in crisis, and I think of the opportunity to use that clinical lens, to think about, “How do we prevent this crisis?” When we think about physical healthcare, I look at the use of the emergency department in general. Let’s take asthma as an example: why do we have action plans that families use at home? Because we know you’re going to get sick, and we want to keep you from having to come into the emergency department.
Mental health should be viewed the same way. It’s important for us to acknowledge that we should have the ability to intervene before people get to the point where they really feel like they could hurt themselves. And so that’s hopefully what I plan to bring, that clinician lens at the end to then think about how we help folks early on and give them the resources to avoid that result where they need that crisis stabilization.
Considering the evolving landscape of technology, do you plan on utilizing any digital tools or resources in your role as Chief Health and Wellness Officer?
EG: Dartmouth has already done that through resources like Uwill Teletherapy for folks, students and others who are interested in having that availability. We want to really look at the evidence-based, supported applications that are online and understand how to use those. Now to be clear, that’s not for everybody, and so it can be part of your portfolio of activities, but those won’t replace the ability for in-person support and therapy that is available and will continue to be available.
Are there any pieces of advice or information on health or wellness that you would like to offer to Dartmouth students?
EG: It’s important that students continue to raise issues that they are concerned about. I believe that my role as I move forward is to be a conduit from the students to the administration, as part of the administration, to make sure that what we’re doing is communicating bidirectionally. I want to meet with students and understand what their concerns are. What do they feel isn’t being listened to?
It’s also important for students to understand that it’s okay to need a break. I know Dartmouth students are really some of the most motivated and gifted students across the country, and that’s fantastic, and I look forward to working with them. But I also want them to know that it is okay to say, “I need some time here, I need to understand what’s going on, I’m not feeling my best today,” and then be able to reach out and get some help.
This interview has been edited and condensed for clarity and length.
