If you’re a college student and you’re depressed, chances are you have a student counseling center that’s available to you, at no charge.
Sounds good, right? In an ideal world, the student counseling center would properly assess, diagnose and even treat students with mental health concerns — such as depression, anxiety, ADHD, and more.
But we don’t live in an ideal world and student counseling centers don’t make a university any money. So they aren’t necessarily well-funded, overflowing with well-paid staff or have access to all the resources they need.
That’s why Emily Merlino’s column about her experience at the University of Massachusetts (UMass), supposedly one of the better universities in the country, was a bit disheartening to read. In it, she details how she was experiencing depressive feelings and sought out help from a professional at the UMass Mental Health Services clinic.
When Emily Merlino first called for an appointment, she was placed on a 2-week wait-list. This is not an uncommon experience for anyone who’s ever sought out services from their university’s health center or student counseling center, or from a community mental health center. When I was in graduate school nearly 20 years ago, this wait-list could extend for as long as 4 to 5 weeks for the first psychotherapy appointment. Since state and federal budget cuts, these wait lists have only gotten worse.
When she finally did get in to see a professional, it was not a positive experience:
After what seemed like an eternity, when a mental health services employee finally spoke to me, she treated me like I was absolutely wasting her time. When I discussed my family’s history of depression and told her I was fairly sure I had symptoms of clinical depression, she did not even take the time to screen me, the first logical step in treating depression. Because I did not have suicidal thoughts, she literally told me that obviously my depression was not pressing or worthy of concern. Finally, her proposed “treatment” was suggesting that I drop out of the University.
I’m not sure if this is standard procedure at student counseling centers — to dismiss the person’s symptom concerns, or to minimize them if they didn’t acknowledge suicidal thoughts. (News flash: Even severely depressed individuals don’t always have suicidal thoughts.)
The problem with student mental health services is that nobody pays it much attention until you need to utilize them. As a prospective student, it’s not even a question that crosses most people’s minds when checking out schools. You just assume there’ll be someone there if you need to talk to someone — that their health and mental health services are going to be, at the very least, competent.
Sadly, that doesn’t appear to be the case at UMass. Such a large, well-funded state university system should be able to do better than what this student detailed in her experience.
The first step in reforming mental health services at universities like UMass is implementing an organized, efficient system to screen students for depression. At Loyola University in Chicago, first-time visitors to the university’s medical center are given a two-question survey to screen for depression. If the patient’s answers indicate a possibility of depression, the student is more extensively evaluated.
We couldn’t agree more.
Read the full story: Better Services for Mental Health
9 comments
This doesn’t surprise me much, I guess I am a bit baffled to why the patient wasn’t sent for a 30 minute psychiatric eval and started on celexa or Prozac, the $4 scripts at WalMart or Target.
Oh, silly me, what university pays for a psychiatrist to do assembly line work?
Students deserve better. But, Virginia Tech has been a while ago, so what have we learned? Just my opinion.
And while the facts of the shooting at the christian college in California are just being sorted, I am hearing already calls about the role of mental health problems as the alleged shooter had “anger management issues”.
Again, we have to figure out who is psychologically impaired, and who is just antisocially inappropriate.
Man, this is just getting old. And just having to endure more arguments about gun laws and trying to preemptively identify impaired people to get them into involuntary treatment does not get us resolution. I still think that the death penalty is a deterrent, if the appeal process would be fine tuned a bit more realistically. One thing is for sure to me, killing multiple people is more easily defined for considering such a punishment.
By the way, anger, in my opinion, is a symptom. If from depression, anxiety, psychosis, organic impairment, or whatever other primary condition, you can’t medicate anger itself. Except by simply sedating a person. And then they get mad from that experience.
This is not the only problem with mental health treatment for students. Most mental health clinics on campus have a limit on number of sessions students can receive. Then most student health insurance has very limited benefits for mental health coverage (including prescription coverage of psychotropic medications.) So if a student can’t get services at their student health clinic they are then paying out of pocket for treatment. And most students can’t do that. So after the first (often 8 or so) sessions there is no other treatment available. Student health insurance is not covered by the parity requirements that are in place for group policies. I have run into their problem both in undergrad and graduate school. When you are worrying about being able to pay for your antidepressants and being able to get therapy, it makes school that much harder. Whereas someone with a physical illness is provided with much more insurance coverage.
While we certainly don’t live in “an ideal world”, I have to say that my experience with Duke University’s Counseling and Psychological Services Center has been pretty close to ideal… as has the experiences of many friends of mine who have taken advantage of the services Duke CAPS offers.
My own experience went something like this: I have a history of depression (both personal and familial) and last semester, when things started to get to be a bit too much, I knew I’d better intervene before I ended up with a full blown depressive episode. I called the CAPS office and was given an initial assessment appointment the next day — and that was after they made sure that I didn’t want/need an immediate, urgent appointment. At the initial assessment, after discussing my concerns, I was even asked if I had any strong preferences as to characteristics of a possible therapist match such as gender, age, and sexual orientation… The day after the assessment, I was called and given the name and contact info for the therapist I had been matched with. I first met with my therapist only three days after I first got in touch with CAPS.
It sounds like UMass should take the time to learn a thing or two from Duke… that any student would be treated like Ms. Merlino was treated at UMass is unacceptable — because, clearly, a better experience is possible.
In your March 26th blog posting you discuss mental health services at UMass Amherst, and generalize to the provision of mental health services generally on college campuses. Of course, ethical and legal constraints prevent any divulging of mental health treatment records without consent. However, the story paints an inaccurate picture of services on our campus, which must be corrected. The provision of such services at UMASS is and has been a priority, in recognition of the significant emotional concerns brought to campus by students nationally—and the critical nature of responding to these proactively.
Given the large flow of students seeking out services at our UMass Amherst Center for Counseling and Psychological Health (70-80 new requests for service weekly during the academic year), having a rapid system to immediately evaluate students for level of care is a critical component of our overall service delivery plan. With increasing flow into counseling services at most universities nationally, and in concert with increasing acuity and a decrease in stigma, it is critical that universities have immediate ability to assess students and match appropriate services to their individual needs.
At the University of Massachusetts Amherst we developed a system for rapid clinical triage of all new referrals that has become a national model. We feel that easy access to counseling is of the utmost importance. The director of CCPH has been consulted by literally dozens of universities and an article that he co-wrote about this with his counterpart from Cornell has been widely read and cited (Rockland-Miller, H & Eells, G. (2006). The Implementation of Mental Health Clinical Triage Systems in University Health Services. Journal of College Student Psychotherapy, Vol 20(4), 39-51).
When a student calls our counseling service, they are immediately asked, “Is this an emergency?†If a student self-identifies as an emergency. or if a member of our staff or faculty identifies a student as being an emergency, they are immediately routed to our on-call crisis clinician. The university maintains crisis availability 24/7. For those who do not identify as an emergency, they are given a rapid telephone screening generally the same day. In this screening there is information gathered about basic demographics, a series of open-ended questions about what is leading the student to call, including a series of critical items looking at issues such as past and present treatment, current suicidal ideation, history of suicide attempt, medical co-morbidity, substance abuse, eating disorders, current medications, etc. By the end of this screening the clinician is able to sort students into one of three levels of care: emergency, urgent or routine. Emergencies are seen immediately. Students screened at the urgent level of care are seen within 48-72 hours for a full, complete face-to-face assessment and routine appointments are seen as quickly as possible. In our last study of this, our mean from triage to full intake for those at the routine level was 9 days.
While no system is perfect, this system of rapid evaluation has allowed us to effectively get students to where they need to be as quickly as possible. Emergency people are seen immediately. All people who are urgent or who are quite distressed are seen very rapidly and other students are seen quickly but with a little more breathing room. With upwards of nearly 80 new patients coming to our service a week, we have great pride in our ability to rapidly and efficiently respond to the varying levels of needs of the students seeking our services.
In addition to the immediate screening of all new students coming to our service, our Center for Counseling and Psychological Health engages in a wide range of other activities. These include an array of individual and group psychotherapies, availability of medication services, extensive community consultation, community workshops on a wide range of mental health related activities, Gatekeeper suicide prevention training as well as a comprehensive training program for social work and psychology interns.
More than “competentâ€, our services are at the highest level of professional standards. We take great pride in these services and their extensive involvement in our community as a whole.
Vice Chancellor, thank you for your thoughtful and timely response to this concern. I hope you also reached out personally to the student in your charge, to help them access the services made available to them through your organization.
When faced with criticism or constructive feedback, good organizations accept the criticism or feedback and look at the ways their system may have failed that specific individual case. Why?
Because if they’ve failed one case, it’s quite likely they’ve failed more than one (since very few people feel comfortable in speaking up in public about their mental health concerns — much less in a student newspaper).
So while I appreciate your university apparently has a state-of-the-art triage system, it appears to be very sensitive to people who are primarily in crisis or say some sort of set of magic words that gets them to the head of the line. At the very least, it appears to need some tweaking, as this case illustrates that unless you apparently scream, “I’m suicidal,” care will not be quickly forthcoming.
Here you have a story of a student who was lost, suffering from depression, and needed help. She didn’t get any kind of immediate help. Instead she got put on a wait-list, and an appointment was given to her for weeks after she called.
Then when she did get an appointment, it appears the counseling she received was at a level consistent with what we might see from a first-year graduate student offering therapy. I’d even go so far as to say that if the student’s account of what she experienced is accurate, the advice given by the therapist borders on the incompetent. Therapists, after all, aren’t even supposed to give advice.
I know student mental health remains a pretty low priority for most university campuses. It’s an area of necessary expense that universities work to keep as low as possible, since it ultimately eats into their bottom line and their primary mission of educating people. But if those people need mental health help, a university should be minimally equipped to provide it, without a 3 or 4 week waiting period.
I think it’s great your center can handle 80 new patients per week… But in this case, one student fell through your system. And where there’s one, I suspect there’s a lot more than one. Whether it was intentional or not, it obviously resulted in more harm coming to that individual than there needed to be.
And that’s an area for improvement.
As a student who has used campus resources, and who is involved in advocating for them (and their improvement), my experience is that:
a) students need access to professionals who are not trainees, while training facilities are important, access to expertise for mental health really needs to be there
b) I found I got MUCH better care going the medical route than the student counselling route. Student counselling – 2 week wait, appts every two weeks, seen by someone in training whose practicum ended 3 months in. To be fair, wait times have since improved, as have linkages with dr. Through the health system (public): I got an immediate psychiatric referral, ongoing treatment and was taken seriously.
Fortunately, all of these services entailed no cost on my end, and all were nearby, all were kind and helpful. It’s just a really needed to see someone with expertise – and a psychiatrist could do that, a psychologist-in-training who was unfamiliar with my condition, couldn’t.
I think it would be really useful to have focus groups of patients who have used these services to give input and help improve them. We’re really on the same side, we see how much these services are needed and want them to be there for others.
Shoot me if you will, but there are a couple of thoughts I have that may be a little less damning of the institution. As someone who has had problems with depression, and seen different professionals, I know that a person- appropriate level of response is not guaranteed anywhere, including with therapists in private practice, or at Mental Health Clinics dedicated to providing such services. In her column itself, Ms Merlino says that 1 in 3 college students suffer from depression – which seems an astounding number – one that colleges and universities would have a major problem dealing with. Most universities etc do not have a “bottom line” in the usual sense in that they are not profit driven. It would seem to me that screening and referral – is the major responsibility of a college counseling service – and clearly should be done quickly, with sensitivity (which she did not get). But going beyond this one story – how much mental health services can be incorporated into the major mission of a university? It doesn’t seem to me that it could include regular ongoing therapy and treatment for serious conditions, which are medical, not educational issues.
The issue of using trainees or interns: it is part of the learning and qualifying for degrees and licensing. Technically well credentialed people aren’t always the best in practice, either.
To repeat, I am someone who uses mental health services. This just set me thinking about whether an educational institution can or should be a major provider of treatment services.
Hi everyone,
As this is my original article, I have few points to make.
To Dr. Kim: I found it quite interesting that you sought this particular article out when the original article was published in the school paper. That would be much more appropriate, no? Additionally, please let me assure you, this is by no means inaccurate and it is frankly irresponsible of you to portray this article as such. Again, I question why you chose not to comment on the original article on The Daily Collegian’s website, as you would have the chance to see actual student’s opinions on this matter.
I have received many emails from fellow students that faced the same substandard treatment I did. I find it troubling that you chose to go on the defensive instead of actually looking into this and developing a better system for UMASS’ students.
To Oldblackdog: You bring up a very interesting point. I think that it is a university’s responsibility to provide decent treatment to a student. For example, would you use the same argument if a student came down with pneumonia and received substandard treatment at the university’s health care clinic? I personally wouldn’t, but that’s my opinion.
Thanks for everyone’s interest in my story. I’m very flattered and hope everyone enjoyed my article.