Should Universities Have Mental Health Facilities

[Puget]

ETA: If there had been no mental health faculty on campus, Mamselle would have escorted the student to an emergency room. I think just about any of us would.

Except I don't own a car, and the nearest hospital in each case was over a mile away.

I doubt if I could have gotten an hysterical student to walk that far with me through the urban landscape without bolting, or worse.

M.

Mamselle also posted this marshwiggle.

This is like my example of emergencies on planes. The fact that "something happened that would have turned out differently had not X been available" is a bottomless pit. The frequency of those incidents has to be considered to make sane policies.

Not rare. I have also multiple times walked students to the counseling center, or activated the care team after hours. I just the other day had a colleague email me with a student in crisis in their office asking what to do and was able to walk him through contacting the care team.

You keep coming up with false analogies to try to show that mental health services aren't needed on campuses. My question is why? Why not complain about spending money on sports that most students won't engage in, or any number of other things that "aren't central to the academic mission"? Why is this the thing you are picking to decide campuses shouldn't provide? Because it seems a whole lot like stigmatizing mental illness to me.

[Wahoo Redux]

I think you work on a campus, Marshy.  Maybe Canadians have better mental health than Americans (which wouldn't surprise me at all) but I suspect your counseling centers are always in business.  Every campus I have ever been on has multiple referrals to mental health professionals.

I also worked at a corporate headquarters for a national company.  We had 5,000 people in several buildings downtown.  And we had in-house mental health professionals working for the company.  They had an office somewhere on-site.  I never availed myself of them in person, but they did multiple workshops, some of which I attended.

Having shrinks nearby any big population is probably a good idea...and this discussion is maybe convincing me to vote.

[mamselle]

A discussion on the retention thread makes some convergent points....

M.

[marshwiggle]

This is like my example of emergencies on planes. The fact that "something happened that would have turned out differently had not X been available" is a bottomless pit. The frequency of those incidents has to be considered to make sane policies.

Not rare. I have also multiple times walked students to the counseling center, or activated the care team after hours. I just the other day had a colleague email me with a student in crisis in their office asking what to do and was able to walk him through contacting the care team.

You keep coming up with false analogies to try to show that mental health services aren't needed on campuses. My question is why? Why not complain about spending money on sports that most students won't engage in, or any number of other things that "aren't central to the academic mission"? Why is this the thing you are picking to decide campuses shouldn't provide? Because it seems a whole lot like stigmatizing mental illness to me.

If you noticed, my answer to the poll was "maybe, kinda"; not "No". My point is that there is a realistic limit to what services can be expected to be dealt with on-campus, (unless there is a medical school and hospital), and the fact that there is an occasional situation requiring more care than can be provided on-campus illustrates when it's time to make a referral to more appropriate facilities that have more resources than could be expected to be available on campus.

[mahagonny]

Having shrinks nearby any big population is probably a good idea...and this discussion is maybe convincing me to vote.

You can believe this if you want. Your school administration does not. Ask your adjunct faculty how they meet their health care needs.
How about making the more mentally unstable students attend class from home on zoom? That way the breakdown doesn't happen in your vicinity.

[Puget]

This is like my example of emergencies on planes. The fact that "something happened that would have turned out differently had not X been available" is a bottomless pit. The frequency of those incidents has to be considered to make sane policies.

Not rare. I have also multiple times walked students to the counseling center, or activated the care team after hours. I just the other day had a colleague email me with a student in crisis in their office asking what to do and was able to walk him through contacting the care team.

You keep coming up with false analogies to try to show that mental health services aren't needed on campuses. My question is why? Why not complain about spending money on sports that most students won't engage in, or any number of other things that "aren't central to the academic mission"? Why is this the thing you are picking to decide campuses shouldn't provide? Because it seems a whole lot like stigmatizing mental illness to me.

If you noticed, my answer to the poll was "maybe, kinda"; not "No". My point is that there is a realistic limit to what services can be expected to be dealt with on-campus, (unless there is a medical school and hospital), and the fact that there is an occasional situation requiring more care than can be provided on-campus illustrates when it's time to make a referral to more appropriate facilities that have more resources than could be expected to be available on campus.

This is already what happens!. Seriously, I've said this multiple times-- campuses refer any time there is need for in patient or even partial hospitalization intensive care. They aren't doing that themselves. They don't want to do that themselves. No on is suggesting that they do that. This is a total straw-man.

That does not mean that you don't still need someone on call 24/7 for emergency responses-- it's the difference between having an EMT response and a trauma-1 hospital. Even small towns have EMT services- they transfer patients that need it to the city with the trauma-1. Universities are like small towns-- they need to do the emergency services and routine care, they transfer out for everything else.

[research_prof]

The question you should be asking is what does the overall US healthcare system do about mental health? And the answer is nothing unless you have enough money to pay them in the same way as it is the case with physical health. In other words, universities can do everything in their power to help their employees and students with mental health, but the matter of fact is that  students will not always be affiliated with a university (the same applies to employees). Also, university populations are a small percentage of the overall population in the US. So, that's why the right question to ask is "does this healthcare system do anything about mental health?". And, of course, the answer is "no".

[mamselle]

Just to clarify...

1) In both cases I cited, I was an adjunct. I had taken the time and trouble to learn about student healthcare options as soon as a student presented with possible issues because, when I was a student, those who recognized what I was going through in my abusive marriage had done so, and probably saved my life by helping me figure out the best, healthiest ways of dealing with things. (I didn't even know until much later that some of them knew, or did this; they let me take incompletes and were in touch with each other because they were concerned about me, let me counsel with them in their offices, etc.).

So, not only does it happen to others, like 'students,' it happens/has happened to those of us among you.

It's not an abstract what-if, it's a real thing.

2) There seems to be, still, some underlying idea that mental illnesses are some kind of student ploy for malingering. Yes, fine, anyone can be suspicious of such games, and those do, also happen. But I'd rather err on the side of consideration and kindness than on the side of penny-pinching suspicion, blowsy self-righteousness, and meanness. In any one year, in a town with several universities, I am only subliminally aware of, say, 5-6 student suicides. There may be more.

Obituaries and articles about those events suggest that at some point, many of those students sought help and were "referred" out, or were waiting for an appointment, or had tried to get help but were considered to be 'faking it.'

They were not.

3) If we can pay for upper-admin's bloated salaries, football teams' flights to off-site games, and extensive campus horticulture, we can find the money for student health care, including mental healthcare. I will be the first to recognize the limits and some of the inanities such a system can develop (I've described elsewhere my 6-block trek in the snow, with a broken rib, twice, to get X-rays because there was an off-site outsourced radiologist who was given the wrong film order) but the issue there was a lack of competent referral care; better, not worse, care would have solved that.

Life happens.

We need to be compassionate, and count the cost later.

M.

[marshwiggle]

If you noticed, my answer to the poll was "maybe, kinda"; not "No". My point is that there is a realistic limit to what services can be expected to be dealt with on-campus, (unless there is a medical school and hospital), and the fact that there is an occasional situation requiring more care than can be provided on-campus illustrates when it's time to make a referral to more appropriate facilities that have more resources than could be expected to be available on campus.

This is already what happens!. Seriously, I've said this multiple times-- campuses refer any time there is need for in patient or even partial hospitalization intensive care. They aren't doing that themselves. They don't want to do that themselves. No on is suggesting that they do that. This is a total straw-man.

Great! Then we don't necessarily disagree.

That does not mean that you don't still need someone on call 24/7 for emergency responses-- it's the difference between having an EMT response and a trauma-1 hospital. Even small towns have EMT services- they transfer patients that need it to the city with the trauma-1. Universities are like small towns-- they need to do the emergency services and routine care, they transfer out for everything else.

The "24/7" on-call requirement may mean different things to different people.

• Many communities have those sorts of crisis lines in place, available to anyone.
• A campus-based crisis line may still be staffed by trained volunteers working from home, not requiring a physical presence on campus.
• The most expensive option is a 24/7 on-campus facility, staffed by mental health professionals.

I think most of the debate is around whether or not campuses need the last option, which will be very expensive and possibly under-utilized, especially considering how many cases could be adequately handled by either of the other two options.

[Puget]

If you noticed, my answer to the poll was "maybe, kinda"; not "No". My point is that there is a realistic limit to what services can be expected to be dealt with on-campus, (unless there is a medical school and hospital), and the fact that there is an occasional situation requiring more care than can be provided on-campus illustrates when it's time to make a referral to more appropriate facilities that have more resources than could be expected to be available on campus.

This is already what happens!. Seriously, I've said this multiple times-- campuses refer any time there is need for in patient or even partial hospitalization intensive care. They aren't doing that themselves. They don't want to do that themselves. No on is suggesting that they do that. This is a total straw-man.

Great! Then we don't necessarily disagree.

That does not mean that you don't still need someone on call 24/7 for emergency responses-- it's the difference between having an EMT response and a trauma-1 hospital. Even small towns have EMT services- they transfer patients that need it to the city with the trauma-1. Universities are like small towns-- they need to do the emergency services and routine care, they transfer out for everything else.

The "24/7" on-call requirement may mean different things to different people.

• Many communities have those sorts of crisis lines in place, available to anyone.
• A campus-based crisis line may still be staffed by trained volunteers working from home, not requiring a physical presence on campus.
• The most expensive option is a 24/7 on-campus facility, staffed by mental health professionals.

I think most of the debate is around whether or not campuses need the last option, which will be very expensive and possibly under-utilized, especially considering how many cases could be adequately handled by either of the other two options.

No one has the last option. You keep using "facility" as if campuses had in patient treatment facilities. They do not. On call means on call-- call the number, get a clinician. Student life staff are on campus because they live on campus-- that is literally their job anyway. Seriously, whatever you are imagining is not reality.

[Caracal]

The question you should be asking is what does the overall US healthcare system do about mental health? And the answer is nothing unless you have enough money to pay them in the same way as it is the case with physical health. In other words, universities can do everything in their power to help their employees and students with mental health, but the matter of fact is that  students will not always be affiliated with a university (the same applies to employees). Also, university populations are a small percentage of the overall population in the US. So, that's why the right question to ask is "does this healthcare system do anything about mental health?". And, of course, the answer is "no".

Yes, and that gets to the basic problem with this discussion. It could be true that universities aren't well set up to provide mental health services to students. (I don't know if I actually agree with that argument, but it doesn't seem absurd to me) However, what's the alternative? If there was easy and free access to these services unaffiliated with the university that students could access, that would be great. But that system doesn't exist. So, what should schools do? Just not provide these services and have students not get the help they need?

[jimbogumbo]

ETA: If there had been no mental health faculty on campus, Mamselle would have escorted the student to an emergency room. I think just about any of us would.

Except I don't own a car, and the nearest hospital in each case was over a mile away.

I doubt if I could have gotten an hysterical student to walk that far with me through the urban landscape without bolting, or worse.

M.

Mamselle also posted this marshwiggle.

This is like my example of emergencies on planes. The fact that "something happened that would have turned out differently had not X been available" is a bottomless pit. The frequency of those incidents has to be considered to make sane policies.

My sense is that it's happening enough that colleges and students think it is necessary. May I point out that students are awake in huge numbers late into the night?

[dismalist]

The question you should be asking is what does the overall US healthcare system do about mental health? And the answer is nothing unless you have enough money to pay them in the same way as it is the case with physical health. In other words, universities can do everything in their power to help their employees and students with mental health, but the matter of fact is that  students will not always be affiliated with a university (the same applies to employees). Also, university populations are a small percentage of the overall population in the US. So, that's why the right question to ask is "does this healthcare system do anything about mental health?". And, of course, the answer is "no".

That doesn't seem to be correct.

As of 2014, most individual and small group health insurance plans, including plans sold on the Marketplace are required to cover mental health and substance use disorder services. Medicaid Alternative Benefit Plans also must cover mental health and substance use disorder services. These plans must have coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. One of those categories is mental health and substance use disorder services. Another is rehabilitative and habilitative services. Additionally, these plans must comply with mental health and substance use parity requirements, as set forth in MHPAEA, meaning coverage for mental health and substance abuse services generally cannot be more restrictive than coverage for medical and surgical services.

[marshwiggle]

As an aside, does anyone know what sort of legal liability (if any) is assumed by an organization offering "counselling"? Specifically, if a student calls a campus crisis line, and then goes on to self-harm, is the institution at risk if the family launches a lawsuit? Does it matter whether the line is staffed by volunteers or by paid employees?

[Caracal]

As an aside, does anyone know what sort of legal liability (if any) is assumed by an organization offering "counselling"? Specifically, if a student calls a campus crisis line, and then goes on to self-harm, is the institution at risk if the family launches a lawsuit? Does it matter whether the line is staffed by volunteers or by paid employees?

My understanding is that courts have held recently that the campus environment confers a responsibility on colleges to respond to foreseeable dangers. So, yes, if a student accessed mental health services and those services didn't react to foreseeable and clear dangers, a school could be liable. However, I think a school could also be liable if they failed to provide adequate mental health services for students.