Mental Health and Counseling University Wide Committee
2015-2016 Student Report
Dear Graduate and Professional Students,
The Mental Health and Counseling (MHC) committee meets several times each semester to address the ongoing concerns of the student body as they relate to mental health services. The committee is composed of the directors of Yale Health and MHC and representatives from GPSS and GSA. The student representatives of this committee have compiled this report to answer commonly asked questions and to provide updates on the committee’s work. Our 2015-2016 report includes:
- Hiring Updates
- Wait Times
- Session Limits
- Rider Program
- Diversity Training
What is MHC?
Yale Mental Health and Counseling is a department of Yale Health that addresses the psychological health and well being of Yale students. Counseling and treatment at MHC is free for all students, regardless of whether they have waived hospitalization/specialty care coverage. MHC employs psychiatrists, clinical psychologists, and clinical social workers to engage students in a variety of modalities, including one-on-one counseling, group therapy, and medication management. Each year, a quarter of graduate and professional students use MHC services. While most students require only short term care, MHC is also committed to caring for students with long term needs.
Hiring Updates and Future Goals
MHC currently consists of 29 staff, including 5 Psychiatry residents and 2 post doctoral psychologists. In 2014-15, the MHC staff count was 26, constituting a gain of three staff members this year. MHC hired two full time clinicians in the past year and is actively recruiting for two more positions (MD and Psychologist). Renovations of additional office space to handle the increased volume will be completed the summer of 2016.
One of the most common concerns students have about MHC is the time they spend waiting to meet with a provider after their intake visit. When a student contacts MHC for the first time, the department is committed to seeing that student within one to four days for their intake visit. At the intake visit, the counselor will gather information and assess the severity of the student’s need. While this visit may result in some initial counseling, the primary purpose of this visit is to triage in order to ensure that students with the most severe needs are seen first. Based on this assessment, the student is then scheduled for their first visit. During the 2015-2016 academic year, nearly 2900 students were seen, reflecting an 11% increase over the 2014-15 school year. Students with urgent and immediate problems start therapy without waiting at all. For elective therapy, MHC aims to keep to within two weeks from time of initial evaluation appointment to connection with a therapist. Looking at monthly averages for the past two years, MHC has been able to reduce this time by about a third to a half. In 2015-2016, nearly half of all students – including those with acute situations – were connected without delay, an additional 35% were connected within two weeks, and the remainder was connected within five weeks. In 2014-2015 there were six months in which the average was slightly or significantly longer than two weeks. In 2015-2015, there was only one month that was significantly out of range (December 2015), and a second month that was only very slightly above 14 days (November 2015). Holidays are an important factor influencing waiting times in these months. All students who are not immediately connected with a therapist are offered group sessions. If their condition worsens or changes, they can also contact the person who saw them for initial evaluation.
Another common concern that students have about MHC is the concept of “capped” appointments, i.e. a limit on the number of appointments a student can have in a given semester or year. There is no policy within the department to cap the number of visits a student may have. Appointments are scheduled at the clinician’s discretion in collaboration with the student based on need. Most students who visit MHC require short term care, and have roughly six to eight appointments. However, MHC is dedicated to serving students with longer term needs, including medication management. Thus, the official policy of MHC does not limit a student’s visits if that student has demonstrated need.
Mental Health Rider Program
MHC investigated the possibility of a rider program for Mental Health. The wraparound program would help students who wanted to go outside of Yale for care and would not be a replacement for the current Mental Health services offered through Yale Health. Unfortunately, both Aetna and United were unwilling to consider such a wraparound program. MHC then contacted Magellan, who is the provider for the employee plan, in order to discuss the pricing for a possible wraparound program. Magellan initially offered a plan that would cost $200 more in premiums plus co-payment costs and would require students to meet medical necessity criteria, which means students would need to be given diagnoses in order to receive treatment (an unpalatable option for many who may not want to carry certain diagnoses for acute situations). The result was that this option would add approximately $1.2 million to the cost of Yale Mental Health each year, and Yale already spends more on Mental Health than any of our peer institutions. Ultimately, Magellan reconsidered and decided they would not be willing to provide a wraparound program to Yale G&P students.
Diversity Training and Recruitment
All staff receive diversity training which is overseen by Dr. Howard Blue, and includes didactic teaching as well as case conferences. In their first year, all staff members must participate in Dr. Blue’s monthly seminar on diversity. This program will continue with updates on the training in response to increased focus on diversity. One of MHC’s newly hired clinicians has extensive experience in training health professionals for cultural competence. This staff member will work with Dr. Blue to develop additional seminars and workshops for clinical staff in the coming year. In addition to regular programming, at the end of the 2016 spring semester, the MHC staff participated in a webinar looking at psychological issues among African American male university students. The department anticipates participating in additional webinars in 2016-2017. Each year MHC also has the cultural house deans present at MHC Grand Rounds. They discuss perspectives on students’ interests and concerns.
In addition to increased training, the 2016-2017 MHC clinician group is more diverse. Forty percent of MHC staff are African American, East or South Asian, or Hispanic. MHC also has therapists from international and/or immigrant backgrounds; LGBTQ; first in the family to attend college; and various religious heritages (Christian, Jewish, Muslim and Hindu). In addition, 2/3 of current clinicians are female. Students are allowed to request a staff member of a preferred ethnicity with whom they would identify (in addition to other preferences). MHC will honor these requests to the best of their ability, but due to practical limitations, these requests cannot be guaranteed. There is also continued emphasis on staff recruitment of minorities and the underrepresented. One of the two most recent hires identifies as a minority.
Communications with Provider
One of the most important aspects of a successful counseling or treatment plan is communication. The MHC department does not use MyChart, which allows students to electronically communicate with providers, due to mental health-specific privacy concerns. The department has piloted a web-based secure messaging system for scheduling by email. Currently, the best way to get in touch with your provider remains by telephone, but by fall semester, all MHC clinicians will be able to offer secure email scheduling.
If a student is, for whatever reason, unhappy with their experience at MHC, the student has several options. First, if the issue is limited to the provider, the student is encouraged to discuss their concerns with their provider. Concerns about a clinician can also be directed to Dr. Howard Blue via the MHC reception desk. This is the way for students to request an alternate provider if they so desire.
Students who are unhappy with their experience at MHC have outlets outside of the department to address concerns. The Member Services department at Yale Health assigns patient representatives to investigate and resolve potential issues. Member services can be reached at 203-432-0246 or email@example.com. The Patient Representative in Members services can be directly reached at 203-432-8134. More information can be found at the Member Services website, http://yalehealth.yale.edu/memberservices.
Students can also notify MHC of a concern via the MHCstudentassistance@yale.edu email address.
The students on this committee are dedicated to accurately representing and advocating for the student body, and are happy to field any questions, comments, or complaints about MHC. Please feel free to contact any member of the MHC committee directly via email, or provide suggestions and log complaints anonymously at https://yalesurvey.qualtrics.com/SE/?SID=SV_a2C5pAHX6KVxVZ3
Will Culligan, MD/PhD
Ann Jacob, Divinity
Alicia Steinmetz, GSAS
Jack Zhao, Medicine