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November 19, 2013

Student Health Series Part III: Counseling and Mental Health

This is the third installment of a quarter-long series on student health care, the second of which can be read here and the last of which will be published December 3. Where only first names appear, names have been changed to protect the privacy of the sources. 

During the 2012–2013 school year, Student Counseling Service (SCS) saw approximately 2,500 students, or 18.4 percent of all eligible students, according to SCS Director David Albert. Stanford and Northwestern’s SCS equivalents saw 14.5 percent and 11 percent of their eligible students respectively.

Albert said that overall utilization rates of SCS have remained constant over the last few years, but the rate of emergency walk-ins has doubled since 2007–2008. Albert believes this may reflect general trends in mental health of college students over the last decade. In the 2010 National Survey of Counseling Center Directors, 44 percent of students had severe psychological problems, versus 16 percent in 2000.

According to the 2012 Association for University and College Counseling Center Directors Annual Survey, the SCS’s utilization rate is more than double that of the average school of the same size. And yet, third-year Marcus Perez said that when he went to SCS, he did not know much about it.

“I guess I thought that SCS wasn’t a very widely used resource, just because no one seemed to talk about it,” he said.

Third-year Himabindu Poroori, who started going to SCS at the beginning of this year, believes that students are often afraid to admit they use the mental health services.

“When I first came out about [going to SCS], dozens of people came out and started talking to me about Student Counseling Services,” she said. “I want us to talk about the SCS the same way that we talk about going to the [Student Health Service] for a broken arm.”

Beyond the services themselves, Poroori said that the culture of “I spent all night at the Reg” or “I haven’t slept in a week and a half” tends to trivialize stress and other mental health concerns brought on by academic pressure.

“People are too scared to talk about the more real stuff that happens to a lot of them,” she said. “I mentioned recently on Facebook that I missed a midterm because I slept through it. And like a 100-something people were like, ‘I feel your pain. I’ve been through shit like that.’ People withdraw [from classes]. People drop classes. People take quarters off. Things like that need to be destigmatized.”

Other students agreed that the rigorous academic culture contributed to their health issues, which were worsened by prevailing attitudes toward stress management.

“The culture of this University spiraled my eating disorder to the point that my life was entirely unmanageable,” sixth-year Christina Pillsbury said.

SCS operations

A student’s first visit to SCS is an intake appointment, during which a therapist will determine with the student what kinds of treatments would be most helpful. SCS will provide short-term psychotherapy, which typically consists of one to 10 sessions and is covered by the Student Life Fee, the sole source of the SCS budget. If the student needs long-term therapy, the SCS will refer the student to another service in Chicago.

According to an opt-in e-mail survey conducted by SCS in October, more than 90 percent of respondents were either satisfied or very satisfied with every aspect of their SCS experience.

Short-term therapy

Mary, a third-year, went to Student Counseling Services her first year because she felt that she needed some help mediating stress as she transitioned into college life. Mary attended six sessions before she was told that she could not continue.

“It was like an ‘oh, by the way’ moment. It was so weird. I just felt sort of duped by that,” she said. “If you’re going to advertise yourself as a supportive, available, accessible student counseling services center, you should probably include on the poster, ‘We are this, but only for seven sessions, until we make you go somewhere else and pay for it privately.’”

Mary did not end up seeking treatment from an outside provider because of the time commitment required. “My life was already really, really busy. That was sort of the reason why I was seeing a counselor.”

Albert said that Mary's situation of being told this information at the end of her course of therapy “would be most unusual” and is not a common SCS practice.

Continuing concerns

Like Mary, Julia, a third-year, went to SCS for six sessions after struggling with an eating disorder and was told during her second-to-last session that SCS could no longer see her.

“It’s frustrating because after six sessions, you develop a trusting relationship with your psychologist, and after six sessions I finally got to that point, and they boot you out the door,” she said.

Afterward, Julia was referred to a free program at the University of Chicago Medical Center (UCMC) for students with eating disorders. She said she found the program’s method of therapy uncomfortable and ineffective because it required her to share her disorder with her family. At the time, she was not ready to be that open and just wanted one-on-one counseling.

However, she could not afford the co-pay associated with mental health services outside of SCS, so she went back to SCS’s website to investigate the possibility of starting a support group for students with eating concerns and found that there were two externs who were starting such a group.

SCS currently runs six support groups consisting of about four or five people like the one Julia joined. These include groups concerning coming out, social anxiety, and sexual assault.

SCS also runs a program called “Let’s Talk,” where a psychiatrist or psychologist holds walk-in hours every Monday, Wednesday, and Friday to talk to students anonymously. Over the last year, 113 students attended. Albert said that he plans on expanding this program as a way of connecting more students to SCS.

Despite the popularity of these services, Julia observed a lack of publicity for her group.

“If there was greater publication of the services and options, then a lot more students would get help,” she said.

Problems with referrals

In order to get help with her eating disorder, Pillsbury went to SCS during her second year. The counseling center referred her to a program at the UCMC that she later discovered was a research study. She discussed with her counselor the possibility of going to a different program downtown called Insight but was told that that program would be too inconvenient for her.

Pillsbury went ahead with the research study and was ultimately misdiagnosed and given insufficient treatment. She also found it difficult to get appointments with the researchers, and while trying to get help, her illness worsened, landing her in the ER. Pillsbury said in the middle of all of this, she was bounced around from counselor to counselor at SCS.

After her ER visit, she tried to make an appointment with Insight. The researchers told her she was unlikely to get an appointment at Insight any sooner than what they could give her. Yet when she called the program downtown, Pillsbury was able to get an appointment much sooner.

“It seemed as if [SCS and the researchers] just wanted me to be in the research study instead of actually caring about my health,” she said.

Julia thinks the challenges faced by SCS in helping students with mental health issues cannot be solved easily.

“This environment is so stressful,” she said. “It creates such anxiety that there’s going to be a presence of a lot of mental issues with students, and having puppies on the quad isn’t going to solve it.”

Editor’s Note: Christina Pillsbury is a former Maroon editor.

The Maroon is committed to understanding all aspects of student health care. If you or someone you know has experiences relating to health care on campus, please contact harinijaganathan@uchicago.edu. 

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