Students See Difficulties In Getting Mental Care

Following a turbulent summer at home, one Harvard student says she is taking the advice of a high school guidance counselor and is seeking out professional help at Harvard. But she is not likely to find the kind of long-term care she had in high school.

The University leaves students like this female undergraduate, who wants counseling but have not been clinically diagnosed as needing it, without limited options. Neither the University Health Services (UHS) mental health unit nor the Bureau of Study Council, Harvard's two professional counseling centers, cannot provide ongoing, long-term care for such students.

The University's policy runs counter to what some mental health experts believe is best for young people. For some undergraduates, the short-term, preventive care Harvard limits itself to may not be enough, says Dr. Robert Y. Berlin, the director of mental health at Brandeis University.

"[Counseling] is one of the only relationships during the course of college years with a neutral adult where someone gets to think about and work through their decision making without judgment or influence," Berlin says.

Brandeis offers students free, long-term psychotherapy for all four years to any student who requests help, he says. "We have a health model here and it is perceived as an emotional accom- paniment to education," says Berlin, who heads a staff of 19 psychologists and social workers.

Of the 3,400 students enrolled at Brandeis, 550 receive counseling on a regular basis and 50 percent have seen a therapist by the time they graduate. At Harvard, 12 percent of the student body sees a therapist by graduation, according to Dr. Randolph Catlin, director of UHS's mental health service.

"To have [therapy] all contained here would require that we have to hire a lot of people," Catlin says.

According to Catlin, Harvard students who want care still have options. They are either referred to outpatient departments in Cambridge and Boston hospitals or given "ongoing therapy"--on average, five irregular appointments with UHS psychologists.

Students using the "ongoing therapy" approach do "not feel that they are in treatment," Catlin says.

"The kind of issues students come for don't require long-term therapy," he says. "We don't have the time to allocate to see somebody on a regular basis."

The doctor adds that while students can be seen as long as they want, it is difficult to give therapy from within UHS.

Their only other option, though, is referrals to hospitals, which can cost students anywhere from $50 to $100 per visit.

Catlin highly recommends the Bureau of Study Counsel for undergraduates who cannot afford to pay for counseling on a regular basis.

Suzanne Repetto, the bureau's associate director, says her group is well prepared to provide short-term therapy.

The bureau offers a wide range of support groups and care, in addition to some one-on-one counseling. In case of severe psychological problems, referrals are made to UHS.

"We are treating people as human beings and our hope is that we support people in taking care of themselves," Repetto says. "We are teaching [students] not to be dependent on somebody else."

Cost Issues

Both University officials and students must decide whether increased mental health care is worth the fiscal costs, according to Brendan A. Maher, Henderson professor of psychology of personality.

"All of us ought to probably think through dispassionately what are the range of things in a student's life...in which the University has a duty to deal," Maher says.

Maher sees a need to "divide genuine mental health from the normal ups and downs of life." He says this division can be made through "a definable index of improvement."

Like Harvard, Boston University treats students solely on a short-term care basis.

"A crisis doesn't last a year," says Leah Fygetakis, the director of B.U.'s counseling center. "You would be amazed at how much work can be done in a short period of time. Most students get the result by the time they end [and] where we think [short-term care] might not be beneficial, we explain to the student."

But Maher says there is a danger to therapists telling patients that further care is not necessary.

"The diagnosis could be used as an excuse for avoiding responsibility," he says.

For his part, Berlin believes mental health is key to education and should be provided at all costs.

"I don't see any reason why a large institution can't take on those responsibilities," he says. "I think it is a commitment to students."

Visibility

Catlin says mental health services depend on word-of-mouth, and, at Harvard, such services suffer from a lack of visibility.

Because of the health service's lack of visibility, Catlin says he doesn't really know how many students the mental health unit should be serving.

Repetto says few students know when they first approach a health professional that they need long-term care.

"How would you know that you want to talk to somebody for four years when you first walk in?" she says.

But Berlin says short-term care is often endorsed by therapists who are constrained by fiscal decisions.

"Most of the [short-term care] come[s] out of bureaucratic necessity and not clinical mandate," Berlin says. "There is just not enough time."Crimson File Photo

Of the 3,400 students enrolled at Brandeis, 550 receive counseling on a regular basis and 50 percent have seen a therapist by the time they graduate. At Harvard, 12 percent of the student body sees a therapist by graduation, according to Dr. Randolph Catlin, director of UHS's mental health service.

"To have [therapy] all contained here would require that we have to hire a lot of people," Catlin says.

According to Catlin, Harvard students who want care still have options. They are either referred to outpatient departments in Cambridge and Boston hospitals or given "ongoing therapy"--on average, five irregular appointments with UHS psychologists.

Students using the "ongoing therapy" approach do "not feel that they are in treatment," Catlin says.

"The kind of issues students come for don't require long-term therapy," he says. "We don't have the time to allocate to see somebody on a regular basis."

The doctor adds that while students can be seen as long as they want, it is difficult to give therapy from within UHS.

Their only other option, though, is referrals to hospitals, which can cost students anywhere from $50 to $100 per visit.

Catlin highly recommends the Bureau of Study Counsel for undergraduates who cannot afford to pay for counseling on a regular basis.

Suzanne Repetto, the bureau's associate director, says her group is well prepared to provide short-term therapy.

The bureau offers a wide range of support groups and care, in addition to some one-on-one counseling. In case of severe psychological problems, referrals are made to UHS.

"We are treating people as human beings and our hope is that we support people in taking care of themselves," Repetto says. "We are teaching [students] not to be dependent on somebody else."

Cost Issues

Both University officials and students must decide whether increased mental health care is worth the fiscal costs, according to Brendan A. Maher, Henderson professor of psychology of personality.

"All of us ought to probably think through dispassionately what are the range of things in a student's life...in which the University has a duty to deal," Maher says.

Maher sees a need to "divide genuine mental health from the normal ups and downs of life." He says this division can be made through "a definable index of improvement."

Like Harvard, Boston University treats students solely on a short-term care basis.

"A crisis doesn't last a year," says Leah Fygetakis, the director of B.U.'s counseling center. "You would be amazed at how much work can be done in a short period of time. Most students get the result by the time they end [and] where we think [short-term care] might not be beneficial, we explain to the student."

But Maher says there is a danger to therapists telling patients that further care is not necessary.

"The diagnosis could be used as an excuse for avoiding responsibility," he says.

For his part, Berlin believes mental health is key to education and should be provided at all costs.

"I don't see any reason why a large institution can't take on those responsibilities," he says. "I think it is a commitment to students."

Visibility

Catlin says mental health services depend on word-of-mouth, and, at Harvard, such services suffer from a lack of visibility.

Because of the health service's lack of visibility, Catlin says he doesn't really know how many students the mental health unit should be serving.

Repetto says few students know when they first approach a health professional that they need long-term care.

"How would you know that you want to talk to somebody for four years when you first walk in?" she says.

But Berlin says short-term care is often endorsed by therapists who are constrained by fiscal decisions.

"Most of the [short-term care] come[s] out of bureaucratic necessity and not clinical mandate," Berlin says. "There is just not enough time."Crimson File Photo