D.C. college counseling centers unable to tackle increased demand

Georgetown University's counseling center

Georgetown University’s counseling center

by Heather Mongilio

At 19, Georgetown University student Ben Saunders, now 21, noticed something was wrong with his brain. He had trouble with his academics, and the subjects he studied like Japanese or economics were difficult to recall.

Saunders went to the Counseling and Psychiatric Services, the counseling center at Georgetown University, where he was diagnosed with depression.

“For me, [being diagnosed with depression] was a relief, I guess,” Saunders said.

Saunders was one of the many students that visit the Counseling and Psychiatric Services, which is known as CAPS to the students, each year. The counseling center sees about 10 percent of the undergraduate student body each year, Asfin Nili, Psy.D., the assistant director for Outreach and Satellite Operations at CAPS, said. This is roughly equal to about 760 students as Georgetown’s population is 7,636, according to U.S. News and World Report.

As the demand for mental health services increases, colleges in D.C. are having trouble providing services. In 2014, 12.1 percent of students reported being diagnosed with depression, an increase from 10.7 the year before, according to the American College Health Association’s National Survey. There were also increases in anxiety, panic attacks and people who experienced both depression and anxiety.

While Georgetown provides long-term services, it cannot serve the entire population of the school, Nili said. American University and George Washington University cannot provide long-term services to their students because of the limited resources. The lack of on-campus services means students are forced off-campus or choose to not seek out services.

The 2013 National Survey of College Counseling Centers run by the American College Counselors Association found that 64 percent of college counselling center directs reported that their jobs were more stressful in 2013 than it had been in the past five years, with time constraints as the number one cause of the stress and budget concerns as the second.

“There needs to be more support for college counseling centers in terms of resources,” Nili said.

CAPS limited by resources

CAPS does not cap the amount of sessions for each student, Nili said. But the counseling center caps how many students they can see. If it was to see every student on a long-term basis, they would not be able to take any new students each year, he said.

“So here at CAPS, we have, basically, free evaluations for students,” he said. “It can be between one to two to three or longer, depending on each case, so we take it case by case.”

During the initial assessment, CAPS professionals determine if the student needs continuing services. If the student does, CAPS works with the student to determine the best course of therapy appointments, Nili said.

CAPS does not provide free appointments, but uses a sliding payment scale to help students pay for the services. The counseling center staff will also help connect students with outside resources that can help provide scholarships or financial help for services, Nili said.

However, the limited amount of slots for appointments means that students will have to wait a week or two to get an appointment, he said. Students are usually seen within a week, but when volume, such as during midterms or finals, picks up it could be two weeks, he said.

Wait times during this busy period are not unusual to colleges. According to the 2013 National Survey of College Counseling Centers, 35 percent of counseling centers had problems with wait times during certain period of times.

CAPS also offers group therapy sessions.

The center also offers two hours each day for priority cases and has an emergency page number for students to call. The center does not define what an emergency is, and instead, allows students to determine what an emergency is for them.

“We are basically available 24-7 for consultation,” Nili said.

But Saunders said the wait time for appointments can reach up to three weeks. Between the long waits and limited funding for CAPS, it isn’t practical for students to rely on CAPS as a long-term service provider, he said.

“I get a sense that a lot of students have negative opinions of the counseling center,” Saunders said.

Saunders is one of the co-founders of Georgetown’s Active Minds chapter. He is also currently serving on a student government committee to look at mental health services. While he is biased by hearsay, he said, he gets a feeling that CAPS is not good for many students.

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Problems across D.C. colleges

The problems that plague CAPS are not limited to Georgetown. These problems also affect American University’s Counseling Center and the University Counseling Center at George Washington University.

Approximately 1,100 students used the AU Counseling Center’s services from mid-May 2014 to mid-May 2015, according to Amanda Rahimi, Ph.D., the assistant director for Training at the Counseling Center. AU’s undergraduate enrollment is similar to Georgetown, with an undergraduate enrollment of 7,341, according to U.S. News and World Report.

The Counseling Center saw roughly 15 percent of the undergraduate body using Rahimi’s numbers.

The amount of students that use the center increases each year, Rahimi said. The increase in students seeking help from counseling centers is a national trend.

The increase and limited funding resources often result in long wait times, and the Counseling Center caps how many appointments students can have at the center. The Counseling Center is not meant to be used as a long-term service provider, Rahimi said.

“I think given the student demand, I think we do a good job with meeting with every student,” she said.

The wait times at the Counseling Center at AU can vary depending on each student, Rahimi said. Some will not have to wait, while others will wait a couple of weeks. In December, the average wait time for an initial assessment was three weeks, according to an article in The Eagle, the student-run newspaper at AU.

Students can be seen by a graduate psychology student, which can decrease the wait time. Students are also given the resources to go off campus if they do not want to wait for an appointment at the Counseling Center, Rahimi said.

AU’s psychology department also runs the James Gray clinic, which is considered to be an off-campus resource because it is a community clinic. The clinic is more affordable for students, Rahimi said.

GW also offers short-term services for students with a cap at 12 sessions, according to the University Counseling Center website. According to the website, most students at GW need one to three sessions to get assistance, while others may use the maximum amount.

After students reach the limit for sessions at on-campus counseling centers, both AU and GW will help students find an off-campus service.

Georgetown will also help students find an off-campus service if they cannot use CAPS or wish to seek services outside of Georgetown, Nili said. Freshman and sophomores often choose to stay on campus, while older undergraduates and graduate students may seek off-campus services.

Georgetown also has adjunct professors that work in practices in DuPont, and the professors will work with students to make the services affordable, Nili said.

Off-campus problems

But going off campus can be challenging for students, Saunders said.

“I think it is not easy for students,” he said.

D.C. has more psychologists per capita than any other city, Rahimi said. Psychology Today, a psychology magazine verified more than 950 mental health professionals in the D.C., with prices ranging from as low as $20 to upwards of $200 or more.

But while there are many options available in D.C., students are busy so going off-campus may be more of a challenge than going to appointments on campus, Saunders said.

Transportation can also be an issue, Rahimi said.

Kristie Chua, a student at AU, said she used the school’s Counseling Center until she finished all of her sessions. She did not pursue services off campus because she will not be staying over the summer and she did not want to find an off-campus psychologist for a short period of time, she said.

However, if she had decided to pursue off-campus resources, she said the Counseling Center would have helped her find someone. During her sessions, she was matched with multiple places off campus.

The cost factor also made her shy away from seeking off campus help. Services are expensive, she said. Mental health services can cost anywhere from $100-$5,000 out of pocket, according to a 2012 Washington Post article.

The AU Counseling Center will work with students to find match them with services that work in their price ranges. Costs can vary depending on what insurance a student uses, whether it is the school insurance or a private insurance.

When students seek out off-campus services, the staff member will talk about concerns with the student, such as reasonable costs. But off-campus therapy is very accessible for those who want it, Rahimi said.

“It’s students wanting to take the first step,” she said.

Parental stigma

Chua has not told her parents she was seeking mental health services, partly because of the stigma associated with mental health, she said. It can be a problem to convince parents to pay for services, she said.

Those who do not tell their parents might try to take on the payment themselves or choose to not seek services in order to avoid telling their parents, Chua said.

Nili has also heard this complaint from students at CAPS, he said.

The stigma can also convince students from seeking services, Emily Cepla, the program director of the Child and Adolescent Advocacy Center in the National Alliance on Mental Illness, said.

People are afraid of seeking services, mainly due to the stigma associated with mental health, Cepla said.

At AU, students often feel that they should be able to handle everything, Rahimi said, and asking for help is thought of as weak. This type of stigma is hard to overcome, she said.

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