Unmet demand

Students and public officials agree, demand for mental health care has outgrown University resources.

History senior Meg Hughes-Morrison does warm-ups during a choir ensemble rehearsal Wednesday, April 10, 2013, in Ferguson Hall. After struggling with depression during her freshman year, Hughes-Morrison was disappointed with the resources at Boynton and now meets with a therapist 25 minutes away from campus.

Emily Dunker

History senior Meg Hughes-Morrison does warm-ups during a choir ensemble rehearsal Wednesday, April 10, 2013, in Ferguson Hall. After struggling with depression during her freshman year, Hughes-Morrison was disappointed with the resources at Boynton and now meets with a therapist 25 minutes away from campus.

by Alma Pronove

She didn’t go to class. She wouldn’t turn the lights on. She couldn’t even get out of bed.

Meg Hughes-Morrison struggled with depression her first semester at the University of Minnesota.

Her grades suffered, and she stopped calling friends.

After some encouragement from her family, Hughes-Morrison went to see a therapist at the University’s Boynton Health Service’s Mental Health Clinic.

“I had this one day where I was feeling great, so I went in, and I tried to get an appointment,” she said.

But staff told her the next appointment was three weeks away. By that time, she was too depressed again to go.

She rescheduled three times and eventually withdrew from her spring semester classes.

Now a senior, Hughes-Morrison hasn’t felt depressed in three years, but students and staff still say the availability of mental health care remains one of the most pressing issues at the University.

Over the past decade, the demand for mental health services has steadily increased at the clinic, where three- to four-week waiting lists are commonplace.

One in 10 University of Minnesota students has been diagnosed with depression and, according to Boynton, more than a third of tuition refund requests are mental health-related.

The mental health clinic requested an increase in student services fees for six new full-time staff members — that would serve an estimated 800 additional students starting in 2014 — but only received partial funding.

Some policymakers in Minnesota are looking for ways to better mental health resources, but the state has cut more than $50 million to mental health programs since 2009, according to the National Alliance on Mental Illness of Minnesota.

Experts at the University and in the state say the demand for mental health care has outgrown the available resources, and without additional funding, that won’t change anytime soon.

Anatomy of a fees request

Finance and supply chain management sophomore Mike Schmit struggled with academic stress during his freshman year. He sought counseling through the University but met a four-week wait at the Boynton mental health clinic.

Schmit was so discouraged that he didn’t bother making an appointment.

“Obviously that’s not OK,” he said. “[The issue] will either iron itself out in four weeks, or you’ll be in a much worse place by the time you get your appointment.”

About 30 percent of students are dissatisfied with the clinic’s delays, according to the Healthy Minds Survey, which analyzed the University in 2012. Student dissatisfaction with scheduling delays is about 13 percent higher at the University than the national average.

On average, a student waits three to four weeks for a first-time visit, but delays fluctuate throughout the year, peaking at six weeks.

“In college time, that’s too long,” Hughes-Morrison said. “If you’re really struggling for three or four weeks, that time can totally wreck your grades.”

Because of her depression, Hughes-Morrison’s grades dropped. A Boynton study found students with mental illness perform slightly worse academically than their peers.

Boynton’s student services fees request would’ve shortened waitlists, officials said, but the Student Services Fees Committee only partially filled the request.

The clinic requested about $380,000 to help cover the cost of hiring six new staff members and eliminate the $10 co-pay for visits. The committee’s funding will eliminate the co-pay but only provide for four positions.

“The demand is there,” said Gary Christenson, Boynton’s Chief Medical Officer. “We know the demand will increase, and we’ve taken a more proactive approach this time instead of just reactive.”

Political science senior Kyle Olson, who chairs the SSFC, said committee members hoped the additional funds could be found elsewhere in the Boynton budget.

But Carl Anderson, Boynton’s Chief Operating Officer, said the clinic doesn’t have the money to fund the two positions.

Christenson, who was disappointed with the allocation, said the clinic doesn’t ask for separate funding increases often.

“We’ve been very judicious about not asking for big increases [in student fees] from Boynton,” he said, “but mental health really is the No. 1 public health issue on campus.”

Anderson said the clinic would re-evaluate waitlists at the end of the year and then decide whether to ask for more money next year.

“There’s no question that we could keep more providers very busy,” he said.

The University of Minnesota is currently one of only three Big Ten schools that bill students differently for mental health visits than physical health visits.

Students receiving mental health care from Boynton must pay a $10 co-pay, but no other visits, except to the dental clinic, require one.

Christenson said eliminating the $10 co-pay will equalize mental and physical health needs.

“Ten bucks is 10 bucks, and if that is discouraging any student from getting the mental health care that they need, then that was a problem,” Olson said.

Graphic by Jeff Hargarten
Sources: Northwestern University: Division of Student Affairs, The Ohio State University: Counseling and Consultation Service, Penn State: Counseling & Psychological Services, Purdue University: Counseling and Psychological Services, University of Minnesota: Boynton Health Service Mental Health Clinic, University of Michigan Counseling and Phsychological Affairs, Indiana University Counseling and Psychological Services, University of Iowa University Counseling Service, Michigan State University Counseling Center, The University of Wisconsin-Madison University Health Services, University of Nebraska Medical Center

Fourth in the Big Ten

As Boynton officials push for more resources, the University still ranks behind many other schools when comparing the number of students to mental health professionals.

With 35 full-time mental health professionals, the University has a student-to-professional ratio of 1 to 1,482. That includes University Counseling and Consulting Services, an on-campus counseling center that focuses on academic stress.

The International Association of Counseling Services, which sets standards for the number of mental health professionals on college campuses, advises large universities to maintain a ratio of one professional per 1,000 to 1,500 students.

The University of Minnesota ranks fourth among Big Ten schools for ratios of mental health professionals to students after the University of Wisconsin-Madison, which has one professional per 1,071 students.

The Big Ten has generally higher student-to-professional ratios than small, private schools.

Massachusetts Institute of Technology, which experienced a series of student suicides in the 1990s, has a ratio of 1 to 466.

Christenson said schools are often more reactive to mental health issues on campus than proactive.

“The sad part about it is that many campuses only really pay attention to mental health needs after something really bad happens,” Christenson said.

Legislators get involved

In light of several mass shootings in 2012, mental health has become a central issue in the state Legislature this session.

Several bills have been introduced to provide more mental health resources for primary and secondary education students.

Legislators have taken a preventative approach, arguing more resources for younger children will prevent more severe cases from developing.

In a 2005 study in conjunction with the National Institute of Mental Health, researchers found that half of all lifetime cases of mental illness begin by age 14, and three-quarters have begun by age 24.

Earlier this year, Gov. Mark Dayton proposed a $170 million increase to the Health and Human Services budget, which funds the state’s health care programs, including mental health.

In March, the DFL-controlled House proposed reducing Dayton’s increase by $150 million, which drew sharp criticism from health care groups.

Rep. Jim Abeler, R-Anoka, who serves on the Health and Human Services Finance Committee, was disappointed with the proposed reductions.

“No one saw that coming,” he said. “I hope that they stick with what the governor has proposed. That could save some kids’ lives.”

Legislators also proposed a bill that asks Minnesota colleges, including the University, to meet with mental health professionals, advocates and providers at an educational summit before 2015 to discuss improving training for mental health professionals and increasing the number of culturally diverse workers in Minnesota.

Sen. Greg Clausen, DFL-Apple Valley, who proposed the bill, said it’s necessary for mental health professionals to meet with schools that will be training future therapists and psychiatrists.

Tuesday, the Senate Higher Education and Workforce Development Committee appropriated $50,000 for the summit.

Legislators have been focusing resources on school-age children, but mental health care availability is generally worse for adults, according to Sue Abderholden, the executive director of NAMI Minnesota.

Compared to the national average, Minnesota has 33 percent fewer psychiatrists per capita, according to a 2007 report from the Minnesota Psychiatric Society.

“The thing to take into consideration is that we don’t have enough mental health professionals — period — in the state of Minnesota,” she said. “Everybody waits, no matter where you are, no matter how great your insurance is.”

Dr. Charles Schulz, head of the University psychiatry department, said Minnesota could improve mental health resources across the state.

“For adult psychiatry, we rank 24th out of the 50 states in the number of psychiatrists for our population and 26th for child and adolescent psychiatry,” Schulz said. “We’re smack dab in the middle. I don’t think that’s a good goal.”

At Boynton, students can see a therapist up to 11 times in 12 months.

Michele Sullivan, a Boynton psychiatric social worker, said she refers students seeking more frequent visits, who need to be seen by a specialist or are at the bottom of a long Boynton waiting list, to other metro mental health clinics.

But in the past decade, she said her job has become more difficult as more practices have developed waiting lists or are no longer able to accommodate new patients.

“It has to be really frustrating to be a receptionist at one of those places, just saying ‘No, we don’t have any openings,’” Sullivan said. “I would just switch myself to voicemail at that point.”

The invisible barrier

Weeks-long waitlists and a shortage of resources can deter a student seeking mental health help, but the stigma surrounding mental health can serve as a larger, more unseen barrier to even more students.

“They might be labeled as someone who is ‘crazy’ or has problems, but like everybody else, it’s normal to deal with issues in life,” said psychology senior Christopher Luhmann, a member of the Provost’s Committee on Student Mental Health.

People often see mental health differently than issues with physical health, said Mariel Lougee, a second-year medical student and president of the University’s Psychiatry Interest Group.

“It’s a lot easier to say you’re going to the doctor’s because you have the flu than because you’re struggling with depression,” she said.

Christenson, Boynton’s chief medical officer, said while crisis help for mental health is readily available, non-emergency care is not.

“Most people can get in with their family practice doctor or one of their colleagues within a day or two,” he said, “but I have never known that to be the case with psychiatry.”

Looking back on her freshman year, Hughes-Morrison believes things could’ve been different.

Had she seen a therapist sooner, she said, she could have stayed in school and likely graduated this spring.

But she’s still two semesters shy.

“Because I wasn’t able to get help quickly enough, I have to add an entire year to my college experience,” she said. “My whole life is set back a year.”