It wasnâÄôt easy for University of Minnesota sophomore Rachel Pollack to watch her good friend Allison Steele struggle with both depression and whether to see a counselor. Steele, a sophomore strategic communication major, said on top of paying tuition and working an unstable job, she didnâÄôt know if she could afford to pay more than $100 for a year of counseling at Boynton Health Service . âÄúShe desperately needed this treatment and she was going to have to pay I donâÄôt know how much for it,âÄù Pollack said, âÄúThat pissed me off, quite frankly.âÄù Mental health treatment is more difficult to come by at the University compared to physical health. On top of a $10 co-pay for therapy sessions at the Mental Health Clinic âÄî a fee that doesnâÄôt exist for doctor visits âÄî students must wait longer to see a counselor and are allotted a limited number of visits per year. Eight universities within the Big 10 offer students individual counseling free of charge, three of which limit the number of free visits students can receive. The wait to see a Boynton counselor is currently between two and three weeks. To see a doctor, however, students can generally get in the same day or the following day. Students are limited to 11 therapy appointments per year, while thereâÄôs no limit on physical health appointments. The co-pay, which is waived for the first visit, has been mandated for about 20 years by the Student Services Fees Committee , Ed Ehlinger , BoyntonâÄôs director, said. At the time, there was a high demand for mental health services and pressure to keep tuition and student fees down, he said. Each year, student groups and administrative units plead their case before the Fees Committee for a portion of the student services fund. While Ehlinger said heâÄôs thought about getting rid of the co-pay, it would leave a hole in the budget to be filled by either decreasing services or finding another source of revenue. In any case, Ehlinger said, he doesnâÄôt like the idea of co-pays. âÄúI think they put roadblocks in the way of accessing care,âÄù he said. âÄúIt has been shown that basically the co-pays keep people from accessing the care that they need.âÄù But eliminating the co-pay would mean charging students the difference through increased student service fees, he said. Each student will have contributed about $233 to Boynton over the 2009-10 academic year, nearly a third of the total student services fee. Gary Christenson , director of the Mental Health Clinic, said he agrees the co-pay creates a barrier for some. While it may be something to consider getting rid of, it would likely translate into higher fees for everyone, he said. It comes down to a philosophical argument of whether people who use services should have to pay more than those who donâÄôt, Ehlinger said. Before the 11 visit limit was implemented in the 2000-2001 academic year, between 5 to 10 percent of students were using 30 percent of the clinicâÄôs services, Christenson said. âÄúThose individuals were using up resources and other people couldnâÄôt get in,âÄù he said. Only 25 percent of BoyntonâÄôs budget comes from student fees, the rest comes from billing insurance companies for service and patient fees. But because so many insurance companies offer lower levels of coverage for mental health, Boynton gets less reimbursement in that area, Ehlinger said. Despite the recent implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 âÄî which grants equality among mental and physical health coverage in some plans âÄî Ehlinger said the amount Boynton is reimbursed for mental health services probably wonâÄôt change. âÄúMore people are uninsured and more people have poor coverage,âÄù he said. âÄúThose things are going to offset the hope that came with the passage of the mental health parity act.âÄù The Equity Act reflects a âÄúcultural changeâÄù toward recognizing that mental health issues can be successfully treated and that itâÄôs unfair to have more barriers to treatment, Ron Brand, executive director of the Minnesota Association of Community Mental Health Programs, said. âÄúIn the interest of the University students and the long-term interests of the health of our future leaders, it would be wise for the University to think about how their policy squares with this idea of parity for access and coverage,âÄù he said. Like other parts of the University, Boynton has been working under a tight budget and has had to make difficult choices, Ehlinger said. âÄúWe canâÄôt make up for the deficiencies of the U.S. health care system,âÄù he said. Students can obtain career, financial and personal counseling through University Counseling and Consulting Services free of charge. There, they can talk to staff members about academic stress, relationship issues, personal conflicts, depression, anxiety or eating concerns or obtain resources on education or occupational information relevant to their skills and interests. There is no limit on the number of visits students can receive. Eventually, Steele got the treatment she needed, but said sheâÄôs afraid students who donâÄôt have jobs or some sort of financial assistance wonâÄôt. âÄúI know a lot of people who donâÄôt want to go because theyâÄôd rather spend money on alcohol; they think they can treat themselves that way,âÄù she said. Pollack agreed. âÄúI can see people saying âÄòI need it to buy foodâÄô or âÄòI want to have this money for something else and maybe itâÄôs not that important that I see a counselor right now,âÄôâÄù she said. âÄúBut it is.âÄù