AFFORDING MENTAL HEALTH TREATMENT IN COLLEGES

SAMANTHA KANG APRIL 2017

Background
Mental health is a common issue in America
with 1 in 5 adults having a diagnosable mental
disorder (equivalent to about 43 million
Americans) and 1 in 5 teenagers, ages 13-18,
have a seriously debilitating mental disorder1.
Unfortunately, these rates are actually increasing
every year, including the growth of youth
depression, leaving 80% of patients left with no or Source: National Institute of Mental
Health
insufficient treatment. In fact, more than half (56%)
of American adults with a mental illness did not
receive treatment. Furthermore, since half of all
lifetime mental health disorders start by the mid-
teen years and three quarters begin by the mid-
twenties, college students are highly susceptible
to behavioral health conditions. However, the
cost of mental health treatment in the United
States is greater than the cost of cancer care,
such as chemotherapy or radiation treatment2.
On top of this cost, for college students, there is
the burden of tuition which itself leaves thousands
in debt. The problem is that too many college Source: Mental Health America
students, who are prone to mental health issues,
are lacking the finances to receive proper
treatment and cannot finish the road to recovery
while attending college. The insufficient funding
for college mental health services leads to
inadequate access to care and treatment.

Source: Centers for Disease Control and Prevention
Looking at the issue:
The number one reason for not
receiving mental health services
among adults ages 18 or older was the
inability to afford the cost 50.1%3. The
cost for mental disorders are greater
than the costs of diabetes, respiratory
disorders, and cancer combined, on a
global level. An average session that
usually can last from 45 minutes to an
hour can range anywhere in price from
$80 to $120, and, in extreme cases,
$300. Psychological disorders and
treatment of them is not covered by
most insurance companies4. In order to
have adequate treatment, there must
be 1 professional (psychiatrists,
psychologists, social workers,
counselors, and psychiatric nurses
combined) per 1,000 individuals,
resulting in a high demand for mental
health professionals5.

Because of the high demand for professionals and large number of students
on a campus, there is often a lack of available staffed professionals to help all of the
students who need help and to the extent to which they require help. Therefore, the
cost of on-campus services often require payment that students may struggle to
afford. At Pennsylvania State University, there are six free individual sessions, but any
sessions after need to be paid for and six sessions is clearly not enough to resolve a
mental health issue. In order to receive an accessible treatment, students may have
to resort to paying for therapy and counseling with money that they do not have.
The cost of recovery is a huge burden on students who most likely are not
working and need to pay for their tuition. Not only do these costs come from direct
places like mental health services and treatment, but there are also indirect costs
that come from losses that the disability causes, such as lost earnings, absenteeism,
presenteeism, and more. There are also possible needs for emergency room care
and private physicians that are expensive and not covered by some insurance
companies. In addition, there can be cases where symptoms of a mental illness are
physical, causing family doctors to call for more costly tests untreated mental
illness actually causes some medical conditions to worsen, such as asthma, arthritis,
and diabetes, which require even more visits to private physicians6.

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 Of course, another major cause of the lack of financial coverage from
colleges is the stigma of mental illness that it is not an actual illness, that it is not
important, that it is just a phase, that people can live well with it, and that people
are just making it up in their minds as excuses, rather than realizing and accepting
that it is a product of a brains chemistry changes. A simple stigma should not be a
reason for financial burden, and colleges should not fail to provide services that
promote mental well-being.

Source: Population Reference Bureau

Risks, consequences
One of the many consequences of untreated mental illness is suicide, which
happens to be the second leading cause of death for young adults 15-34 years of
age, and this rate has not decreased in two decades. 1,100 college students die by
suicide every year7. When untreated, those with a mental illness are at a high risk for
harming themselves and those around them. They are more likely to be homeless,
arrested, incarcerated, victimized, have job stability issues, or be involved in familial
violence. Individuals with diseases like schizophrenia and bipolar disorder are 10
times more likely to be in a jail or prison than a hospital bed. People with a mental
health crisis can be forced to wait for days or weeks to be treated in ERs and for
months to schedule counseling appointments due to an insufficient amount of
services and staff. 7% of all homicides, 20% of all law enforcement officer fatalities
and up to 50% of mass homicides are associated with a serious mental illness8.
Obviously, when left untreated, mental health will worsen with a steady, rapid
decline, and the longer a mental illness persists, the more difficult it is to treat.

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 There are also physical health problems that can likely occur from an ongoing
mental illness because they can become so difficult to handle that the pain can be
transfer to the body, in an effort to lessen the
mental strains. Some of these physical effects could
be tense muscles, headaches, muscle pains, and
gastrointestin al distress. When these bodily
problems persist for a long period of time, they can
actually develop into real health issues. In addition,
chronic mental illnesses can cause patients to
neglect their health, which is commonly seen in
people with depression. There are also instances,
such as those with chronic stress, when there is a
higher risk of heart attacks, stroke, obesity, and Source: Health Tap
premature death9.
Mental health issues make it difficult for students to handle the demands of
everyday life, let alone the stresses and burdens that come with attending college.
It interferes with students ability to perform well academically, socially, and
physically. Academically, an untreated mental illness can deter a students ability to
concentrate and focus, proving positive academic performance to be challenging
and not a priority. About one-third of U.S. college students have difficulty functioning
due to depression, and almost half feel overwhelming anxiety, which was examined
from 125,000 students from more than 150 colleges and universities10. Mental health
issues in college students are also associated with lower GPA and higher probability
of dropping out of college11. Research led by University of Michigan economist
Daniel Eisenberg, PhD, shows that investing in mental health services for college
students helps to prevent them from dropping out this would help retain tuition
revenue and secure significantly higher lifetime earnings for the students. College
mental health services also increase a colleges retention rate, which is one of the
indicators of a successful university, as people wish to stay and are succeeding
there12. Socially, mental illness brings about poor self-esteem and low self-worth,
which can lead to relationship difficulties, vulnerability in risky situations and under
peer pressure, and social isolation13.

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More Americans have access to services... Access to insurance
and treatment increased, as healthcare reform has reduced the
rates of uninsured adults. -MHA

Affordable Care Act

What has already happened so far?

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires
health insurers and group health plans to provide the same level of benefits for
mental and/or substance use treatment and services that they do for
medical/surgical care. The Affordable Care Act further expands the MHPAEAs
requirements by ensuring that qualified plans offered on the Health Insurance
Marketplace cover many behavioral health treatments and services. MHPAEA
requires many insurance plans that cover mental health or substance use disorders
to offer coverage for those services that is no more restrictive than the coverage for
medical or surgical conditions. This requirement applies to: copays, coinsurance,
and out-of-pocket maximums14.

At Pennsylvania State University, ranked 50 in national universities and 14 in top

public schools according to U.S. News, there are numerous services and resources
for students to receive treatment. The college highly values its Counseling and
Psychological Services, which offers both group and individual counseling. They
provide short term individual counseling where they give insight to understand better
difficulties, and then provide future action that can be used in daily life. This is free to
any undergraduate and graduate student registered as full time for the semester
they are seeking services. There is a limited number of individual therapy that is
available for any student in any year (about 9 per year) with limited counseling of 6
free sessions it focuses on brief, short-term counseling than long-term counseling.
There is no charge for phone screening, initial consultation, crisis intervention, groups
and 6 sessions of individual counseling. There is a charge for $30 for psychiatric
appointments (meeting with a doctor for medication only when in counseling
services). $15 for sessions 7 through 9. In 2014, CAPS received $300,000 in funding from
Penn State, which allowed them to hire five new staff members15.
Psychiatric Services are also available at CAPS, though you need to pay for
those. There are fees of $30 per visit, that need to be paid up front at the time of visit
via cash, check, or charged to your student account. Proper paperwork to be sent
to your insurance can be provided upon request. The Psychiatric services are only if
a staff member has referred you, you will be scheduled for an hour appointment,

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and then that plays the part if you continue with the services or not. If your illness
requires the prescription of medication, you will be required to schedule regular
follow-ups averaging about 20 minutes every 2-3 weeks. Realizing the still prevalent
lack of resources, CAPS and various student organizations have been lobbying for
several years on affordability.

CAPS and various student organizations have been lobbying

for several years on this very topic. -Mary Anne Knapp,
Clinical Social Worker/Sr. Staff Therapist at Pennsylvania State
University
Recently, PSU administration has come to recognize the priority of students
mental health and have made a decision that within the next year CAPS will be
receiving approximately 1 million dollars between the President's allocation of
$400,000 and an addition to the Student Fee of approximately $ 9.50 per semester
to add funding for CAPS and counseling services. CAPS is currently and will be in a
hiring process as these funds become available.
CAPS is the only place located on campus where an individual can receive
any type of treatment for a mental illness. Unfortunately, CAPS is not fully equipped
to help you in the way you may need. They only provide you with six sessions for free,
per year. If you would like to pay, you get three additional sessions. Treatment ends
after 9 sessions at Counseling and Psychological services. After that, students must
find services off-campus. Off-campus, the Meadows Psychiatric Center is roughly 10
minutes from campus. They offer a free 24-hour telephone crisis hotline as well as free
mental health assessments. They also do their best to work with a wide range of
insurances to cover the costs of the visits. Beck Psychotherapy is located less than a
mile from campus on Beaver Avenue. There are multiple different psychologists
inside of this building. The cost is roughly $135 per hour16.

It is the universitys responsibility to care for students; otherwise, universities

send a message that they do not see the mental health of their students as not
important and not a priority they may stigmatize it as not important. When
universities do not provide affordable ways of recovery, it tells students that their
mental health issues is their problem and not the universitys. A universities focus is
on students the goal of a college is to educate their students who will represent
the college. Obviously, students require good mental health to do well in school, to
be the best. Colleges cannot come to point where they revolve around money
over people. In fact, if the colleges invested more money per year per student for
mental health services, it would increase students productivity.

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Next steps
Our country has a problem with implementing because resources are already
there and available, but university doesnt even have the resources available the
struggle right now is to even get it. Across the nation there are not enough affordable
resources for college students colleges fail to be accommodating to the students
who hold the future of the college in their hands. It is an issue of simple supply and
demand, and there is a huge need for more supply. Colleges need to provide health
services to students for free or at a more affordable price. This can be done by
donating class funds/gifts, raising student fees and tuition by a small increment,
receiving grants from organizations, taking out existing fees for an activity and
redirecting it toward mental health, provide online services to curb the cost, and/or
encourage support groups to raise money.
Class gifts are a great way to help lower the cost of mental health services for
students by dedicating the finances to paying for staff and resources. There is also
an option, such as PSU to raise student fees that would ultimately result in a large
amount based on the large number of students. Colleges are also able to receive
grants from places such as SAMHSA, which provides training, resources, and
technical assistance to support health care professionals. SAMHSA provides grant
funding to institutions of higher education to enhance mental health promotion,
prevent underage drinking and substance use, and to address mental health issues
such as suicide, which is already being used by several campuses17. Like PSU,
mental health services can provide streamline programs, video calling, and more
technological services to help lower costs of counseling and availability. In fact, the
University of Florida's Counseling and Wellness Center created a Therapist Assisted
Online program to deliver therapy to students with anxiety disorders over their
computer or smartphone. The program is seven weeks long and consists of several
modules that teach students to observe their anxiety. Students also have weekly 10-
to 12-minute video conferences with counselors and receive text message
reminders to prompt them to complete assignments to help them outside of
counseling. The university found that compared the outcomes of their original face-
to-face services with TAO's outcomes, the online students improvement in well-
being and symptoms was significantly better than those receiving face-to-face
therapy18.

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Conclusion
The prominence of mental health issues concerns the lives of college students
as they are confronted with difficulties in both simple functioning and their ability to
strive in all aspects of their lives. However, the great cost of treatment proves to be
a large burden on students as they cannot afford it, preventing them from being
able to fully recover. Untreated mental health issues lead to numerous risks that harm
the individual, those around them, and the institution. Prioritizing the mental health
of students should be a clear objective for all universities, as it not only benefits the
students during and after their academic career but also the entire institution. There
are currently clear movements and policies enforced on and off campuses and a
growing attention on the issue of mental health. As people and institutions invest
more time and money in an effort to improve mental health, the more students will
be able to have a healthy lifestyle during and after their time at college. Colleges
must provide funding for services that students can take advantage of in order to
receive treatment and recover from their illnesses. Funding can be found in both
within and outside of the college, whether it is through tuition costs, different therapy
methods, or funds from organizations that support colleges. Ultimately, mental health
services should be provided for students by the college so that they may receive the
proper treatment needed for their road to recovery.

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 Notes

1. National Institute of Mental Health 2015 data

2. Mental Health America

3. Centers for Disease Control and Prevention

4. National Institute of Mental Health

5. Centers for Disease Control and Prevention

6. Mental Health America

7. Active Minds

8. Upper Bay Counseling and Support Services

9. Treatment Advocacy Center

10. Psychology Today

11. American Psychological Association

12. American Psychological Association

13. Paradigm Malibu; Adolescent Treatment Center

14. Mental Health America

15. The Collegian

16. Pennsylvania State Counseling and Psychological Services

17. Active Minds

18. American Psychological Association