Gaps persist in campus mental health services

My six-month investigative project on the University of Wisconsin’s mental health services ran today. Here’s the main story. You can also click here for the complete coverage.

Amid surge in demand, students take public role to combat stigma

 By Amy Karon, Kate Prengaman and Jenny Peek

Wisconsin Center for Investigative Journalism

Matt Vohl meets with Rachel Steidl in the Student Activity Center on East Campus Mall in Madison, Wis., Jan. 27, 2012. Vohl and Steidl help lead the UW-Madison campus chapter of the National Alliance on Mental Illness. Lukas Keapproth/Wisconsin Center for Investigative Journalism

A decade ago, Thomas Murphy was a college dropout who used alcohol and drugs to deal with undiagnosed depression. Now he’s back at the University of Wisconsin-Madison, where he co-leads a chapter of Active Minds, a national, student-run group promoting open conversations about mental illness.

Therapy made the difference for Murphy. But he can’t receive it at school. When he re-enrolled at UW-Madison and went to the counseling center, he walked out with no appointment and a list of referrals.

“They couldn’t help me because of my extensive history,” Murphy said. “So I go out and pay on my own for the services I need.”

Murphy’s story underscores a national dilemma: a surge in students seeking intensive counseling and psychiatric care, which college mental health centers often lack resources to provide. The problem has become even more urgent in the wake of mass shootings by troubled students at Virginia Tech and Northern Illinois universities.

In Wisconsin, understaffed counseling centers are prioritizing services for those with urgent needs, expanding group therapy options to reach more students, and referring patients off campus for long-term treatment. And students like Murphy are forming campus organizations to support peers and fight the stigma of mental illness.

A growing need

Step onto a U.S. college campus today and you’ll still find students rushing between classes or holding hands with first loves.

But 80 percent of college counseling center directors reported seeing more students in crisis during the past five years, according to a national survey in 2011. The same study found that students with severe psychological problems now account for nearly 40 percent of counseling center visits — more than double the proportion in 2000.

Last spring, 19 percent of college students surveyed by the American College Health Association said they’d been diagnosed with depression sometime in their lives, up from 12 percent a decade ago. Almost one in five students had seriously considered suicide.

These statistics aren’t all bad news, said psychologist Danielle Oakley, director of mental health services at UW-Madison, where counseling visits increased 10 percent last year alone. More people know about mental illness and are seeking help, and better psychiatric medications enable some to attend college who couldn’t have a generation ago.

But Oakley said the faltering economy is fueling worries about paying for school. Many students are stressed, overworked and sleep-deprived, which can cause mental health problems.

Though studies show people with serious mental illness usually aren’t violent, there have been tragic exceptions: In 2007 and 2008, troubled students shot themselves after killing 37 people and wounding dozens more at Virginia Tech and Northern Illinois universities.

Campuses across the country responded by revamping policies for handling disturbed students and staff. At UW campuses, threat assessment teams — whose members hail from deans’ offices, academic departments, campus police, and counseling centers — try to identify and help such people before they hurt themselves or others.

“If there is a silver lining in something like that happening, it’s put the spotlight on some needs on our campus,” said John Achter, counseling director at UW-Stout.

Still, most people with mental illness fly under the teams’ radar. And despite attempts to meet demand, Wisconsin students are being turned away — or told to wait weeks for care.

Long waits, but some improvements

UW-Madison senior Rachel Steidl was one such student. “I grew up really focused on helping other people,” she said. “When I had my own problems with depression, I didn’t feel like I had anyone to turn to. I was pretty lonely my freshman year.”

Steidl later saw a psychology intern at the campus counseling center. She learned to open up more and made friends. When she returned to the center this year, an intake provider saw her the same day to assess her needs.

That’s because at Oakley’s urging, UW-Madison began offering same-day assessments in early 2011.

“We don’t want any barriers to get to us,” Oakley said. “The day you decide that you want support, all you have to do is walk in.”

But what happened next frustrated Steidl. Because her immediate needs weren’t deemed urgent, she said, she was asked to wait three weeks for her next appointment.

“If my depression gets worse, it could escalate,” she said. “I want to avoid getting to the point where I have to call the crisis hot line.”

Most UW campuses use such triage systems to help students in crisis first. A UW-Eau Claire student, for example, was prescribed Paxil when she sought help for panic attacks in 2009. After she stopped eating and sleeping and went on a “financially disastrous” shopping spree, her campus counselor and psychiatrist correctly identified and treated her bipolar disorder — ending eight years of bouncing between clinicians who’d misdiagnosed her.

“They saved my life. Literally,” said the student, who works as a pet groomer and asked not to be named for privacy reasons. “I wasn’t able to complete a degree, but they gave me a brighter future than education.”

But Steidl’s wait time is more typical. Last fall, UW-Madison students went an average of 14 days between their intake appointment and first regular counseling session, said Dr. Sarah Van Orman, health services director. Other UW campuses report similar waits.

Such delays stem partly from inadequate staffing. A UW System audit found that five years ago, only UW-Madison met the international standard of one mental health professional for every 1,000 to 1,500 students. The auditors recommended that over the short term, UW institutions aim to employ one mental health staffer for every 2,000 students.

But as of 2011, just eight of 13 campuses had achieved that ratio, an analysis by the Wisconsin Center for Investigative Journalism showed. Of those, only two schools — UW-Stevens Point and UW-Superior — met the international standard.

To improve counselors’ availability, UW-Madison wait-lists students for earlier sessions, offers daily drop-in groups and confidential consultations in several campus locations, and has more than 25 process and support groups to help students deal with issues ranging from low self-esteem, grief and social anxiety to graduating or coming out as a sexual minority.

None of these options was right for Steidl, though. She found a therapist in private practice.

Referred off campus, some never find help

It took a violent mugging in the Dominican Republic in 2008 for Thomas Murphy to finally face his depression. During rehabilitation for a brain injury, he also got the counseling he’d needed.

Milwaukee native Mary Martinco sought help sooner, seeing a therapist for depression for two years in high school. But transitioning to UW-Madison was painful.

“Freshman year I felt so alone, crying all the time,” recalled Martinco, now a junior.

Like Murphy, Martinco sought help at UW-Madison’s counseling services and left with a list of off-campus referrals. But in her case, they either weren’t a good match or didn’t take her insurance. In the end, it was her mother, not her school, who helped her find a therapist.

Most UW counseling centers limit students’ counseling sessions. UW-Madison students like Martinco, who need more than the 10 permitted each academic year, are often asked to go elsewhere from the beginning.

Oakley said that’s because making students change therapists disrupts their treatment. But a 2006 University of California-Davis study found that 42 percent of students referred off campus never connected with providers — usually because of financial concerns.

To address that problem and help prevent tragedies like those at Northern Illinois and Virginia Tech, UW System officials recommended in 2008 that campus providers follow up with high-risk students to help ensure they’re successfully referred.

A half-time case manager now fills this role at UW-Oshkosh. And in 2010, after Martinco’s failed referral experience, UW-Madison hired a full-time case manager who saw 300 students her first year — five times more than expected.

Still, lack of health insurance “poses great barriers” for students referred off campus, Van Orman said. She cited campus surveys that show 6 to 8 percent of students at UW-Madison are uninsured and another 30 to 40 percent have no coverage in the Madison area.

The case manager connects these students to agencies that charge a fraction of the going rate or to the student health insurance plan. She also helps students navigate deductibles and co-pays.

Some students struggle to pay for psychiatric prescriptions. Martinco saw peers risk going off medication when short on cash. She and Murphy said they knew students who self-medicated with alcohol or illegal drugs because they couldn’t afford mental health care.

“The self-medication issue is complex,” Oakley said. “For example, students who use substances such as alcohol to treat anxiety can end up with substance abuse problems in addition to their anxiety.”

Alcohol withdrawal symptoms can mimic anxiety, Oakley added, leading students to drink more or use stronger drugs. In the end, she said, money spent on drugs and alcohol, lost time at work, medical treatment for accidents and legal consequences can far outstrip medication costs.

Student groups expand 

Frustrated by her experiences on campus, Steidl joined fellow student Matt Vohl two years ago in reviving the campus chapter of the National Alliance on Mental Illness.

“We saw a lack of resources available for students with mental illness or even just mental health problems,” Vohl said. “We wanted to offer an alternative.”

Students responded en masse: More than 70 signed up at the campus organizational fair last September, Vohl said. A month later, they peppered Bascom Hill with signs.

“The best way to reduce the stigma is by educating people,” Vohl said. “We want to let people know that (mental illness) is not this inherent condition that makes people freaks, it’s not demonizing, it shouldn’t be taboo. It’s something that can affect anyone.”

Steidl and Vohl are working with the counseling center to train students to provide confidential, face-to-face support for peers who want to talk about everyday problems.

“You can go there and know that people kind of understand you at least,” said a member with obsessive-compulsive disorder who asked not to be named for privacy reasons. “You get to know their struggles every day, whatever they are, and to be there to be support for them and other people as well.”

Murphy and Martinco now run UW-Madison’s branch of Active Minds, which promotes mental health awareness.Five other Wisconsin campuses also have chapters. At UW-Parkside last semester, members practiced yoga, colored and made squeezable stress balls.

“Finally I feel able to talk about it, and I want to help others talk about it too,” Martinco said.

“I had this deeper, darker side that I never talked about,” Murphy agreed. “For me, communicating my emotions, my struggles, and my successes has been vital.”

Amy Karon is a reporter for the Wisconsin Center for Investigative Journalism. Kate Prengaman, Jenny Peek and Sam Zastrow contributed as students in a UW-Madison journalism class taught by Professor Deborah Blum, in collaboration with the nonprofit, nonpartisan Center (www.WisconsinWatch.org). The Center also collaborates with Wisconsin Public Television, Wisconsin Public Radio and other news media. Works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or its affiliates.

Deciding whether to take antidepressants? Careful of ‘expert’ advice

(Updated Dec. 29)

The idea that patients with depression should eschew antidepressants for other remedies has gained popularity lately, sparking vehement debates in some corners of the web.

Take an interview of Dr. Andrew Weil this week on NPR’s Science Friday. Weil promoted his new book recommending non-prescription remedies, such as exercise and supplements, for people with mild to moderate depression.

Research does suggest that both aerobic exercise and fish oil may ease symptoms of depression. But a number of listeners criticized Weil, who has trademarked himself as “Your Trusted Health Advisor” while also selling his own line of customized vitamins and supplements (just $74.99 for his 30-day “Energy Support” pack).

Weil, I noted, didn’t correctly answer Science Friday host Ira Flatow when asked whether farmed fish (the source of much fish oil) tend to be fed a diet low in omega-3 fatty acids, the component of fish oil thought to combat depression.

Instead, Weil answered an unrelated question, saying that most fish oil is free of contaminants like mercury and PCBs.

(Flatow was right, by the way, according to this National Academy of Sciences article. The authors state that during the last decade, farmed fish were increasingly fed vegetable oils, which cause fish to have lower concentrations of omega-3 fatty acids.)

While researching the excellent PBS series This Emotional Life, I also found this article on the series homepage decrying the use of antidepressants.

“Love — not drugs — can save you and your relationship,” wrote marriage and family therapist Deb Schwarz Hirschhorn, adding that “partners can learn how to inject serotonin into each other’s brains with just a well-placed smile and a thoughtful gesture.”

“That’s so much more powerful than drugs, isn’t it?” she asked.

Hirschhorn raised some important points: in some studies, antidepressants have performed no better than placebos; industry-funded research should generally be interpreted with caution; and antidepressants can increase risk of suicide, especially in adolescents.

But she didn’t acknowledge that the increase in risk appears to be small, and that talk therapy can’t effectively replace medication for everyone.

The true picture of both depression and its treatment appears far more complex than that portrayed by Weil or Hirschhorn.

In one health care consumer study, for example, patients tended to report the most benefit from a combination of medication and talk therapy. But other studies found that patients were more likely to get better if they received the type of treatment they asked for, whether or not that included medication.

And in yet another study published this month, depressed patients tended to respond no better to medication or talk therapy than to placebo pills — except African-American men, who responded best to talk therapy.

The bottom line? Watch out for ‘experts’ with straightforward answers about treating depression. No matter where they fall on the spectrum of debate about antidepressants, they’re probably not telling the whole story.

Read more: Buddhist communities in the West have long criticized antidepressants, but that’s changing. Check out this 2009 article by physicians and long-time meditators Roger Walsh, Robin Bitner, Bruce Victor, and Lorena Hillman, published in the quarterly magazine Buddhadharma.