Adding Insult to Illness: The Lack of Long-term Care at CMHS

As a student who came to Tufts during the first school year of the pandemic, I have been dissatisfied with the lack of long-term care at Tufts mental health services. Counseling and Mental Health Services (CMHS) describes itself as a center for “time-limited counseling services based on students’ individual needs.” Explicitly interpreted: it is a place to get therapy in the interim between getting your own therapist or getting better on your own. As frustrating as that is for students who want to establish a relationship with their counselor, who don’t want to rehash their trauma every few weeks to someone new, who lack the financial means to seek external therapy, or who fear telling their parents they need it, most of us, including me, accepted the absence of long-term care as a sad reality of college mental health services. Until author Grace Talusan came to speak in my Asian American Literature class.

Talusan, a Tufts alumna whose memoir The Body Papers won the Restless Books Prize for New Immigrant Writing, spoke to our class in February 2022. Talusan doesn’t mention Tufts by name in The Body Papers, but it has a substantial presence in her narrative as the place where she experienced the most serious depression of her life. She says of her junior year, “I have never been as ill as I was then, and every year since then has been an attempt to swim away from the dark depths of that illness.” 

When she came to my class, I knew about those dark times in her life, and I knew that she found her solace in therapy. I didn’t know the long-term therapy she received was at Tufts.

Talusan describes her college therapist in The Body Papers, noting the silence that filled the room as she stared at the therapist’s succulent, unable to speak. “At the time, being seen by her was enough to make progress,” she writes. Talusan mentioned to our class that she owes a lot to this therapist for her continual support, for meeting with her several times a week over the course of her time at college, throughout summer vacations and holidays. I thought her therapist was an external provider, a counselor from Medford or Somerville whose proximity would make them an easy support system for a young woman in need of weekly sessions. Only when she came to our class did I realize that the therapist was a clinician at CMHS.

As a student who has personally sought out Tufts counseling services, I was in disbelief: that kind of care doesn’t exist at Tufts anymore. When I went to CMHS in Fall 2020, during Tufts’ first year of the pandemic, the therapist I saw almost immediately began the external provider process with me. I sought her out early in the semester, before the influx of students that usually marks the midterm period at college mental health facilities, and the concerns I discussed with her weren’t acute enough to require more specialized care; nothing about my case at that time pointed to the need for an external provider. Yet, after only a few sessions, she asked me to consider talking with James Kane, the clinician at CMHS who helps students find outside counselors. I didn’t want to find an external provider when therapy was available and free at Tufts. “How long can I stay with CMHS?” I asked. She told me they could see me for about four sessions before they begin the external provider process. Four 50-minute sessions is equivalent to one showing of the Titanic, which I think many students would rather watch than begin a relationship with their counselor only to be shifted off to someone new. This mid-length care delivery model may benefit students whose mental health issues are situational and impermanent, but many have more enduring mental health concerns.

Other students were immediately referred to local providers before ever receiving therapy directly from Tufts. An anonymous sophomore stated, “I came to CMHS struggling, and I was basically told that I needed to find a counselor on my own… I didn’t know what qualities to look for… so I ended up trying three different counselors and made a connection with none of them. I wish I could have at least gotten some guidance from CMHS, even if they weren’t able to offer me counseling services.”

Barriers for service already exist outside of the short-term/long-term debate around CMHS. The institution still doesn’t have a cohesive, user-friendly website for counselors’ availability, and students still have to book appointments over the phone. In a win for irony, the mental state which causes students to seek out therapy also magnifies all hurdles against it. The same anonymous sophomore said of the search for an external therapist, “I didn’t know what I was doing and I surely didn’t have the motivation to figure it out.” Small obstacles become big barriers for students seeking therapy during mental hardship. And having to search for your own external therapist—having to find someone compatible, inexpensive, and within network—is a big barrier under normal circumstances.

CMHS should offer long term therapy. That it doesn’t is not surprising—what is surprising is that it did. Talusan sought therapy from Tufts in the ’90s. “Overall, 12.2 percent of the population 18 to 54 years of age received treatment for emotional disorders between 1990 and 1992,” according to a study from the New England Journal of Medicine. Since then, Tufts’ own Report of the Mental Health Task Force from 2019 cites a “notable increase in the number of students with significant, ongoing mental health needs.” In a report about the mental health of college students from years 2007 – 2017, the American Psychiatric Association found a decrease in mental health stigma and an increase in the rate of treatment from 19 percent to 34 percent. If stigma against mental illness is falling, and an awareness for the importance of mental health treatments rising, why do students at our institution have poorer access to long term mental health care in the 21st century than they did in the 20th? 

An Observer article from 2019 has the answer: “Michelle Bowdler, the Executive Director of Health and Wellness Services, said that due to the high amount of student need, if CMHS were to treat patients long-term, it would only have the resources to support 375 students, down from the over 1,800 undergraduate students it currently sees.”

In distributing mental health services broadly rather than deeply Tufts has constructed a dangerous dichotomy. Short-term and long-term care aren’t mutually exclusive; the same institution can offer the former and the latter, depending on the needs of the population. If more students are seeking treatment, and more are suffering from mental illness, it is no less the responsibility of their institution to provide the same quality of care that it did when mental health stigma kept those numbers low. Other institutions have proven themselves able to supply consistent care. For instance, Colby, a NESCAC school with a much smaller endowment provides individual, 50 minute sessions which “typically occur on a weekly or bi-weekly basis.” 

Many students can’t pass up free therapy for financial reasons, and others rely on the autonomy it gives them over their own treatment during a stage of life characterized by dependence on one’s parents. Talusan wrote in an email of her own experience with CMHS, “I didn’t have to ask my parents for money to pay for it and I appreciated that privacy over my healthcare needs.” Tufts has proved itself an institution capable of changing quickly to meet public health developments; it has constructed, deconstructed, and reconstructed several modular housing units designed for COVID quarantine in the past 2 years alone. Doesn’t the pandemic-related public health phenomenon of increased mental illness deserve similar attention? If Tufts must increase the budget of CMHS to increase access to long-term care, so be it. We spent $137,000 on prom.