Expectations Unfulfilled: Addressing the Disconnect between Students and CMHS

Each academic year, Tufts Counseling and Mental Health Services (CMHS) works with over 25 percent of the undergraduate student body on both the Medford/Somerville and Boston SMFA campuses. Another 8 to 10 percent utilize local community-based mental health providers. According to the Task Force on Student Mental Health Report that was released earlier this month, CMHS saw an increase of 60 percent of students coming in between Fall, 2015 and Fall, 2018. 


Due to the high demand for its resources, CMHS uses a “brief model” of assessment and counseling. This model typically focuses on helping students to effect a desired change or goal, consistent with college counseling services across the country. 


“I believe there’s a misconception in what [CMHS] offers and what it means to be a patient there,” Ailie Orzak, a junior, said. “It is built to be short-term and collegiate-focused.” 


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.


The Task Report indicates students are satisfied with the quality of care at CMHS, pointing to a Healthy Minds survey from 2018. Of all the respondents, 89 to 90 percent of those who had used CMHS reported that they were satisfied with the quality of the therapists they saw. However, experiences and frustrations expressed by the student body call this statistic into question. 


A current sophomore, who wishes to remain anonymous, said that after only meeting with a therapist for 50 minutes, they diagnosed him with a serious manic depressive disorder. It later turned out to be an incorrect diagnosis. 


“I know the therapists are all qualified to give diagnoses, but not after one session,” he said. “I didn’t know what to do. I thought, ‘oh fuck I need serious help,’ but then I was scared: scared to tell my parents, scared to seek serious help, scared to go back to CMHS.” 


After he missed his next scheduled session, CMHS did not reach out to check in, or to see if he wished to be referred to an outside therapist. 


“I was able to find a therapist on my own terms, but only after months, and after all of it they told me the diagnosis was incorrect,” he said.


While the survey measures student satisfaction with the quality of care, there was no data in the report regarding follow-up care practices, nor the quality of the referral after the “brief model” of assessment was over.


“Since it is a short-term provider, their referral services need to be stellar,” Orzak said. 


CMHS does offer a referral service meant to function as a link between Tufts and local providers. The referral service has a clinician help students acquire a local provider that matches their insurance or financial resources for longer-term or more frequent treatment. According to the Task Force Report, the decision regarding whether or not the needs of a student require longer-term care is usually made after an initial meeting with a counselor. However, some students feel this is not the case.


A female-identifying senior said, “It was not made clear to me when I went that they were not going to see me after the semester ended, which is why I think many students express that they felt like they were ‘kicked out’ of CMHS.” 


Even though there is a referral system in place, many students have found difficulty accessing a therapist that fits their needs or financial status in the surrounding area. 


A female-identifying junior with low-income status at Tufts, said that after CMHS decided she needed to seek more serious care, the referral process was “unhelpful and disorganized.”


“I went in to get a referral and they were just scrolling through Google, which is something I could do myself,” she said. “All my referrals did not match my insurance or straight up weren’t accepting new patients.” 


She expressed frustration that neither the therapists at CMHS nor the person doing the referral recognized that going off campus to receive therapy is a significant barrier for many people. In addition, there appeared to be little to no communication between the person making the referral and the therapist.


“The person was like so what’s up?’ as if I could rehash everything I was going through and what I was looking for in a therapist in a short five-minute period,” she said.


While students have found it difficult to seek longer-term care via the referral office, much of the university-wide Task Force Report is comprised of recommendations for how to better implement services and resources. The report also addresses potential changes with respect to education, outreach, mental health promotion, and policies and practices. 


Both the Task Force Report and Bowdler discussed how CMHS is working to remove barriers to accessing treatment by deepening relationships and referral networks with local community providers. For the 2018–19 academic year, six additional local community providers were added to Tufts insurance and require a five dollar copay for students with Tufts insurance and a ten dollar copay for students with other insurance. The low cost of a copay is something Bowlder noted to be “unprecedented” with regard to university mental health care. 


In addition to significantly reduced copays for students who see off-campus mental health clinicians, CMHS has piloted new evening hours on-site at CMHS, and is promoting new telehealth options like BetterHelp and iHope. These changes are meant to make CMHS’s services more accessible to students who may work during their regularly scheduled hours. While significant changes have been made, students remain mostly unaware of this progress, demonstrating a lack of communication between the administration, faculty, and the student body.


“When I was aFirst Year Assistant (FYA) last year, I learned a lot about CMHS through our training,” Maya Hamberg, a junior said. “Since I didn’t have that training this year, I don’t know a lot about the progress CMHS has made and additional services being provided.”


For this reason, Bowdler stresses the need for community support and education on these resources to be facilitated by the administration and faculty.


“You never just look at just one aspect of an issue, so when you’re looking at mental health you have to look comprehensively at prevention, treatment, and response,” Bowlder said. 


The Task Report found that across the university, faculty and staff expressed an interest in deepening their understanding of student mental health, preventative measures, and knowledge of how to appropriately support students and make referrals. This aligns with one of the major goals of “enhanc[ing] training opportunities for faculty and staff to deepen their knowledge about student mental health.” In addition, the Task Force urges faculty to consider ways in which they can work to reduce stress and promote a healthy learning environment for students.

Although many of the recommendations made in the Task Report require significant planning and a willingness to cooperate from both the administration and faculty members, Jennifer Stephan, the dean of engineering and co-chair of the Undergraduate Working Group (UWG), remains optimistic.

“I’m hopeful,” Stephan said. “I think we can definitely build upon efforts we’re already making to shift a culture and really promote wellbeing.”


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