As students and administrators focus on the state of Yale’s mental health resources, questions of availability have become particularly contentious — namely, whether students are allowed more than 12 visits to Mental Health & Counseling per year. The short answer is yes, they are. No such cap exists.
During an open forum on Feb. 25, at which administrators opened the floor for discussion about Yale’s mental health resources, Caroline Posner ’17 questioned why Yale Health limits students to 12 therapy sessions per year. When MH&C Director Lorraine Siggins responded by claiming that no such limit exists, her voice was quickly drowned out by noises from students in the audience who, like Posner, had heard the very opposite.
While Siggins acknowledged that MH&C needs to improve the way it communicates with students, little else since the forum has been said publicly about the supposed cap on therapy sessions, leaving students as confused as they had been before the forum. Students interviewed maintained that they had been told that a 12-session cap exists, with some adding that the limit is indicative of a larger resource shortage at MH&C.
“When my therapist [gave me more than a certain number of sessions], she specifically said she was bending the rules,” Posner, a staff columnist for the News, said in an interview.
DOES THE LIMIT EXIST?
During the forum, Siggins asked the audience where on the MH&C website they had read that such a limit exists. Students said they had learned about the cap not from the Yale Health website but rather from their individual therapists.
The MH&C website does state that some students attend only a few sessions of therapy while others take part in “ongoing therapy,” with those decisions made on an individual basis. It also states that students who have private health insurance and are interested in having sessions “more than once per week over a long period of time” can seek care outside of Yale Health.
Though Posner’s therapist never told her explicitly that she was limited to 12 visits, Posner said she had read about the cap elsewhere and been told by numerous friends that their own therapists had told them about a similar limit.
Another student stood up at the forum and described her experience with a perceived limit, adding that her therapist told her at each of her sessions exactly where they stood in the 12-visit limit. She said her therapist had to adjust their meeting schedule so that they did not exceed the limit that year.
While Posner conceded that, as in her own case, she had heard that therapists do sometimes work with students for more than 12 sessions if they feel it is appropriate, she felt that her therapist was under pressure to be frugal about the number of therapy sessions the she offered.
After the remarks at the forum garnered significant attention, some students decided to look into the confusion on their own. Eli Feldman ’16, president of the campus organization Mind Matters and a member of the Coalition for Mental Health and Wellbeing, said he spoke with a therapist at MH&C in an attempt to gain more clarity. The therapist affirmed that there is no absolute limit on the number of sessions available to students, Feldman said.
Still, Feldman acknowledged that there seem to be pervasive misconceptions regarding the policy. He said he thinks poor communication is to blame.
“I get the sense that [staff at MH&C] don’t have one standard way of explaining how therapy works [to students],” he said. “Perhaps some individual variation is the cause of that.”
Neither Siggins nor any of the 28 MH&C clinicians listed online returned request for comment.
SHORT-TERM CARE MODEL
Although she denied that there is an absolute limit on sessions allowed per year, Siggins acknowledged at the open forum that MH&C does “roughly” follow a short-term model of treatment. The goal of this model, she added, is to allow therapists to reevaluate the student’s condition after a few visits and decide how to proceed from there.
Some students supported this method. Matthew Kemp LAW ’15, who contributed to a December 2014 report on the state of mental health at the law school, said 12 visits is actually “kind of a lot” and should afford plenty of opportunity for patients and therapists alike to reevaluate the situation.
But Posner said that rather than giving patients the opportunity to assess their progress, the short-term model — and the notion of a 12-visit cap in general — forces therapists to prioritize some patients over others and might make some students feel as if their issues are not as important.
In fact, she added, any suggestion of a limit on therapy sessions may worry students in treatment who are managing well. Furthermore, when students are given the impression that the issues with which they are struggling are not important, she said, they are less likely to seek help in the first place. She emphasized that when students reach a point at which they decide it is necessary to seek treatment, hearing that their illness is not important enough to be treated more than 12 times can make their situation even more difficult.
“I think it’s a problem that people only start talking about depression when someone commits suicide,” she said.
While Siggins defended the short-term model as one that has flexibility “built into the system,” she explained that MH&C tries to make it clear from the outset that it does not aim for a longer timeline.
“Some people we do explicitly see for the whole year because their condition is such that it needs to happen,” Siggins said. “[But] we do it individually per person, and we decide that some people don’t need it for as long. That’s why we don’t want to say, ‘Sure, you can come weekly for all the four years you’re at Yale.’ ”
UNDERSTAFFED AND OVERBOOKED
One possible explanation for the limited availability of therapy sessions is understaffing at MH&C, Feldman said. MH&C serves around 2,500 students every year, rendering constant, long-term care logistically impractical, he added
“They do not have the capacity to do the same types of very long-term therapy as a private practice might,” he said. “That would mean [it would take] even longer to get in the first time. Whatever the wait times are, if they’re two to three weeks, they could become six to seven. They don’t have enough slots where they could both give the average Yale student more than 12 [sessions] and also be taking in new cases.”
Feldman’s comments were echoed by Corinne Ruth ’15, a member of the Mental Health and Counseling Advisory Committee, a student group that consults with Yale Health staff. If a therapist and patient come to the conclusion that the student requires more long-term, continuous care, then MH&C will work to meet that need, and in some cases the therapist may look into outside care as well, Ruth said. But because of resource and staffing constraints, guaranteeing continuous therapy to every student who comes to MH&C is impossible, she added.
As Kemp put it, “the money has to come from somewhere.”
These staffing constraints come despite the fact that Yale’s mental health services are relatively well-staffed compared to those at other comparable institutions. A September 2013 Yale College Council report on mental health noted that Yale MH&C actually has more staff than many of its peer institutions. Feldman said MH&C has twice as many clinicians per student than other peer institutions.
But for Jessie Agatstein LAW ’16, a member of Yale Law School’s Mental Health Alliance, the fact that there still are not enough mental health staff members simply points to another flaw in Yale’s mental health policies: insurance. While acknowledging that there are practical constraints on Yale Health’s ability to deliver care, Agatstein said its insurance policy of limiting coverage to Yale Health itself is “harmful.” Many of Yale’s peer institutions refer students to outside providers — and allow them to use their health insurance there — but Yale does not do the same, she said.
Agatstein added that many students that she has spoken to have expressed that they would have chosen different insurance plans had they known about MH&C’s short-term approach and constrained resources, she added.
“While I understand Yale Health as an institution [has limits], Yale as a university should be thinking about how to provide students with consistent access to mental health care, whether that is at Yale Health or not,” she said.