In the conversation about Yale’s mental health resources, the issue of capacity has surfaced over and over again: Mental Health and Counseling is overbooked and understaffed. But while many students have recommended MH&C address this problem by referring patients to therapists outside of Yale Health, this suggestion has been repeatedly rebuffed.
On April 2, Yale College Dean Jonathan Holloway, Director of Yale Health Paul Genecin and Yale College Council representatives met to discuss the Yale College Council’s October 2013 recommendations on mental health reform. Holloway and Genecin agreed to a number of the report’s recommendations, such as improved patient-therapist communication and allowing students to schedule appointments via email. However, they did not accept the YCC’s recommendation that Yale Health coordinate with therapists outside of MH&C or extend its insurance coverage to other providers. Such a plan, the administrators said, would be costly and impractical, according to the YCC’s write-up of the meeting.
YCC President Michael Herbert ’16, who attended the meeting, said the administrators raised concerns with the proposal on two grounds. First, they said, there is a limited number of mental health providers in the New Haven community, and many do not accept health insurance. Additionally, they said the scope of such a reform would be limited, as only roughly 20 percent of students utilize the Yale Health plan, Herbert said.
But students and practitioners interviewed disagreed, citing the plentiful mental health resources available nearby as well as dissatisfaction with the care offered at MH&C.
“There are many, many licensed psychotherapists, psychiatrists and psychologists in the New Haven metro area,” said Joseph Woolston, vice-chair for clinical affairs for the Yale Child Study Center, which serves as the home of the Yale School of Medicine’s and Yale-New Haven Hospital’s Department of Child Psychiatry. “I’ll bet a lot of money that the number of mental health professionals in New Haven exceeds most other places in the country.”
School of Medicine professor Dorothy Stubbe, who is also a practicing psychiatrist in the city, agreed, noting that New Haven has “plentiful” psychiatrists for a town of its size.
Genecin did not return request for comment.
Woolston acknowledged that many of these practitioners often have full practices, which may entail a waiting time for new patients, but he said that this should not be an insuperable obstacle for students who want to seek care outside of MH&C. A number of CSC faculty, himself included, have been providing treatment to Yale College students for decades, he added.
But insurance coverage for these providers can be limited, Stubbe conceded, noting that most of these providers charge on a fee-for-service basis. CSC services would need to be paid for out-of-pocket, Woolston said.
Scott Abbott, managing director of Arete Psychological Services in North Haven, said that though out-of-network providers — those that do not accept health insurance — can be perceived as expensive, they also are often able to take on new patients much faster. While the wait time at in-network providers can be considerable, he said, he is usually able to fit in college students for their first appointment at his out-of-network practice within eight to 10 days.
Care at MH&C is free to Yale students. But for some students, cost is not as important a factor as quality of care — a quality which they believe they cannot obtain at MH&C.
For one currently withdrawn student, who asked to remain anonymous due to the sensitive nature of the subject, the medications prescribed when she visited MH&C were not at all suited to the problems she faced. She was never given a long-term prescription, she said, but was instead prescribed short, five-day dosages of insomnia medicine for an anxiety disorder.
At a Feb. 25 college-wide forum on mental health, Chief Psychiatrist of MH&C Lorraine Siggins said MH&C tries to follow a short-term model of care. While the student said she does not know if MH&C follows that model for prescriptions as well, she added that it should have become apparent after several visits that the issues she faced were not isolated incidents, but required a longer treatment schedule.
“I don’t want to say that all of MH&C doesn’t know what they’re doing, but the person I saw specifically had absolutely no idea what he was doing,” she said. “I don’t have any degree, and I could’ve done a better job.”
Siggins did not return request for comment.
Rather than continue care at MH&C, the student said she decided to commute home each month to see a provider there. She is not alone in her frustrations: According to the 2013 YCC report, 31 percent of 353 students surveyed called the quality of care they received at MH&C “poor” or “very poor.”
Abbott said he is currently treating several Yale students, who said they were driven to seek an outside psychiatrist by the difficulty of getting timely appointments at MH&C.
Jessie Agatstein LAW ’16, a member of Yale Law School’s Mental Health Alliance, said the short-term model of care only makes sense if students are referred to outside providers when MH&C becomes overbooked and are given support for those providers through extended insurance coverage.
“Yale … should be thinking about how to provide students with consistent access to mental health care, whether that’s at Yale Health or not,” she said.
Over half of Yale undergraduates seek care at MH&C at some point during their time at Yale.