Content warning: This article contains mentions of mental health treatment, some discussion of eating disorders — without specific numbers or health details — and references to campus suicide.
The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 1-800-273-8255.
The recent tragic death of one of our peers has revived the discussion about the failures of Yale’s mental health infrastructure. Despite emails detailing the supposed plethora of services dedicated to suffering Yalies, the situation is clear: Yale Health does not have the capacity to meet the mental health needs of the student population. Even worse, students come into Yale with an inaccurate picture of its mental health services. When we enroll, we are bombarded with resources and phone numbers, encouraged to sign up for an intake appointment and then disappointed that Yale Health does not provide the level of care we need.
I’m no stranger to this phenomenon. After graduating from high school, I spent the summer struggling with a then-undiagnosed eating disorder. I did not have adequate professional support at home, but my glimmer of hope was that at the end of August, I would enroll at Yale and find a good treatment team through Yale Health. Of course, things were not quite that simple.
Looking back, I wish my Yale Health intake provider had said to me: “Look, we’re sorry, but we do not have the resources to assign you to a comprehensive treatment team. Here are your options for outside help.” Instead, like so many others, I was put on the mysterious therapist waiting list.
I eventually got a therapist at Yale Health, and we met three times before I was hospitalized. I spent as much time in inpatient treatment, missing as much class as I could until I would need to take a year-long medical leave. I then switched to outpatient treatment at a nearby facility. I enrolled again in the spring and gained traction in my recovery, with support from an extensive, yet standard, team of an outside therapist, an eating disorder dietician, a medication provider and my three-day-per-week intensive outpatient treatment, or IOP, program. By the end of the semester, I was ready to step down from IOP to a lower level of care.
Although it was hesitant to admit it, Yale Health simply could not offer a sufficient treatment team for my needs. And students know it. Awareness of Yale Health’s limited scope often prevents people from even seeking help on Yale’s campus at all.
Mentally ill Yalies feel forced to prove that we are sick enough to warrant a hasty therapist assignment, but not so sick that we should be kicked out of school. The process of delay, intake, delay, therapist assignment and then a potential outside referral is dangerously inefficient. In the mental health treatment world, there is a spectrum of care between once-a-week therapy and a hospitalization or a year-long medical leave. During many Yale Health intakes, there is not.
As I read and listen to other Yale students’ narratives, I can’t help but reflect on my own first year. I can’t stop thinking about how lucky I was to have access to comprehensive treatment and alternative support networks. How can Yale accept a system in which students make it through their first year based on privilege and luck?
There have been calls for Yale to hire more mental health clinicians for years. Although I support this effort, it’s clear that the gradual increases have not fully addressed the problem. I would like to propose an alternative solution: increased referrals to and contracts with external providers.
Under a transparent referral system, no student would have to wait weeks for urgent mental health care: Yale Mental Health and Counseling could refer students to specific, pre-identified experts in the greater New Haven area. This would also allow Yale Health intake providers to be more responsive to each student’s unique treatment needs. The expanded list of Yale Health-approved providers, programs and facilities should be accessible to all students seeking services through Yale Health. Intake providers should always immediately refer students to the quickest, most comprehensive service that meets their needs and expectations.
Rapid referral could sound like:
“It seems like you need a dietician and a therapist to treat your disordered eating. Our nutrition department does not have a Health at Every Size provider on staff, so we contract with a nearby office for folks who are interested in healing their relationships with food.”
“We don’t have a BIPOC therapist immediately available to treat your PTSD symptoms, but if you’d like, we could refer you to a nearby specialist who is covered by Magellan, and you can start next week.”
“It seems like you urgently need a higher level of care for your borderline personality disorder, but hospitalization seems inappropriate. Would you be interested in supplementing your therapy here with a three-day-per-week dialectical behavior therapy program through Yale’s hospital?”
Currently, Yale Health Hospitalization/Specialty Care coverage — Yale’s insurance program for students without outside insurance — only covers services that are internal to the Yale Health network, except for an “emergency or urgent condition or for care that has been arranged in advance by a Yale Health clinician.” The Yale Health Student Handbook does not explain how these arrangements work, nor does it detail Yale Health’s behavioral health partnership with Magellan Health Services, which represents a small step toward increased health care accessibility.
I propose that Yale Health clearly outline and implement an expanded list of mental and behavioral health treatment options under Yale Health coverage — including and beyond those covered by existing contracts — on the Yale Mental Health and Counseling website. A comprehensive list would include New Haven-area clinicians, IOP programs and residential centers that are eligible for a referral by a Yale Health clinician. With clear options, students can enter intake meetings with the ability to advocate for their unique needs. Further, if YMHC, network and Magellan providers are all at capacity or do not offer appropriate services, Yale Health should pay for students to see certain out-of-network providers.
When Yale Health fails to transparently convey which services are available to students, students are forced to become the experts on mental health. Yale Mental Health and Counseling administrators must step up, demonstrate expertise and connect all students with comprehensive treatment.
EMMA KNIGHT is a junior in Branford College. Contact her at firstname.lastname@example.org.
Editor’s note: Because of an editing error, an earlier version of this piece incorrectly read, “Although I was hesitant to admit it, Yale Health simply could not offer a sufficient treatment team for my needs.”