Counseling and Mental Health Services seeks to improve student experience

Especially during stressful midterm weeks, many students rely on Counseling and Mental Health Services (CMHS) to provide assistance. In order to improve students' experiences, CMHS has been working with student groups to gather feedback about the quality of its treatment services.

Marilyn Downs, director of outreach for CMHS, explained that CMHS aims to address the mental health needs of the whole Medford/Somerville campus' student community.

“[Our goal is] to provide direct clinical care, to consult with people on campus when they're concerned about a student, to advise them or make sure that that student gets the services they need, whether that's with us or elsewhere,” she said.

Downs noted that about 20 percent of students seek assistance at CMHS each year. Initial appointments are usually scheduled within a week of an initial phone call, she said.

“That's a somewhat high utilization rate for a campus mental health clinic,” she said. “We feel positively about that because we think it signals that we are doing our job.”

With the high number of requests, however, sophomore Eric Snyder said that it is often difficult to schedule appointments because CMHS is so busy. He mentioned that although he usually meets weekly with a clinician, he had to skip a week of therapy because CMHS had no availability during any times in which he did not have classes.

“I really don't blame people for [seeking treatment], it's just...I really need this weekly thing that I can hopefully get down,” he said. “It's just frustrating because I have to be...so proactive about getting a good spot. I don't want to have to be fighting other people just to get therapy."

According to Downs, there is no fixed-session limit, and the number of sessions provided for a student is determined based on the individual student’s need, how much assistance the student wants and the particular details of the student’s circumstances, such as the student's access to off-campus treatment resources.

“We often try to emphasize that we don't have a set session limit because we do want people to know we try to meet their needs in the best way we can,” she said. “At the same time, we know that if we don't end care with some people, there won't be room for somebody else who is knocking on the door.”

She explained that CMHS conducts treatment in this way in order to ensure that there is never a waitlist to receive treatment.

“We're actually a well-staffed counseling center for the size of the university," Downs said. "But we can't see everybody on-going. We don't have that [capability], and that's a frustration sometimes.”

However, senior Paige Roberts, a representative of Ears for Peers, an anonymous student-run support hotline, had a different opinion. She explained that she does not believe the number of counselors available allow CMHS to adequately meet the mental health needs of students.

“It's really hard for people to get appointments -- the schedule is always changing,” she said. “Because the counselors are so busy, they don't always follow up with people who need to kind of be forced into going to counseling, or need a reminder, or people who are just going to let it go when they think it's not their top priority and it really should be, and they need someone else to tell them that.”

Working closely with CMHS, Ears for Peers strives to provide supplemental assistance for students who need someone to listen. All its call-takers, who are on call every day between 7 p.m. and 7 a.m.,  are trained by CMHS clinicians every semester,  Roberts said.

Mahlet Meshesha (LA '15), author of the Mental Health and Counseling article in the most recent Disorientation Guide, explained that she understands that accommodating every student seeking assistance is difficult, but believes that CMHS’s time-limited treatment ultimately deters students from seeking the help they need.

“I think students are less likely to follow through with getting care because of the many barriers of seeking treatment off campus, like finding time for traveling to and from appointments,” she said.

She also noted that figuring out how to finance off-campus treatment can be a barrier for students. One difficult aspect of arranging off-campus counseling is managing insurance. Even if students can afford the copays associated with off-campus counseling, many students remain on their parents’ insurance, which can be an issue for students worried about communicating mental health issues with their parents, she said.

Meshesha also believes many students are unaware of the time-limited nature of on-campus treatment until they reach the end of their sessions.

According to Downs, however, all students are told at the onset of their treatment that there is a limit to the type of services CMHS can provide. She mentioned that this conversation is different for each student.

“[A student] might know fairly quickly that there are some difficult things to talk about [and that] it's going to be a little bit hard to make a relationship with somebody and open up about things and then make the transition [to another treatment provider], and so together, we might decide that maybe making that transition sooner will actually feel better for you," she said.

Downs noted that CMHS clinicians complete safety assessment forms for every patient during treatment and that the clinician’s degree of concern about a patient may alter the process of transitioning a student off campus.

“If we're worried about a student, we're going to be careful and slower about how we do that referral, because we want to make sure students' needs are met,” she said. “People have a range of what they are able to manage at any given time. So if somebody is really needing more from us right now, we might see them for a while until they get stabilized and sort of work on that transition slowly."

Downs also said that clinicians always follow up with students if they cancel or do not show up for an appointment, as well as after referring students off campus.

Snydernoted that his current clinician did not mention that treatment is time-limited during any of his sessions but that he is aware that he may be directed off campus in the future.

Downs noted that CMHS collaborates regularly with Tufts student groups that work to address issues related to mental health on campus, including Tufts Health Advocates (THA), Active Minds and Ears for Peers.

THA Mental Health Co-Chairs and seniors Sophie Ehrlich and Emma Brenner-Bryantexplained that the two serve as liaisons between the student body and CMHS administration to advocate for student needs surrounding mental health. Last fall, THA led focus groups to survey students’ feelings about the treatment provided at CMHS. Each of the three focus groups contained eight to 10 students, they said.

Through the groups, THA found that some clinicians seemed to be more proactive than others about bringing up the topic of transitioning off-campus. Brenner-Bryant also noted that this seemed to depend on the student’s relationship with the individual counselor.

“Figuring out how to get that to be more of a consistent supportive transition is something we're working toward,” she said.

Brenner-Bryant explained that she hopes that CMHS can further develop resources for students who do not seek treatment at CMHS but rather want to start their treatment off campus.

Additionally, THA found that students generally expressed a need for increased support during transitional phases. THA has shared specific student feedback with CMHS, which has been relatively receptive to its suggestions, Brenner-Bryant said.

“Something that the staff has been really great about doing has been starting to send out emails when something big happens in the world that might be affecting students' mental health, or during finals period -- kind of making it more personalized,” she said.

Based on feedback through the focus groups, Ehrlich and Brenner-Bryant are also working to push CMHS to increase proactive outreach to historically marginalized communities. They mentioned that CMHS has accordingly started a group for students of color to discuss their experiences attending a predominantly white institution.

Downs noted that diversity within the staff is a top priority for CMHS when hiring new clinicians.

“We have a fair amount of diversity on our staff across those areas in terms of areas of expertise -- race/ethnicity, language ability, gender/sexual orientation,” Downs said. “Could it be more diverse? Absolutely. And we know that. That's something we're always paying attention to and working on.”

She added that CMHS has ties to all of the culture centers, along with liaisons with academic departments, athletics, Greek life, deans’ offices, the study abroad office, the Academic Resource Center and accessibility services.

Ehrlich and Brenner-Bryant said these liaisons serve as a "great start" but that they are not sure how often the liaisons are utilized.

Even with liaisons in place, many students expressed that they felt “mismatched” with their clinicians, according to Ehrlich. Downs acknowledged that a clinician's identity may impact a student's experience with CMHS.

“Sometimes the identity of the clinician is a salient factor for students seeking services; sometimes it's not,” Downs said. “That can be important, and of course, when we can do that, we do it, but we can't always do that. What we have to do is be a staff who are as competent and concerned as we can be about really understanding students' experiences. Even if that experience is very different from our own.”

Brenner-Bryant and Ehrlich hope to work with CMHS to increase transparency about clinician backgrounds.

“We've been working with staff to create biographies online, so people can realize that they have a lot of control over the people they directly see and that if they have a preference, that they can ask for it, and people will try to do their best to meet those requests,” Brenner-Bryant said.

Mesheshanoted that it would be helpful for students seeking assistance to be directly prompted about whether or not they have preferences about a clinician’s identity.

Based on suggestions from THA, CMHS tested the helpfulness of prompting students with this question over the summer,Ehrlich said. The THA co-chairs explained that their current work involves following up on the results of this pilot.

Downsexplained that some schools conduct phone-screening appointments to triage students before they come in for their first appointment.

“We don't do that partly because we don't want to create a barrier, and we want people to have their first clinical encounter to be as positive and personal as it can be,” she said.

Junior Danielle Mulligan, president of Active Minds, hopes that students who feel mismatched with specific clinicians express their concerns so that they can find better matches to improve their counseling experiences.

“With any therapist anyone goes to anywhere, you're not necessarily going to find that the first time you go to a counselor that it's going to be the best fit,” Mulligan said. “I think CMHS has a good array of counselors, and I think if they make it more clear that people can change counselors or pick their counselor, that would be a really helpful thing.”

Meshesha recommends that students be proactive in seeking out the resources they need.

“My rule of thumb is first figuring out who you would like to talk to, what your preferences would be, and then thinking about the type of treatment you want to get if you know that, and then asking if [the clinician has] any availability, and then ask about insurance,” she said.