Maddy’s psychiatric care provider at Arizona State University had just increased the dosage of the anti-depressant she was taking and it wasn’t going well. She felt like a “zombie,” she said, and was struggling to keep pace with her busy schedule taking 16 credits and working two jobs.
“I really needed to see a doctor,” she said.
But a couple of days before her appointment in June, ASU called to inform Maddy the university was shutting down its only on-campus psychiatric program. She and some 200 students are now scrambling find mental healthcare elsewhere.
“It kind of made me mad,” said Maddy, a senior studying communications, whose name has been changed. She had been working with the same psychiatric provider every other week for eight months to treat chronic depression and anxiety, and they’d built up a rapport. “It sucks having to go find someone new, get re-diagnosed, and start all over.”
In a statement to New Times, ASU framed the move as a way to streamline services.
The psychiatric nurse practitioner Maddy was seeing at ASU’s downtown campus was the only such provider employed by the university. For the most part, students who need medication for mental illness are referred to off-campus psychiatrists through ASU’s robust counseling program, which offers individual and group therapy, as well as 24-hour crisis intervention and educational outreach.
“These providers are known to ASU — they are more accessible, faster, closer to home, and take a variety of insurance carriers, making them more affordable to more students,” Herminia Rincon, a media relations coordinator at ASU, wrote in an e-mail, adding that a referral system was “more efficient” than providing psychiatric care on campus.
When giving referrals, Rincon wrote, ASU takes students' "needs for care, insurance, and location" into account.
"As a university in a major metropolitan area, we have a distinct advantage of utilizing robust medical expertise in the community," Rincon wrote. "Our network also means faster service, as a students can get the next available appointment from among a variety of providers instead of relying on the availability of a single provider."
Nationwide, the number of colleges that offer psychiatric services has dropped more than 10 percent in the last five years, the Association for University and College Counseling Center Directors reported. In 2014, only 55 percent of colleges employed a psychiatric care provider, compared to 66 percent in 2010.
Under the right circumstances, referral programs like ASU’s work, said Victor Schwartz, medical director at the Jed Foundation, a national nonprofit that promotes mental health among college students. Universities just need to evaluate the off-campus health network for quality and proximity as well as consider student characteristics, such as access to transportation.
“We think it’s in the university’s interest to make sure mental health services are as accessible and affordable as possible because it helps students thrive in school,” he said. “But we also recognize that universities aren’t in business to provide health care.”
It’s important for psychiatrists working with students to understand the unique elements of college life, he said. That may come easier to doctors working exclusively on campus — but does not exclude off-campus providers.
“If it’s the week before finals, you wouldn’t want to start somebody who has moderate levels of depression on medication because it’s very possible the student is stressed out, is not sleeping well, and may look better in three weeks,” he said. “Similarly, you don’t want to be adjusting someone’s dosage before a big test because they may experience side effects that could affect their performance.”
On-campus psychiatrists often network with professors to help students get accommodations for mental health problems, such as extended deadlines. But Schwartz noted, "You don't have to be a psychiatrist to do that. A therapist can get the job done."
College students dealing with mental illness who rate their campus health care as “good” or “excellent,” however, list having a qualified on-site psychiatrist as one of the top five reasons for satisfaction, along with free counseling and a 24-hour help line, according to a recent survey from the National Alliance on Mental Illness. About 50 percent say they feel it is “critical” for universities to employ at least an on-call psychiatrist.
The main benefit to having psychiatric care on campus is accessibility, Schwartz said.
Only about 60 percent of mentally ill adults get treatment, according to NAMI, and, research shows, difficulty navigating the United States’ complex, fragmented mental health care system is a major barrier.
For college students, not getting treatment often means not graduating. Sixty-four percent of college students who had been diagnosed with mental illness drop out.
“It’s common sense: the closer the services are to the students, the more likely they are to take advantage of them,” Schwartz said.
Maddy struggled to find a new psychiatrist.
Rincon said ASU posted a list of providers who were accepting patients on an online patient portal, but Maddy was unaware of it. Over the phone, Maddy said the university declined to give her a referral.
When she set out to find a new psychiatrist on her own, “they were all booked and not taking appointments for at least a couple months.”
"I had to beg my general practitioner to refill my prescription," she said. "I only had two pills left."
In the end, she said the only provider she could find that met her needs was 15 miles away.
“I think ASU is trying to present themselves like they care about students and their mental health,” she said. “But they’re leaving a lot of students without options.”
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