Handle With Care

Seth Riddley ’08-’12 had never suffered from psychiatric problems before coming to college, but soon after moving from South Carolina to Cambridge to begin his freshman year, he faced family difficulties and began to seriously consider suicide.

Riddley approached his resident dean, who immediately referred him to Harvard University Health Services. UHS physicians sent Riddley to McLean Hospital—a psychiatric facility associated with Harvard Medical School—escorted in a cab by his resident dean.

The experience ushered Riddley into Harvard’s mental health system, which he has been intimately involved with throughout the six years since he first arrived on campus as a freshman. Since his initial crisis, Riddley has taken four years off—mainly due to mental health issues—and he continues to see therapists and prescribers at UHS.

“I don’t know how I would have made it without what I’ve encountered as tremendous quality mental health care here,” Riddley recalls.

Students and UHS administrators have endlessly debated the quality of Harvard’s mental health services, which treats about 15 percent of the students in the College—or roughly 1,000 undergraduates—in any given school year, according to Director of Behavioral Health and Academic Counseling Paul J. Barreira.

The wrongful death lawsuit filed against Harvard College and UHS last November focused campus attention on potential issues with UHS’s mental health policies. The family of John B. Edwards III ’10, who committed suicide in Nov. 2007, alleges that the negligent psychiatric care that Edwards received at UHS contributed to his death.

While several students say that UHS services have improved in recent years, particularly praising the accessibility of appointments, others say they have encountered frustrating limits on the amount of therapy they can receive or have had negative experiences with therapists during some of their most vulnerable moments.

LIMITATIONS ON CARE

One of the primary concerns among students who have frequented UHS mental health services over an extended period of time is the perceived restriction on the number of visits they are permitted.

Harvard undergraduate Joseph, whose name has been changed to protect his privacy, began receiving therapy at UHS during his freshman year, and says his therapist told him that he was limited to only receiving therapy once every two weeks.

“No matter how good the therapist is, every two weeks isn’t necessarily the right amount,” Joseph says.

Rachel, a freshman whose name has also been changed, says she was similarly limited to one therapy session every two weeks—inadequate for her needs. Though she liked her therapist, she says she stopped receiving care at UHS because of the limited amount of help the system could provide.

“I was just very upset that I didn’t get as much out of it as I had expected or hoped to,” Rachel says. “I do feel stuck and lost, and I need help and it’s there—but it’s not enough.”

Rachel says her therapist directly referenced a 12-session limit at which Rachel’s therapy would have to be re-evaluated, although her therapist was confident that she would qualify for treatment beyond that constraint.

Several students interviewed for this piece say that they have been limited in the amount of in-house therapy that UHS was willing to provide. While some say that they were restricted to an every-other-week therapy regimen, others say that they had been cognizant of some form of an unofficial limit on sessions.

But according to UHS officials, there is no official restriction on the number of therapy sessions that students can receive.

“The notion that you can only be seen 12 times is just false,” Barreira says. He adds that the only restrictions on therapy apply when students seek care from therapists outside of UHS; in these cases, the student health insurance plan will only cover 12 sessions.

“There’s a review, but the review just has to do with getting our colleagues to look at what we’re doing with the treatment and what we should be doing differently,” Barreira says.

Chief of Mental Health Richard D. Kadison concedes that during the busiest months, some students must receive slightly less care to accommodate appointments for students with acute distress.

“Sometimes people who have been seen more, their visits will be spread out a little bit more due to supply and demand and trying to accommodate students,” Kadison says.

A SENSE OF RUSH

Some students say that they faced disquieting experiences at key moments in their care, including a sense that they were either rushed through intake appointments or faced with excessive wait times at after-hours urgent care.

Ellie, whose name has been changed to protect her privacy, sought care this past fall when she began to feel anxious and depressed. While she was given an intake appointment within a week, she was shocked when her therapist told her she was bipolar after a 20-minute conversation.

“I was surprised that she could come to the conclusion so quickly,” Ellie says.

One freshman student, who does not wish to be named, says that when he accompanied a friend to Mental Health Services during finals period in the fall, he was disconcerted by how long it took for a therapist to arrive.

“The fact that it took an hour and a half to see someone is alarming,” the individual says.

A student involved with mental health advocacy at Harvard, who also does not wish to be identified, says that some of these issues were widely acknowledged as weaknesses in the Harvard mental health system.

“I personally have gotten a lot of complaints from students that the counselors themselves rush people through appointments. [And] there are some pretty terrible stories of people going in after hours, and the on-call psychologist coming in 45 minutes late,” the student said.

Another potential source of difficulty is the division of mental health care between therapists, who provide counseling, and prescribers—nurse practitioners or psychiatrists—who dispense medication to students.

While some students say they appreciate having two different people to turn to, others say this system creates a disconnect between the different aspects of their treatment.

QUALITY CARE, ROBUST RESOURCES

Although many students with long-term issues express discontent with UHS’ treatment system, students who have received short-term mental health treatment from UHS shower praise upon the system, particularly the accessibility of appointments and the relatively short wait times.

Barreira says that the availability of care is partly a function of the robustness of UHS staff, which he says is one of the largest on a per-student basis for any university in the country.

New patients receive a 20-minute appointment to speak with a clinician by phone within two days of their initial request, and they are then set up with a follow-up appointment to see a UHS therapist in person.

“I think the mental health side of UHS is a lot more helpful than the physical health side,” says Emma, another student who has used UHS’ mental health services and whose name has been changed to maintain her privacy. “There was a lot of flexibility in times, and they were really good about contacting me about appointments and setting things up.”

Undergraduates who received less than 10 therapy sessions at UHS say they never felt as though their therapy was being restricted, and they were not informed of any limit on the amount of treatment they could receive.

Students who approach UHS for a specific issue also praise the system, like Caitlin E. Carey ’13, who receives treatment for obsessive-compulsive disorder.

“I haven’t really had any negatives with UHS mental health services,” Carey says.

Barreira says that UHS continues to increase and restructure its staff to reduce wait times and increase the availability of therapy.

“Mental Health Services is always evolving,” Barreira says. “It is never the same today as it was a month or even a year ago.”

—Staff writer Danielle J. Kolin can be reached at dkolin@fas.harvard.edu.

—Staff writer Evan T.R. Rosenman can be reached at erosenm@fas.harvard.edu.