Students seek counseling off campus

Most college students don’t know what a deductible is, or which questions to ask a psychologist when making an appointment for the first time.

They don’t know how much money constitutes a reasonable fee for a therapy session or which bus line goes where.

But that’s what they have to find out when they have a mental health issue that extends beyond the resources available at UNC’s Counseling and Psychological Services.

Dr. Allan O’Barr, director of CAPS, said about 25 percent of students who come to CAPS are referred to the community.

He said CAPS limited students to eight sessions until two years ago. CAPS now operates on a brief therapy model, meaning they encourage students with serious psychological issues to seek help outside of the University — but O’Barr said there isn’t a set number of sessions for students before they are referred out into the community.

“The counseling and wellness center is fantastic, but they have very limited resources,” said Dr. Ruth Bard Rampel, a Chapel Hill psychologist on CAPS’ list of community providers.

Referring students into the community

Senior Lara Taylor, 31, said she has used CAPS since the start of the school year. Now, her CAPS therapist is helping her transition into the community.

She said she went to CAPS because she was undergoing difficult changes in her life — she transferred to UNC from Forsyth Technical Community College after her sophomore year and divorced her husband about a year later. Taylor commuted from Winston-Salem to Chapel Hill until she moved to Chapel Hill last summer, separating her from her children.

Therapists at CAPS diagnosed her with anxiety and associative depression and sent her to a psychiatrist on campus for medication, she said.

Taylor said she only has two sessions left with her therapist at CAPS, but her therapist has given her the names of two community clinicians.

“She told me that she thinks they’ll be a good fit for my personality and the therapy I like,” she said. “I’m set up to have a smooth transition.”

But N., a UNC senior who asked to remain anonymous for privacy reasons, said CAPS’ referral process was inconvenient for her.

N. said CAPS clinicians told her she was showing signs of post-traumatic stress disorder during her first visit in January 2012. After her second session with CAPS, a counselor referred her to different places in the community for long-term therapy.

But she said CAPS didn’t consider her insurance coverage, and she didn’t immediately pursue any treatment.

She returned to CAPS a year later, and a counselor there helped her narrow her options by finding a cognitive psychologist who held Saturday sessions and was located on a bus route.

But travel was time-consuming, and N. said she wasn’t ready to tell anyone she was seeing a psychologist. She never met with any clinician outside of the University.

“It’s a lot of stress for someone who doesn’t really want to add stress to their life,” she said.

Dr. Judi Oleski, a Chapel Hill psychologist who works primarily with college students, said college is the most transitional period of someone’s life — and with transition, comes a lot of stress.

Rampel said the process of finding a clinician is overwhelming, even for a seasoned adult, because many college students have no experience.

She said to ease the process, CAPS will sometimes write a script for students to follow on the phone with insurance companies or counseling offices.

Oleski said she has had a longstanding, positive relationship with CAPS.

But Rob Danzman, clinical director and founder of Fonthill Counseling in Chapel Hill, said CAPS doesn’t take advantage of some resources in the community.

“They just don’t seem interested … which is unfortunate,” he said. “We can make their job a lot easier.”

Fonthill builds support teams for patients, made up of case managers, therapists and psychologists — from Fonthill and others in the community.

O’Barr said there are 251 community clinicians to which CAPS refers students, but he couldn’t disclose the whole list. Danzman said Fonthill is on that list, but he has not seen any referrals from CAPS.

“We know there are thousands and thousands of students there, and statistically, a lot of them need help,” he said.

The cost of treatment

T., a UNC student who also asked to remain anonymous, sought help at CAPS at the end of her freshman year after having trouble adjusting to college. She said she had two sessions with a CAPS counselor before she was given five names of therapists in the community.

She said after a month of therapy in the community, she went back to CAPS for the psychiatrist, where she was formally diagnosed with a form of bipolar disorder.

She said she has had a positive experience working with her psychiatrist.

“When you have a mental illness, there’s the whole fear of losing control of yourself,” she said. “I still have control of myself and my health.”

She said she stayed in therapy for a year, but still sees her psychiatrist when necessary.

T. said her insurance covers most of CAPS’ psychiatrist fees as well as the cost of therapy in the community.

Rampel said she accepts most insurance plans, but coverage varies among clinicians.

Some practices will lower the fee per session, based on patient’s income and whether they have insurance, to $50.

Without insurance, the price is about $150 a session.

“If you’re really going to someone who is good and is really helping you … then it’s a service worthy of spending money on,” Rampel said.

Dr. Barbara Lowe-Greenlee, who runs her own practice in Chapel Hill and once worked at CAPS, said copays for people with insurance average $20 to $30 per session.

Greenlee said community practices allow students time to develop a trusting relationship with their therapist — time that CAPS can’t provide for each student.

“We want to put ourselves out of work with each client,” she said. “That’s the goal — to work ourselves out of a job.”

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