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The Daily Tar Heel

UNC responds to mental illness with limited resources

Allen O'Barr is the Counseling and Psychological Services Director.
Allen O'Barr is the Counseling and Psychological Services Director.

Battling anxiety and depression, former UNC student R. struggled daily to get to class and contemplated suicide last fall.

R., who has asked that her full name not be disclosed for privacy reasons, is one of many students who seek assistance from Counseling and Psychological Services (CAPS) with suicidal ideations. She is part of an even larger group of UNC students who seek therapy for a range of mental health concerns.

“There are occasions that a person’s suicidal ideations will be ramped up because of academic stress,” said Dr. Allen O’Barr, CAPS director and UNC psychiatrist. “When they come in, they see no way out but failing out or killing themselves.”

Students like R. find themselves supported and at odds with CAPS as it strives to balance limited resources with growing need.

CAPS provides students with brief individual therapy, and O’Barr said there is no limit on the number of short-term sessions students can receive. He said students’ therapy is usually resolved within four to six sessions.

However, junior Johanna Ferebee, who is a photographer for The Daily Tar Heel, said her CAPS therapist told her there was a six session limit during her sophomore year. She said she felt like the service was impersonal.

“(CAPS) should be the first organization to make you feel like you’re not alone, and I found that my experience with CAPS made me feel more alone and more rejected than ever,” Ferebee said.

A resource gap

Due to limited funding and space, CAPS cannot offer long-term therapy, O’Barr said.

“Every therapist who works with me wants to do long-term psychotherapy with their patients,” he said. “You really get to know someone over time. We just don’t have the funding to do that.”

There are 16 therapists providing brief therapy at CAPS and four psychiatrists who strictly prescribe medication. There is approximately one therapist for every 1,800 students, O’Barr said. If CAPS were to provide long-term therapy, he said there would need to be one therapist for every 50 students.

“I can’t even begin to tell you how tight it is,” O’Barr said. “It is almost impossible to provide long-term psychotherapy to this size population.”

A recent survey conducted by the Association for University and College Counseling Center Directors reported the average ratio of paid mental health professionals to students for a midsize university is one for every 1,864 students.

CAPS is funded in part by student health fees and session charges, O’Barr said.

The first meeting a student has to discuss medication is free, but students are charged $85 for each additional visit, which can be reimbursed by student insurance.

O’Barr said CAPS connects students to 251 therapists in the community who can provide long-term therapy for ongoing disorders such as depression and anxiety. Students are matched with a therapist who specializes in their needs and accepts their insurance.

When Ferebee went to CAPS, she said her therapist told her that her case was too severe to handle at CAPS and sent her to a community therapist.

“I walked out in the spring with a ripped up piece of paper with a number on it,” she said.

“It just feels like they don’t give a shit.”

Working with CAPS

Senior Emily Wiggins said she went to meditation therapy at CAPS for a few weeks to manage her anxiety.

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“The combination of speaking one-on-one with a therapist and learning how to train my mind to be still … was so beneficial for me,” she said.

“After counseling and meditation, my grades improved tremendously, and I wanted to make friends and challenge myself to totally take advantage of my time in college.”

Last semester, R. said she regularly saw a therapist referred to her by CAPS to address anxiety. But eventually her anxiety turned into depression, which led to suicidal ideations.

R. approached CAPS about her suicidal thoughts and wanted to withdraw. She was able to that day.

“They didn’t give me any trouble with it,” R. said. “For me, what I needed was to leave. When I came in it was the day after I had this really low, suicidal moment.”

In the 2010-11 academic year, 98 students withdrew for psychological reasons. This number jumped to 180 and 168 for the 2011-12 and 2012-13 school years, respectively. Last semester, there were 89 psychological withdrawals.

CAPS can help academic stress by putting a student on an exam excuse list, taking an incomplete or withdrawal.

Responding to students

Withdrawal is not always the first response to students with suicidal ideations.

Responding to a suicidal student involves different arms of campus, including housing, Campus Health, Department of Public Safety and the Dean of Students Office.

“We create a plan on a case-by-case basis,” said Associate Director of Housing and Residential Education Rick Bradley. “It is certainly the health professionals who take the lead with that.”

Bradley said housing works with other departments if there is a suicidal student in a dorm.

“(For ideation), RAs have a full-time community director on call 24/7 and their initial call is to that person,” he said.

If there is an attempt, Bradley said DPS is contacted immediately and the student is transported to the ER.

Randy Young, spokesman for DPS, said almost half of the officers have gone through Crisis Intervention Training, a 40-hour, week-long course.

DPS’ main concern is the safety of the student, he said.

“We do not make determinations of mental and physical sickness,” he said. “We make a determination as to whether in the field the person is a danger to themselves or others.”

Young said DPS does not have standard policies to handle mental health emergencies.

“We approach everyone as different than the last,” he said. “This takes all shapes and forms, and we are constantly educating and re-educating our staff in how best to deal with the situation on the ground.”

In the legal spotlight

Lewis Bossing, senior staff attorney at the Bazelon Center for Mental Health Law, said mentally ill students have rights under the Americans with Disabilities Act and Rehabilitation Act.

“The technical definition of a disability is that you are significantly limited in a major life activity — this could be studying, concentrating, getting along with others, sleeping, working,” he said.

Bossing said mentally ill students can go to the disabilities office and identify themselves as a student with a disability in order to receive accommodations such as a change in class schedule.

“If you have to have treatment at a certain time of day and take a different section of a certain class, then that might be an accommodation that is very reasonable in the sense that it doesn’t really cost anything,” he said.

Many times when university personnel notice a student is exhibiting atypical behavior that could signal a mental illness, Bossing said there might be a request that a student seeks treatment or take a leave of absence in order to do so.

In a recent essay in Yale University’s student newspaper, a student said she was asked to leave Yale after disclosing suicidal thoughts.

“The problem for us when students come to us is when they’re being asked to do something that they don’t want to do, like go on some sort of leave or sign some sort of behavior or treatment contract,” Bossing said.

A university can justify mandatory withdrawal if a student is a direct threat to themself or others, he added.

Dean of Students Jonathan Sauls said students are never asked to leave UNC for mental health reasons.

“Our institution takes a lot of pride in helping students wherever they are in whatever continuum,” he said.

Bossing said students are sometimes asked to share their treatment plan or information about it in ways they find invasive to their privacy, which can be a violation of the ADA and section 504 of the Rehabilitation Act.

He said he feels universities still see students with mental health issues as liabilities.

“They have had to face more heat when someone gets hurt than they have to face heat when someone is discriminated against on the basis of disability,” he said.