Charlotte’s journey to a psychiatrist’s office was a long one.
Years to recognize she had a problem, months to visit UNC’s Counseling and Psychological Services for an outside referral, weeks to find herself in the testing room of a psychiatrist’s office.
And then hours later, she had a diagnosis and a prescription. But the process was far from intuitive, she felt, and very quickly became too much for the UNC junior seeking help for her anxiety.
“There are so many intricate details to it,” Charlotte said. “It is really confusing the first time you go through it. Now it’s crystal clear what exactly the steps are, but figuring the steps out is hard.”
After her initial visit to CAPS in January, Charlotte left with a list of insurance-friendly psychiatrists in the community and started calling.
After several trials and countless errors, she learned that psychologists typically test for attention deficit disorder, but only psychiatrists can prescribe medication.
She learned the details of her insurance and which nearby offices accepted it. She learned that even if you’ve found the right practice, the earliest available appointment can be months away.
“It sounds like if you know these things going into it, it would have been a lot simpler,” Charlotte said. “How would I have known how that works? It’s just kind of something you learn along the way.”
Finding help for her ADD and anxiety ultimately became a source of anxiety itself, so Charlotte called on her dad for help.
“There’s just all of this insurance jargon that my dad’s aware of, and I’m not,” she said. “I don’t think I would have gotten tested without him.”
Charlotte’s dad, Mike, said he went through a complicated process of calling psychiatrists, calling insurance and calling CAPS to find some solution that would work for his daughter. Mike estimates he called 15 psychiatrists total before finding one that fit.
One of the main challenges they faced was the two and a half hour distance between them. Had he and his daughter been in the same city, Mike said, the whole process could have been a lot more efficient.
“Ultimately it worked out, but it was stressful for me — frustrating, I should say. But I knew (Charlotte) needed the help, and I wasn’t going to give up,” he said. “Once I got in the middle of it, I realized there was no way she could have done this.”
Young people often struggle with the logistics of getting help because they lack life experience, said CAPS Director Allen O’Barr.
CAPS offers referral coordination services to help shepherd students through the process. O’Barr said about 30 percent of the students who visit CAPS are referred to off-campus providers, and of those students, about half use referral coordination.
“And even the ones that go through referral coordinator don’t always stick with a therapist,” he said.
“So our goal in the next couple of years is to get everyone to have the opportunity to go through referral coordination and then have some way to see if they in fact get to the target.”
O’Barr said students have praised the referral coordination service, but it has holes because of a lack of resources.
“I think that’s a legitimate criticism that is only a problem because and the staffing stays the same,” he said.
CAPS will refer students out if they have issues of mental health that are unlikely to be resolved in a semester, O’Barr said. That’s what happened in Charlotte’s case — but college students face a number of barriers to seeking mental health help.
If a student doesn’t have a car, their options for community resources are limited. If they’re supporting themselves, the copay for a visit could be too steep to sustain.
“The whole goal is to find out what the barriers are and help overcome them,” said Wendy Kadens, therapist and case manager at CAPS. “Needing help is hard, wanting help is hard, all those things are really hard. But we really want the message to be, ‘Try to the extent possible to talk with a referral coordinator or a therapist about what’s getting in the way, and give us a chance to help figure it out.’”
Chief among the barriers for college students is time. Nearly two months after Charlotte’s initial visit to CAPS, she went back to discuss psychological underload at the encouragement of a friend.
“They’re really designed for students who have an existing ongoing mental health concern at the beginning of the semester, and they’re saying ‘I know this could potentially interfere,’” Kadens said.
In order to underload — take less than 12 credit hours in a semester — for psychological or other medical reasons, students must provide adequate documentation, according to the CAPS website. The student must also continue treatment for the duration of the underload.
“The idea is not to say, ‘You’re so ill you need treatment,’” Kadens said.
“But if your mental health concern is interfering with your being the best student you can possibly be, we really want to encourage people to be getting the support that they need.”
In order to drop her course load below 12 hours, Charlotte has to start seeing a therapist, who would then write a letter on her behalf that she can present to an appeals committee because it’s so late in the semester.
That means another round of phone calls until she finds a therapist who works for her. CAPS gave her a new list, this time for off-campus therapists. But she said the effort is worth it for a lesser course load that would allow her time to work on her mental health.
“If I weren’t able to do the appeal, the therapy would really be impossible for me to go to because I’m in class or work from at least like 8 to 5 or 9 to 5 every day,” she said. “The underload is so important.”
Though finding a psychiatrist earlier in the semester was so difficult, Mike said he thinks Charlotte is now more prepared to find a therapist on her own.
“She’s starting the process I went through,” he said. “And she’s in a better state of mind.”
Charlotte started making calls on Monday and heard back from one as early as Wednesday.