'Therapy should be affordable to everyone': CAPS addresses financial burdens of therapy

This article is part of the Mental Health Collaborative, a project completed by nine North Carolina college newsrooms to cover mental health issues in their communities. To read more stories about mental health, explore the interactive project developed specifically for this collaborative.

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In 2022, UNC launched the Heels Care Network, a mental health resource hub where students, faculty and staff can search for mental health support on and near campus. Since then, the website has averaged 27,000 visitors per year, according to UNC Media Relations. 

Despite the broad accessibility of this resource, Counseling and Psychological Services Director Avery Cook said there are still several pervasive myths surrounding mental health access on campus.

“A lot of folks come in, and they think that there are session limits — that they only get a certain number of sessions at CAPS,” they said. “That hasn't been true for about 15 years.”

Cook also said they have heard students think there is a waitlist to see a CAPS therapist, which is not the case — they can walk into CAPS and speak with a therapist that same day.

Most of the services provided by CAPS are covered by the Campus Health fee, a mandatory fee paid each term through tuition and fees by all degree-seeking students. About 71 percent of the fee is allocated toward the Campus Health budget and about 29 percent goes to CAPS, according to Media Relations. Revenue from the fee constitutes a little over 50 percent of the total CAPS and Campus Health budgets. 

Initial assessments, brief therapy, group therapy and referral coordinations at CAPS are all offered at no additional cost to the student. For medication services, CAPS works with students to bill fees through their insurance, Cook said.

CAPS's primary service is called brief therapy, which is not limited in its number of sessions and helps students work through one area of need. Cook said brief therapy is appropriate for about 70 percent of students who visit CAPS.

For students seeking long-term therapy outside of CAPS, there are several resources to offset the cost. Cook said CAPS has a specific fund to cover outside therapy for students who demonstrate a high level of need. Others can be set up with providers who offer psychotherapy on a sliding scale at a reduced cost or can be connected to different clinics that also have lower fees.

Tausha Watson, a licensed psychologist in Chapel Hill, said she works with low-income students to offer psychotherapy services at a price that meets their needs while covering overhead costs for her business. 

"I really do believe that people should be able to receive financial assistance, that therapy should be affordable to everyone," Watson said.

Watson said the most common reasons why students would need a sliding scale is because the provider they want doesn’t accept their health insurance plan, they need to access therapy without their parents knowing or they prefer to forego using their insurance for other reasons.

Under the Student Blue health plan, administered by Blue Cross and Blue Shield of North Carolina, there is a $10 copay fee for undergraduate students seeking mental health services from providers within their network.

Watson also said many providers in the area are hesitant to accept Medicaid insurance due to unwanted audits and interference in therapy, so some students with Medicaid choose to pay out-of-pocket and have the cost reduced with a sliding scale.

“A lot of time with students who have Medicaid, they’re going to struggle to really find outside providers who are Medicaid providers here,” Watson said.

UNC sophomore Mari Tyndall said she walked into CAPS in the fall of 2022 when she was on Medicaid and received help from referral coordinators to match her with a therapist in the area who fit her needs and took her insurance. 

During referral coordination, CAPS providers account for students' preferences regarding the identity and background of a therapist and send them several suggestions that fall within their parameters. Tyndall said this process helped her get set up with a Black, female therapist who specialized in substance use issues.

She said she is currently working with CAPS to avoid the fee of an official ADHD evaluation so she can be prescribed medicine by a psychiatrist.

“That was a really neat thing that took a load off my shoulders because I’ve had an ADHD diagnosis since I was two,” Tyndall said.

According to Media Relations, CAPS saw 1,812 different students for walk-in appointments last semester, provided 2,414 total brief therapy appointments and serviced 7,067 total medication appointments.

Well Ride, a program started by the Undergraduate Student Government and currently managed by CAPS, provides free Lyft rides for students who live on campus to get to their off-campus therapy appointments.

“Our goal is to make sure that we do everything we can to help students overcome the barriers that they may have to get the services that they need, whenever possible,” Cook said.

CLARIFICATION: The language about substance use has been updated in this story according to recommendations by the National Institute of Drug Abuse.

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