‘People deserve to have resources’: Habif faces legal obstacles, funding questions with telemental health
Habif Health and Wellness Center will provide “telemental health” services in place of its usual in-person counseling services this fall.
Barring limited or emergency circumstances, students and counselors will meet virtually for counseling, therapy and other programs. However, students studying remotely outside of Missouri will likely be unable to access these services.
Under current law, both the mental health provider and recipient of care must reside in the state in which the provider is licensed. Habif’s counselors are licensed in Missouri and thus unable to provide the Center’s usual care to students located in other states and countries.
“Very few of the practitioners that we employ get licensure across multiple states,” Associate Vice Chancellor for Student Support and Wellness Kirk Dougher said. “There are very different loops you’d have to jump through, different requirements. And so again, it’s not just which state you’re in but what license you have and what the different requirements are for those different areas.”
Over the past few months, Habif counselors have made “check-in” calls to students with whom the Center had been working prior to campus closing in March. Students can also call Habif to request check-in phone appointments, which Dougher stressed are not regular or a form of therapy.
“It’s more of a check-in to see if we might be able to connect them to [Care Manager] Missy Showalter in Habif or Wash. U. Cares, to be able to connect them with providers in their community, or to be able to see whether there’s resources we can turn them to, or just check in and see how they’re doing,” Dougher said.
Students previously had to make a short phone appointment in order to schedule a sit down meeting with a counselor. Referring to the phone triage system as a “barrier to students being seen more quickly,” Habif Director of Mental Health Services Thomas Brounk said that Habif has recently eliminated the phone appointment and is instead replacing it with a 25-minute session with a counselor so that students can further discuss their situations and start to plan next steps.
Habif also has three hiring searches underway. While two searches are to fill already existing positions since two employees recently left the 23-person Mental Health Services staff, Habif has also created a Crisis Manager position, which would increase the staff size to 24.
However, the sources of Habif’s funding this fall remain uncertain.
Dougher noted that much of the University’s Health and Wellness funding comes from the student health and wellness fee in addition to funds allocated from each school. With student access to resources such as Sumers Recreation Center and telemental health dependent on how and from where they study this fall, the University is currently discussing the possibility of adjusting the health fee for different study plans.
“If that health fee is refunded to a lot of students, then my operating budgets for all of my areas will go down as well,” Dougher said. “So we’ll have to wait to see what happens there and then hopefully react accordingly with trying to make sure that we have as little impact on the students as possible.”
Brounk said he hopes that telemental health services make it more convenient for students in Missouri to access resources, as they can now meet with a counselor virtually from the comfort of their residence. However, he noted that the “jury’s still out” on the efficacy of telemental health.
“I think probably for low to moderate forms of depression, online treatment probably can be effective,” Brounk said. “It’s where if something requires a very behavioral approach, which, sometimes in the treatment of [Obsessive Compulsive Disorder] or certain types of anxiety, using a behavioral therapy approach can be most effective, that could be more difficult to provide in an online environment.”
Habif will continue other mental health services such as Let’s Talk consultations, Therapist Assistance Online (TAO), the after-hours support line, group therapy services and virtual workshops. Brounk added that Assistant Director of Mental Health Outreach and Programming Jordan Worthington has been working to reach students through expanding Habif’s social media presence.
While the University cannot currently provide counseling virtually to students outside of Missouri, it is investigating possible solutions to the issue. One option is supporting legislative action that would temporarily remove license restrictions.
“Washington University knew that [Senator Roy Blunt of Missouri] is very interested in mental health access, so we started speaking with his staff about the problems we ran into and we recommended some solutions,” Assistant Vice Chancellor for Federal Relations Jason Van Wey wrote in a statement to Student Life.
Blunt and Senator Chris Murphy of Connecticut introduced the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act on Aug. 4, which would “provide temporary licensing reciprocity for all practitioners or professionals, including those who treat both physical and mental health conditions, in all states for all types of services (in-person and telehealth) during the COVID-19 response and for future national emergencies.”
Washington University is listed as a supporter of the act in Murphy’s Aug. 4 press release. Under the TREAT Act, Habif counselors would be allowed to provide telemental health services to students across the country. However, the United States Senate is on recess until Sept. 8, meaning that the bill has no immediate path forward.
The release notes that, although states have recently expanded licensing rules, the act is necessary due to these state rules being “varied, inconsistent, and time-limited.” However, Dougher noted that the University is currently considering the possibility of providing interstate counseling through a program by the Association of State and Provincial Psychology Board (ASPPB) that facilitates interstate licensure. The program, called the Psychology Interjurisdictional Compact (PSYPACT), allows accepted counselors to conduct temporary practice in 14 PSYPACT states.
The University is also researching possible third-party organizations that provide teletherapy to patients across the country. However, these kinds of contract services pose their own set of risks and challenges, such as quality and confidentiality issues, according to Brounk.
“We have to do very close due diligence with that type of arrangement because a lot of those organizations, though they provide certainly a valuable service, they are in it to make money and make a profit,” Brounk said. “…Some of these third-party vendors, what you have to do is agree that some of the content of your information could be still reviewed or mined for [public relations] purposes, for data, so we want to actually be able to provide something that we can stand behind.”
Demand for counseling
Student Union has long advocated for the University to expand Habif’s counseling staff to decrease the two-to-three week wait times and increase the number of counselors that hold marginalized identities. While the passage of the TREAT Act would allow a larger number of students to access counseling, Dougher noted that this raises concerns about Habif’s ability to meet demand.
“This ends up being a little bit of a double-edged sword because we want to make sure that we have support accessible to all of our students in supporting this legislation,” Dougher said. “But it’s also a potential that as this rolls out, or if it happens, that we may be in a place where we again don’t have enough providers to be able to meet the therapeutic demand.”
According to Brounk, the number of students seeking Habif’s mental health services increases each year. While it is not yet known what that number will be this fall, some students worry that the pandemic’s impact on mental health will lead to increased strain on Habif’s resources.
“We’re definitely concerned with the services that are going to be available just considering the circumstances of the fall and making sure that there are services available for students who are taking their classes remotely,” SU Senate Health and Wellness Chair sophomore Nicole Leers said. “But at the same time, we are still very cognizant of the long wait times at Habif. And we’re anticipating an influx in mental health related struggles. So those wait times could get longer. We don’t know.”
Student work and activism
Student Union Senate recently created a National Therapist Database to connect students to counselors across the country. In addition to continuing its mental health fund, Senate is working with Habif and student counseling group Uncle Joe’s to create a mental health resource sheet detailing all the services available to students. The sheet, which will also highlight resources specifically geared toward students of color in light of recent protests against police brutality, will be available at the end of August and included as a part of First-Year Orientation.
“With the increased isolation and lack of socialization that we’re going to be seeing in the fall, I think it’s really, really important that the University is providing resources for students to be able to take care of themselves and be very mindful of their mental health and well-being,” Leers said.
While Uncle Joe’s Co-Director senior Georgia Bartels-Newton does not foresee the organization holding their usual in-person office hours this fall, they are planning to open their 24-hour phone line. Uncle Joe’s is also considering meeting with students over Zoom, though Bartels-Newton noted that this raises concerns about protecting client’s anonymity. Members have spent the summer compiling national and international resources so that they can assist students calling from a variety of locations.
“Everyone is going to be going through some sort of adjustment in the upcoming year, and people deserve to have resources,” Bartels-Newton said. “People deserve to have support.”
The National Alliance on Mental Illness (NAMI) can be reached Monday through Friday 9 a.m. to 5 p.m. Central Standard Time at 1-800-950-NAMI (6264) or through email at [email protected]