Information to Consider

The Counseling Center (CC) staff wanted to provide some information about our treatment model, factors that affect clinical decisions, and some of the choices we are forced to make. Every semester we set a record for number of students seen. Within the last decade, there has been a significant increase in demand for clinical services, severe mental health issues, and increased consultation about students of concern. JMU’s increasing enrollment also impacts clinical services. Those factors require us to make decisions that can feel disappointing, confusing, and frustrating, especially to people who are not involved in the system. We're also frustrated by it.

Increased Demand

The additional positions and resources we have received over the years, are not enough to keep up with the skyrocketing demand for services. Although our staff has increased, our total number of clients has increased 165% and individual sessions have increased 230%. Take a look at the infographic for information about the increase in emergency services. It’s not a typo! 

The reality is that it is impossible to provide all of the clinical services required to meet the needs of all JMU students. We’ve made numerous changes over the years to increase efficiency, decrease wait times, and enhance the services offered. However, the current model is unstainable. We've simply reached the limit of what we can provide.

Brief Treatment Model

Our goal is to provide the highest quality of service to the most students possible. In order to achieve that, we have adopted a brief treatment model. The majority of clients who present at the CC (over 82%), receive ongoing clinical services with us. We keep as many students as we can. The majority of student get their needs meet within 4-8 individual counseling sessions or through another CC service. However, in order to see those students, we need to make referrals for certain issues.

We are not able to see clients who present with issues that require longer-term services, for chronic mental health issues, or for issues that are not appropriate in a short term model. We make those decisions by assessing what specialties we have on staff, what the needs of our students are, and what resources are available on campus and in the community. Instead of seeing one client for 25 sessions, we can see five clients for five sessions. We only refer when it is clinically appropriate to do so. Anytime we provide a referral, we provide a rationale, specific contact information, review how to connect with the service, and offer case management services for individuals who require additional assistance.

Rapid Response

In the face of increased mental health emergencies on campus, we have had to shift resources to rapid response services. Most of that time is spent on same day emergency appointments and consultations about students of concern. The goal is to get at-risk students seen as quickly as possible, assess their needs, and get them connected to the appropriate resource. However, there are only so many hours in a week. The more time we set aside for emergency services, the less time we have to accept new clients. That means we have to increase referrals. It also means we have to see current clients for fewer sessions.

Counseling Center Reality

We have a limited amount of hours in the week to offer services. Everyone wants students who are in distress to be soon as quickly as possible. However, prioritizing imminent risk for same day appointments, means other students who are in distress, but not in crisis, have to wait longer. Students who are experiencing suicidal or homicidal thoughts, psychotic symptoms, or a recent traumatic event must be seen as soon as possible. The person in the ER with a broken arm is in a lot of pain and wants services as quickly as possible. However, the person having a heart attack will be seen first. It doesn’t mean the broken arm isn’t important. It means that when resources are limited, certain issues are prioritized over others.

We meet with every student who is interested in clinical services, assess their needs, and provide a referral based on what will help them the most. That referral is to a CC service, another JMU department, a community provider, or a combination. If a student gets referred to a service outside of the CC, they were not denied services. They were assessed and provided a treatment recommendation. It’s similar to when you see your family physician for a check-up and they refer you to a specialist.

We only refer 15% of students to a community provider. Some of those referrals are because they want a specialized service that we do not offer. For example, we don’t offer ADHD assessments. There is already a low-cost option on campus. There is no point in duplicating an existing service. Plus, we don’t have an ADHD assessment specialist. Other students get a referral because they request one. Some students receive a CC service, but have additional needs. A student may participate in a CC depression group and receive treatment in the community for OCD. Finally, some presenting concerns are not able to be adequately addressed with the resources that we have. It would be unethical and inappropriate for us to refer a student to a service that would not effectively address their concerns.

Ideal Counseling Center

If there were enough resources to meet all the clinical needs of JMU students, things would look a lot different at the CC. Students would be seen for their first appointment the same day they wanted it. Students who were in distress could be sent right over instead of having to wait for an initial assessment. Students would meet for their first appointment with the clinician they would see for counseling. Everyone would get the clinical service of their choice. We would have walk-in hours dedicated to students who are in distress and need support, even if it was not an emergency. We would be able to provide long-term psychiatric services. Clients could be seen as often as they needed, for as long as they needed, and we wouldn’t have to refer anyone to an off-campus provider. We have dedicated our education, careers, and lives to helping others. It is difficult to make decisions where not everyone gets what they want. However, we are committed to making sure that students get connected with what they need.

The future

Counseling Center clinicians in 2016 are responsible for 81% more sessions than CC clinicians in 2000. As the university grows, every 1% increase in student enrollment results in a 5% increase in CC clients. That ratio is consistent across counseling centers nationwide. As the student body and clinical demand increases, we will have to make more and more difficult decisions about how long students can be seen, what kind of issues are appropriate for our model, and who we have to refer.