Out of the waiting room

New leadership team vows to end the dreaded waitlist at Engemann Student Health Center and hire five new therapists. But we’re far from an ideal model.

Talia R., a junior, heard the phone click on the other end. Her eyes brimmed with tears and her shoulders shook, but the therapist never would have known. She had been promised a phone consultation with the Engemann Student Health Center and had been waiting for three weeks, but spoke for no more than two minutes before a therapist interrupted and asked if she had thought about suicide. When she replied no, she said the therapist immediately told her, “Since your situation is not dire, you will be placed on a waitlist. If you don’t hear back from us in two weeks, you can try again.”

She hung up and did not get a follow-up call until four months later at the end of the semester. By that time she had resorted to therapy outside of USC to cope with another stressful semester.

Dr. Robert Mendola, Engemann’s executive director for student mental health, says more than 20 percent of students requested mental health services this academic year compared to 11 percent in the past few years, a trend consistent with most college campuses. American college students report a growing culture of stress and anxiety on campuses.  A 2017 New York Times article attributes the increased demand for mental health services to universities nationwide finally taking steps to address mental health problems. Seeking help for mental health issues is becoming widely accepted.

USC’s response to the increasing demand for mental health services began in 2011 when the Engemann family donated over $15 million to create a new health center with abundant space and resources. Five stories high and over 100,000 square feet, Engemann’s grand and imposing structure falls short of meeting the student body’s need for mental health care.

Last September, a new leadership team took over at Engemann and eliminated the waitlist model for students seeking therapy. The new hires, Dr. Robert Mendola and Dr. Sarah Van Orman, the Associate Vice Provost for Student Affairs and Chief Student Health Officer, were brought in to improve the student health and wellness program.

Their installment is part of The Keck School of Medicine’s plan to increase administrative oversight of Engemann and Eric Cohen Health Center. This merger aims to allow the student health centers to benefit from the faculty expertise and organization of Keck and address grievances regarding access to care.

“Four is not enough. There will never be enough.” Mendola says. “We probably need 20 more therapists.”

Mendola and his team, along with USC Vice President for Student Affairs Ainsley Carry, are constructing more preventative services and promoting group therapy. Within Engemann, The Office for Wellness and Health Promotion in collaboration with Be Well USC put on a “happy hour” in which students are encouraged to develop self-care and stress management through yoga or tai chi. They also offer a therapy dog, Beau.

Increasingly common on college campuses, these low-intensity preventative services can be effective. Students say they find brief bliss in petting Beau or crunching on a shiny green apple. But for students like Talia R., who did not want to be fully identified for privacy reasons, Engemann’s current “acute care model” means barriers to therapy access, long wait times, and little follow up.

National health experts say one therapist for every 1,000 students is a reasonable ratio. Mendola acknowledges USC simply does not have enough therapists to confront the skyrocketing need for access to higher intensity services. Four new therapist positions have been included in the Fall 2018 budget.

“Four is not enough. There will never be enough.” Mendola says. “We probably need 20 more therapists.”

Engemann’s acute care model targets students who are an imminent danger to themselves or others since room for routine therapy is extremely limited.

Elly Rauch, a junior, believes once a student is in the door, Engemann provides quality care. “I had a truly life-changing experience with my Engemann counselor. Even as someone who has never been to any form of therapy before, I felt comfortable sharing my feelings and experiences and in fact, looked forward to doing so.”

USC offers a subset of therapy dealing specifically with sexual assault — RSVP, Relationship and Sexual Violence Prevention and Services. Four faculty members run RSVP and a fifth therapist for RSVP is in the budget for Fall 2018. Two students who have received mental health through RSVP praised this niche of Engemann for providing personable and focused care. These therapists know their patients by name and students can quickly and easily get appointments. One junior said her therapist checked on her twice in a day after a particularly tough session. Since the demand for services is lower and there are more resources, this program can offer personable and reliable therapy. But general therapy is limited to 12 sessions at Engemann.

A 2014 female graduate, Cynthia, who did not want to be fully identified for privacy reasons, told Neon that freshman year, her parents moved back to China and she fell into a deep depression. She spent weekends whittling away the hours in her twin XL bed in Marks Tower. Her resident adviser urged her to seek help through USC’s therapy program, but when she found out that she could only receive 12 sessions over her entire undergraduate career, she was discouraged.

“I already wanted to give up,” she said. “I thought, what if I feel suicidal by junior year? I can’t waste these sessions now.”

USC offers group therapy as a more easily accessible alternative to individual counseling but is only offered at specific times. A wide variety of group programs focus on problems ranging from eating disorders, to sexual trauma, to substance abuse. But while group therapy covers many issues, not all students can fit the offered time of the group therapy they need into their schedules. Plus, some students simply do not feel comfortable sharing in a group setting.

The demand for mental health services cannot be met by Engemann’s staff alone. Students who do not require acute care treatment are referred to providers in the Los Angeles area.

If students do not have a car in Los Angeles, it becomes difficult to access outside providers for routine sessions in the greater LA area. A senior says that only one of the 10 therapists referred to her by Engemann was in Downtown Los Angeles. The rest were located in Santa Monica or Marina Del Rey. Because she could not get to her sessions easily, she gave up on therapy altogether. Mendola says that feedback suggests most students stop seeing outside therapists after one or two sessions. During Mendola’s career at Cornell University in Ithaca, New York, 40 percent of the Cornell students were referred outside of the system.

“Another big problem is the student health fee,” Mendola says. USC students can either enroll in the school’s health insurance or stick with their waived outside healthcare provider. A waived provider means that the student is covered by a comprehensive health care plan that meets the university’s requirements and is in compliance with the Affordable Care Act. Either way, all students must pay the student health fee — $334 for fall 2017 and $333 for Spring 2018. This fee is mandatory and cannot be waived. It lets any student access Engemann.

When students are covered by an outside health care provider that has been approved by the school, if they seek mental health resources from Engemann and are referred to an outside therapist, the system won’t necessarily ensure that their therapy referrals are covered by their waived in-network providers. If the referrals are not covered, the sessions with outside providers quickly become expensive.

A junior majoring in International Relations says that when Engemann referred him to a list of outside therapists, only 2 of the 10 therapists were covered by his waived, outside health care provider.

The UC schools have a systemwide health care plan for their students: UC SHIP. All registered UC students are automatically enrolled in UC SHIP. According to a UCLA junior studying communications, mental health services for students are free, but free therapy sessions are also capped at six sessions per year and the cap on therapy at their school deters them from seeking long-term mental healthcare as well.

Despite the challenges that Engemann faces, more changes are coming at USC. Mendola says that they are seeking to increase collaboration between mental health and medical health services. The overall goal: provide quicker, more efficient treatment for more students. Beginning this spring, students now go into USC therapy or are referred out immediately.

A 2016 UCLA graduate, Jacob Temkin, says that UCLA CAPS, Counseling and Psychological Services, is highly promoted by student government and faculty on campus. Specific student support groups for LGBTQ students and students of color are publicized and encouraged as well. UCLA also has a program called The Student Wellness Commission, which is a rapidly growing student and faculty club that promotes holistic well-being through programs and projects like anti-smoking campaigns and awareness on mental health fairs. Seeking help or advice in mental health is widely encouraged on the UCLA campus.

USC Undergraduate Student Government has been advocating for new services for several years, and mental health is part of many election platforms this year. However, many students believe student organizations could do a better job spreading the word about these programs. Students like senior Joy Ofodu have taken it upon themselves to speed up change and increase awareness.

Ofodu met with Provost Quick and Van Ormann to voice student grievances about Engemann. “It is comforting to know that they are working on things,” says Ofodu. “Being a student on this campus you can feel small, but we have to take advocacy into our own hands and make our complaints heard.”

Art by Maya Bingham

Becca is the co-editor of NEON. She is a senior double majoring in English and Political Science.