College students make up one of the largest demographics of individuals affected by mental health issues, with nearly 40% of students experiencing a mental health issue. This is unsurprising, considering the constant pressure to excel in academics while balancing a social life and extracurriculars. Stressors are even more exacerbated now, as we concern ourselves with the pandemic, the election and climate change. This is to say nothing of the added anxiety of being a person of color or an LGBTQIA+ individual, who may face daily discrimination and violence. 

Given the prevalence of mental health issues among college students, universities play a critical role in addressing self-care, mental health and long-term health care. Case Western Reserve University does offer many initiatives to promote health lifestyles and address concerns with anxiety, depression and other mental health issues. All students are given up to 12 free sessions of counseling per year through University Health and Counseling Services (UHCS).

However, we should carefully analyze if UHCS services are adequate at meeting the needs of students—on and off campus. After all, 67% of people aged 18-24 with anxiety or depression do not seek treatment. 

One second-year student who has used UHCS Counseling since their first year at CWRU said, “They’re good in the fact that anybody from [CWRU] can go, but it is definitely built toward short term progress.” They elaborated that perhaps it’s best for UHCS to only try to address the short-term and connect students to third-party professionals for more long-term counseling, just as an individual would be referred from a general practitioner to a specialist for more precise care. 

The student raises important questions of the role that CWRU should play in helping students with mental health. It could hypothetically be fine for the university to only address immediate and short-term mental health problems, as long as they are also able to effectively refer people to third-party professionals when necessary. However, the referral system is part of the problem, as it prevents students from accessing counseling. 

Students have varying relationships with their parents or guardians, from friendly, to cordial, to estranged. When the relationships are closer to the latter, students may have reservations about sharing some of their health concerns, especially those related to mental health, with their parents. Meanwhile, if a student is on their parents’ health insurance—as many of us are—then any third-party visits to psychologists or counselors will appear on an invoice sent to the holders of the policy: parents. If parents discover their child is lying or pursuing certain health measures they may not approve of, there may be irreversible damage to their relationship. 

This concern raises a two-fold issue. First, is the prevalent belief that mental health is somehow less of a “real” medical issue than physical health. If parents believe mental health conditions are fictitious, a student will surely abstain from sharing their concerns; moreover, hearing these erroneous comments will likely worsen the student’s mental health, suggesting their feelings are invalid. 

Second, students should not be dissuaded, or even prevented, from receiving long-term counseling on account of their parent’s beliefs. This issue is of even greater concern since the onset of the pandemic because licensure laws prevent students outside of Ohio from receiving regular counseling from UHCS. Other than counselors covered by insurance, how can these students access long-term assistance? 

Additionally, UHCS counseling is further complicated by bureaucracy. One third-year student is frustrated that students are reassigned therapists every year, rather than being able to keep the same professional and build a relationship with them. They believe this policy is related to why UHCS does not commit to offering more long-term services. “I think the goal is to make a person feel better in the moment and refer people who need more help to the community,” they said. 

While it is certainly important that students’ short-term health and immediate concerns are addressed, UHCS should also be shouldering the responsibility of ensuring students are working on their issues in the long-term. For most people, mental health is not something that just disappears or flips on and off like a switch. It’s something that is always present, but ebbs between being a background concern and being so distracting that students can’t focus or complete any work. 

UHCS offers a wide variety of resources to help students, each with their own individual concerns and issues. There is a counselor available on-call 24 hours a day, seven days a week and UHCS has established some additional virtual programs, such as Anxiety Toolbox, BIPOC (Black, Indigenous, Person of Color) Support Space and Getting Unstuck (to address depression), which are available for free regardless of geographical location. However, these important initiatives do not excuse UHCS from addressing the previously raised concerns about availability of long-term counseling. 

UHCS Director of Counseling Richard Pazol was made aware of these many concerns, and the more general availability of long-term counseling through the university. In response, Pazol said, “Most students find that they need, on average, between three to five individual counseling sessions to address the issues for which they present. When students need more than that, [UHCS] is equipped to consistently provide them with additional individual counseling sessions.” 

If this is indeed the case, why are some students reporting only being able to see a UHCS counselor for 30 minutes every other week? Is this not a widely inadequate amount of appointments for serious mental health concerns? 

We asked Pazol nearly ten questions regarding students’ access concerns and whether the availability of mental health services differs from that of physical health. Encouragingly, Pazol acknowledged that biological, social and psychological factors all affect mental health and, as such, students should be treated individually and holistically. However, it’s disappointing that he neither addressed the raised concerns about the availability of consistent counseling sessions nor those regarding students who feel they cannot be referred to the third-party resources due to insurance invoices breaking confidentiality. 

Rather than answering any of our questions, Pazol responded with approximately 300 words on the effectiveness of their policies, even with an increase in demand—many of his comments about available resources could be found on the UHCS website. 

Given the possible consequences of relying on third-party long-term counseling services, UHCS, and by extension CWRU, may be inadvertently harming students’ mental health and access to resources. As such, UHCS should commit to covering all costs of any counseling any CWRU student needs. This may include more regular counseling appointments, even multiple times a week, rather than capping the number of free hours. 

Moreover, by accepting these costs, if UHCS does not expand its services to offer more regular long-term counseling services, it should assume the costs of students to see third-party therapists. 

“Finances” cannot be used as a justifiable excuse. CWRU has increased the cost of tuition multiple years in a row, including by nearly 4% for the 2020-21 academic year while many families are suffering additional financial losses due to the pandemic. In preparation for the most recent increase, Dr. Sara Lee—director of UHCS—stated in a town hall event that part of the additional money would go to increasing healthcare and wellness services. Yet, students are reporting no improvement in reliability. Pazol failed to respond to a question about how this money has been spent to improve UHCS services, and did not comment on a timeline for increasing space for more staff—another reason stated by Lee for the increase in tuition.  

Moreover, the university could consider adjusting the president’s pay to relieve students of some of their current financial and emotional burden. Barbara Snyder was one of the top-paid university presidents in the country, with her annual compensation totaling $2,021,313 (as reported in 2017). Perhaps it’s time CWRU reconsiders its priorities: is it committed to its administrators, board of trustees and affluent donors, or to its students—after all, CWRU is an academic institution, isn’t it? 

In addition to the availability of long-term resources, UHCS should ensure the current initiatives are adequate. Referral counseling sessions need to be accessible by the transportation available to the particular student. Students should be able to keep the same counselor at UHCS for as long as they want, rather than being bounced around to a new professional each year. UHCS should also hire additional counselors who are people of color. The current staff is predominately white, causing many students of color to not seek out therapy or not address racial issues in their sessions. The Feminist Collective has been working to encourage UHCS to officially add an option for students to schedule a counseling appointment specifically with a person of color. Despite Pazol previously committing to adding the option by Sept. 16, the initiative has yet to be confirmed. 

Students are trying to balance the stress of academics with being social and doing their extracurricular activities, all during a global pandemic and period of intense political polarization. UHCS has a responsibility to us and our health, not just in our individual moments of panic or depression, but for the long-term by supporting us while we are students here and providing us with the tools to continue living healthy lives once we graduate.