This Date in UCSF History: Therapy Cut Short


A proposal to extend current Student Health Insurance benefits for mental health has been removed from the 1989-90 registration fee budget by Chancellor Julius R. Krevans, due to concerns about funding and pending a broader reevaluation of mental health resources for students.

UCSF students are currently eligible for 10 visits to a therapist at Student Health Services (SHS) under the mandatory SHS basic insurance policy. SHS has one fulltime position for therapy for students, currently filled by four part-time therapists.

SHS representatives say this service is fully utilized, with space limitations at SHS precluding any real expansion of services there.

Psychiatrist Lynn Schroeder, who works half-time at SHS, estimates that about 25 percent of the more than 200 students seen for therapy at SHS would be appropriate candidates for more extended therapy.

“It's pretty awful when the 10 visits are up and the student now has well-identified needs, but nowhere to go,” she says.

In recognition of these needs and resource constraints, the SHS Advisory Committee last year began developing a trial proposal to extend mental health benefits, utilizing off-campus therapists who would agree to see students for a pre-determined fee.

The proposed plan, developed by SHS director Dr. Lourdes Olivares, would make students eligible for up to 50 additional visits to the community therapists, with costs of $25 per visit covered via a contract negotiated with Blue Cross.

Blue Cross would charge $55,000 per year for this additional coverage; it would be met by using $45,187 saved from SHS salaries and $9,813 from registration fee funds.

In making his decision, Krevans expressed reluctance to approve any new program with only one year of guaranteed funding, and cited the existence of a separate proposal for a new off-campus counseling center.

Krevans asked Vice-Chancellor Thena Trygstad to review the various proposals and make a recommendation. He directed that the $55,000 proposed for Olivares' program be held in the Registration Fee reserve account.

Administration officials stress that there is no quarrel with the need for expanded services, but that there are conflicting perspectives on how to fill those needs.

“It's clear that there is a need for additional counseling resources for students,” notes Trygstad.

“Students are concerned, and that's where the recommendation to have an extension of SHS benefits came from. The problem with that idea, as the Chancellor stated, is that there is only one year of money. He'd rather have us take a look at the entire problem, see what the options are, and come up with a funded plan.”

Olivares says the Chancellor's decision surprised her, and she plans to ask him to reconsider. Concerns about the SHS plan extend beyond cost issues.

Trygstad cites a longtime perception among some students that medical records at SHS are not truly confidential, and that even if confidentiality is assured, some students still just do not like the idea of going to a part of the UCSF organization for mental health care. SHS personnel are adamant, however, that confidentiality is assured there.

“We recognize that some students have that perception, but mental health records are kept separate here and are not accessible to anyone other than the therapist,” says Dr. Miriam Gould, part time SHS psychiatrist.

Gould, who has worked at UCSF for 39 years, does recall some past problems with SHS staff around the confidentiality issue, but maintains that is no longer an issue.

“Our duty is to the student, and we are especially careful because of the situation students are in here,” she says. “There isn't anything more we can do about our location here.”

The alternative proposal, coming from the associate deans of the UCSF schools, is to establish a separate, off-campus counseling center which would provide prevention and wellness programs as well as short-term counseling and referral.

“I think it's long overdue that there be a counseling center for students,” notes Trygstad. “Basically we need to look at an array of counseling services for students and see what it will take to get the best program. We need to figure out what level of staffing would be required, what resources we have, how much we're short, and how we might make up the difference.”

Funding for the counseling center proposal would have to come from registration fees and the individual schools, although no specific requests for funds have yet been made.

Trygstad hopes to have a more solid idea of what the program might entail by the end of September, and then plans to start consulting with the schools to see if funding will be available.

The new center could be in operation by next Fall.