ACCESSING CARE AT COLLEGE

Can a therapist share what I said during therapy?

All mental health professionals, whether on or off campus, are ethically bound to keep what you say during therapy confidential unless you specifically authorize the release of information about your diagnosis and treatment. However, therapists may be required to take certain steps if they believe you might harm yourself or someone else. Some campus counselors report threats of self-injury or hospitalization to administration officials. You have a right to know about confidentiality and how information may be shared. Ask your therapist about the limits of confidentiality and who can be notified without your permission.

What am I protected by?

Family Educational Rights and Privacy Act (FERPA)

The Family Educational Rights and Privacy Act (FERPA) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Click here to learn more about FERPA.

The Americans with Disabilities Act 

The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, State and local government services, public accommodations, commercial facilities, and transportation. It also mandates the establishment of TDD/telephone relay services. The current text of the ADA includes changes made by the ADA Amendments Act of 2008 (P.L. 110-325), which became effective on January 1, 2009. Click here to learn more about ADA. 

HIPAA

The HIPAA Privacy Rule provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes. Click here to learn more about HIPPA.

The Affordable Care Act 

The Affordable Care Act puts consumers back in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives the American people the stability and flexibility they need to make informed choices about their health. Click here to learn more about The Affordable Care Act.

Where do I start on campus? What can I do?

Often, the best place to start is your school’s counseling center. Visit its website or call its main number to find out what they can offer you. Most on-campus centers provide two to eight free visits. Counseling centers can offer a range of services, from individual sessions with psychologists or social workers, to group sessions for people who share a common issue (such as body-image issues, grief and loss, or academic anxiety), to sessions with psychiatrists. Since services vary campus to campus, your best bet is to find out exactly what your school offers.

If your school doesn’t have a counseling center, check with the school’s health center; mental health professionals may be able to see you there. Campus counseling centers provide a very valuable service. In addition to asking about the services the counseling center can provide, you may want to ask about the confidentiality policy and other school policies that may apply, such as leave policies, or ask the counseling center or dean of students about school policies and practices.

You also want to look into what health insurance you have (if you have it) and what it covers. (Some plans don’t cover mental health care at all while others have limits on the number of visits.) If you don’t want to see a clinician on campus, or if the number of visits your counseling center will allow you isn’t enough, your insurance policy may dictate what outside options are available for you. Be aware that if you are on your parents’ health insurance, they may learn that you are receiving treatment from the insurer. You may want to ask your insurance company about its billing practices. Even if you have no insurance, there are agencies in most communities that offer services on a sliding scale.

Many religious groups operate family service agencies that provide a range of counseling services. If you choose not to seek services on campus, your school’s counseling center can be a resource for referral to practitioners and programs offcampus. You may end up seeing a psychologist, psychiatrist or social worker in a private practice near your campus or in your hometown. You can also go to a family doctor to discuss your symptoms, though it is a good idea that you follow-up with a mental health professional since a general practitioner is not the most knowledgeable about mental health issues.

What will happen when I call to make an appointment?

When you call to make an appointment at the counseling center, the receptionist will likely take your name, address, student information (class year) and ask why you are calling. You may not be asked directly, but if you are experiencing an emergency, you should say so immediately so you get in to see a clinician as soon as possible. If you are calling an off-campus resource, spend a few minutes talking with the clinician on the phone, ask about his or her philosophy and approach to working with patients, and whether or not he/she has a specialty or concentration. If you feel comfortable talking further to the counselor or doctor, then make an appointment. If you call a professional off campus you may not get a return call right away, if you are a new patient.

What are some questions to ask my counseling center?

Especially if using an off-campus or independent therapist, use this checklist as a guide to set your goals for a first conversation. Many of these questions will probably be covered without your asking, but if not, don’t be afraid to ask.

• What academic qualifications and training have prepared you to practice as a therapist?

• What specialized training and/or experience have you had in working with the issue I am dealing with?

• What professional associations do you belong to?

• What are your fees? Can you accommodate me if I don’t have insurance? Is any payment required at the time of the visit?

• How will my insurance claim be handled?

• What type of therapy do you do (e.g., mostly talking, medication, role-playing, visualizing, hypnosis, artwork, “body-work”)?

• Can you prescribe medication? If not, what arrangement do you have for doing so?

• What are your office protocols (booking appointments, payment for missed appointments, emergencies, etc.)?

• Can you accommodate my academic or work schedule?

• Can you give me a brief explanation as to what I can expect to happen in my first session?

What are the steps for choosing the right therapist?

1. You may want to see your primary care physician to rule out a physical cause of your problems. If your thyroid is “sluggish,” for example, symptoms—such as loss of appetite and fatigue—could be mistaken for depression.
2. Once you know your problems are not the result of a physical condition, you should find out what the mental health coverage is under your insurance policy or through Medicaid/Medicare.
3. If possible, it may be helpful to get a couple of referrals (from your counseling center, friends, online) prior to making an appointment. If a particular characteristic, such as age, sex, race or religion, is important to you, you may want to mention that when asking for referrals.
4. Be sure the psychotherapist takes a unique approach to your treatment and does not believe that what works for one individual will necessarily work for another.
5. An important element of successful therapy is rapport. After your first visit, reflect on how you feel about your therapist. 

If you felt comfortable with the therapist, schedule another appointment. If for any reason the match does not feel right, it is perfectly common to discuss these concerns openly with the therapist. And, of course, you may choose to call another mental health professional from your referral list and schedule another appointment.

What are some questions to ask my therapist during my first appointment?

• Can you give me a brief explanation as to what I can expect to happen in subsequent sessions?

• How often will I have therapy sessions and how long will each session last?

• Do we agree on the goals of my treatment? 

• What should I do in case of an emergency?

• How will my confidentiality be assured?

If seeing someone on campus, you may want to specifically ask about whether and under what circumstances information will be shared with your parents or the administration (e.g., the dean of students). 

What happens if I call, and they can’t see me for two, three or four weeks?

If it’s an emergency, you should tell the receptionist right away—just as you would when making a doctor’s appointment for a physical health problem. If you say that it is an emergency, they can try to fit you in right away. 

If it is not an emergency but you still don’t feel comfortable waiting weeks until your first appointment, ask the person at the counseling center if they can notify you if an earlier appointment becomes available and if there are any other resources for you in the meantime—for example, a Women’s Center, an appropriate person at the health center or a peer group. Otherwise, you may want to seek off-campus treatment through a clinic or a therapist in private practice that would likely be able to see you earlier. 

What happens if I don't like my therapist?

You should feel comfortable with and respected by your therapist. If your first choice in a therapist isn’t working out, you have the right to choose another one with whom you have better rapport. Remember, the therapist works for you and it’s appropriate for you to express any discomfort you feel—in fact, talking it through may be an important part of your treatment. If you feel the therapist is not listening to your concerns or providing enough feedback, let him or her know. If it still isn’t working for you, don’t be afraid to change. Although it’s not easy to end any relationship, it helps to remember that the therapist is a professional. The best way to find a good therapist is by word of mouth.

Satisfied customers say a lot about the kind of therapy you will receive. Of course a therapist who was right for someone else may not always be right for you. Although you might feel embarrassed to ask friends or family for a referral, you should consider doing it anyway. It increases the odds that you may find a therapist who will really help you.

Will my parents find out if I seek treatment?

School counseling centers and outside providers generally will not release your medical information—including to family, parents/legal guardians or faculty—without your written authorization. However, there are practical issues. If your parents get insurance statements or bills related to your care, they will know you are seeing a therapist. Also, as noted above, disclosure without your consent is permitted to protect your safety and the safety of others. School administrators, faculty, disability services coordinators, resident advisors and other non-clinicians are bound by different confidentiality restrictions.

If mental health information is reported to a school administrator or disability services coordinator (in the application process, as part of a request for accommodation or by a mental health professional in an emergency), the school administrator may be able to share that information with individuals who the school determines have a “legitimate educational interest” in the information, as defined by law. Those individuals may include the Academic Deans, residential advisors, counselors, faculty or student judicial services personnel. The school must provide annual notice to students of the criteria for determining who constitutes a school official and what constitutes a legitimate educational interest.

School administrators and faculty may also share information that they personally observe. They may also share information from your education records with your parents if you are a dependent for tax purposes. The law in this area is complex. The federal Health Insurance Portability and Accountability Act (“HIPAA”), Family Educational Rights and Privacy Act (“FERPA”) and Public Health Service Act as well as state laws may apply to your situation. These laws may allow disclosure of information without your consent to other treatment providers, payers of health care, other sources of financial assistance, public agencies that oversee treatment providers and others.

These laws may also allow disclosure when you are considered incapacitated. If you believe that your privacy rights have been violated, you can file a grievance within the school or a complaint with the Department of Education, Family Policy Compliance Office, http://www.ed.gov/policy/gen/ guid/fpco/index.html Given this complexity, you should discuss confidentiality with your treatment provider to understand if, under what circumstances and with whom your information will be shared, and how you will be notified if information is being released. 

What can I expect from my school?

Your school officials should provide an environment conducive to your mental health. This includes working to reduce stigma and discrimination; training staff to better recognize warning signs and assist students with mental illnesses; reducing barriers to mental health services; adequately staffing the mental health or counseling center; and maintaining active relationships with providers in the community who offer care to students. The school should appoint an individual and implement a coordinating group with the responsibility and authority to work toward these goals. As a concerned college student, you should ask these questions of your Dean of Students or the director of the counseling center:

• Have staff and faculty received adequate training to identify and provide support for students who have mental illnesses or are experiencing extreme emotional distress?

• Are mental health services adequately available on your campus?

• Are support services available to families of students who are receiving mental health services?

• Have students received training and information about how to recognize warning signs in themselves or others?

• Does your college or university maintain relationships with available mental health providers in the community?

• Is there an adequate crisis management plan in place for students and staff to deal with a suicide or traumatic event?

• What are the school’s policies regarding voluntary and involuntary leaves of absence, involuntary leaves of absence and confidentiality? All students have a right to review and inspect their educational records.

The educational record includes academic records as well as those in the offices of the registrar, residential life and student judicial services, among others. A request must be in writing and may need to be directed to multiple departments. The school handbook should instruct you how to request your records. The school must respond to a request for records within 45 days and may charge a fee for copies. If the record contains information that is inaccurate, misleading or in violation of your privacy rights, you have a right to request that the school amend its records. If the school does not do so, you have a right to a formal hearing. If, after the hearing, the school does not amend the record, you have the right to place a statement in your educational record about the inaccurate information. 

What should I do if my school wants to discipline me for something I think happened because of my illness?

You should not be disciplined for seeking help or because of behavior that is due to your illness. However, in recent years some schools have responded to students who have threatened to hurt themselves or who have had mental health crises by taking disciplinary action for violation of student codes of conduct. Schools may justify such responses as best for the student or for other students. Also the school may be concerned about potential danger and legal liability. School administrators may genuinely believe they are doing the right thing by removing the student or initiating disciplinary action. Without knowing what school you attend, we cannot assure you that you will not be disciplined for any behavior brought on by a mental health crisis, but we can say it isn’t the policy at most schools. However, you may want to ask school administrators about your school’s policies.

If university personnel seek to discipline you for something you think was caused by your illness, they must provide some type of hearing and/or appeal process. It may make sense at that point to disclose your illness, if you have not done so already. Obviously, this is a difficult and deeply personal decision. It also has legal implications, and you may want to seek legal counsel (see the Resources section below). However, offering information about your illness might help the school better understand the behavior they seek to discipline. As a reasonable accommodation, you can request that disciplinary action not be imposed or that it be modified when the offense was the result of your mental health condition. If your school takes extenuating circumstances into consideration in imposing discipline, it must take your disability into consideration. It may be helpful to show that, with specific supports, services or accommodations, you can comply with university rules and/or the code of conduct in the future.

Also, if a university has a policy that charges students with violation of university rules or its housing contract for engaging in behavior that poses a risk to life—the student’s own or others’—a student with a mental illness can argue that an episode such as a suicide attempt or other self-injury should not subject him or her to the policy. The policy would be discriminatory when implemented against a student in need of mental health services whose behavior was a result of mental illness. If a student is disciplined for violation of a rule that prohibits disrupting a class, the student would need to disclose his or her disability and demonstrate how the disruption was caused by the disability and how it would not recur with accommodation in the form of appropriate supports and services. In general, the more a student can support a claim that his or her disability contributed to the action, and the more specific the plan for addressing the behavior, the more likely it is that disciplinary action for disability-related behavior will be waived.

Can my school require me to take a leave?

The decision to impose a leave of absence should only be made in the uncommon circumstance that a student cannot safely remain at a university or meet academic standards, even with accommodations and other supports. The same applies to exclusion from university housing, which should be imposed only if a student cannot safely remain in the housing, even with accommodations.

A school should impose a leave of absence or require a student to live off campus only after an individualized assessment. The assessment should consider whether there is a significant risk that the student will harm him/ herself or another and whether the risk cannot be eliminated or reduced to an acceptable level through accommodations.

Information from mental health professionals may be vital in making this assessment. If the school then does decide to act, the student is entitled to what are called “due process protections.” These include notifying the student of the action the school is considering and an explanation of why the school believes that such an action is necessary. The student and his or her representative should have an opportunity to respond and provide relevant information. The school may inquire into a student’s current condition and request recent mental health information and records. But it can only request information and records that are necessary to determine whether the student is a threat. The school cannot insist on unlimited access to confidential information or records.

You have a right to limit a release of information to specific dates, and you have a right to approve and to review information that is being made available to the school. At the very least, the school should provide the same arrangements for withdrawal from classes, incompletes and refunds of tuition or other costs as it does for a student who takes a leave of absence or leaves college housing for physical health reasons. 

Can a school put restrictions on my returning from leave?

Students on leave, whether voluntary or involuntary, may request to return to the school. Similarly, students excluded from housing may request to return to university housing. A university cannot require that your mental illness be “cured” before you return. If you were on leave because of a direct threat to the safety of others or yourself, you will need to demonstrate that the threat no longer exists. The school may ask you to agree to receive treatment, including prescribed medication, before returning.

A mental health professional, not the school administration, should make the decision about whether you need to continue treatment. School officials may also ask you to sign a behavioral contract and agree to various conditions before they will allow you to return to school. For example, they may ask you to agree that you will leave the campus if there is another incident of self-injury. Keep in mind that a school cannot require that a mental illness be cured or that disability-related behavior not recur unless that behavior creates a direct threat that cannot be reduced to an acceptable level with accommodations.

Therefore, be cautious about signing a behavioral contract that limits your rights. You may want to negotiate about the terms of any such contract. For example, rather than agreeing that the school can make you leave if you try to hurt yourself, you could agree to seek help if you feel like hurting yourself. These types of contracts may give you flexibility if the future does not go as well as you had hoped. A student who wants to return to school after taking a leave of absence for mental health reasons should not be subjected to more rigorous standards or procedures than a student who wants to return after taking a leave for physical reasons. An opinion from the student’s mental health professional that the student is fit to return should usually be sufficient. 

Source: Bazelon Mental Health Law Center (Karen Bower); The JED Foundation