January 30, 2019

TRUSTEE VIEWPOINT | Reducing Wait Times for Mental Health Support

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Perhaps unsurprisingly, the accessibility and quality of student mental health services continue to be of high interest to the Cornell community. Written recommendations, like those submitted by the student-led Mental Health Taskforce, and ongoing discussions amongst campus stakeholders, like those facilitated by the Coalition on Mental Health, continue to highlight ways in which we can improve services and better support students.

A recurring theme is that student demand for counseling services exceeds the possible support Counseling and Psychological Services can provide. While more than 22 percent of Cornell students used CAPS services in the last academic year, CAPS reports that for students seeking individual counseling, they aim to schedule first appointments within two weeks with wait times increasing even further during periods of high demand. The wait to see a counselor for individual counseling is a significant barrier to receiving high-quality care in a timely manner for many students. As the demand for services has historically increased each year, with no indication that this trend will plateau or disappear, finding a solution to this supply and demand problem is becoming of paramount importance.

The most straightforward solution is to continue hiring more and more mental health practitioners as quickly as possible in the hopes that we can meet demand. The CAPS team is currently comprised over 40 highly-qualified psychologists, social workers, psychiatrists and psychiatric nurse practitioners from a variety of diverse backgrounds with plans to hire more. However, finding and retaining high-quality practitioners continues to be a challenge resulting in a historical inability to simply hire more counselors to meet the demand. We are not the only university facing this problem, which allows us the opportunity to look to other institutions and see what changes they are exploring. In my opinion, there are two specific changes worth highlighting to the broader community.

The first strategy is a shift away from the traditional 50 minute initial mental health assessment to a 30 minute one. Like Cornell, institutions that adopted this model had students waiting anywhere from two to three weeks for their first treatment session. However, changing to this model has resulted in the average wait time dropping to around three days, with most students being seen the same day they reach out to the health center. Students then have the option after the first assessment to stick with either a 30 minute or switch to a 50 minute session if they would like to continue seeing a practitioner. For many students, this change not only allows them to see a practitioner much faster — meaning that they may receive help while the problem is still moderate preventing its escalation to a crisis — but it may also be easier for them to schedule more frequent sessions as it may be easier to find 30 minutes in a packed weekly schedule compared to 50.

While there are additional adjustments that must be made in order to make this shift successful, this change is particularly exciting because it accelerates the development of a relationship between a student in distress and Cornell Health. It now positions students to not only receive high-quality treatment as soon as possible but also positions Cornell Health staff members to rapidly connect students to additional resources on campus that may support them. The benefits of this change exceed simply reducing wait times. It increases the flexibility of CAPS staff while reducing staff burnout. The cumulative change being the elevation of CAPS services to one that is better prepared to meet students needs and provide support.

The second strategy is the integration of telemedicine into an institution’s health, and by extension, mental health services portfolio. Technological advancements now allow patients to interact with a health care provider and receive care via virtual text chat or video. For patients living in communities where the demand for certain health services outpaces the supply, such as rural cities, telemedicine is proving to be an effective strategy for bridging this gap. Our own medical school is successfully using telemedicine to evaluate patients in the Emergency Department, once again not only reducing time spent obtaining care but also effectively managing to maintain high levels of patient safety and satisfaction. A recent survey disseminated by the Student Assembly and Graduate and Professional Student Assembly found that 50 percent and 21 percent of respondents believed developing online and app-based mental health resources should be a medium or high priority respectively. All of this suggests that offering telepsychology and telepsychiatry may allow Cornell students to obtain professional support faster than before.

The flexibility associated with telemedicine means that students can schedule sessions not only when but also where it is convenient for them. Many students have vocalized that making it into Cornell Health is a barrier for them receiving care. Telemedicine could minimize or even eliminate this problem. While telemedicine may not be of interest to every student, even a subset of the population utilizing this resource allows CAPS staff members to see more individuals. Also, Cornell Health could potentially invest in creating physical offices on campus allowing students to utilize this service in comfortable and confidential spaces at a comparatively lower cost. Once again, this shift is well positioned to connect students to Cornell Health and mental health practitioners sooner rather than later. 

To be clear, I am not advocating for a complete shift in practices to either model detailed above. The path forward may instead be adding these both as options for students. The decision is then in the hands of students. They are ultimately given greater power to choose which model best suits their needs and expectations. For CAPS and Cornell Health staff, the addition of these techniques should help them engage and support more students without increasing burnout. The desire of all campus stakeholders, including students, staff, and administrators, is to provide high-quality care to students in a timely manner and to ensure student success at Cornell. Both of these suggestions should, in theory, serve this goal, and therefore make them worthy of serious consideration.

Manisha Munasinghe is the graduate and professional student-elected member of the Board of Trustees, and a Ph.D. candidate at Cornell University. Trustee Viewpoint runs every other week this semester. Munasinghe can be reached at mmunasinghe@cornellsun.com.