In the Know: UCLA’s Counseling Crisis

On this week’s “In the Know” podcast, Opinion editor Keshav Tadimeti talks to Kristie-Valerie Hoang, the Daily Bruin’s social media director, to get an inside look at UCLA’s Counseling and Psychological Services center. Why does the name CAPS come with so much baggage? And what barriers prevent it from serving all students? Find out on this podcast.

Transcript

Keshav Tadimeti: From the Daily Bruin, I’m Keshav Tadimeti. And this is “In the Know.”

[Intro music plays]

This time on the podcast, we examine the mental health landscape at UCLA and get an inside look at a familiar name for all students: CAPS.

Mental health facilities are a central part of UCLA’s student services. The quarter system is demanding, and many students seek counseling or mental health treatment on campus. But for years, students have been hearing stories about long wait times and limited options at UCLA’s Counseling and Psychological Services center. So for this week’s podcast, I wanted to get the inside story – why the name “CAPS” comes with so much baggage. To do that, I went to someone with a big presence in the Daily Bruin office – someone who has been reporting quite a bit about mental health services offered at California college campuses.

Kristie-Valerie Hoang: My name is Kristie-Valerie Hoang. I’m The Bruin’s social media director and senior staff News reporter and photographer.

KT: Wow, you do a lot for the newspaper, then.

KH: I do.

KT: So, tell us: What is CAPS?

KH: CAPS is UCLA’s Counseling and Psychological Services center. It offers short-term mental health treatment for students on campus. And this treatment includes, per its website, psychiatric evaluation and treatment, crisis consultation and emergency intervention, organizational consultation and psycho-educational workshops for students, staff and faculty. So students with UC SHIP, or University of California Student Health Insurance Program, can receive up to six therapy sessions with a CAPS counselor. Students without this insurance plan can get up to three therapy sessions.

KT: Three therapy sessions?

KH: Yes, three therapy sessions. And it’s important to note that these services are short-term. So once a student exhausts their therapy sessions, they are directed to mental health service providers through their insurance or to Behavioral Health Services at UCLA.

KT: What you’re meaning is to say is that CAPS, which is UCLA’s sort of official campus entity, effectively diverts students to different services?

KH: Yes, so basically, CAPS will work with a student’s insurance plan to help find, like, a Blue Anthem service provider in the community or direct them to behavioral health centers at the Ronald Reagan Medical Center.

KT: And how prevalent is the demand for mental health services on campus?

KH: When you go to a campus like UCLA, which by the way, we are the No. 1 public university –

KT: I’m sure we can’t overstate that enough, I suppose.

KH: [laughs] There is a huge amount of stress with the rigorous course load that students are balancing, plus the extracurriculars that students are also participating in. According to studies done by numerous psychologists, including UCLA psychology professor Carrie Bearden, one in four Americans will experience a mental illness at some point in their lifetime. And about 75 percent of those illnesses develop before the age of 24. So, when you take this data, coupled with the information I stated earlier, there is a huge demand for mental health services on campus.

KT: And has CAPS been able to cope with this high student demand for mental health resources?

KH: CAPS has not been able to cope with this demand.

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Any student who seeks mental health treatment at CAPS undergoes what’s called an intake, which is essentially a brief psychiatric screening. Using this screening, CAPS determines how critical a student’s mental health need is. About 50 percent of students are seen within two weeks of their intake, and 50 percent of students are seen almost three to five weeks after their initial intake. Intakes, the very first step in receiving mental health treatment at UCLA, become backed up throughout the quarter.

There’s about six therapists available to complete these screenings, and even then, CAPS has trouble retaining clinicians. There’s also issues with funding and space. CAPS primarily receives its funding from student fees, which clearly aren’t enough to keep clinicians long-term at the facility. And even if they did receive more funding, there isn’t enough office space to house those clinicians.

KT: Okay, so I see a couple things here, and I want to break them apart. The first thing you’re saying is that CAPS does this sort of assessment – what you call an intake. And then there’s a two- to five-week delay. Explain this to me: Why is there such a delay? How come they can’t see you within a couple days?

KH: Well, there’s a lot of reasons for that. First of all, there’s a limited number of clinicians available to see all these students. And all of these appointments get incredibly backed up. Especially, to the point where they’re backed five weeks after finals, according to an interview that I had with Nicole Green, the director of CAPS. Students who do receive intakes near finals don’t actually get seen until after their final exams are taken.

KT: You say there are six therapists who can do this screening, and there’s been trouble retaining these clinicians. Talk to me about that: What are the challenges with keeping these clinicians, and how has that been affecting how CAPS has been able to address increasing student demand?

KH: There’s pros and cons to working at any public institution versus a private institution. Obviously, as a licensed professional, you would be paid more if you worked at a private institution. Obviously working at a public institution at UCLA there are a lot of limitations, especially in terms of funding. Because of that, CAPS has trouble retaining its clinicians, because they are obviously not paid as much as a psychologist who opens up their private practice – that’s one reason.

There’s 44,000 here at UCLA, and there are not enough clinicians to see each and every one of those 44,000 students if they wish to receive that care. I believe the ratio at UCLA is that there is one mental health profession per 1,150 students. And that’s a drop in the bucket.

KT: So this is a very internal look at CAPS. I’m curious: Do students have this kind of vantage of CAPS – are they aware of these difficulties – or are they seeing it in a very different way?

KH: Students see CAPS in such a different way.

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From the point of New Student Orientation, where students are first introduced to UCLA, to the way CAPS is advertised on the Hill, CAPS is seen as this one-stop shop for all of your mental health needs. Even my friends who are going through mental health issues will refer them to CAPS. Students aren’t actually aware of these shortcomings until they go to CAPS and are faced with these difficulties themselves.

Students are not aware of the fact that there are only six therapy sessions for students with UC SHIP. Not everybody has UC SHIP. Even if you do have your own health insurance, you only get up to three therapy sessions, and it’s a huge issue because as a student, you’re living here at UCLA. When you force that student to go and travel extra miles just to see a therapist, it brings up the question of whether or not that travel to see that therapist is even worth it.

As I was interviewing some students about this issue, one student commuted to UCLA – 30 miles – and she was disappointed when she had to commute an additional ten to 15 miles to see a therapist through her insurance company. You know if you’re on campus the entire day at UCLA, you would expect that there would be some sort of person available to provide you that mental health treatment at the university.

KT: It seems like CAPS is going through a lot of difficulties, but a lot of problems you seem to bring up are things that should be endemic of any public university that has counseling services. What is unique to CAPS that’s causing these shortages in clinicians and these long wait times and congested lines?

KH: When I spoke with Nicole Green, she said that this sort of issue is actually prevalent through a lot of mental health institutions across the country. I wouldn’t say that there is anything unique about UCLA or unique about this particular story because I think you can find this story at any other college campus.

For CAPS, at least, the unique thing: CAPS frames itself as a short-term mental health facility. But, students don’t find out that CAPS is a short-term mental health facility until they actually go to CAPS.

What CAPS is doing right now is they have a lot of initiatives. It’s not as if CAPS isn’t aware of these problems. It’s not as if CAPS isn’t aware that there is a an increasing amount of mental health need. In 2019, they’re hosting a mental health resilience summit in efforts to culturally change the attitudes surrounding mental health at UCLA. They have a student advisory board to advise them on mental health issues on campus. They’re working with a student club called Wazo Connect, which is a peer-to-peer counseling club. They’re working with USAC.

It’s not as if CAPS isn’t trying. But the thing is, it’s sort of deflecting the responsibilities that it has as an institutionalized mental health treatment facility at UCLA to student groups and to others who don’t have the resources.

KT: What you’re saying basically is that CAPS has been marketed as the official campus counseling and psychological services entity – but it’s not able to provide those official services, and is more of a conduit for people to pass into other services, be that long-term care at the Ronald Reagan hospital or wherever insurance providers provide these resources, or to more short-term care that can be taken care of by students?

KH: Right, so once a student exhausts those six therapy sessions or perhaps if CAPS decides that a student doesn’t need therapy sessions, they try to connect them to peer counseling. But the thing is is a lot of times, students, in that three- to five-week waiting period after the intake, when students do have the option to seek peer counseling, a lot of students decide “I’ll just wait for CAPS.” And that’s because there’s a big trust barrier that exists.

If a student who decides to seek mental health treatment was able to get that treatment by talking to his friend, they would have done that. There is real value in having a licensed medical professional treat your illness – not an actual student. There’s a lot of things that I wouldn’t want to tell my friends. There’s a lot of things that you as a reader or you as a listener that you wouldn’t want want tell your brothers or your sisters or your peers because they are personal. A licensed medical professional can help you work through those problems because that’s why they got their degree.

KT: You talked a bit about how CAPS has been trying to address these challenges: that it’s trying to interface with student groups, that it’s organizing these summits, that it’s trying to address its high demand by diffusing its large student congestion among various student groups. But I think something that students are really wondering is why doesn’t UCLA just give more funding to CAPS? Why can’t Chancellor Gene Block or whoever is in charge of the financial committee just write a big fat check to give it more funding to allow it to hire more people and expand its services?

KH: Well, UCLA did give more money to CAPS. In 2016, the #UCLAWellness initiative referendum raised student fees by $6 – $1.50 of that goes to CAPS. The office so far accumulated around $200,000 from that referendum, as of May 2018. If CAPS wants more funding, there needs to be another referendum passed through the undergraduate student government elections.

KT: With UCLA having a Centennial Campaign that has raised more than $4.2 billion, with so many alumni and so many philanthropists who give this campus their time, their energies and most importantly their money, doesn’t CAPS have other ways of getting the institutional support it needs?

KH: The UCLA Centennial Campaign, as of Oct. 11, has raised $40 million toward student affairs, of which CAPS falls underneath the general umbrella. I’m sure it will receive some sort of money through the general effort.

KT: But has there been any sort of an indication, supposed from Nicole Green or any of the administrators, that this would be used to fund and expand it? Or is the facility locked in on this short-term, mental health facility image that it’s crafted?

KH: It seems to me that CAPS is locked in on this short-term mental health treatment mandate. According to Nicole Green, the responsibility for medical treatment does not entirely fall on CAPS.

There’s an analogy she used: she sees CAPS as the 405 (highway). if she were to add another lane, that would for sure cause more traffic on the 405. And a lot of people have requested their own lanes on the 405, such as graduate students, such as the athletics department – and there’s no way she can add a lane for every single group on campus. So CAPS has to find alternative routes, or methods, of travel – such as carpool, such as buses. CAPS seems to be very locked into this idea that they are a short-term mental health treatment facility. She said there needs to be a cultural change on campus, and that we view mental health not as a taboo.

However the problem is that CAPS is UCLA’s institutionalized mental health treatment facility. If Nicole Green and CAPS wants there to be a campus cultural change, CAPS has to be the vehicle to lead that change.

KT: So I want to dwell a bit on that highway analogy, because it has a sentimental connection to anybody who has lived in Southern California. What Nicole Green seems to be hinting at is that adding more facilities to CAPS would only increase demand for CAPS.

I wonder if that’s what your reporting has shown as well: whether, students go more to CAPS because they’ve heard more about it or it’s just that increased student population on campus is driving more students to attend CAPS because of the greater population?

KH: According to Carrie Bearden, psychology professor, if students were aware of all the resources for mental health treatment on campus, they would actually use them. Unfortunately, as of right now, CAPS is advertised as that one-stop mental health treatment. I’m not sure if there are any other services for students on campus. Nicole Green said that students have opportunities to go utilize clinical trials through the psychology department to receive this sort of treatment. But all of those clinical trials aren’t exactly advertised either. And when you’re seeking mental health treatment, you don’t exactly look up clinical trials. You want to see a doctor – you want to see CAPS.

As it becomes harder and harder to get into college and classes and life becomes more stressful and and more competitive, there is an increasing amount of mental health need – additionally, because I think, as a society, we are changing, and people are more willing to speak up when they need help.

KT: It seems that UCLA is in this catch-22: If it advertises CAPS, more people will be aware of it, but that can also increase traffic. And with increased mandates from the state government to admit for California residential students, its own student population is increasing, and that also could be driving up demand for CAPS. So I wonder: is California as a state supporting any initiative to improve mental health resources on college campuses in the state?

KH: As of now, Gov. Jerry Brown vetoed Senate Bill 968, which would have mandated one full-time, mental health professional per 1,500 students on campus. He vetoed this because of budgetary concerns: He did not think that the state should decide a minimum mental health counselor for every college campus, and he felt that each college campus could decide on their own based on their budget about how many counselors they can have.

KT: So what you’re saying is effectively, universities are on their own?

KH: Yes.

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KT: Is there a way out for CAPS? Is there a way for it to properly address students’ needs in a way that students understand what they’re getting from the get-go from CAPS.

KH: CAPS Director Nicole Green doesn’t believe that the sole responsibility for mental health falls on CAPS. Again, she believes it is a campus and institutional, and frankly culturalwide phenomenon that we need to address. And she also doesn’t know the mandate of CAPS when it was originally established.

But, if mental health were a priority, then CAPS would have been established as a long-term mental health treatment facility on campus since the beginning. If mental health were a priority, then it wouldn’t be so difficult for CAPS to become a long-term mental health facility.

It’s very logical for students to think that a college campus should provide mental health care, seeing as college campuses already provide some sort of medical treatment on campus. This whole issue highlights the fact that there’s really no official UCLA mental health treatment for students on campus.

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KT: That’s it for this week’s “In the Know” podcast. Check back in two weeks where we’ll talk about a different topic. Got any ideas for what we should talk about for a future podcast? Send us an email at [email protected].

From the Daily Bruin, I’m Keshav Tadimeti, and this is “In the Know.”