What does it mean when a university says it offers mental health services?
By Mitchell Levesque
When a university says it offers mental health services, what does that mean? Does it refer to just stress and wellness care? Or are services to address chronic mental health disorders included?
Sarah Vadnais, a fourth-year at the University of Minnesota studying environmental science, who uses the pronoun they, remains confused about what mental health diagnoses are treated by Boynton Health Services.
Vadnais has been using mental health care since high school. In their first year of college, they decided to try shifting care to the University’s Boynton Health Services. But when they called in October, the first intake appointment wasn’t offered until March.
Vadnais said it was also difficult to understand if Boynton was the right place to go. The Boynton website does not list disorders covered, nor any mention of specialists.
These factors made it unclear whether going to Boynton was “even worth it to try,” Vadnais said.
Paul Galvinhill, a licensed psychologist at College of the Holy Cross and president of the International Accreditation of Counseling Services, said Vadnais’ experience illustrates the confusion many students encounter around the labeling of mental health services on college campuses.
“I think there is a lot of misunderstanding about terminology,” Galvinhill said. “There’s a fair amount of using interchangeably ‘mental health’ and ‘well-being,’ in ways that I think can be confusing for people.”
When this happens, Galvinhill said, there is a tendency to treat campus mental health with stress-relieving and fun activities. “[These activities] can certainly help with general well-being for students, but when we talk about mental health and those who have mental illness, those things aren’t going to make that mental health or mental illness presentation go away.”
According to the Centers for Disease Control, the term “mental health” is not the same as “mental illness.” Mental health includes “emotional, psychological, and social well-being,” whereas mental illnesses are “conditions that affect a person’s thinking, feeling, mood, or behavior, such as depression, anxiety, bipolar disorder, or schizophrenia.”
The term “mental health” is by far the prevailing reference within the University of Minnesota’s formal mental health material, whereas diagnosed mental health conditions are not usually explicitly named. Last year, President Joan Gabel launched a three-year drive to transform the University’s approach to student mental health called the President’s Initiative on Student Mental Health, or PRISMH. On the initiative’s website, the term “mental health” is used 22 times, whereas “mental illness” is used just once.
Boynton Health Services’ messaging uses “mental health counseling” or “urgent mental health care” as appropriate umbrella terms to refer to its services. Yet specific references to diagnosable conditions such as “depression,” which might help students see what is treated, are fewer; the website only mentions specific diagnosed mental health conditions five times in any of its group therapy or individual therapy listings. The term “mental health” is used 13 times.
Students with all diagnosed mental health conditions are always welcome to seek care as needed, Boynton’s director of public health and communication, Dave Golden, said.
According to Golden, Boynton does not draw a big distinction between mental health and mental illness, except to assert that focusing on mental health is preventative for mental illness. “We use the language interchangeably,” he said. “We always say: ‘If you need care.’ This is how you access it. That’s all our messaging.”
Proper care is the bottom line for treatment of mental illness, whatever the terminology, he said. “The only thing that we know that is certified with data and good studies for mental illness is that the best way to treat it is early and with care,” he said.
When students do seek care, Boynton does its best to accommodate them despite limited resources, Golden said. In fall 2021, Boynton’s mental health clinic saw approximately 700 to 750 students per week. During the spring of 2022, this number was somewhere around 600 to 650 students.
On average, however, 15% of students who seek treatment at Boynton per week are eventually referred elsewhere. Matthew Hanson, the interim director of Boynton’s mental health clinic, said this is either because the clinic’s 10-visit limit per year isn’t long enough to address the student’s condition, or because those with complicated diagnoses require specialized therapies.
What are complicated diagnoses? Boynton’s website makes it clear that its therapists cannot treat eating disorders, stating it will refer students who “present an active eating disorder” to specialty clinics in the Twin Cities such as the Melrose Center or the Emily Program.
Beyond that, for individual therapy, the website makes no mention of referrals for certain diagnoses.
Vadnais ultimately decided to get care elsewhere. Along with the waitlist, they said, confusion around terminology was a reason.
An article published last year on the website of McLean Hospital, a Harvard Medical School affiliate, argues that conflating mental health with mental illness can pose problems for those seeking proper care and understanding for mental health conditions.
Mischaracterizing a mental health problem“can discourage people from getting needed treatment,” the article states. “Moreover, blurring the lines between health and disease can cause people to misjudge, dismiss or even stigmatize those who have a mental illness.”
Galvinhill agrees, particularly in a campus setting where students are just coming to terms with what are often chronic conditions that they must learn to manage.
“The more specific and concrete colleges can be about what’s offered, the better,” Galvinhill said.