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I'm a licensed clinical psychologist and I work at a large university counseling center on the east coast. My organization is housed within the student healthcare building, but we are two separate organizations.
Unfortunately, the physicians in Student Health don't think so, nor does the university administration. This has created a whole host of problems and a lot of stress on my staff, and I'm looking for recommendations and advice on how to handle this situation.
As any ethical therapist should have, we have treatment guidelines. We are a small staff and, in line with most university counseling centers, our caseloads are bursting at the seams. As such, we limit the scope of our practice to specific mental health diagnoses. Though we are happy to conduct assessments, we are unable to provide appropriate treatment services for SPMI (schizophrenia, bipolar, etc), history of suicide attempts and non-suicidal self-injury, and other diagnoses that would require a higher level of care.
Unfortunately, the students have established a narrative that our counseling center "turns students in need away". This could not be further from the truth. It is our policy, again per the ethics code's statements on abandonment, to work with a student by providing appropriate referrals and doing our best to ensure transfer of care.
The physicians and university administrators perpetuate the student body's chant that we turn students away. I've had clients regularly tell me that the doctors say not to use our services, or "if you get assigned this therapist ask for someone else". There is pressure from the higher ed admins to treat everyone who wants help.
Myself and my directors have repeatedly tried to explain why this is inappropriate and unethical. We do not offer 24/7 crisis care. We are able to see students on a monthly basis due to clinician availability. We do not offer the resources for sufficient care.
I even tried to use their own logic against them. "Do you treat cancer here?" They said no, of course not. I said, "Why? If you are saying we are expected to treat all students then you should be following your own principles as well."
Their response, word for word, was "Well, medicine is different than Psychology."
Yes thank you, Dr. Schmuck, for telling me how to do my job.
I have no idea how to resolve this. I keep telling my organization admins that we need our own building to create a physical boundary from the other organization. But even then, it seems like our reputation on campus is tarnished and we are being expected to do the unethical.
Frankly, it's having a negative impact on the morale of my staff. We work very hard to meet the demands of students, but it's never enough and we're always being told what we're doing wrong.
What can be done about this?
Are you stating this as a matter of fact regarding your clinic, or is this what the physicians and admin are saying about your clinic? If you are saying this, then that’s where I’d start. If you can’t meet the needs of many of the students referred to you, then you really aren’t going to be seen as a valid referral source. Whenever you have a policy of not treating the significant needs of the population you purport to serve- regardless of reasons- you will be seen as a lesser option than those who don’t....We do not offer 24/7 crisis care. We are able to see students on a monthly basis due to clinician availability. We do not offer the resources for sufficient care...
I'm a licensed clinical psychologist and I work at a large university counseling center on the east coast. My organization is housed within the student healthcare building, but we are two separate organizations.
Unfortunately, the physicians in Student Health don't think so, nor does the university administration. This has created a whole host of problems and a lot of stress on my staff, and I'm looking for recommendations and advice on how to handle this situation.
As any ethical therapist should have, we have treatment guidelines. We are a small staff and, in line with most university counseling centers, our caseloads are bursting at the seams. As such, we limit the scope of our practice to specific mental health diagnoses. Though we are happy to conduct assessments, we are unable to provide appropriate treatment services for SPMI (schizophrenia, bipolar, etc), history of suicide attempts and non-suicidal self-injury, and other diagnoses that would require a higher level of care.
Unfortunately, the students have established a narrative that our counseling center "turns students in need away". This could not be further from the truth. It is our policy, again per the ethics code's statements on abandonment, to work with a student by providing appropriate referrals and doing our best to ensure transfer of care.
The physicians and university administrators perpetuate the student body's chant that we turn students away. I've had clients regularly tell me that the doctors say not to use our services, or "if you get assigned this therapist ask for someone else". There is pressure from the higher ed admins to treat everyone who wants help.
Myself and my directors have repeatedly tried to explain why this is inappropriate and unethical. We do not offer 24/7 crisis care. We are able to see students on a monthly basis due to clinician availability. We do not offer the resources for sufficient care.
I even tried to use their own logic against them. "Do you treat cancer here?" They said no, of course not. I said, "Why? If you are saying we are expected to treat all students then you should be following your own principles as well."
Their response, word for word, was "Well, medicine is different than Psychology."
Yes thank you, Dr. Schmuck, for telling me how to do my job.
I have no idea how to resolve this. I keep telling my organization admins that we need our own building to create a physical boundary from the other organization. But even then, it seems like our reputation on campus is tarnished and we are being expected to do the unethical.
Frankly, it's having a negative impact on the morale of my staff. We work very hard to meet the demands of students, but it's never enough and we're always being told what we're doing wrong.
What can be done about this?
Are you my former boss? Because he liked to tell me to be better without giving me the resources to be better. I agree that the needs aren't being met, but at the same time if you don't have the staff, you don't have the staff and you do the best you can. Expecting a college counseling center to handle SPMI is a tall order.Are you stating this as a matter of fact regarding your clinic, or is this what the physicians and admin are saying about your clinic? If you are saying this, then that’s where I’d start. If you can’t meet the needs of many of the students referred to you, then you really aren’t going to be seen as a valid referral source. Whenever you have a policy of not treating the significant needs of the population you purport to serve- regardless of reasons- you will be seen as a lesser option than those who don’t.
In summary, the best way to keep people from talking down about you often starts with you being better. Reputations are usually earned. The other option- there is a large and baseless conspiracy against your clinic- seems a little far fetched.
If you're arguing with anyone other than administrators about anything other than getting more resources, you're doing it wrong.
Are you my former boss? Because he liked to tell me to be better without giving me the resources to be better. I agree that the needs aren't being met, but at the same time if you don't have the staff, you don't have the staff and you do the best you can.
You are only able to see students once per month? For therapy?
Are you stating this as a matter of fact regarding your clinic, or is this what the physicians and admin are saying about your clinic? If you are saying this, then that’s where I’d start. If you can’t meet the needs of many of the students referred to you, then you really aren’t going to be seen as a valid referral source. Whenever you have a policy of not treating the significant needs of the population you purport to serve- regardless of reasons- you will be seen as a lesser option than those who don’t.
In summary, the best way to keep people from talking down about you often starts with you being better. Reputations are usually earned. The other option- there is a large and baseless conspiracy against your clinic- seems a little far fetched.
If you don’t treat suicidality or NSSI at a UCC, you are turning away a lot of your clinical student population.
Are you my former boss? Because he liked to tell me to be better without giving me the resources to be better. I agree that the needs aren't being met, but at the same time if you don't have the staff, you don't have the staff and you do the best you can. Expecting a college counseling center to handle SPMI is a tall order.
As far as the conspiracy goes, it doesn't sound like there's some deliberate thing going on: "Let's bash the ccc." Rather, it sounds instead like people who don't understand mental health treatment, clinic pressures, mental health diagnoses, and so on have started voicing their opinions and reinforcing each other. Groupthink and all that.
If I were in that situation and fortunate enough to be able, I'd vote with my feet.
If you don't have the resources to provide adequate care, you SHOULD be turning people away (sans an acute SI/HI situation).
How does it help to continue to "do the best you can" when that is substandard care? It doesn't help patients. Delaying treatment (via referring out) is preferable to subpar treatment. Also, continuing to "do the best you can and keep moving the meat doesn't give incentive to the administration to get more staff for the clinic.
Ugh, this was a typo. We see students bimonthly, as in once every two weeks. We cannot offer weekly services, and students requesting weekly services are those we refer out as well. I have edited the OP. My apologies for the error.
Yeah - you’re probably right about that. Sorry. Sounds like you’re working hard in a difficult situation. Working for places that don’t have adequate resources to meet the mission is a major drag.Being so black-and-white to label this a "conspiracy" is needlessly hyperbolic.
Yeah- my post comes across a little harsh. Let me rephrase it: If you can’t be better, you can’t expect others to think you are better. If you don’t have and can’t get the resources to meet your mission, then you might need to walk. However, if you are meeting your actual mission but not the mission others believe you have (or should have), continue to do good work and focus on better educating the referring sources and admin regarding the work you do.Are you my former boss? Because he liked to tell me to be better without giving me the resources to be better. I agree that the needs aren't being met, but at the same time if you don't have the staff, you don't have the staff and you do the best you can. Expecting a college counseling center to handle SPMI is a tall order.
As far as the conspiracy goes, it doesn't sound like there's some deliberate thing going on: "Let's bash the ccc." Rather, it sounds instead like people who don't understand mental health treatment, clinic pressures, mental health diagnoses, and so on have started voicing their opinions and reinforcing each other. Groupthink and all that.
If I were in that situation and fortunate enough to be able, I'd vote with my feet.
Yeah - you’re probably right about that. Sorry. Sounds like you’re working hard in a difficult situation. Working for places that don’t have adequate resources to meet the mission is a major drag.
End of the day, you are still describing what sounds like and under-funded, understaffed clinic, and that is contributing to the reputation amongst referring physicians. It’s also probably contributes to the perpetuating cycle of admin not giving you resources because of your reputation, while your reputation is the result of admin not giving you resources.
Is there some misunderstanding of the mission of your clinic? What is your (the clinic) role on campus? If you don’t serve certain populations, why would people be referring them to you?
I’m still trying to jibe together you saying that you meet the needs of 97% of people who come to you with you also saying you do not have the resources to offer sufficient care. Do you see where that would be confusing?
Are you using a triage system? Some other thoughts: Prevention measures such as campus health fairs, going into classes and doing some psychoeducation, having lots of group therapy options, having a fairly strict attendance policy since there is such a shortage of providers. Sounds like you need more money to hire more clinicians!
If you don't have the resources to provide adequate care, you SHOULD be turning people away (sans an acute SI/HI situation).
How does it help to continue to "do the best you can" when that is substandard care? It doesn't help patients. Delaying treatment (via referring out) is preferable to subpar treatment.
This is a grey area. It's not like we say, "Oh, you cut yourself once a week, we aren't going to see you." But if an assessment shows that they have been self-harming since age 12, have multiple suicide attempts, past trauma, and unstable relationships, it is likely that specialist trauma treatment or a DBT program is clinically indicated. We do not offer that here.
Ha. I was just going to post this.Can you tell this to VA administrators?
Can you tell this to VA administrators?
Ha. I was just going to post this.
Maybe the UCC should just start PCMHI. :/