Counseling, for a fee

On a rainy day last fall, sophomore Ali Lozano was looking for any excuse not to go to her appointment at the University Counseling Center – she was embarrassed, it was raining and she didn’t want to spend $50.

The UCC offers a free initial assessment with a trained staff member – but this was a scheduled appointment made after Lozano’s first meeting, and so the $50 fee the center charges for any counseling appointments stood in her way. It was enough to make her stay home.

While GW is not the only university with a counseling center that charges its students for each visit, a survey by the Association for University College Counseling Center Directors taken in the 2007-08 academic year indicates that it is among the few that do.

The survey said only about 14 percent of 391 university counseling centers across the U.S. charge for counseling appointments, while about 23 percent charge for more expensive therapies, like those given by psychiatrists. The survey includes the most recent data published by the AUCCCD, a group that includes directors from nearly 700 facilities, including GW’s.

At the UCC, students can either undergo an initial assessment in person or through its telephone triage system, which UCC describes on its Web site as an “approximately 20- to 30-minute private call with a counselor who will then recommend what type of treatment the student may need.”

“The initial assessment is free, as has always been the case,” UCC Director Dr. John Dages said. “Students can call us, speak to a trained mental health professional counselor or licensed psychologist within 24 hours.”

After this initial phone assessment, however, students are charged $50 for each individual counseling or therapy session and $10 for each group session at the center, which is staffed by mental and behavioral health experts including psychologists and clinicians.

Dr. Gregory Eels, president of the AUCCCD and the associate director of Gannett Health Services at Cornell University, said that at many collegiate centers appointment costs are lower than $50 per visit, sometimes as low as $5 or $10. Eels added that while many universities fund their programs differently, high fees could impact students’ access to mental health services.

“You’re talking about a complicated issue,” Eels said. “The larger fee you charge for usage, the less accessible it is. I think that is an issue and that is why universities lower fees.”

While it is difficult to compare the services offered at one university counseling center to another, nearby schools like American, New York University and Boston University do not charge students per visit; instead, these schools use other means to finance their behavioral services, like charging general health fees at the beginning of the year.

Margaret Ross, director of behavioral medicine at Boston University Student Health Services, said BU charges all of its students a modest amount for medical services, including behavioral services, in order to keep individual visits to the office free.

“The care we offer is accessible, low barrier and high quality,” Ross said in an e-mail. “I do believe that charging for the visits could serve as a disincentive or barrier for students to come in.”

Dages, however, said he does not see the $50 per individual visit and $10 per group therapy visit as a barrier for GW students.

“I do not think that the fees are currently a deterrent,” Dages said.

When asked what UCC does to reach students who may not come into the center in the first place because of the fees, Dages emphasized the center’s willingness to work with students for whom the fee may be a significant burden.

“The fees are really not flexible,” Dages said. “They are established, but we are not going to turn a student away who cannot afford our services.”

Linda Donnels, associate vice president and dean of students, said the center can make accommodations for students in extreme situations who do not have the means to afford its services.

“For students with more serious financial constraints, UCC provides referrals to low or no-cost clinics in the community, referrals to private therapists who accept the students’ health insurance plans, and a sliding scale of fees when severe need is substantiated by financial aid,” Donnels said in an e-mail.

For Ali Lozano, who chose not to attend her scheduled counseling appointment in part because of the fee, the deterrent is real.

“I was embarrassed about going to a ‘counselor’ and honestly I didn’t want to spend money just to talk because at the time I didn’t have the GW student health insurance plan, and actually no insurance at the time,” Lozano said in an e-mail. “If there wasn’t a fee, I definitely would have been more inclined to go.”

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