Engemann reevaluates student mental health care

One day last October, Ariella Amit suffered a panic attack in her dorm.

“It was [from] a buildup of issues that I had with my mental health in the past,” said Amit, now a sophomore majoring in public policy. “Just dealing with school and adjustment.”

Once she was able, Amit requested an in-person consultation with a mental health counselor at Engemann Student Health Center. But getting one took over a week because Amit did not meet the requirements for a student in “crisis” — she was not experiencing either a loss in her family or a breakup, among other possibilities.

When she finally got to meet a counselor in person, she was told she was in need of “long-term counseling,” which Engemann does not provide for students on an individual basis. Instead, the counselor sent Amit a list of four clinics and centers in downtown Los Angeles.

“I felt that they pushed me off to the side because they prioritized short-term counseling,” Amit said. “I would have appreciated even short-term counseling, but they just told me that since my issues were more long-term, they couldn’t offer me anything except group therapy, which I didn’t want.”

Amit’s experience is not uncommon. At Engemann, approximately 70 percent of students who come in for mental health services are referred out, creating challenges for those who can’t afford to commute or don’t have time to travel off campus.  

Engemann is now working to reduce these numbers, announcing earlier this fall that the mental health department will add 12 new full-time therapists over the next two years. According to Robert Mendola, USC’s executive director for student mental health, the center’s goal is to establish trust between students and mental health service providers on campus.

“That is something that we face across the country, not just here,” Mendola said. “How do we have students receive the care and the feeling that they are truly being helped right from the outset?”

A model for short-term care

Engemann’s mental health services prioritize students in crisis or at risk of harming themselves, Mendola said. To that end, short-term care aims to help students grappling with problems like failing an exam or getting over a breakup. Counselors evaluate students and refer those like Amit — who might require more specialized therapy or prefer to talk to someone of a specific gender — to clinics, centers or social workers based on their needs. The places students are referred to can be as far as Santa Monica or Beverly Hills.

From the list she was given, Amit called CENTERED Individual and Family Counseling on Vermont Avenue, since it accepted her health insurance and was within walking distance. Almost a year later, she has yet to receive a response.

“I just feel that it’s a lot harder for students to get a referral and then muster up the strength to call them and deal with that on your own,” Amit said. “[Engemann] should hold your hand and walk you through the referral process if they don’t offer the services.”

The referral process, Mendola said, can feel “very demoralizing.” While the initial consultation serves as a brief assessment to determine the student’s needs, it does not necessarily lead to treatment.

Though the University focuses its resources on short-term care, Mendola said, the department is so underfunded that one therapist oversees 1,800 students. The International Association of Counseling Services recommends having one therapist per 1,000 students for the highest quality of care.  

“With that ratio, you will hear from most people that all they do [at Engemann] is refer you out,” Mendola said. “[It’s] really hard to change one’s reputation when the fact is that that’s what you’re doing.”

In a memo to the USC community on Aug. 20, Chief Health Officer Sarah Van Orman stated that Engemann aims to reduce the percentage of referred students down to 20 to 30 percent by adding 10 full-time therapists throughout this academic year and two more the following year. So far five new therapists have already begun working at Engemann.

“I felt that they pushed me off to the side because they prioritized short-term counseling.” — Ariella Amit, sophomore majoring in public policy

But for Amit, these changes don’t address the need for long-term care — which would treat more serious issues like depression, anxiety and schizophrenia. Amit said at the very least officials should provide more support and follow-up with students throughout the referral process.

“USC should make more of a sustained effort to bring in even more counselors to make sure that everyone is supported at least by the [counselors] we have for short-term [care], and then [can be] guided for the referral process,” Amit said.

Short-term care can work for some students, as Angela Villamizar found — but not everyone has access. A few weeks into her sophomore year, Villamizar sought help from Engemann’s mental health services, starting with a brief phone assessment in 2016.

“There were just a lot of transitions that were happening from all the excitement from freshman year,” said Villamizar, now a senior majoring in international relations and non-governmental organizations and social change. “There was a period in September for two weeks where I really didn’t want to do anything. I was always in bed, and when I woke up, I didn’t look forward to the day.”

Knowing that the lack of counselors would place her on a waitlist, Villamizar decided to enroll in a program in Engemann that allowed her to meet with a graduate student pursuing a career in mental health counseling. She spent eight sessions with the graduate student, an unlicensed therapist, an experience she called “very lucky.”

Most students are restricted to six sessions at Engemann before they are referred off campus,  if they still require more support. But mental health cannot be solved by a “magical pill” that wipes away students’ problems, Villamizar said. It requires time and consistent meetings.

“The first session is really you just processing through things and then seeing where you’re at,” Villamizar said. “The rest of the sessions really help you open up more, and your counselor gets to know you. If you only have four sessions, that really hinders their ability to pinpoint certain things and for you to feel the benefits of going. You need the time and the process.”

Rebuilding a reputation

When Mendola started working at Engemann last September, his first move was removing the waitlist.

“If you’re in a season [where] there is more acuity, students are coming in with greater distress,” Mendola said. “What that does is push back your routine — people who could benefit from short-term counseling even farther into the wait because with the limited amount of staff, you are always going to see the ones who are in acute need first.”

Mendola said he spent the past year reevaluating the mental health department — for example, hiring more therapists from the Keck School of Medicine of USC’s psychiatry department. Mendola hopes this will help reduce the number of referrals by bringing therapists closer to where students live on campus. He also plans to hire two behavioral health consultants who can help establish policies and procedures.

“To send a student without a car [and] with a tight schedule to take an hour each way just to see someone for 50 minutes is not realistic,” Mendola said. “The fact that we could make a difference at USC around those struggles will be something that we should be proud of, and we are in the process of that.”

Engemann has also adopted JED Campus, an assessment and strategic planning initiative, to gather more insight on students’ mental health. Through JED Campus, Engemann has launched surveys like Healthy Minds to gather student responses for a four-year internal review.

The center is also looking to launch a peer counseling program based on the initiative’s recommendation.

“[It] makes sure that we are plugging all the gaps, meeting all the best practices for how to provide health for the campus, which includes a public health model [and] not just an individualized care for the students,” Mendola said.

Let’s Talk, a program Engemann piloted this semester, allows students who do not feel comfortable with the school’s mental health services to receive support. Students can walk into sites scattered throughout cultural centers and the School of Cinematic Arts, as well as on the Health Sciences Campus, and have conversations with Engemann officials without feeling the pressure of having a counseling record at the health center.

“It is truly a drop-in,” Mendola said. “It’s a way of helping students feel comfortable with us … of reaching out. It’s not a form of clinical treatment.”

On Sept. 10, USC Student Health held two open discussions in light of National Suicide Prevention Week, but they were cut short when no students showed up.

“It’s not [the students’] fault,” Mendola said. “It points more to our need to have a more effective relationship with the students, to be part of the framework.”

Villamizar, a resident assistant at Fluor Tower, said that Engemann has been offering resources like therapy groups through residential education, as well as support meetings for residential assistants. However, she thinks that the center still has a long way to go in establishing trust with students.

“They’ve been trying to address the issues that are there, but I don’t think they know how to,” Villamizar said. “They’re still trying to be proactive, but they’re actually reactive … But it’s important that they’re engaging with the community and in those conversations.”

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