Counseling Conflict

Georgia State University’s decision this month to replace its counseling center staff with outsourced employees is worrying those in the field, who say such moves are extremely rare and will likely prove detrimental to the mental health services available to students.

The shift is doubly troubling because a number of former staff members (as well as others in the field) are accusing the university of outsourcing services as a retaliation for their complaints that some university policies involving the counseling center had the potential to hurt students. While the outsourcing was announced shortly after the complaints were made, the university says there was no relationship between the two developments. The director and two associate directors will stay on as full-time employees of Georgia State, spokeswoman Andrea Jones said.

The university says it replaced its nine counseling center clinical positions (three of which were vacant) with contracted employees “in order to increase institutional effectiveness in delivering mental health services to students.”

Because the staff were eliminated through a “reduction in force” process, which is done without regard to an employee’s performance, the change could not have been retaliatory, Jones said. The new model will mimic that of Georgia State’s psychiatry services and health center (both of which commonly use independent contractors).

“Counseling services will be outsourced, resulting in substantial savings and increased flexibility,” a university statement said. “Immediate service improvements will include: walk-in; same-day service to students seeking non-emergency initial consultation; an increase in client services by licensed providers; and more specialized providers tailing services to the changing needs of the client community.” The university could not elaborate on how services will be improved.

The university expects to save more than $160,000, it said in the statement. In 2011, the center had more than 4,000 individual appointments, 1,000 group appointments, and 1,100 psychiatric appointments, “in addition to many other services and outreach programs.”

It is precisely those services and outreach programs -- which have become increasingly important to counseling centers in the years since shootings at Virginia Tech and Northern Illinois Universities -- that may be at risk with a contracted staff, said Dan Jones, director of counseling and psychological services at Appalachian State University and president of the Association for University and College Counseling Center Directors.

Counseling center staff these days do far more than just see students – they educate the campus about preventing suicide, alcohol abuse, and sexual assault and other violence; they help staff in distress; and they consult with faculty seeking advice on whether a student should be referred to counseling. They serve on behavioral intervention teams and they coordinate with off-campus agencies when a student goes home for the break.

“What they’re looking at is one-on-one counseling, and they’re saying, ‘Oh, we’ll still be able to provide that so student services aren’t being cut.’ What they aren’t looking at is all the other services that we provide on campus,” said Mary-Jeanne Raleigh, director of counseling services at St. Mary’s College of Maryland and president of the American College Counseling Association. However, Raleigh said, what Georgia State is doing is "much less concerning" than it would be if all the staff -- directors included -- were on the outs. "I do wonder what prompted the choice, however. It sounds like they are not actually changing anything but rather changing the financial source. I do wonder about [behavioral intervention teams], consultation and the larger campus involvement, but that could be the responsibilities of the full-time staff."

Even still, staff who are employed by someone else are less likely than institutional employees to fill that void because their employer doesn’t share the student-centric mission of the university, counselors say. They’re less likely to respond to an emergency 24/7, and certainly won’t be in a position to work with academic affairs to get a patient on track. As a result, possibilities that were never before on the table – session limits, per-visit fees, restrictions on after-hours work – will likely be up for discussion, Raleigh said.

Georgia State's Jones, though, said there will be no change in the of sessions provided per year (15), and that sessions “will continue to be conducted at no cost to students." Many colleges with problematic budgets in their counseling centers have imposed fees and session limits, even when services are not outsourced.

At least one former employee is alleging that the university got rid of the staff because they had criticized the administration and directors for the counseling center’s “mandated assessment program,” through which any student identified as potentially suicidal or harmful to others is required to undergo a mental health assessment that stays on the student’s record – or, if the dean of students feels the student is a risk, face non-academic withdrawal.

Yared Alemu resigned as interim director of clinical services to protest the leadership of Jill Lee-Barber, the counseling center’s director of psychological and health services, and her decision to suspend the center’s doctoral practicum program. Five days after his Feb. 9 resignation, Alemu took on the mandated assessment program in a memo to Provost Risa Palm, in which he said Lee-Barber had ignored the concerns raised by Alemu and his colleagues. Alemu says his data show that 7 in 10 referrals turn up no problems, and the program disproportionately affects students who are black, of low socioeconomic status, and have a history of psychological disorders. He also believes the program is the administration's way of "transferring liability" from the dean of students' office to the counseling center -- meaning the counseling center could be blamed if a student does harm someone. (The provost denied all charges in a response to Alemu.)

Instead of addressing the issues, Alemu says, administrators “cleaned house.”

Alemu and others said the former counselors, who are still employed by the university (until when is unclear, Jones, the spokeswoman, said), are under a gag order and cannot speak to the media. Attempts to reach them and Lee-Barber were unsuccessful.

But two Georgia State alumni who are mental health professionals in the state backed the former staff in a letter to the university’s president, and in addition to asserting that the change will negatively affect students, speculated that the reduction in force was not in good faith.

“We are concerned that this decision may have been aimed at silencing the staff and shutting down healthy criticism and dialogue about university policies and procedures and the impact of those policies on students,” the alumni wrote, noting that the staff were not allowed to terminate therapy or even contact their student clients, which is not only counter-therapeutic, it is an ethical violation under American Psychological Association guidelines. “The abrupt nature of this disruption in care was foreseeable and avoidable; thus it not only represents poor clinical judgment, but also raises serious ethical questions…. Even if these students are contacted by new [Georgia State] staff members, they may not feel comfortable returning to therapy with an unfamiliar person. These high-risk students may not get the care that they need. If these students were or are a danger to themselves or others, any action that they take in the future may possibly be directly connected to the university’s decision to abruptly transfer their care and end their relationships with these staff members.”

Outsourcing became trendy in the 1990s, Appalachian State's Jones said, when many colleges were wooed by private companies that promised they could provide counseling services for less than it cost for the institution to employ staff itself. But the staff they provided tended to be trained and paid less, and their unfamiliarity with student issues and the ins and outs of college counseling (like outreach and consultation) ultimately drove many centers back in the other direction.

“These agencies provide us a reasonably adequate but cheap service,” he said. “Their mission is to make money by undercutting some other entity, which in universities, is the counseling center. So they’re profit-driven, and universities are not profit-driven.” But, Jones made clear that there is a difference between full outsourcing and what Georgia State is doing. Appalachian State's Jones said he hasn’t heard of a major university doing complete outsourcing -- directors and all -- since the early to mid ’90s.

These are tough times for counseling centers, regardless of which campus they’re on. Center directors are reporting more students than ever coming in with severe psychological disabilities, an overflow of clients making it difficult to impossible to see everyone, and budgets that are either shrinking, stagnant or just starting a slow increase back to pre-recession levels. So counseling centers are naturally looking for ways to save money.

But Brian van Brunt, director of the counseling and testing center at Western Kentucky University and past president of the ACCA, called Georgia State’s decision “close to tragic.”

“There is some kind of odd math in legislators’ heads that somehow equates cutting or outsourcing mental health services with cost savings or risk reduction,” Van Brunt said. “In the end, it does neither. What it really does is pass on the cost to various departments like residential life, faculty in the classroom and front office staff who are now working with students struggling with mental health problems without proper access to care.”

Even if the center directors will still work for the university, Van Brunt said, “it is likely to have a cost to student care.”

Melinda Hawley, director of personal counseling and wellness at Gainesville State College’s Oconee Campus, emphatically shared her colleagues’ concerns about the potential losses in service and outreach that can occur when a center opts to outsource. But she was less certain that things might deteriorate if the staff are working under Georgia State employees.

“I think it would depend on the policies of this third party – for example, are there a limited number of sessions that students are allowed to have, are the students charged for visits (and if so, what is the pricing system), and do the counselors consult with faculty, staff and administration,” Hawley said in an e-mail. “There is a very real benefit to being a part of the ‘system’ – attending meetings, being involved in service activities with faculty/staff (committee work, for example) – but I’m not sure if the third-party arrangement precludes their participation in those activities.”