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Med Students' Own Mental Health Care

September 7, 2011

A study published Tuesday paints a grim picture of America’s increasingly stressed medical students, in what researchers say they hope will be a “wake-up call” to the nation’s medical schools and health care policy makers.

The study, led by the Cambridge Health Alliance, a hospital system near Boston, includes data from 115 of the nation’s medical schools, looking specifically at what type of health insurance they offer to students with mental health and substance abuse problems.

“This is one small example of how the system is failing at-risk people,” said Rachel Nardin, chief of the neurology division at Cambridge Health Alliance and a co-author of the study, which was part of a special issue of the Journal of the American Medical Association on medical education. “The study is partly a wake-up call to look at the health insurance [the schools] offer. They are struggling in the face of a health care system that has unsustainable costs.”

Studies have shown medical students have higher rates of depression than their peers and are equally at risk for substance abuse issues, said Nardin, also an associate professor of neurology at Harvard.

The researchers looked at medical students’ annual maximum visit limits, co-pay amounts, dollar limits and co-insurance, which is the percentage of total costs paid by the patient. The study found that fewer than 22 percent of the medical schools provided mental health and substance abuse coverage without a cost-sharing requirement. What’s more, six of the 115 offered no coverage for in-patient mental health visits, substance abuse treatment or either.

“This is worrisome because of evidence that cost-sharing discourages students from seeking both [mental health treatment and substance abuse treatment],” the study says.

Researchers culled student insurance data from college websites and surveys. The study did not look at how many students use outside insurance or university-wide counseling services separate from the specific colleges. Those limitations were among several problems cited by medical school officials about the JAMA study.

The majority of medical schools are making a “valiant effort” to provide mental health coverage for their students that is affordable and cognizant of the societal stigma attached to such disorders, said Sam Parrish, associate dean of student affairs at Drexel University’s College of Medicine.

Parrish pointed to a 2009 survey conducted by the Association of American Medical Colleges, which indicated that 59 percent of schools reported that mental health services for students were available with no out-of-pocket costs associated. The survey did not separate out substance abuse care. Parrish, a member of the AAMC survey’s committee, said his college provides a psychologist and psychiatrist for its medical students at no cost. Communication between those professionals and their patients are kept confidential by several “firewalls” put in place by the college, he said.

This, however, does not fully address the issue of confidentiality, Nardin said. Some medical students fear that by seeking help for mental health or substance abuse issues, they will jeopardize future opportunities as doctors, especially if that help is from someone right in the college, she said.

Elizabeth Wiley, a fourth-year medical student at George Washington University, said access to services that entail seeing faculty members can be difficult for some medical students. At George Washington, the psychiatry faculty who oversee students in class are also oftentimes the doctors that treat students.

“The only option is to be seen by someone that will likely play a role in evaluating you,” Wiley, also a student member of the American Medical Student Association, said. “It creates a deterrent in seeking care.”

“My goal is not to demonize these schools that are struggling,” Nardin said. “Health care costs are just staggering for all types of institutions these days. Although it was bad, it’s not necessarily worse than private coverage in general. This is a particularly poignant example of this because we can see the consequence of this for these patients.”

At-risk medical students are an example of a larger systemic problem with a health care system that relies on a patchwork of private plans, Nardin said.

The real solution, Nardin believes, will not come from the schools themselves. It’s lawmakers on the national level who have to put in place more regulation to protect students, medical or otherwise.

Aaron Smith, co-founder and executive director of the health care advocacy group Young Invincibles, said the reality is that college health care plans vary widely.

Smith said it is a “weird contrast to have these medical students who are so passionate about helping others” be left in the lurch when it comes to mental health and substance abuse care from their schools.

“I think all schools, not just medical schools, should see this as an opportunity to provide decent health care for their students and improve it when it is not up to par,” he said.

But students can hopefully look forward to new proposed regulations for student health care, Smith said. Proposed federal regulations through the Department of Health and Human Services call for less cost-sharing, restrictions on benefits caps and free preventive care, among other policies. If approved, these regulations would tentatively take effect next academic year, Smith said.

Even so, Parrish said the mental health professionals at his school have been consistently busy for the 11 years he has held his position. If time is any marker, this is a problem that is unlikely to go away.

 

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