Moving Away From Charging for Counseling

Though University of Texas at Austin called getting rid of fees for counseling "a new investment" in mental health, few institutions charge students for these visits.

February 7, 2018
UT Austin

The president of the University of Texas at Austin announced last month he would eliminate counseling center fees for students -- a step, he said, that would remove a “barrier for students seeking needed care.”

But few centers across the country even charge students out of pocket, and campus mental health professionals prefer that students hold onto that money because they already face, in many cases, steep expenses, they said in interviews.

“There are students who come from circumstances where their parents are not in a position to really provide a lot of financial assistance in regard to college education,” said Sharon Mitchell, president of the Association for University and College Counseling Center Directors (AUCCCD) and senior director of counseling, health and wellness at University at Buffalo, of the State University of New York. “It’s a myth that all college students are being subsidized by their parents. A lot of students are living off loans and grants, and working.”

“Whenever you can find a way to fund things without the students paying for it is a step in the right direction.”

UT Austin president Gregory L. Fenves told the campus in January the Counseling and Mental Health Center would no longer charge students a $10 fee for appointments and that he would reduce the fee for psychiatric-related visits from $15 to $10.

“This new investment in the Counseling and Mental Health Center underscores a university-wide commitment to addressing the mental health of students. Mental health is not a peripheral issue -- it touches every aspect of life and affects us all. Your psychological well-being is an essential part of your success -- both in academics and in life,” Fenves said in a statement.

Instead, part of the counseling center budget will be funded through the university’s deal with ESPN and its Longhorn Network, which gleans the university about $11 million annually.

About 50 percent of that money from ESPN goes toward non-athletics-related initiatives, and the cost for covering the counseling fees will be between $250,000 and $280,000 every year, according to spokesman J. B. Bird.

The university was already the exception in the state, though, in terms of charging for counseling services, at least among public institutions -- Texas A&M University, Texas State University, Texas Tech University and others don’t make students pay a fee for a counseling session.

Even though the university is early in the semester, the removal of fees has apparently already made a difference, said Chris Brownson, associate vice president for student affairs and director of the Counseling and Mental Health Center.

The center compared the first nine days of the spring semester last year versus the current semester and found students used counseling services 48 percent more, Brownson said. He did not provide the number of clinical visits that represented.

"I see one of my biggest responsibilities as removing barriers for students to seek the help they need to receive. And certainly knowing finances can be an impediment to seeking care, I thought it was certainly important [to remove fees]," he said. "We want students to able to see us in the most barrier-free way as possible."

Only about 15 percent of counseling centers nationwide charge students out of pocket, according to the AUCCCD's 2016 annual survey. Generally, the centers are funded through a separate student fee that’s already rolled into tuition, or other areas of a college or university’s general budget.

So students usually are subsidizing the counseling center in some way, and they shouldn’t have to worry or consider paying anything else when they’re seeking mental health treatment, Mitchell said.

Mitchell noted, though, that universities fund their centers in any number of ways, and an increased demand for services can lead to a staff stretched thin and a need for institutions to find a way to pay for everything counseling centers offer.

UT Austin didn’t start charging a fee until roughly eight years ago, during the economic downturn. At first it was only $5, but the university raised the fee to $10 in 2015.

“Where fees exist it is probably out of necessity to provide the level and amount of service to cover the demand,” Mitchell said.

Lisa Adams, director of counseling at the University of West Georgia and the president of the American College Counseling Association, said she understood that a fee could be problematic for students, but said that adding monetary value to something could lead to students committing to treatment if they know they’re paying for something.

But, Adams said, especially on her campus, where more than half of the students are Pell Grant eligible, she would worry that a fee would dissuade students from seeking help.

Students’ perceptions on fees come into play, too, Adams said.

There’s already a stigma associated with mental health problems, she said. So $10 may seem nominal, but if a campus isn’t charging for a concert on campus, then a student could perceive a college wants to make that more accessible than counseling services.

College counseling centers also often have shorter wait times for students compared to other professional mental health services, and the centers employ people with a greater understanding of a college student’s mental health needs than a general practitioner out in the community, Mitchell said.

A recent report from the Center for Collegiate Mental Health found that only 0.1 percent of college students went to a counseling center primarily to discuss financial concerns. The data come from nearly 150 colleges and universities that provided information about 1.2 million clinical appointments in the 2016-17 academic year. The top reasons for seeking counseling were anxiety and depression.


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