A Broken Brain: The Story of Broken Insurance at Universities

My brain was broken. I do not even know how to describe it. All I know is that when something that felt catastrophic happened to me in early April, it was the final straw in an already rough spring. The world became an unfriendly place, and I struggled to get through each day. I was finishing up the second year of a three-year graduate program at an Ivy League University, about to leave for a summer internship 300 miles away. As is common for graduate students, I purchased an insurance plan through the university which allowed me to see clinicians employed by the university in the student health building or the nearby hospital if necessary. Since I was about to leave campus for 14 weeks, however, Yale refused to prescribe the anti-depressants that I needed until I returned in the fall. Student health requires regular check-in appointments for someone starting antidepressants as they can have side-effects and psychiatrists slowly increase the dosage until it becomes effective. Unable to get the care I needed, I suffered all summer.

Unfortunately, I doubt I was alone. The lifetime prevalence of any mental health disorder in the United States is 47.45%; according to a recent study at Berkley, 47% of PhD students, and 37% of Master’s students report depression. Suicide is in the top three leading causes of death for people between the ages of 15 and 34. Universities need to provide better summer mental health care options.

Staff-model, narrow-network insurance plans can be an effective means to control healthcare costs and therefore allow students and university employees to purchase relatively cheap insurance. I have no argument against this model during the school year. However, such plans do not make sense during the three months students leave campus for required summer internships. Many universities attempt to circumvent this problem by allowing students to purchase supplemental insurance for the summer. However, this is an expense not included in the loans many graduate students receive each semester to pay for tuition, academic-year medical insurance, and cost-of-living. For me, and for many students, supplemental insurance wasn’t feasible. I did not have $500 to spare for the plan’s premium and deductible.

While I recognize this argument could be made for both physical and mental health, I think it’s important to address- and potentially simpler to solve- access issues related to mental health care first. I don’t mean to say we should ignore physical health, but I do think mental health is a particularly pervasive problem that is highly stigmatized. By definition, people like me who suffer from depression experience symptoms such as lethargy and an inability to concentrate that make it more difficult to seek out help. Unfortunately, physical health and mental health are treated differently in our society.

I admit that the Mental Health Parity Act theoretically ensures equal coverage under most insurance plans, but this does not account for the stigma associated with mental health care. Without purchasing a supplemental plan, emergency care may have a copay, but it will not be restricted anywhere in the United States. If I had an infection or hurt my ankle, I could have fronted the cost of a one-time appointment at a minute clinic or, if necessary, gone to the ER. However, it’s one thing to walk into an ER with a broken bone or an infection, and quite another to walk in asking for mental health care. Furthermore, most people will find it much more excusable to request a sick day from work to travel to a doctor’s appointment for a chronic or acute physical condition, but would balk at asking their employer for a sick day to travel back to their university to receive mental health care. In fact, I am writing this article under a pseudonym. I want to voice my concern for the current system and propose a solution, but I fear negative consequences from future employers associating my name with a depression diagnosis.

Universities should provide better coverage for mental health disorders as students travel across the country to pursue practical experiences in their fields of study. The most obvious solution would be to provide a cheaper health insurance product during the summer, however that may not be feasible because while $500 plus copays may seem like a lot for a graduate student, it really isn’t that bad in the scope of insurance deductibles or premiums. As a second, less ideal solution, universities could allow students to take out loans to cover summer mental health medical expenses that they cannot afford.

In my opinion, the solution that is most practical and affordable, is for the university to cover mental health services provided over the phone or a video connection. Many electronic medical record systems, often already in use by universities associated with hospitals, would allow universities to easily accomplish this and eliminate the need for a supplemental insurance plan for those suffering from mental health issues. Furthermore, this would improve continuity of care. In my case, I could have received the medication I needed this summer and not suffered every day for over three months. (It took about a month to get an appointment with a psychiatrist to receive antidepressants after returning to school, but understaffing of mental health clinics is another issue.)

Some argue that telehealth isn’t as good as in person treatment. Yes, it may be harder to treat conditions that need a physician’s touch or a laboratory test to diagnose an issue. But do doctors need any physical contact with patients to do psychotherapy or medication management? A study completed in 2002 using telephone management of recently diagnosed depression patients showed promising results. However, a decade and a half later, telehealth treatment of mental health still isn’t widely used by universities.

Mental health is a stigmatized subject. It’s easy to say that we should de-stigmatize mental health, but cultural shifts take time. We cannot begin to get there without providing adequate treatment. A third to a half of graduate students have mental health issues, but they are often left without any real treatment choices over the summer. Universities can and should do better to treat their vulnerable populations.