Mental Health Support on College Campuses: What Parents Need to Know

Most larger universities like Indiana University (close to where my office is located) have health programs called CAPS which stands for Counseling and Psychological Service. They are often staffed with licensed therapists/counselors and psychiatrists with a range of experience and expertise. Their primary goal is to act as a stabilizing resource for most mental/behavioral health or substance use issues. Many university CAPS typically offer individual, group and couples counseling along with occassional free workshops. Here’s the list from IU CAPS on what they typical help with:

  • Academic Concerns
  • Relationship Concerns
  • Stress Management
  • Power and Privilege
  • Time Management Help
  • Sleeping Issues
  • Adjusting to College Life
  • Anxiety
  • Depression
  • Substance Use
  • Body Image, Eating, and Exercise Concerns
  • Sexual Assault or Abuse

They have the same confidentiality requirements as counselors like me off campus but are limited in many ways. CAPS limits the number of unpaid sessions (IU CAPS allows for two) and mandates that a student must be working with one of their counselors if they want to meet with a psychiatrist for medication management/evaluation. Here’s a breakdown of IU CAPS fees:

COUNSELING  With IU Health Fee  W/O IU Health Fee
First two sessions (per semester) No charge $55 per session
Additional full sessions $30 per session $55 per session
Additional half sessions $20 per half session $35 per half session
Additional group counseling $15 per 60 min. session

$17 per 90 min. session

$29 per 60 min. session

$35 per 90 min. session

PSYCHIATRY
First visit $55 $105
Follow-up visit $30 per visit $55 per visit

IU CAPS does not accept insurance but does provide a super detailed invoice to be submitted to a student’s insurance company for reimbursement.
Over the last few years, I’ve noticed many CAPS programs around the country have had a huge increase in demand for their services while also having budget cuts or mediocre increases that leave them without the full team of professionals they need for each semester. At IU CAPS, every one counselor is responsible for 2,110 students (yikes!). This is not a new problem at IU and not isolated to IU.

So what can a parent or student do? If CAPS doesn’t seem like a good option, look for a therapist/counselor convenient to campus who specializes in college students. Therapists should be flexible to accommodate busy course loads and social events. In my practice, I have extended evening and weekend hours since many students a slammed with class 9-4pm most days. It’s also important that the therapist be willing to talk with parents and provide updates and suggestions. Parents can sometimes feel like their kids are a million miles away. A good therapist can often act as a bridge and lower the anxiety associated with having kids at school.

Finally, talk with CAPS (or encourage your son or daughter to) the first week of school. It’s easier to cancel an appointment than to stand in line after all the students are back on campus. The intake process should be thorough and your kid shoul feel like the therapist/counselor will really understand their issues and help.

Insider’s Guide: Psychological Testing and Evaluations

Right after we moved to Indiana, something under the hood of our car started rattling loudly when it was first started-up each morning. I was sure the engine was failing and we’d either need a new car or, at minimum, a new engine. Fearing the worst, I took it to the dealership and tried my best to describe the noise. They took the car, hooked it up to their computer and ran diagnostics. Based on their findings, they adjusted some engine controls and replaced a sensor. Total cost was under $150 and about an hour of time. I was lucky it wasn’t more expensive. The technician said that if I had driven muh further, the engine would likely have overheated, blah, blah blah ….basically, bad things would have happened if I had not run the diagnositics. Money well spent.

My experience with our car reminded me of psychological evaluations and how often I talk with parents that want to wait a bit longer, save a bit more money or hold off until ‘things calm down’ before getting some diagnostics run. A shot engine would cost a few thousand dollars. Untreated behavioral health issues can cost tens of thousands of dollars and leave perminant scars. 

But when are things bad enough that you need to get a psychological evaluation? When is a car sounding bad enough to get diagnostics run? My definitive answer is this: When the symptoms are impacting a life domain (eg. school/work, relationships, family, activities) …and yes, this holds for both cars and people I believe. If things are bad enough to keep you up at night, it’s probably a good time to get evaluated.

The Basics

A psychological evaluation is a generic term used to describe a clinician’s use of tests, assessments and clinical interviews to determine a diagnostic presentation. Or, more simply put, what do all their symptoms add up to. There is no single test that makes up a psychological evaluation. A psychologist (often the most qualified type of behavioral health professional to administer testing), based on basic initial information about the client, chooses from a menu of tests and assessments all of which are evidence-based tests and procedures of assessing specific aspects of a person’s psychological profile. Some tests are used to determine IQ, some are to determine processing speed, others are used for personality, and still others for something else like depression or delusions.

Testing can be used to identify and sometimes determine the severity of just about any behavioral health disorder. Psychological testing is not definitive. While it can provide significant insight and give us a solid understanding of why someone is experiencing the symptoms they are, it can never provide certainty or causation. Clients can be found to ‘meet criteria for depression’ though, technically, we can never say without doubt they have depression. Sounds crazy but that’s how science and scientific testing works.

Here are the steps you should expect for the evaluation:

  1. Initial Intake: Initial intake appointment gathering basic background, symptoms and goals (1 hr)
  2. Testing: Psychological testing (1-6hrs)
  3. Write-Up: Psychologist writes-up the results (2 weeks)
  4. Results Session: Review of results and recommendations for treatment

Initial Intake and Testing

Let’s drill down into the details of testing. Once the tests are chosen, the evaluation is typically done in a formal manner by a licensed psychologist or therapist in their office. Depending upon what kind of testing is being done, it can last anywhere from 1 hour to a full day and consists largely of computer and paper-and-pencil tests.

There are generally four categories of tests:

  • Clinical Interview. The clinical interview is a core component of any psychological testing. Some people know the clinical interview as an “intake interview”, “admission interview” or “diagnostic interview” (although technically these are often very different things). Clinical interviews typically last from 1 to 2 hours in length, and occur most often in a clinician’s office. Many types of mental health professionals can conduct a clinical interview — psychologists, psychiatrists, licensed counselors, clinical social workers, and psychiatric nurses.
  • IQ. The most commonly administered IQ test is called the Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV). It generally takes anywhere from an hour to an hour and a half to administer, and is appropriate for any individual aged 16 or older to take. (Children can be administered an IQ test especially designed for them called the Wechsler Intelligence Scale for Children – Fourth Edition, or the WISC-IV).
  • Personality Assessment. Personality assessment is designed to help a professional better understand an individual’s personality. Personality is a complex combination of factors that has been developed over a person’s entire childhood and young adulthood. There are multiple variables that influence our personality such as genetic, environmental and social components. Personality tests take this into account. There are two primary types of personality tests 1) objective, by far the most commonly used today, and 2) projective. Objective tests include things like the Minnesota Multiphasic Personality Inventory (MMPI-2), the 16PF, and the Millon Clinical Multiaxial Inventory-III (MCMI-III). Projective tests include the Rorschach Inkblot Test, the Thematic Apperception Test (TAT), and the Draw-a-Person test.
  • Behavioral Assessment. Behavioral assessment is the process of observing or measuring a person’s actual behavior to try and better understand the behavior and the thoughts behind it, and determine possible reinforcing components or triggers for the behavior. Through the process of behavioral assessment, a person — and/or a professional — can track behaviors and help change them.

In addition to these primary types, other kinds of psychological tests are available for specific areas, such as aptitude or achievement in school, career counseling, management skills, and career planning. For instance, in our Kentucky office, we provide neuropsychological testing for head trauma, sports injuries, pre-employment and a bunch of other neuropsychologically-related areas. 

Results Session – What Next?

At the results session, you will meet with the psychologist and go over the results. You should get a copy of the full psychological evaluation (typically 5-20 pages). It should be broken down into the following format (or something very similar):

  1. Basic Demographic Information
  2. Reason for Referral
  3. Names of Tests Administered
  4. Data from Each Test
  5. Results (Diagnoses)
  6. Recommendations
  7. Signature and Title of Psychologist

A good psychologist will go through the entire document, explain the tests used and results fully. He or she will also review all the recommendations which will likely include one or more treatments like outpatient therapy, medication evaluation with a psychiatrist or placement in residential treament. The most important sections are the Results and Recommendations. The Results are the psychologist’s list of diagnoses that were supported from testing and observation. The Recommendations is the ‘what now’ piece where you understand your options for treatment based on the results. If you don’t understand something, ask. They should completely answer any questions you have.

A great psychologist will either offer a list of specific providers who offer the type of intervention or care recommended or refer you to a therapeutic placement consultant or educational consultant who can help with treatment placement.

Cost

If you are paying out of pocket, expect to pay $500-$2500 for the entire evaluation service. If you have insurance, contact the insurance company before scheduling an evaluation and ask what their coverage is for outpatient therapy and what your copay will be.

FAQ

Q: What if I disagree with the results or think the psychologist did a bad job?

A: During the final session when results are discussed, present your concerns and be a specific and factual as possible. Psychologists can only test based on information they have. If the psychologist had all the information but ignored important pieces, discuss this and, if necessary, make sure they do retesting to capture what they missed.

Q: Our daughter needs testing for an IEP at school. Is there a difference between psychological testing and testing at her school?

A: The testing you need is referred to as psychoeducation testing and often includes IQ testing. Testing for an IEP within a school system is not supposed to be used for diagnoses, only determining elegibility for an IEP or 504.

Q: How do we find a psychologist to do an evaluation?

A: If you are working with a therapist, start by asking if they have any recommendations of someone they trust and have worked with. If you are flying solo and have no one in your corner yet, check out Psychology Today (https://therapists.psychologytoday.com) > Type your Zip code into the search box > Under the Treatment Orientation on the left side, choose Psychological Testing and Evaluation. You should get a list of providers that conduct evaluations.