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Hawaii college students are waiting weeks, sometimes months, to see mental health counselors on their campuses.
Most universities have a plan in place to provide immediate assistance for students who say they’re experiencing a crisis. But those walk-in appointments are limited to operating hours. And for students whose cases are deemed not as urgent by the counseling centers, the wait can be discouragingly long.
Nationally, the percentage of teenagers and young adults who report mental distress, depression and suicidal ideations has increased significantly among those 26 and younger over the past decade.
As anxiety and depression swells among students across the nation, student counseling centers in Hawaii, like their mainland counterparts, appear unable to keep up with demand.
College counselors in Hawaii have also noticed the issues students show up with are becoming more serious. At the University of Hawaii Manoa, anxiety diagnoses have surpassed depression diagnoses, and suicidal ideations have increased in number, according to officials.
“I’ve been in private practice for a long time, and I think this day and age is different,” said Desrae Kahale, the mental health counselor at Windward Community College. “The problems are the same but the severity is different.”
“I feel very afraid in my job because I care about the students, and I care about the wait time,” added Dr. Steven Taketa, the University of Hawaii West Oahu psychologist. “I feel that students are suffering and I never really feel like we’re doing enough.”
In acknowledgement of the situation, the University of Hawaii system is requesting $2.65 million from the Legislature to add more full-time staff.
Colleges across the state are struggling to keep up. At most community college campuses, there is only one full-time psychologist in charge of student populations of 2,000 to 3,500.
Leeward Community College, which has 6,568 students — the highest number of students at a UH community college — does not have any psychologists on staff and refers students to UH West Oahu.
At the university’s main campus in Manoa, the current backlog of students waiting for a non-urgent appointment is 60 people long. It can take an average of 17 days to get the initial intake interview, according to UH Manoa officials.
That’s followed by another wait to be matched to a psychologist, which can take up to about a month.
The backlog of students waiting for help fluctuates, since it is often tied to pressures caused by academic schedules.
“To have only 60 (students on the waitlist) is actually a good number,” said Dr. Allyson Tanouye, the director at the University of Hawaii Manoa’s Counseling and Student Development Center, noting the waitlist was about 20 people longer toward the end of the spring 2019 semester.
The Manoa student body is 17,500 students.
The Manoa counseling center currently employs eight full time psychologists, but also utilizes additional help from about seven to eight doctoral psychology interns, post-doctoral staff therapists and graduate student practicum trainees.
“I feel that students are suffering and I never really feel like we’re doing enough.” — Dr. Steven Taketa, UH West Oahu psychologist
Two teams of counselors meet twice a week to triage and assign cases.
“We’re looking at urgency, we’re looking at capacity and we’re doing a lot more referring out,” Tanouye said. “Those that are at any risk are checked in on more intensely or they’re plucked off the list before it gets to that place.”
According to Tanouye, wait times for an intake appointment range from no wait to up to a month. Then, the following wait time for a non-urgent assignment to a therapist after the initial consultation can be as long as another month.
But there wasn’t always a waitlist to get help at the Manoa campus, she said.
“I want to say 10 to 12 years ago we were working off an absorption model, where we expanded to meet the needs,” said Tanouye. “About five years ago we could no longer absorb anyone, so it’s only been four or five years where we’ve even entertained a waitlist.”
Neither appointment requests nor the number of students requesting help at the Manoa campus have increased over the past five years, according to data provided by the university to Civil Beat.
Manoa’s campus data run counter to the national trend of increased appointment requests, which makes the backlog puzzling.
Tanouye says the waitlist is tied to the fact that the center is currently short two full-time psychologists and a part-time psychiatrist, and it has been difficult to fill positions of retired clinical faculty.
To address wait times, she said the center began this month to expedite its intake interview process when students get analyzed for their needs. The center now allots time for two intake interviews per hour, rather than one.
“Since we initiated the 30-minute initial consultation this week, we have doubled the number of students assessed,” she said. “Therefore, we have shortened the wait for initial contact with students, but have maintained the amount of students waiting for an assigned therapist.”
The center also provides group therapy sessions, she said, and when the counseling center is closed, Counselors in Residence are paid to live in dorms and provide weekend support.
Dax Garcia, a graduate student at UH Manoa, said the potential for a cumulative wait of 60 days or more is unreasonable.
Garcia received diagnoses of major depressive order and post-traumatic stress disorder when he was in high school. As a graduate student in his 40s, he continues to seek therapy.
“Counseling has been critical for me,” he said. “That’s the one thing that’s helped, and I’ve tried all kinds of medications.”
Garcia used to rely on the center for its services, attending weekly therapy at Manoa CSDC. But when he returned to campus this fall, counseling staff told him the center is only capable of short-term care and offered a referral to outside providers.
The center has a cap of 10 sessions per student, although it does make exceptions and sometimes more sessions are allotted.
“Essentially, it feels like a referral service,” Garcia said. “I haven’t been able to do that. Paying out of pocket on a sliding scale is difficult for me.”
Campus psychologists told Civil Beat that they fear wait times are discouraging students from showing up.
Data provided by the university shows that only about two-thirds of students end up attending their scheduled appointments, and it’s been that way for the past five years.
Dr. Patrick Jichaku, who has worked at the Manoa CSDC for a decade, found that only about 35% of the students he was assigned to ultimately attend their appointments.
Yet a backlog persists.
“The process to connect the counselor to the student is not streamlined,” he said. “When you throw them on a waitlist they can fall through the cracks.”
Mental health counselor-to-student ratios are much more severe at community college campuses.
Only two of the University of Hawaii campuses meet the The International Association of Counseling Services’ recommended ratio of one professional to 1,000-1,500 students.
“We’ve had a progressively larger and larger amount of students who required it, but we maintain the same level of personnel,” said Aris Banaag, who joined UH Maui College as a personal support counselor in 2008.
Before he joined, mental health services weren’t part of campus offerings, he said.
“I started putting out flyers all over campus but then I realized I got inundated very, very quickly and so much so that now I don’t put out any fliers,” Banaag said, noting faculty referrals are enough. “It got to a point where I couldn’t keep up.”
At the time, he was responsible for a student body of more than 5,000. In the years since, the student population has decreased to a little over 3,000, but it’s still a heavy work load.
As of this fall, wait times for non-urgent appointments are a week to a week-and-a-half at the Maui campus, he said.
Banaag and his colleague have a caseload of about 42 clients per month.
“It’s staggering when you have one person that has to address the entire (student) population,” he said. “Even with my half-time (counselor) helping me that started last year, it’s still very difficult to keep up.”
At UH West Oahu, it’s a similar story. Dr. Steven Taketa handled a student body of more than 3,000 on his own until a part-time psychologist came on board earlier this year. He said his job can feel overwhelming.
A part-time psychologist joined him in May. But because the mental health counseling position at Leeward Community College has remained vacant for about a year, Taketa and his colleague have taken that load on as well, meeting with students on both campuses.
“The problem is if we’re not able to treat enough students and we’re only preventing a small portion from crisis, well, the other ones are not receiving the same level of care,” Taketa said.
An administrative assistant who does scheduling has relieved some of the pressure, he said. Even security staff has stepped in to assist in urgent situations.
“I’ve had a couple of situations where it was only me, and we had two students in crisis at the same time,” Taketa said. “Fortunately for us we have really awesome security staff who are very mental-health minded.”
The UH system plans to request $2.65 million from the Legislature for 19 full-time positions, five of which would be dedicated to Manoa, one to Hilo, one to West Oahu, and 12 to community colleges.
“If fully funded, this will help address student mental health concerns across the university by adding psychologist positions to all campuses,” said Dan Meisenzahl, university spokesman.
Chaminade University declined to comment for this story. Hawaii Pacific University and Brigham Young University-Hawaii did not respond to multiple requests for an interview.
Trisha Kajimura, the executive director of Mental Health America of Hawaii, said she has met many professors and teachers who feel overwhelmed by an increasing number of students who need extra mental health assistance.
“What we notice in a lot of different settings is that people feel unqualified to assist others with mental health,” she said. “We promote that it’s always OK to ask somebody, ‘Is there something else going on with you or I could help you with?’ If we don’t ask, we don’t know.”
The MHA affiliate conducts workshops and trainings on mental health awareness and suicide prevention. The nonprofit used to have a stronger presence on university campuses, but currently focuses on middle and high schools while also providing training for businesses.
“Honestly I feel like their issues are more serious than what we can address with our program,” she said.
Kieko Matteson, an associate professor and undergraduate advisor at UH Manoa’s Department of History, said many of her students are struggling with mental health issues.
“On the one hand we’re expected to be reporting and responding, but on the other hand we’re really not equipped with any skills as faculty,” she said. “I feel a little disingenuous to say there are mental health resources when I hear anecdotally that the waitlists are so long.”
Nationally, mental health issues across college campuses have raised the question: How much mental health clinical time should colleges provide?
“I think there’s increasing expectation that these kinds of resources are going to be available,” said Matteson. “The university needs to balance its other budgetary pressure with its obligation to ensure that students have the best learning environment available which includes mental health.”
“I feel that we owe them access to services,” added Jichaku. “It’s concerning because these are students who are paying fees for these services.”
Garcia says the face-to-face time he did receive from Manoa’s counseling center in the past was invaluable.
“Counseling does work — there’s a process and there’s a connection that needs to take place,” he said. “I think that it’s a process that unfortunately UH can’t provide right now.”
Civil Beat reporter Blaze Lovell contributed to this report.
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