She returned to campus and sought help from the student health center. Next, she wanted to see a psychiatrist. But then the coronavirus forced GWU to close. Hannah didn’t hear back from the counseling center until after she settled home in rural Iowa.
“[GWU’s] big thing is that you should try to find counseling at home. But there is no counseling at home,” said Hannah, who spoke on the condition that she be identified only by her first name. “The closest psychiatrist is two hours away, and they also have a long waiting list. For therapy in the area, there’s two or three within a half-hour drive, but they’re not taking patients right now.”
For millions of students, their universities also serve as health-care providers. Students purchase school-sponsored health care, get yearly checkups with on-campus physicians and seek advice from therapists in the counseling center.
But those relationships were thrown into chaos when the virus sent students scrambling back home in other states, where crucial services often can’t be accessed or simply aren’t available.
Campuses have responded by offering group counseling sessions on Zoom and wellness webinars. But with students scattered throughout the country, schools have had to scale back one of the most important services they provide: clinical therapy.
On-campus therapists face a hodgepodge of state licensure laws that dictate where they can and can’t practice. Medical and psychology boards in nearly every state have relaxed some guidelines, and some states are allowing anyone with a valid license to practice. But Maryland, Virginia and about two dozen other states still require psychologists to apply for temporary licenses or receive special permission to practice.
The result is that many college students can’t access therapy. Some on-campus practitioners are getting emergency licenses, said Joy Himmel, member of a covid-19 task force for the American College Health Association, an organization of college health professionals. But many schools are limiting clinical therapy to students who either live in-state or in a state where interstate telehealth is legal. Several schools aren’t taking any new clients, according to a survey from the national college health group.
Last month, a group of student leaders representing 2 million students at more than 130 schools called on states to suspend their regulations so caregivers can practice freely in any state.
“Once we moved online, students who were receiving continuous counseling from the university were unable to have that continuous care,” said SJ Matthews, the outgoing student body president at GWU
She and other leaders who signed the letter say students aren’t getting the near-immediate care they would normally receive on campus. As the semester winds down, students are worried about how they will transition to care over the summer. Some students may face the same issue come fall, if their universities start the semester remotely.
When campuses across the country emptied, it quickly became clear that the health and economic crises caused by the coronavirus would trigger new cases of anxiety and depression among a population that is already vulnerable.
“All the uncertainty is really building and affecting our students,” said Grace Wickerson, a senior from Florida and the outgoing student body president at Rice University, the private school in Houston. But many students weren’t able to get help from counselors at Rice after leaving campus.
Student leaders there surveyed 1,400 undergraduates and found that 30 percent reported exacerbated mental health issues. In a matter of weeks, they have confronted a host of new challenges — adjusting to online classes, losing jobs and scholarship money, and moving into hostile home situations. Many have lost friends, parents and grandparents to covid-19, the disease caused by the novel coronavirus. Their social lives have collapsed.
“There’s a real element of grief here that goes beyond, ‘I just want to be back at school,’ ” said Lisa Henderson, a licensed professional counselor and trauma expert at the American Counseling Association. “For a lot of students, this is the first time they’ve started carving out their own way of life.”
School psychologists are no stranger to these hurdles: Their patients often travel over state lines for summer and other breaks, raising cross-state licensure issues. Typically counselors try to connect students with psychiatric services in their own communities, Himmel said, and many are doing the same now. But this break is different.
“During the summer, students leave to their homes and there’s plenty of time to transition to other care providers,” said Christopher Holstege, executive director of the Department of Student Health at the University of Virginia. “This happened quickly.”
The university’s counseling center had an average of 229 visits per week in the month that followed spring break, counseling center data shows. Staffers are working with caregivers in other states and, in many cases, providing services to in-state students directly.
After the University of Maryland’s flagship campus in College Park shut down, the number of students seeking consultations increased by more than 30 percent, said Chetan Joshi, director of the school’s counseling center. Staff have been ramping up outreach efforts, including workshops, newsletters and other nonclinical services that focus on teaching skills and educating the campus community.
“It is mind-boggling because it is such a mishmash of rules and regulations,” Joshi said about state licensing laws. “That aspect of things has been one of the biggest challenges of working remotely.”
Campuses are dealing with the regulatory roadblocks by beefing up self-help resources but restricting clinical services. U-Md. has maintained relationships with all students who started therapy before campus shuttered, but out-of-state students who want to start therapy are being redirected to providers in their home communities, Joshi said.
American University has limited clinical services to students living in the District, but the staff is promoting a 24-hour emergency hotline and consultations about off-campus therapy and treatment options. Georgetown University students living outside the city can access teletherapy and telepsychiatry services so long as their state of residence allows it.
GWU counselors are licensed in the District, Maryland and Virginia, but officials are trying to extend their reach. Counseling center staffers said they may be able to get temporary licenses on a case-by-case basis.
“Right when students left, there was a three-week gap before state licensure laws were relaxed,” said M.L. “Cissy” Petty, vice president for student affairs and dean of students, explaining why Hannah may have not been able to receive care when she moved back to Iowa. Many of the laws have since been softened.
Now, campuses are confronting the possibility of spending another semester online, and school psychologists don’t want the complexities of interstate care to deter students from asking for help.
“Most clinicians would say that working across state lines would be ideal,” said Kelly Greco, assistant director of outreach and prevention services at the University of Southern California. But, she said, “we don’t want people to not reach out because of that. We want to have the conversation about what are your current needs, is there anything that we’re offering now that can help that need and address it, and then how can we connect you with the services where you’re at.” Greco said the school is offering services designed to fill in the gap: daily workshops about coping and stress management, drop-in virtual consultations, multilingual counselors and special hours for international students.
Looking ahead, Janet Orwig, associate executive officer for member services at the Association of State and Provincial Psychology Boards, said an agreement between about a dozen states called PSYPACT could start to address students’ concerns. Orwig is executive director of the agreement, devised in 2015 and set to take effect in July, which will allow psychologists in participating states to practice across state lines without individual state licenses.
Particularly as students are faced with the possibility of spending another semester at home, there is an opportunity for states to standardize their practices, said Henderson, the American Counseling Association expert.
“There certainly are things that are different about each state, but there are also things widely accepted about the human condition,” Henderson said. “When treating someone in Ohio versus Oregon versus Tennessee, the principles of doing so are going to be pretty consistent.”
Susan Svrluga contributed to this report.