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Policy in Action

To some, governmental programs like Medicare, Medicaid, Head Start, and Temporary Aid for Needy Families are little more than abstractions. If we work in higher education, however, such programs affect our students and our colleges.

Take these examples of community-college students. In one case, a student exhibiting signs of paranoia was terror-stricken about the prospect of returning to her home. Counseling staff later learned that she was supposed to be participating in an inpatient-treatment program. The physician of another student with chronic physical and mental illnesses directed him to stop taking his mental-health medications, apparently without consulting his psychiatrist. In both cases, staff arranged for the students to be transported to the hospital via ambulance, due to the severity of the students’ symptoms.

Our urban campus has had an upswing in these types of mental-health emergencies, and many of the students have been Medicaid beneficiaries. Interestingly, the Monroe County, N.Y., Budget shows that our county has experienced a 13-percent growth in Medicaid case load since 2008, yet the appropriations for Medicaid in the county budget have declined steadily since 2010. Meanwhile, the New York State mental-health budget is also down 5.4 percent from 2009-2012, according to a report by the National Alliance on Mental Illness.

Continued high unemployment has led to higher demand for Medicaid, yet “the cumulative effect of two recessions since 2001 and a decade of constrained spending has left no cushion,” says Diane Rowland, Executive Vice President of the Kaiser Family Foundation and Executive Director of the Foundation’s Commission on Medicaid and the Uninsured. These conditions have led states to adopt cost-cutting policies, such as cuts in provider payments, benefit reductions and restrictions, and new and higher copayments for beneficiaries.

Of course, I cannot prove that these policy changes are the direct cause of the increase in health emergencies. Nonetheless, a consistent lack of coordination of care suggests a systemic problem in local health-care systems. Regardless, when a distressed student seeks assistance on a college campus, we must respond. The first priority is to get the student the most appropriate level of care. However, secondary effects can lead to disrupted classrooms and traumatized classmates, faculty, and staff. Further, when counselors’ time is spent with such serious crises, there is less time available for academic advising and other student-development services.

Don’t get me wrong. I’m not arguing that we shouldn’t spend time managing such crises when they arise. But we must recognize that we are often placed in the position of filling in the holes in the social safety net, dealing not only with students’ mental-health needs, but also their housing, child-care, and financial-assistance needs. As community colleges, we have a stake in such policies. If we are to continue to meet our core academic mission, we must also draw attention to the full spectrum of policies that affect our ability to do so.

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