American University came under fire this week for a campuswide email that detailed the rate of students’ “unkept mental health appointments” last fall at the campus’s counseling and student-health centers. An administrator sent the notice on Sunday after students expressed concerns over access to mental-health services.
The email caused frustration among students who said it implied they were to blame for the long wait times that some patients experienced when scheduling appointments. Several students and alumni took to Twitter and Facebook, sharing their negative experiences with the university’s mental-health services.
Students missed about 20 percent of all appointments made last semester. That’s roughly five no-shows per day.
The incident at the Washington, D.C., university is the latest in a broader conversation about access to mental-health care at campuses throughout the United States. And while the message was regarded by some as administrative finger-wagging, it focused attention on a very real problem for college counseling centers: no-shows and late cancellations that prevent other students from being served..
Around 20 percent of all appointments made at American University’s Counseling Center last semester were not attended — that’s roughly five no-show appointments per day — according to the email. That’s more than double the national no-show rate, according to an annual survey conducted by the Association for University and College Counseling Center Directors.
The average no-show rate in 2018 was just over 9 percent nationally. No-show rates among the 321 universities surveyed ranged from 2 to 23 percent.
No-shows are a common problem for all doctors and therapists, said Victor Schwartz, chief medical officer at the Jed Foundation, a nonprofit that advocates for mental-health protections for teens and college-aged adults.
A student’s crammed schedule can make attending appointments a challenge, Schwartz said. Because therapy appointments are often provided at no or low cost, students might not feel motivated to show up.
“Students don’t take it as seriously because it’s free,” he said.
Some colleges assume that students will miss appointments, Schwartz said, “and sort of bake that in and expect that clinicians will use that time for their paperwork.”
North Carolina State University cuts down on no-shows by sending text reminders and charging students $25 for missed appointments. Monica Osburn, executive director of the counseling center there, said initial appointments are walk-in only.
“Students don’t call to get an appointment,” she said. “They walk in to start services, which allows us to immediately see them, figure out what the needs are, how urgent the needs are.,”
N.C. State’s no-show rate is 7 percent, Osburn said.
Similar measures have succeeded in dropping the wait time at the University at Buffalo’s counseling center.
The university restructured its mental-health services last semester after seeing the no-show rate for intake appointments hit 29 percent, said Sharon Mitchell, director of Counseling Services. Mitchell also is president of the national counseling directors’ group.
“What was happening in our old system is the day that they called they were upset. But then a week or so later, they were less upset,” she said. “And so then they didn’t follow through with the appointment.”
The university added same-day wellness assessments that allow students to see a counselor right away instead of scheduling a later appointment. They also shortened the length of appointments to allow more students to get help.
“We knew that it was time to try something different,” she said.
At American University, conversations about mental-health services are continuing. In the fall, the student government hosted two forums for students to express concerns about resources on campus, including mental-health counseling.
Traci Callandrillo, assistant vice president for campus life at American, said blaming students was not the intent. Instead, administrators wanted to provide them with information that could help them realize the impact of missing an appointment.
“That’s empowering our community with information,” Callandrillo said. “It also aligns with the world of health care outside of higher education, where you make an appointment, you might get a reminder for that appointment, and then you’re responsible for either attending or canceling the appointment.”
Regardless of resources and staffing, universities need to approach conversations about mental health carefully, said Laura Horne, chief program officer at Active Minds, a nonprofit that strives to raise awareness about mental health among college students.
“In communicating with students at a time like this, where anxiety and depression is so high,” she said, “it’s paramount that students feel like their campus is cheering them and cares about their well-being.”
