ASU ends on-campus psychiatric-care program

Madeleine Schaffner was expecting a confirmation call. The Arizona State University student had an upcoming appointment with her psychiatric nurse practitioner, who recently increased the dose of medication she uses to keep her mental health in check.

Instead, a representative from ASU’s Community Health Center had news about a change to the university’s psychiatric-care program.

“They called me and said, ‘Unfortunately we are not offering psychiatric services anymore,’ so they’re canceling all appointments from this point on,” said Schaffner, 21. “I was astounded.”

The university completed the switch in June to a model in which students seeking psychiatric care are referred to a network of off-campus providers.

Schaffner said she was told during the call that budget cuts signaled the change, which ASU denies. Gov. Doug Ducey and the Legislature approved $99 million in state funding cuts to the state’s three universities this year, resulting in budget thinning and a surcharge for ASU students.

Among the 10 largest public, national universities in the U.S., ASU is the first to outsource psychiatric services. The other nine all offer on-campus psychiatric care.

The change does not affect mental-health and counseling services, which ASU continues to offer students on all four of its campuses.

ASU’s on-campus primary-care physicians still can prescribe psychiatric medications, such as anti-depressants, anti-anxiety agents, mood stabilizers to treat bipolar disorder, and stimulants to treat ADHD. But students seeking specialized treatment, such as a tweaking of dosage or an assessment to determine if psychiatric medication is right for them, will be referred off campus.

“These providers are known to ASU — they are more accessible, faster, closer to home and take a variety of insurance carriers, making them more affordable to more students than if ASU offered one or two staff members to fill this role,” according to an ASU statement. “As a university in a major metropolitan area, we have a distinct advantage of utilizing robust medical expertise in the community.”

About 7 percent of college students nationwide reported having a psychiatric condition, according to a 2014 survey of the American College Health Association. Conditions include anxiety, depression, bipolar disorder and schizophrenia, and can be addressed with talk therapy, psychiatric medication or both.

The demand for psychiatric services at Northern Arizona University has prompted the school to expand its offerings. NAU has three staff members providing psychiatric care and is hiring a fourth, said Dan Bruey, Medical Services’ director of administration. They perform initial mental-health evaluations for about 500 students seeking psychiatric care every year, in addition to about 1,900 annual follow-up visits, he said.

The University of Arizona offers two psychiatric clinics for adults and children through its College of Medicine’s Department of Psychiatry. Dozens of professors, assistant professors and advanced trainees in psychiatry and psychiatric nursing provide care for students and community members.

Most universities offer on-campus care, through counseling or health centers, or through a medical school if the university has one, said Dr. Nance Roy, clinical director of the Jed Foundation, a non-profit that works to promote emotional health and prevent suicide among college students nationwide.

Between 35 and 40 percent of universities do not offer on-campus psychiatry, Roy said, and instead develop relationships with community providers who can provide medication management off campus. Such arrangements can be “very effective,” Roy said, if the university has strong communication with the providers so as to coordinate care, if the providers are close to campus and if they accept the university-offered insurance, which ASU says many of them do.

ASU offers Aetna Student Health Insurance, and students must enroll by Sept. 2 to obtain insurance for the fall semester. A plan for the 141-day fall semester goes for $889, and one for a full year $2,308.

“Is it easier for students to access care on campus? Of course, and we want to try and remove as many barriers to care as possible, but many schools have developed very good protocols,” Roy said. “The easier it is to access services, the more availability there is, it’s better for the students.”

The referral system also assures that students can continue getting psychiatric care after they graduate, said Dr. Gurjot Marwah, a Tempe psychiatrist who said ASU has referred students to her for about 14 years.

“My feeling is the patients who do get referred to me, get referred at a good, appropriate time in their treatment,” said Marwah, who is president-elect of the Arizona Psychiatric Society. “I feel the referral process is fairly streamlined.”

ASU would not discuss any cost savings from using the referral system. But Roy said outsourcing may make the most financial sense for a school in a metropolis full of providers. In the way universities don’t employ specialists such as surgeons, many don’t employ psychiatrists, who have an average annual wage of $182,700, according to the U.S. Bureau of Labor Statistics.

Until recently, fewer than 0.5 percent of ASU students received psychiatric care — from a single practitioner at the Community Health Center at ASU’s College of Nursing & Health Innovation on its downtown Phoenix campus. The other campuses have practiced off-campus referring for years, ASU said. Conversely, the university says about 3,500 students — 5 to 6 percent of the more than 73,000 students attending on-campus classes — utilize counseling services provided by the ASU’s 21 professional, clinical staff members.

Schaffner, an ASU senior, had been part of the 0.5 percent. She lives in Tempe but says she commuted to Phoenix once or twice a month for seven months to see Ruth Flucker, a psychiatric nurse practitioner based until recently at ASU’s downtown Phoenix campus. Flucker was the only staff member listed on ASU websites as providing psychiatric care.

Flucker has since left the clinic and is not scheduled to teach this fall. She declined The Republic’s request for comment on her departure from ASU.

“They should have told us three or four months out they were discontinuing this,” Schaffner said. “The whole process is really stressful, trying to find someone else. ... It still makes me really angry.”

Schaffner said she has taken psychiatric medication on and off since she was a teenager, and although she has private insurance through her parents, she was mainly concerned about finding a new psychiatrist in time. She said she was told that ASU would refill her prescriptions for one more month and advised that she call her own insurance company and ask them where to find a new doctor. It took her about a month to find a new psychiatrist on her own, she said.

The new program could be a hardship for students of limited means. Grecia Magdaleno, a 20-year-old ASU junior, was seeing a therapist through ASU Counseling Services but recently decided to see if medication would be a good option to treat her depression and anxiety attacks.

“Now that that got cut, I’ve just had to put it on the shelf, the back burner, and not think about it,” Magdaleno said, “which is a little bit unnerving because I’m not sure if I’m missing out on an opportunity to get better.”

Magdaleno does not have insurance and said her family was denied for AHCCCS, so she depended on low-cost on-campus care. “It’s already hard for me to get to ASU from my house without a car, and I’m very limited in my budget. ASU was most convenient,” she said.

Reach the reporter on Twitter @kailawhite, on facebook.com/KailaWhiteAZ, or e-mail at kaila.white@arizonarepublic.com.