New Mexico State University Chancellor Garrey Carruthers decided last week not to outsource student health services as part of efforts to reorganize the university and cut the budget.
The decision followed discussions with the student body president and other university leaders, according to a July 22 memo Carruthers sent to the entire campus.
“…we have decided NMSU will not house a privately operated health center on campus and will continue to operate our Student Health Center as a university entity,” Carruthers wrote.
NMSU is in the process of negotiating a no-bid contract with a private company to outsource employee health services – which have been provided by NMSU in the Campus Health Center along with health services for students. The last day NMSU will offer on-campus employee health services is Friday.
Now that student health services aren’t heading toward outsourcing, Carruthers wrote in his memo, the university plans to “soon issue a request for proposals on how best to design an integrated and comprehensive student health facility on campus.”
Officials acknowledge that “integrated” could mean somehow combining the NMSU Counseling Center with medical services for students provided at the Campus Health Center – though they say no decision has been made. Currently the two are housed in separate buildings and considered separate entities.
Carruthers told NMPolitics.net earlier this month that a merger could come in the future.
“The Counseling Center is not in this mix at the moment,” the chancellor said. “If anything happens to the Counseling Center, it will happen after we make these cuts (such as eliminating jobs and defunding the equestrian team). That’s not a decision I have to make today.”
But plans change. The equestrian team is getting funding for a year longer than Carruthers initially intended. Student health services aren’t being outsourced. And the Board of Regents still has to vote on whether to approve Carruthers’ proposal to eliminate the Surveying Engineering academic program.
Now, apparently, integration of various campus health-related offices is under consideration. Some campus leaders, including the student body president, favor a plan to merge or integrate health and counseling services.
“To me it just makes perfect sense,” said ASNMSU President Matt Bose. “Students coming in are provided the discreet service they deserve. Unfortunately, there is a stigma associated with seeking help, especially mental health, and when a student walks into the Counseling Center, anybody walking by can assume that they’re receiving some sort of help. Moving it to the health center would provide some much-needed privacy.”
Another advantage of a potential merger could be full medical records available to nurses and doctors in the Student Health Center, he said.
“Doctors seeing these students can fully understand what’s going on in a student’s life and diagnose and treat accordingly,” Bose said.
NMSU’s student regent, Amanda López Askin, said it seems to her “there would be a lot of benefits (to a merger), but at this point, I think we’re still trying to establish that.”
“Because it is still a ‘potential,’ there’s a lot of moving pieces and I don’t have all of the information on how that would affect the Counseling Center, as well as the Student Health Center,” Askin said.
Askin is pursuing a doctorate in educational leadership and has a master’s degree in marriage and family therapy. For the past 11 years, she has worked at the N.M. Department of Health as a school mental health advocate. She said she has “promoted and advocated for integrated health centers at high schools across the state” and “believes in integrated health.”
During her time with the DOH, she has seen students “with physical symptoms” that frequently can be “assisted with mental health services.” She said integrated health centers can benefit students, as well as staff.
“I don’t know if that’s the best fit for NMSU,” Askin said. “I think that’s something we have to establish. But I do know that it’s something that has worked in high schools across New Mexico.”
Opposition from the Counseling Center
Counseling Center staff, on the other hand, say “integrated” – the word Carruthers used in his recent memo – means “merged.” Karen Schaefer, the director of the NMSU Counseling Center, said staff at the center unanimously prefer not to merge.
“A medical operation and a counseling operation are fundamentally different things,” said Corey Vas, the Counseling Center’s associate director. “…Remaining autonomous is what is best for the students.”
One big difference: An appointment at the Student Health Center lasts about 15 minutes, with the focus on diagnosis and treatment of symptoms, while appointments at the Counseling Center are typically 50 minutes and diagnosis and treatment of symptoms are nowhere near as quick, Schaefer said. Vas said the average student who utilizes the Counseling Center has 6-7 sessions.
Counseling is an integral part of retaining students to graduation, which has been a problem for NMSU for several years now, Vas said.
The Counseling Center and the Student Health Center already work in tandem, Vas said. The Counseling Center often refers clients to the Student Health Center in order to receive medication. The Student Health Center refers clients to the Counseling Center for services.
Further, Schaefer said, the Counseling Center is already “integrated” with other offices – and she is concerned that a merger with the Student Health Center might dismantle that.
The Counseling Center is part of Counseling and Student Development Services (C&SD) – various health and wellness-related offices that are housed in Garcia Annex. Along with the Counseling Center, they include the Career Exploration Center, Social Work Services and the Wellness, Alcohol and Violence Education (WAVE) program.
As an example of integration between those offices, doctoral interns in the Counseling Center are required to perform outreach. Many choose to do this with the WAVE program. Examples of outreach, Schaefer said, include giving presentations on topics such as campus sexual assault, eating disorders and suicide.
Another example is providing impromptu counseling services to the community.
“This past spring WAVE showed the film The Hunting Ground about rape on campus,” Schaefer said. “And there were several of us counselors there in case any one of the people who were in attendance became upset.”
Counseling Center interns are able to get outreach credit because WAVE is headed by Debra Darmata, a mental health counselor with a master’s in clinical psychology. Supervision by a licensed psychologist, such as Counseling Center counselors, or someone with adequate training, such as Darmata, is required to complete the internship.
The Student Health Center has no licensed psychologists on staff.
If WAVE becomes “an arm” of health education as a result of a merger between the Counseling and Student Health centers, Schaefer said she fears the focus will shift to health education, rather than counseling, and will no longer prove an effective outreach program for Counseling Center interns.
The offices that are part of C&SD are not solely focused on counseling, Schaefer said, but also on outreach, supervision and consultation of staff, interns and clients. A merger, Schaefer said, could shift the focus solely to therapy.
“The concern then becomes will staff stay?” Schaefer said. “Because they come here for the variety of things we offer.”
Schaefer said salaries at the Counseling Center are low, but staffers are drawn to NMSU’s Counseling Center because it’s not solely focused on therapy. If a merger were to happen, “We could wind up losing some experienced staff” who came to NMSU to help students in a variety of capacities, she said.
“And if the staff leave, then there are no supervisors for the interns,” Schaefer said.
“And the internship ends,” Vas said.
Accreditation, internship program may be at risk
Because the philosophies of the Counseling Center and the Student Health Center are inherently different, Vas said, there would be a high chance of friction between the center’s merged staffs, as is often reported nationally by universities that have merged their counseling and health centers. Vas said somewhere between 26 and 27 percent of universities nationwide have merged their counseling center and health center services, and that it’s a growing trend.
However, a merger between the two centers does not have to entail an integration of services, Vas said.
“There are different models for merging,” he said.
One entails having both entities inhabit a single building but on different floors.
Schaefer likened this potential setup to how Memorial Medical Center and the Sexual Assault Nurse Practitioner (SANE) program are arranged.
“The SANE program is less institutionalized, has a warmer and caring atmosphere, is in a building connected to MMC but not within the hospital itself,” Schaefer said. “That is similar to the nature of our work — so much of what we do is work with folks dealing with trauma and it helps to have an atmosphere that is conducive to talking about difficult experiences.”
Without significant and costly renovations, this model would not work at NMSU.
On the other extreme of merger possibilities would be the sharing of medical records, Schaefer said. While there may be advantages to counselors and physicians sharing records, as Bose pointed out, there are also drawbacks.
One of the most significant Schaefer pointed out is the potential loss of one of the Counseling Center’s two accreditations, this one from the International Association of Counseling Services (IACS).
“The guidelines that they have do not permit us to share front-desk staff (such as with the Student Health Center),” Schaefer said. “There also has to be a separate entrance. Records need to be maintained separately. We can’t have student employees interacting with clients.”
The Counseling Center is already in danger of losing its IACS accreditation because it does not have a sufficient ratio of counselors to enrolled students, Vas said. Per IACS guidelines, Vas said, there needs to be one counselor for every 1,500 students. Currently the NMSU Counseling Center has six counselors — about one for every 2,600 students, according to a 2015 demographic of enrolled students at NMSU’s main campus.
“The advantage of having an IACS accreditation is that, every seven years, you’ve got a site visit where quality control is looked at,” Schaefer said. “It’s the only accrediting body for university counseling centers.”
While many university counseling centers do not have IACS accreditation, Schaefer said, she likes having it, as it “keeps us on our toes.”
“It’s a best-practices model,” said Vas.
In an email to Carruthers, Schaefer said the Counseling Center would be willing to lose its IACS accreditation for “cost-saving purposes,” so long as it remained its own separate entity.
But if a merger were to happen and, as she fears, the offices within C&SD were “farmed out” to various other parts of Campus Health, the Counseling Center’s second accreditation and internship program through the American Psychological Association (APA) could also be in danger. The Counseling Center currently has four clinical interns. In addition, a fifth is due in 2017 as part of an $890,000 grant obtained by Eve Adams, a professor in the Clinical & Educational Psychology Department. This fifth intern will work 80/20 at the Counseling Center and at La Clinica de Familia.
These interns help ease the workloads of counselors in the NMSU Counseling Center, which in turn benefits students, Schaefer said.
“Intern pay is less than I would like it to be,” Schaefer said, but paying four doctoral-level counseling interns is more cost-effective than paying three master’s-level counseling students, as the doctoral interns are able to perform more services.
Without the intern program, master’s level-counselors would have to fill the void, Schaefer said. And while the master’s-level counselors are trained to see clients, there are services currently offered to NMSU students, such as ADHD or disability assessments, that they are not trained to offer. Consequently, there would be an increase to the already-full workloads of the staff psychologists, Schaefer said.
Further, the doctoral interns at the Counseling Center supervise doctoral practicum students. These practicum students see five to seven patients a week at no cost to the Counseling Center (they are compensated with course credit).
Without the internship program, it would be more difficult for practicum students to gain clinical experience at the Counseling Center because they would have to be supervised by licensed psychologists, and the Counseling Center is already understaffed, Schaefer said. Master’s students could not supervise the practicum students because master’s students are not licensed.
Losing the APA accreditation would additionally prevent NMSU from recruiting doctoral interns, who come from other APA-accredited programs throughout the country,. That would in turn harm the Counseling Center’s ability to help students, Vas said.
Schaefer said she has a meeting on Aug. 4 with Provost Dan Howard to discuss the effects a merger would have on the Counseling Center’s internship program.
If merger talks continue, Schaefer said she hopes she will be brought in to give her perspective.
“I really hope the chancellor is receptive to our being part of that discussion about the proposals,” Schaefer said.
Andrea Joseph, an associate professor in NMSU’s Department of Criminal Justice, has already shared her concerns about a merger in an email to Carruthers. Joseph took a student to the Counseling Center for reasons she did not disclose in that email. In the waiting room, “peaceful and private…with a TV with beach scenes and the rolling sound of gentle waves,” Joseph waited with her student until a counselor came.
“It was in this quiet space that (the student) felt comfortable disclosing the fact she was raped,” Joseph said. “I do not believe such progress would have occurred in the hustle and bustle of the health center.”
“I strongly encourage you not to merge the Counseling Center with the health center,” states Joseph’s email, which Schaefer provided to NMPolitics.net.
Carruthers and Lori McKee, director of the Student Health Center, declined NMPolitics.net’s interview requests.
“No direction has been decided on yet. It’s too premature to say one way or another,” NMSU spokesman Justin Bannister said.
Bose, meanwhile, said NMSU “is currently transforming to be the best university we can be.” He participated in talks about health services and was instrumental in preventing the outsourcing of the Student Health Center.
“Along with that came a decision to analyze the services that the health center offered and evaluate any potential changes that could be made to better serve our students,” he said.
NMSU plans to soon send out a request for proposals “to evaluate the strengths and weaknesses of our health center,” Bose said.
“We anticipate being able to evaluate that proposal in the very near term,” Carruthers’ July 22 memo states.
“And at that point,” Bose said, “we will make changes to better accommodate our students’ needs.”
A prior version of this article incorrectly stated that Darmata is a licensed psychologist. It has been corrected. The article has also been updated to clarify what the Counseling Center’s clinical interns do.