Frequently Asked Questions About MIT Medical's Mental Health Service
FAQ Major Topics
- Who Should Use the Mental Health Service
- Demystifying the Experience
- Costs and Insurance
- Confidentiality
- Mental Health Hospitalization
- Medical Withdrawals
Who Should Use the Mental Health Service?
Who should use MIT Medical’s Mental Health Service?
Any student is welcome to come to MIT Medical’s Mental Health Service, even if it’s for help in dealing with a typical amount of stress. In fact, just checking in with us now may prevent you from feeling overwhelmed later. Any student who is having trouble with stress, substance abuse, or other issues should feel free to come to the Mental Health Service. It is a sign of strength to recognize these kinds of concerns and make a plan to deal with them constructively.
Typical mental health concerns include relationship difficulties and break-ups, family stress, school stress, anxiety and worry, questions about sexual identity, eating issues, and depression. Often these issues affect the student's ability to do his or her schoolwork and enjoy activities that usually are a source of pleasure.
How can I help a friend who is depressed, especially if he or she has reason to be unhappy? What if I’m worried that my friend may want to harm himself or herself?
It is not your responsibility to diagnose your friend’s depression. Your first step should be to listen to your friend and share your concerns. If your friend seems to have withdrawn from activities, let him or her know you've noticed. Even if your friend says nothing is wrong, it may help to know that you care.
Second, you should never keep this kind of worry to yourself. You can encourage your friend to see a clinician at MIT Medical’s Mental Heath Service, or involve a housemaster, GRT, or RA. Staff members of the Mental Health Service can help you figure out the best approach for helping a friend; you can call us at 617-253-2916 or visit us during walk-in hours, Monday–Friday, 2 to 4 p.m. If the situation seems urgent, you, the housemaster, GRT, or RA should contact the campus police and have your friend transported to MIT Medical or a hospital emergency room.
Studies of people who have committed suicide have found that many told someone else about their thoughts beforehand, although the people they told were often not mental health professionals. One goal of many suicide prevention programs is to make sure that anyone who is thinking about suicide has an opportunity to speak with a mental health clinician.
Is it normal for a student to be talking about suicide?
Thinking existentially about the meaning of life and whether it’s worth living is normal; sincerely wishing you were dead or thinking about ways to take your own life are not. However, some people go through difficult periods in their lives when thoughts of suicide are a constant presence.
People who are depressed often feel hopeless, which can lead them to consider suicide as a way out. A recent survey* of college students in the United States found that 10 percent had thought about suicide in the last year. Another study**—one that excluded people who were depressed—found that only about four percent of 18- and 19-year-olds had thought about suicide in the last year. In the same age group, 32 percent of depressed individuals had thought about suicide.
Anyone thinking about suicide should talk to a mental health clinician. People thinking about suicide often feel that there is no way out of a particular situation, but there are often many more options than they realize. People dealing with such feelings usually find that talking privately to a professional counselor reduces their sense of despair and isolation.
*Brener, N.D., Hassan, S.S., and Barrios, L.C., 1999, Suicide Ideation Among College Students in the United States, Journal of Consulting and Clinical Psychology, V67, No.6, 1004–8.
**Fergusson, D.M., Beautrais, A.L., and Horwood, L.J., 2003, Vulnerability and Resiliency to Suicidal Behaviours in Young People, Psychological Medicine, v33, 61–73.
Sometimes I feel sad and overwhelmed, but usually I get over it. Would going to the Mental Health Service be helpful to me?
If you are finding it hard to get your work done, and if talking to your friends or parents doesn't help, you should come to the Mental Health Service to review the situation. If talking to your friends helps, but they can’t offer you the level of attention you need, you should come to the Mental Health Service. If you are having trouble sleeping or concentrating, you should come to the Mental Health Service. If you are not sure whether you should come in, consider making an appointment just to talk to someone about what services are available and whether you could benefit from them.
Does talking really help?
Talking helps many people, and it certainly never hurts. Of course, it depends on the person and whom he or she talks to. If you're more comfortable talking with a parent, GRT, housemaster, or one of the MIT chaplains, that is a good place to start.
The above was prepared by the mental health work group of the MIT Student Health Advisory Council with input from the staff of the Mental Health Service at MIT Medical. [Note: This source should be acknowledged if the material is used elsewhere.]
Demystifying the Experience
What should I expect?
During the first visit, you will talk with a clinician about the concerns that prompted you to make the appointment. The clinician will ask you questions about your family, childhood, and substance use. Usually the session will end with some feedback and suggestions about treatment options, both within the Mental Health Service and in the wider community. Sometimes we’ll recommend treatment outside of MIT Medical; sometimes we’ll make a recommendation to consider medication.
Subsequent visits will be similar to the first but will focus more on current difficulties and less on your general history. During the second session, the clinician will often ask for your thoughts about the first session and the recommendations that were made.
What if I don't like the clinician I'm seeing? How can I express this to the Mental Health Service?
Feeling comfortable with your counselor is essential for a positive outcome in psychotherapy. You can always request to see a different clinician, either by asking your clinician or a receptionist. The staff understands that sometimes it takes time to find the appropriate counselor and will not take your request personally.
On the other hand, it might be that you feel uncomfortable with your clinician during the first few sessions because of assumptions you are making about what the clinician thinks and feels. For example, you may think your counselor is too old to understand you or would be upset to hear what’s really on your mind. Before requesting a different counselor, try discussing these thoughts with your current counselor; you may find that he or she understands you more than you think.
If I go to the Mental Health Service, will I have to explain my situation over and over to many different people?
No. When you call to make your first appointment, you can simply say, "I want to make an appointment." You will usually have to explain your concerns briefly to a clinician during the triage phone call, which will allow us to match you with a clinician appropriate for your particular needs. Then you can go into more detail with your counselor during your first appointment. Occasionally, if you are interested in medication or switching to a different clinician, someone else will need to have information about your situation.
What if I am seeing a counselor outside MIT but want to use MIT Medical's services?
If you are an MIT student, you can use all the mental health services we have available. If you are receiving outside treatment and using MIT Medical services, such as the infirmary or the after-hours mental health on-call system, we should talk with your outside counselor to make sure that we are all working together. If you would like to transfer your treatment from an outside therapist to MIT Medical’s Mental Health Service, call 617-253-2916 to schedule an intake appointment.
Does the Mental Health Service prescribe medications?
The Mental Health Service provides psychotherapy and prescribes medications as necessary. As part of an initial evaluation, the clinician will review the various treatment options available to you. If the most appropriate treatment for your situation is not offered at MIT Medical, you will be referred to an outside clinician.
How long does it usually take someone to get over a problem?
It depends on the problem. Most students who use mental health services come for an average of seven visits.
Are MIT students more depressed than students at other schools? Are they more prone to suicide?
Compared to other large, top-tier schools, MIT students are neither more depressed nor more prone to suicide than other students. All colleges and universities are making an effort to reduce the stigma associated with mental health issues and help students understand that mental health is just another part of overall health and wellness.
What resources are available for someone with eating and body-image concerns?
MIT Medical social worker Audra Bartz serves as the care coordinator for the eating concerns team and can help connect students to the appropriate resources, including nutritional counseling, medical care, and mental health support. If you have a question about yourself or how to help a friend, contact Audra at bara@med.mit.edu or 617-253-5200. For free workshops or books on these topics, contact health educator Zan Barry at bars@med.mit.edu or 617-253-3646.
How is MIT Medical’s Mental Health Service linked to other campus support networks such as Nightline, GRTs, or housemasters?
Mental Health Service staff members are advisors to the Nightline workers, and Nightline workers may refer callers to the Mental Health Service. GRTs and housemasters may also advise students to use the Mental Health Service or may contact us for advice about how to work with a particular student.
How do the Counseling Deans (Student Support Services or S3) relate with the Mental Health Service?
If a student requires a change in housing or needs to be excused from an exam because of a personal problem, he or she should contact S3 (617-253-4961), not MIT Medical. The S3 staff can help negotiate with professors and address academic, housing, and other personal concerns. MIT Medical will not share personal information with S3 without your permission.
The above was prepared by the mental health work group of the MIT Student Health Advisory Council with input from the staff of MIT Medical’s Mental Health Service. [Note: This source should be acknowledged if the material is used elsewhere.]
Costs and Insurance
Are all mental health visits free?
Visits to the Mental Health Service are free for registered MIT students. There may be a charge for appointments outside of MIT Medical.
How are mental health services covered if I am on my parents' health insurance policy?
There is no charge for visits to MIT Medical’s Mental Health Service. If you are referred to a clinician outside MIT Medical, you will be charged according to the fee schedule associated with your parents' insurance plan. Most health insurance plans specify the number of visits per year that are fully covered or that require a small copayment. For many plans, this fee schedule may apply only to a limited set of providers. There is probably a phone number on the back of your insurance card that you can call to find out what the exact benefits are.
Will my parents find out if I use their insurance for mental health prescriptions like Prozac or Zoloft?
According to psychiatrist Simon Lejeune, who has prescribed medication for many students on their parents' insurance policies, no parent has ever been notified of the student using the prescription benefit. The only problem can sometimes be finding a pharmacy that accepts a specific type of prescription coverage, but major pharmacies, like CVS, tend to accept most insurance plans. If you want more information about how prescription coverage is handled, it’s best to check with your parents’ insurance. Call the billing department of the insurance company, and ask if your parents would be notified if the prescription benefit is used, or call the separate toll-free number for “behavioral health coverage” or “mental health coverage” that is probably printed on the back of your insurance card.
How are mental health services covered if I have the MIT Student Extended Insurance Plan?
All registered MIT students can receive mental health services at MIT Medical at no charge as part of the MIT Student Medical Plan, which is included with tuition. If you are referred to a clinician outside of MIT Medical, those services would be covered by whatever additional insurance plan you have—the MIT Student Extended Insurance Plan or your parents’ insurance plan. The Extended Plan uses Blue Cross Blue Shield (BCBS) for its outpatient mental health benefit, which means that any outside clinician you see must be a BCBS provider. (Almost all mental health professionals in Massachusetts are BCBS providers.) The Plan pays for 24 visits per year. It pays 100 percent of the cost for the first 12 visits and 80 percent of the cost for the next 12 visits. You should not schedule more than one session per week.
What if I want to see a clinician outside MIT? Does the MIT Student Extended Insurance Plan cover that?
Visits to clinicians outside of MIT Medical are covered by whatever insurance plan you have in addition to the MIT Student Medical Plan, which is included with tuition and covers most services provided at MIT Medical. If you have the MIT Student Extended Insurance Plan, visits to outside mental health clinicians (as long as they are Blue Cross Blue Shield providers) are covered at 100 percent of the cost for the first 12 sessions and 80 percent for the next 12 sessions. This coverage will occur only if a clinician at MIT Medical has referred you to the outside provider. But if you have a clinician in mind or are already seeing a clinician, you do not necessarily have to make an appointment to get a referral; it can be done over the phone. Just call the Mental Health Service at 617-253-2916, and tell them you need a referral to an outside clinician.
The above was prepared by the mental health work group of the MIT Student Health Advisory Council with input from the staff of MIT Medical’s Mental Health Service. [Note: This source should be acknowledged if the material is used elsewhere.]
Confidentiality
Does information about mental health appointments go in my medical record?
No, information about mental health is not part of your medical record. Separate mental health medical records are kept in the Mental Health Service. However, as a medication-safety precaution, copies of prescriptions written by mental health providers go into the general medical record, so other care providers will know what medications you are taking.
Is everything that happens during a mental health visit really 100 percent confidential?
Everything you tell a mental health clinician is “privileged information.” That means this information cannot be given to any other person without your permission, nor can other information about your treatment or diagnosis be shared with anyone else without your permission. There are a few exceptions: 1) if a patient is in serious danger of harming self or others, the clinician can notify other people in order to protect the patient and other people; 2) if another individual is in danger, that person can be informed; and 3) if a patient is involved in the abuse or neglect of a child or an elderly person, the clinician is mandated by law to inform the appropriate agency.
I am applying for a job, and the application asks if I have ever been diagnosed with a psychiatric disorder. Does seeing someone at the Mental Health Service mean I have to answer “yes” to this question?
Not necessarily. Many people are seen at the Mental Health Service for issues other than "psychiatric disorders."
I am applying for a job that requires a security clearance. Will the fact that I have been seen at the Mental Health Service have an impact on my clearance?
This question comes up frequently. Typically, the agency that is doing the clearance contacts the Mental Health Service after notifying you (we need your permission to release information; usually the agency has already asked you to sign something to this effect). The agency will simply ask your clinician for his or her professional opinion as to whether you are a risk to security. The agency is generally more interested in the clinician's overall assessment regarding your potential risk to security than in the details of your medical record.
The above was prepared by the mental health work group of the MIT Student Health Advisory Council with input from the staff of MIT Medical’s Mental Health Service. [Note: This source should be acknowledged if the material is used elsewhere.]
Mental Health Hospitalization
How often are students hospitalized for mental health issues?
Mental health hospitalizations are unusual at MIT and result only from careful assessment of the student and his or her supportive environment. For example, there were more than 11,000 student visits to MIT Medical’s Mental Health Service in academic year 2007–2008; only 17 of those visits resulted in hospitalizations. In addition, most of those hospitalizations were voluntary, meaning that the patient agreed that he or she was at risk and would benefit from intensive treatment.
When is someone hospitalized involuntarily?
In the Commonwealth of Massachusetts, a person can be hospitalized involuntarily only if the person requires hospitalization in order to avoid the likelihood of serious harm to self or others. To assess risk, the clinician uses his or her clinical judgment to weigh a variety of factors, such as the individual's current situation, past history, and mental status. For example, an individual who currently exhibits signs of depression, has previously attempted suicide, has a specific suicide plan, is intoxicated, or has a history of not being able to control violent impulses would be considered at higher risk. Clinicians also consider factors that reduce an individual's risk, such as the availability of social supports. But the bottom line must always be the individual's safety and the safety of others.
What is meant by social supports?
A student’s “social supports” refer to all the people and services that are available to the student and that the student is using to help deal with the difficulties he or she is experiencing. Social supports most often include family, friends, significant others, faculty advisors, housemasters, GRTs, mental health professionals, and members of the clergy.
How is a mental health hospitalization similar to and different from a hospitalization for a physical health concern?
Medical and psychiatric hospitalizations are similar in that the purpose of both is to provide more intensive treatment and monitoring than can be provided at home. In both cases, the hospital environment is set up with safety and treatment as its first priority, and a patient does not have easy access to all of the things that he or she is used to at home. Further, in a psychiatric hospital, intensive treatment means that the patient is observed closely; the actual level of supervision varies according to the staff's assessment of the patient's level of risk for destructive behavior. The most closely observed status is one-to-one, where a staff person observes the patient continuously. The least observed status is when the patient is able to move freely around the hospital unit.
Can patients in psychiatric hospitals use cell phones and check email?
Access to phones and the Internet may not be available in psychiatric hospitals. The basic philosophy is that the person is there for treatment, and other activities should not interfere with this work. On the other hand, therapists also recognize that preserving contact with the outside world is important for a person's mental health, particularly for a student. Each inpatient unit has its own policies about the use of phones and the Internet, and some can make special arrangements for access in certain cases. However, most places are not set up with resources such as WiFi or other types of high-speed Internet access.
What about visitors?
Most inpatient units have specified visiting hours and will allow a patient to have visitors if the patient says he or she wants to see those visitors. Generally, visiting hours are designated to avoid interruption of treatment sessions, so if you want to visit a hospitalized friend, it is best to determine the visiting hours before arriving at the hospital. The hospital's emphasis is on treatment, and visitors who arrive when the patient is receiving group or individual therapy may not be able to visit until the therapy session is finished.
How long is a mental health hospitalization?
Lengths of stay vary considerably, anywhere from one or two days to several weeks. The most important factors in determining length of stay are usually severity of the illness, participation in treatment, and the patient’s insight into his or her condition. Most hospital stays are less than a week.
Since a hospitalization interrupts the patient's usual life and routines, the stay is kept as short as possible. On the other hand, hospital staff members want to be sure that there is not a large risk for violent or self-destructive behavior if the patient is discharged. Hospital staff members need to assess two important factors prior to discharge: 1) the patient's mental status and how it has improved since admission, and 2) the situation into which the patient is being discharged. Before being discharged, the staff must determine that the patient is feeling more stable and safe, and that he or she is being discharged into a supportive environment with appropriate treatment.
Who decides when a patient can leave the hospital?
The decision about when to discharge a patient from a psychiatric unit usually involves a number of factors and a number of people—just like the decision to discharge a patient from a medical unit. The attending psychiatrist in the inpatient unit has the final word, but the decision is usually made in consultation with the rest of the inpatient team and the patient’s outpatient care providers. MIT Medical’s mental health clinicians will be involved in these consultations and can provide important information about the kind of community supports that are available to MIT students. A patient is discharged when the hospital staff believes he or she can live safely in his or her home environment and can receive the treatment that he or she needs. In the case of an MIT student, community factors also play a role; sometimes the impact of the student's behavior and state of mind on his or her living group has to be considered.
Sometimes a student may no longer require a hospital setting to maintain his or her safety but may still need a level of support that exceeds that which is possible in a residential university environment. In this situation, a withdrawal from MIT for medical reasons may be considered to allow for a more extended period of recuperation.
I have been hospitalized, and I don't think I need to be here. What do I do?
There are many means of recourse if you feel that you have been hospitalized unjustly. These range from negotiating with the attending physician for discharge to taking some form of legal action. Every hospital is required to have a human rights officer who can help to mediate these kinds of discussions.
Even though it may have been the staff at MIT Medical who initiated the hospitalization, it is the staff at the hospital who makes the decision about discharge. The first step is for you to find out who the members of your treatment team are and discuss the situation with them. In most hospitals, every patient will have a single person who acts as his or her main contact with the treatment team; this contact is often called a “case manager” or “primary clinician.”
The vast majority of disagreements about discharge are resolved through negotiation with the treatment team. If this is not effective, you can request to speak to the hospital’s human rights officer, or you can refuse to sign in to the hospital (or, if you have already signed in, you can sign a three-day letter of intent to leave). Either of these actions starts a legal process that will result in your discharge, unless the hospital applies for a court hearing to keep you against your will.
Leaving the hospital earlier than the staff recommends does not mean that you may immediately return to school. That is a separate administrative decision made by the senior associate dean for students after conversations with the hospital staff, student support services, and clinicians in MIT Medical’s Mental Health Service.
How can I help a friend who is hospitalized?
Many people who are in the hospital appreciate visitors. Some people may feel like having more privacy at the start of a hospitalization but will want more contact with friends as time goes by. There is such a stigma attached to psychiatric hospitalization that people who have been hospitalized often worry that their friends won't want to be around them. The most important thing you can do is to be supportive and stay in touch. You might offer to bring your friend things he or she needs, like shampoo or problem sets.
Whom can I talk to if I have questions about a friend’s or roommate's hospitalization?
To learn specific information about how a person is doing or what happened, speak directly with your friend or ask for a meeting with a hospital staff member and your friend. It is best not to meet with staff without having your friend present, as he or she probably doesn’t want to be "talked about" without being there. It’s important to remember that members of the hospital staff are bound by law and hospital policy to safeguard patients’ confidentiality. This means they cannot share any information with you without your friend’s permission, but they can listen to concerns that you may have about your friend.
For general information about psychiatric hospitals and psychiatric illnesses, you can talk to anyone in the Mental Health Service, either by coming to walk-in hours or scheduling an appointment.
What if I have more questions?
It is usually best to talk to the staff at the hospital where your friend is staying. However, most hospitals are very careful not to give out information about a patient without the patient's permission, so it can take some time for the staff to get back to you and answer your questions. MIT Medical clinicians and counseling deans are also unable to give out any information without the student's permission. But it is often the case that someone, such as a housemaster, will have discussed with the student what information he or she would like to have conveyed to friends and can provide that information when asked.
The above was prepared by the mental health work group of the MIT Student Health Advisory Council with input from the staff of MIT Medical’s Mental Health Service. [Note: This source should be acknowledged if the material is used elsewhere.]
Medical Withdrawals
What's medical withdrawal?
Medical withdrawal—a leave of absence from MIT for medical reasons—is often recommended when it becomes clear that the student needs intensive treatment and should be focusing his or her resources and time on getting better rather than studying. In many university settings, medical withdrawal is a virtually automatic consequence of hospitalization. However, at MIT, each individual case is assessed with the goal of determining what is best for the student.
How is it decided who needs to take a medical withdrawal?
A medical withdrawal is recommended, or is initiated by a student, when a student's medical condition interferes with his or her ability to do schoolwork, manage day-to-day functioning, or live safely in the school environment.
What happens to someone who needs to take a medical withdrawal?
For undergraduates, medical withdrawals are processed through Student Support Services (S3) with consultation from the Mental Health Service or another medical service at MIT Medical. A medical withdrawal is reevaluated each semester. It is usually for a minimum of one full semester but may be as long as two semesters plus a summer. Often there are specific requirements for the student to fulfill during the withdrawal, such as obtaining medical treatment and taking courses or working. For graduate students, medical withdrawals are processed through the Graduate Students' Office.
What happens when someone on medical withdrawal comes back to MIT?
For undergraduates, the readmission process is initiated through SSS. The student is asked to prepare a readmission application, including a statement about what he or she has done during the medical withdrawal and how he or she is now ready to return. In addition, either the chief or the associate chief of Mental Health will interview the student applying for readmission after a mental-health-related withdrawal to see if he or she has stabilized enough to return. (Another MIT Medical care provider will interview applicants for readmission after for non-mental-health-related medical withdrawals.) As part of the readmission assessment, the Mental Health Service chief or associate chief may want to speak with clinicians the student saw during the withdrawal period. At times, it is a requirement that the student be in therapy after returning to MIT. The Mental Health Service has a therapy group for students who have recently returned from medical withdrawal.
For graduate students the process is different; the request for readmission goes through the dean of graduate students. In most cases, the mental health clinician with whom the student worked prior to the medical withdrawal is the one who evaluates his or her readiness to return.
The above was prepared by the mental health work group of the MIT Student Health Advisory Council with input from the staff of the Mental Health Service at MIT Medical. [Note: This source should be acknowledged if the material is used elsewhere.]
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