To establish a policy and procedure regarding management and scope of services for patients/clients who present to University Health Services (UHS) for mental health care.
Policy:
Using a short-term therapy approach, UHS Mental Health Services provides time-limited, outpatient mental health services to currently enrolled UW-Madison students:
Services for domestic partners may also be provided under the appropriate benefit plan; and
Non-student partners may be seen for couples treatment with enrolled students.
Enrolled students, upon request, will receive a minimum of an access consultation with a UHS provider to assess for safety and to determine the services most appropriate for their needs. Recommendations for additional mental health services are made on a case-by-case basis.
A full course of treatment with regard to individual and couples counseling services consists of 10 sessions per calendar year and 20 sessions per academic degree. These session limits reflect a maximum number of sessions available in the brief model and do not reflect a guarantee of sessions.
Limited additional mental health sessions beyond the above-described limits are available upon recommendation of a Mental Health provider.
Psychiatry services (e.g., medication consultation and management) may continue on an ongoing basis if recommended by a Mental Health Services psychiatric provider. These visits are not included in calculating session totals.
Crisis services, group services, and stress management visits may continue on an ongoing basis if recommended by a mental health provider. These visits are not included in calculating session totals.
Specialized assessments and scheduled consultations are not included in session totals.
No-show individual and couples counseling appointments are a concern because they reduce services available for other students in need, and therefore will be included in individual and couples counseling session totals.
Specific concerns or situations for which a student most likely will be referred to other agencies during either access consultation or during the course of treatment at Mental Health Services include, but are not limited to:
Chronic and/or long-standing mental health conditions that have required ongoing treatment prior to Mental Health Services presentation;
Significant substance use requiring specialized treatment service, including students seeking mandated substance use assessment services;
Suicidal or homicidal risk or behavior that exceeds the scope and intensity of care able to be reasonably provided at Mental Health Services to maintain client safety;
Noncompliance with an established plan of care, including contingencies to ensure student safety;
Inability to make use of or participate in available Mental Health services;
Repeated failure to attend scheduled sessions;
Unstable mental health conditions that require intensive stabilization, supervision, or ongoing care;
Students for whom transfer of care after initial treatment at Mental Health Services may be highly disruptive or counter-therapeutic;
Active violence, threats of violence, or high potential for violence;
Treatment for aggressive or violent behavior legally mandated;
When a student is currently in treatment with mental health providers external to UHS and a transfer of care to Mental Health Services is not desired or deemed to be appropriate;
Students who refuse to permit the release of records from previous or current internal or external health providers such that adequate assessment or coordination of care is unable to be achieved;
Loss of or imminent loss of active student status;
Students seeking medication or other services just prior to departure and/or extended absence from the University;
Students who have previously received a full course of counseling services at Mental Health Services and request or require an additional full course of counseling services;
Students who request a provider change after a significant number of sessions have already been provided;
Any other situation in which Mental Health services may be inadequate or inappropriate for meeting a student’s needs or request for service; and
Students requesting multiple provider changes within Mental Health Services.
Procedure:
Recommendations for services are derived through a triage process conducted by a Mental Health Services provider that consists of assessing for safety, determining the services most appropriate for student needs, and completion of confidential information forms.
When a short-term therapy approach is determined not to be appropriate in addressing a student’s needs, or if a student presents with safety or health concerns that require a more intensive level of care than can be provided at Mental Health Services, the student will be referred to alternative providers/agencies in the community that may better meet these needs. In these situations care management and/or crisis services may be provided on a short-term, interim basis to the student while referrals to alternative resources are pursued.
Students who disagree with a recommendation for referral to outside agencies may appeal the referral recommendation by putting their concerns in writing to the attention of the Mental Health Services Director or the Director’s designee in the event that the Director has had a direct care role with the student making the appeal. A written response will be sent to the student informing them of the outcome of the administrative review of the student’s appeal request.
When a client is referred to treatment in the community, this referral information will be communicated to other care providers in UHS.
Notification of the referral should be documented in the student’s clinical record.
If appropriate, additional notification may be entered into the clinical information system (CIS) so that schedulers are aware that the student has been referred to community resources and that the student should be referred to a Mental Health Services director if further mental health services are requested by the student.
If the student has a regular primary care provider within UHS, that provider should be notified of the referral.
If the client is being conjointly treated within Mental Health Services, all mental health providers should be included in the decision to refer.
Referrals will be entered and tracked into the CIS referral workplace.
