Access to Mental Health Services and Case Assignment to Providers

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Policy Number:
UW-2110
Responsible Office:
University Health Services

University Policy

Rationale/​Purpose:

To establish guidelines for facilitating access to mental health services and case assignment to mental health providers.

Policy:

University Health Services (UHS) values timely access to mental health consultation to assist students in linkage to appropriate services and providers, within UHS or the Madison community, as well as to 24-hour crisis intervention services for enrolled students and others who may be concerned about an enrolled student.

Rapid access to mental health services is provided in three ways: 1) scheduled access appointments via phone or in-person, 2) drop-in on-call visits during business hours for those with immediate need or in crisis; and 3) 24-hour telephone crisis intervention services focused on suicide or other harm prevention and linkage to appropriate follow-up services.

Guidelines have been established for students accepted into care with respect to case assignment, service limits, re-establishing care, provider transfers, and for students who wish to appeal service recommendations/decisions. 

Procedure:
  1. Access service requests are provided on a scheduled basis during business hours to assess for safety, to determine the services most appropriate for student needs, and to connect students to resources.
    1. When engaging in an Access visit, students are asked to complete a student questionnaire consisting of a checklist of reason(s) for seeking services and other relevant information for determining disposition.  
    2. They then meet with the Access provider over the phone or in person and verbally review the Informed Participation in Mental Health Services form and the consent for digital recording. The access provider then discusses presenting concerns, functional impairment, risk, and options for appropriate services within UHS, on campus, or in the community. The access provider also explains the availability of UHS’ 24-hour crisis services.
    3. If a crisis situation exists during the Access appointment that needs immediate attention, the provider transfers the student to an on-call provider or speaks with the student for as long as is needed to reasonably address any immediate safety concerns and arrange for appropriate follow-up care.
    4. If further services at UHS are recommended, the access provider creates a referral within the electronic health record.  This referral communicates the type of appointment referred to, the appropriate provider assignment options, and any other relevant information.  Referrals are made based on functional impairment, clinical presentation and symptomology, student resources and vulnerabilities, and availability of services.  Referrals within Mental Health Services may include to crisis stabilization, counseling, psychiatry, and/or care management.  Referrals may also be made to services within UHS including Survivor Services, Medical, Nutrition, or Wellness.  
    5. If referral to community resources is determined by the access provider to be the most appropriate plan for meeting the student’s service needs, the access provider makes the initial referral, and identifies the follow up plan that meets the students need and level of complexity of the situation, which may include secure messaging or an in person care management appointment.  
  2. Acceptance for Mental Health Services and Service Guidelines:
    1. Initial appointments scheduled after completion of the access visit are typically hour-long (50-minute) appointments in which a mental health provider provides more in-depth consultation and assessment related to the student’s service requests and needs. If the provider and student (and their partner if couples counseling) think they can work together within the scope of practice of Mental Health Services, the student is accepted for care.  Follow-up appointments are negotiated between the student (and student’s partner in cases of couples counseling) and mental health provider with respect to frequency and total number of sessions within session limits, if applicable. See related policy 6.03A Limits of Service.
    2. Existing Mental Health Services clients may be referred by their current Mental Health Services provider for other services or consultation within UHS, as needed. Examples of services include: individual and couples therapy, group services, psychiatry, crisis stabilization, wellness services (i.e., stress management, yoga, meditation, massage, nutrition, acupuncture, and fitness), care management services, survivor services, and medical services.  Examples of provider consultation requests include: medication evaluation, diagnostic second opinion, ADHD screening, substance use assessment, eating disorder assessment, medical evaluation, or other diagnostic evaluation.
      1. If multiple Mental Health Services providers are involved in the provision of care, the individual counseling provider typically functions as the care coordinator unless otherwise specified and collaborates with other providers in care management and treatment planning.  
    3. If referral from existing Mental Health Services to community resources is determined to be the most appropriate plan for meeting the student’s service needs, the counselor offers an appointment with a care management provider to support the student in making a connection.  The counselor will continue to meet with the student as indicated until linkages are complete to care in the community.  
  3. On-Call services are available every day during business hours to assist students who present with urgent or emergent mental health concerns.  On-Call visits focus on the immediate need of students, and often will focus on suicide and other harm risk assessment and prevention, safety planning, de-escalation of the immediate crisis state, restoration of adaptive coping behaviors, and linkage to appropriate internal, campus, and/or community resources.  Referrals may be made from On-Call to additional care depending on the level of care required given symptomology and presentation.
  4. 24-hour telephone crisis intervention services:
    1. During business hours, telephone crisis intervention services are available to currently enrolled students or others who may be concerned about a student.
      1. Calls are answered by an administrative staff person, who connects the caller or takes a message for immediate return of the call by the on-call counselor.
      2. Callers who report an immediate emergency are advised to call 911.
    2. After business hours, which includes evenings, nights, weekends, and holidays, telephone crisis intervention services are available to enrolled students or concerned others.  
      1. After-hours callers are automatically routed to a contracted crisis intervention service that assesses for risk, provides crisis management interventions, and refers the caller to appropriate services.
      2. If appropriate, the crisis intervention service refers the student to Mental Health drop-in services on the next business day.
      3. If the situation warrants more immediate protective measures, the crisis intervention service may facilitate transportation via police or concerned others to the emergency room where the student can be evaluated for admission.  
      4. In crisis situations that warrant an immediate notification of Mental Health providers (e.g., death of a student), the Co-Directors of Mental Health Services or their designee is notified.
      5. In crisis situations in which immediate consultation is necessary to determine care (e.g., student hospitalization for mental health reasons), the Co-Directors of Mental Health Services or their designee is notified.
  5. Re-establishing mental health services after care has been discontinued:
    1. Former clients/patients who wish to re-establish mental health services will routinely be referred back to their previous mental health provider if it has been within 6 months for counseling or within one year for psychiatry services and the provider is still employed at UHS. If the last visit occurred outside of that timeframe, the client/patient will be scheduled for an Access Appointment to reassess need and appropriate service referral.
    2. If a former client/patient wishes to re-establish counseling services within 6 months, but requests to meet with a different counseling provider, the student will be encouraged to speak directly with their former provider to address factors related to the transfer request. If the former client/patient declines to meet with their former provider, they will be offered the ability to speak to the Associate Director of Clinical Services to assess the appropriateness of the transfer request and attempt to make a better match. If the student declines both options, the student may complete a new Access appointment for overall reassessment of service needs.  If the transfer request is approved, re-assignment options are identified, and an hour-long scheduled consultation with the new provider is scheduled. If the transfer request is not approved, resources in the community are recommended and a care management appointment is offered.
    3. If a former patient wishes to re-establish psychiatry services within one year, but requests to meet with a different psychiatry provider, the request will be forwarded to psychiatry RN.  Nursing staff will follow up with student and offer a visit with current provider to discuss transfer of care options.  If student declines, RN will consult with current psychiatry provider on transfer options.  If transfer request is approved, an hour long follow up appointment may be scheduled.  Patients may request one transfer of care within UHS psychiatry providers.  If neither provider is an adequate fit, the student will be offered a care management appointment for referral to appropriate provider in the community.    
  6. Appeals Process:
    1. Students who are dissatisfied or disagree with the service recommendations of the access provider or another Mental Health provider may, if desired, appeal the provider’s decision/recommendations to the Co-Directors of Mental Health Services or designee.
    2. Appeals should be made in writing and sent to the attention of the Co-Directors of Mental Health Services or designee.  The Co-Director of Mental Health Services or designee and other selected agency providers not directly involved in the case will review the appeal and contact the student to convey the outcome of the review.  
Related UW-Madison Policies:

UW-2107 Limits of Mental Health Services

Related UW–Madison Documents, Web Pages, or Other Resources:

Policy Administration

Approval Authority:
Associate Vice Chancellor & Executive Director, University Health Services
Policy Manager:
Associate Vice Chancellor & Executive Director, University Health Services
Contact:
Executive Assistant, University Health Services -- Pam Miller, pamela.miller@wisc.edu
Effective Date:
06-18-2018
Revised Dates:

04-01-2018

Reviewed Dates:

06/2018

Retrieved:
10-12-2024 08:54:57