Mental health care on campus has become increasingly important and deservedly so. Mental health has direct effects on students’ academic performances, social lives and personal lives. Unfortunately, our current wellness system is overwhelmed. With forty-day long waits, complaints about poor service and a general lack of access, something needs to be done. Everybody agrees that building a workable mental health care system on campus is of utmost importance, yet at the same time we all agree that some solutions are unfeasible. The College of William and Mary just does not have the resources to provide every student with a personal therapist. So, what is the middle ground? What are possible reforms that could solve this problem? There were several proposals put forth in the recent Student Assembly elections. Most proposals centered around increasing the supply of therapists and other workers on campus, expanding the resources of the Wellness Center, and hiring more diverse therapists. While these solutions would help deal with the large demand for services, they come with difficult trade-offs. Any increase from the supply side means one of two things needs to happen. Either the price of tuition needs to be raised in order to pay for new therapists or funding for other services needs to be cut. Neither of these choices is enviable.
So, reform must focus on the demand side. This means deciding how to ration the scarce resource of mental health care on campus. Whether we decide to acknowledge it or not, this rationing is already being done in the form of “first come first serve.” Whoever manages to get into the office first is placed in the front of the long lines for access to therapists, while people who come later are stuck in the back of the line waiting for the line to slowly shuffle forwards. This completely ignores the heterogeneity of need for mental healthcare. People who could benefit and need the resource more are stuck waiting, while some people who may not be as desperate and could wait longer get the resource first. At the same time, in order to get through the line quickly, the quality is reduced as well. In the Flat Hat article, “Waiting for Help,” people reported numerous example of being disappointed the care they received feeling pushed into less-useful services and ultimately having an overall poor experience. Clearly the system in place is not working.
I have a simple proposal that can alleviate many of these problems without any major trade-offs. It simply involves changing how we ration mental health resources. Currently the second largest fee every student pays, regardless of whether they use it, is the Health and Wellness fee. I propose that instead of having this be an upfront cost, every student is given a voucher equal to the fee. At the same time the Health and Wellness Center should charge a fee for all its services. If a student doesn’t use up the entire voucher, a portion of the money would then be returned to the student. This proposal will give back a choice to students that is being made for them, will help cut down and beneficially rearrange the line for services, and will help foster a community of wellness rather than a centralized system.
Consider which of these scenarios will produce the highest benefits at the lowest cost: you order lunch for yourself using your own money, or somebody else orders lunch for you using your money. Clearly you would be much better off choosing how much to spend and what kind of lunch to get. Yet the current system restricts us to giving our money to somebody else and hoping that they get it right. By giving a voucher to students, we simply return the power of choice to them. That’s all the voucher is: a choice. Now students can decide for themselves whether going to counseling or reiki or even forgoing services and keeping the money is best for them. There is no person better to evaluate what is most beneficial for an individual than the individual themselves. More importantly, though, is the effect this system will have on how the services are consumed and allocated. Currently, demand for therapists is being artificially subsidized by this fee. This means that people who would rather not pay the fee and forgo therapy are being forced to go, and people who really need the service and would be willing to pay for it are being beat out by people who are on the margins or don’t need it as bad. By creating a voucher system and charging a price, people who would rather have the money will drop out of the line. Finally, people will search out substitutes that are less expensive, like group therapy. This frees up the most intensive resources for those who most value and need them and allows them to get it in a timely and effective basis. At the same time the quality will improve because there won’t be as much pressure to move through patients as quickly. Even if this doesn’t eliminate the line, it will still make it shorter and improve care and it will ensure that the neediest students are the ones receiving care.
Finally, a voucher helps to promote a campus-wide community of wellness rather than a centralized system. A voucher helps students recognize the different levels of care available and what works best for them. As some students will still want care, they will search out alternatives, whether this be student groups, The Haven or their fellow peers. It will also help students to feel in control of their mental health and how to deal with it. Imagine if Chick-fil-A was financed by a fee rather than through dining dollars. The line would be enormous, the chicken sandwiches would be rushed out and nobody would be happy. That is the system we have now for the campus Counseling Center. While expanding the amount of resources dedicated to the Counseling Center would help solve problems, just as making Chick-fil-A the entirety of tribe square would solve problems, this comes with unfortunate and painful tradeoffs. By instead reforming how people choose care, we can alleviate the extreme demand, shorten wait times, improve quality of care, return choice to students, and foster a campus wide community of wellness. It seems clear to me that implementing a voucher system is a simple decision to make.
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