Waiting for CAMHS to Care

On February 18, 2022, Demya T. Toogood ’23 got stood up. It was just four days after Valentine’s Day, but it wasn’t a date who flaked on her — it was her Harvard Counseling and Mental Health Services therapist.

The excuse? None was provided in the short, to-the-point note that Toogood received from her clinician, in which she learned that her appointment — slated to take place in just four hours — had been postponed to April 8, thundering in a rain-check of nearly two months.

“I feel like literally everyone has had problems with CAMHS,” Toogood told me. “It’s what’s here, but I didn’t really have very high expectations.”

Toogood’s underlying intuition is woefully prescient: Today, according to University spokesperson Jason A. Newton, the wait time for an initial appointment at CAMHS stands at six weeks. That’s a lengthy drudge in any setting, but it’s particularly weighty within the domain of mental healthcare, where a single day of delayed access could induce a 1 percent loss of patients. And in Harvard's own gates, weeks-long appointment delays are not only a cornerstone of campus-wide chatter, but have also been tied to help-seeking aversions, worsened wellbeing, and even hospitalizations.

The resource strains which undergird this problem are taking place at the wealthiest academic institution in the world. So why can’t Harvard just dole out some gold from its 53 billion dollar pot? Sadly, it’s not that simple: According to University Health Services Director Giang T. Nguyen, the endowment is already earmarked for specific schools and units. And so the outwardly bottomless chest retains an untouchable mystique, a dismal reflection of its limited flexibility despite its enormity.

Instead, the entirety of HUHS’ infrastructure — of which CAMHS is just one small portion — is funded by the student health fee, currently set at $621, and bolstered by occasional philanthropic donations. In other words, HUHS functions much like a traditional health maintenance organization. Every system of this sort tends to require some form of rationing, because healthcare demand will virtually always outstrip supply. In some cases, rationing is gratingly explicit, and patients are flat-out turned away. In others, care is rationed based on one’s ability to pay. And in still other instances, like here at home, we get slapped onto a CAMHS waitlist, or flaked on by our very own providers.

But we’re all getting manhandled by the system, clinicians and students alike, as we struggle to operate on a student-fueled budget that’s bereft of any financial backing from the University; an institution that, while seeping with wealth, is seemingly just as detached as it is endowed.

As the University fails to lift its invisible hand, CAMHS has spent years swimming in a sea of since-sunken solutions: In April 2017, CAMHS started working with iHope, an online program that was met with tremendous success; offering students free, evidence-based care through video-conferencing sessions. But the partnership has since been severed – swapped out for a collection of online CAMHS groups and workshops, according to Newton. In another reach for a lifeline, CAMHS crafted a revised appointment model back in the spring of 2018, which cut wait times for a short while. But its limited success flickered with the seasons, dimming almost completely by the following fall.

But as CAMHS has been treading through testy waters for years, pushing with resolve to stay afloat, the organization hasn’t come out completely empty and dry. The July 2021 introduction of the CAMHS Cares Line, reachable at 617-495-2042, marks the team’s latest stab at wrestling excess capacity — and the 24/7 support line, made possible by parent philanthropy, has in fact gained steady traction.

Admittedly, this line – despite its ambitious aims – is limited in its capacity to deliver efficacious care, not least because most students turn to CAMHS in pursuit of consistent and stable therapy, a demand which the evidence backs. But the significance of the line rests more in what it tacitly signals than in what it can tangibly do: CAMHS cares, as the line’s name so fittingly suggests.

And those who care, I’m convinced, will find a way to deliver. Maybe that includes bringing iHope back in the game — after all, CAMHS has proved that it has the infrastructural capacity to forge such partnerships. Maybe it means more proactively soliciting donations; or maybe it means something else entirely.

Only time will tell. In the interim, we’re waiting for solutions – and the line is out the door.

Gemma J. Schneider ’23, a Crimson Associate Editorial editor, is a Government concentrator in Pforzheimer House. Her column, “Wilted Wellbeing,” usually runs on alternating Tuesdays.