UHS qua HMO

Recognized by peer counselors, administratorsand fellow counselors as one of the most effectivetherapists at UHS, Gould is also one of thebusiest.

In addition to her regular duties as a clinicalsocial worker and therapist, Gould supervises fiveof the College's peer counseling groups, is thefirst person on call for rape crisis situations,supervises pregnancy counseling and the AIDSsupport group as well as teaches medical studentsand oversees psychiatry students.

"It's difficult when students call or e-mailme," Gould says. "Right now, I'm booking for theend of June."

UHS mental services saw 12 percent of theUniversity's students--at 26,000appointments--last academic year.

Dr. Richard D. Kadison, the new chief of mentalhealth services at UHS, says every student whowants an appointment gets one. To accomplishthis--and manage costs--UHS has established agradient of care.

Students with less pressing needs get shorterappointments, and UHS recommends that manystudents who cope with similar long-term problemspursue group therapy, instead of individual visitswith UHS doctors.

Though he describes group therapy as "verypowerful," Kadison says managed care and studentservices mix "like oil and water."

"The more accessibility, the more flexibility,the better your mental health services," Catlinsays. "[But] there are limitations because of theneed to maintain a managed structure--there has tobe cost containment."

Limited accessibility is not the only problemstudents face when dealing with the UHSmanaged-care behemoth; because they are a medicalservice, many health professionals say UHS has todiagnose students, stamping their file with someclassification.

"We try to work around that problem," saysCatlin, who works to find the "least troublesome"label--"adjustment reaction" rather than "neuroticcondition."

Catlin acknowledges that his office oftendiagnoses a problem "when all they're doing isgrowing up."

Holes in the House

The problem of mental health care at Harvardbegins long before the first appointment, however.Most students visit UHS on referrals, not entirelyon their own, making House tutors and teachingfellows (TFs) the first line of defense.

But it is a line with cracks.