Students often complain about their experiences with campus health care, and Counseling and Psychological Services has been the subject of particular scrutiny in recent months.
In response to internal concerns, the University has been working to evaluate how it handles students' personal health issues.
Last semester, a number of administrators released a paper that outlined mental health trends within the University and detailed the main challenges Duke faces regarding mental health care.
The research paper, entitled "Duke University Students: Mental and Physical Health Challenges and Needs," proposed short- and long-term plans to address problems that the University is now examining.
The study was presented last semester to the Board of Trustees in what Larry Moneta, vice president for student affairs and editor of the paper, called a "pulse-taking" exercise to gauge the reactions of the Board and to inform them about the mental health problems faced by students.
The report was co-authored by CAPS director Dr. Kathy Hollingsworth and Dr. Bill Purdy, executive director of Student Health.
The first critical issue facing counseling centers was the lack of professional resources to treat the growing number of highly distressed students, the paper stated.
"It's probably the strongest concern that I have as a director new to this campus," Hollingsworth, who became CAPS director last summer, wrote in an e-mail.
The issue became particularly pronounced at Duke around December, when the CAPS waitlist was at its peak and the University's Hospital Outpatient Clinic could no longer accommodate urgent cases, Hollingsworth wrote.
Another critical issue Hollingsworth mentioned was the lack of consistency and proper coverage among various student health insurance plans.
Dr. Jim Clack, the former CAPS director who retired last year, also said this has been a recurring problem.
All students living within a 50-mile radius of the University are required to pay a standard health fee, which covers basic services at the Student Health Center and at CAPS. Students are also required to have health insurance, whether it is their own-typically coverage under a parent's plan-or a plan that can be bought from Duke.
Disparities among different plans-some only provide mental health care coverage in a student's hometown and others do not provide mental health care coverage at all-often result in students using CAPS as their primary source of mental health care.
"This presents real problems because CAPS never purported to be able to deliver long-term, intensive care," Clack said.
He added that even if students have mental health coverage under an alternate plan, they are often reluctant to use it because of the social stigma associated with mental illness. They are also often afraid of their parents finding out they were seeking help for mental health issues, Clack said.
"A major problem was the stereotype going along with people seeking mental health treatment-that they're nuts, they're crazy, they're off their rocker-and that just isn't true," Clack said. "They're simply individuals seeking help. all of us face situations like that in certain times in our lives."
A student health insurance committee, of which both Hollingsworth and Moneta are members, has been examining the disparities of coverage among different insurance plans.
The committee has been trying to negotiate discounts for both the University's health insurance plan and for outside plans whose mental health coverage is either nonexistent or too expensive.
Moneta could not give an estimate on when the renegotiated fee structure would be in place, and he explained that solving one problem inevitably leads to five more issues that need to be addressed.
"We can't conceive of this problem and say in three years it's going to be fixed," he said. "It's really more about persistence.... Really there are no barriers-we just have to grind out the work and do it."
Moneta called hiring Hollingsworth the single best thing he has done during his time at Duke. He added that although he has been helping with the financial aspects of improvements for CAPS, most of the work that will benefit students directly will be done by the CAPS administration.
"A lot of this is going to be led by Dr. Hollingsworth," he said. "I'll fight the political battles. I'll be the cheerleader."
Moneta, however, noted that the state of student health insurance is just a part of the problem and not the "do-all, end-all of mental health needs."
He pointed out the importance of maintaining a quality safety net for students through the watchful eyes of resident advisors, faculty and administration.
Moneta also mentioned the problem of excessive drinking on campus, which the research paper cited as "the greatest threat to the mental and physical health of Duke students and our campus climate."
"We're trying to shift the culture away from an alcohol-dependent system, but it's not easy," Moneta said. "It's a national issue, not a Duke issue. It's a big uphill battle and not one we are going to fix in a year or five."
The results of a Harvard School of Public Health survey also acknowledged the presence of such a trend, showing that 44 percent of college students described themselves as binge drinkers, often using alcohol to "self-medicate" and deal with problems of depression and low self-esteem.
The paper also cited the importance of facilities like CAPS in recognizing at-risk students and developing a plan for their safety.
Both Moneta and Hollingsworth said they hoped CAPS would expand to satellite clinics on East Campus or the new Central Campus to account for the 33-percent increase in students CAPS has seen over the past five years.
Moneta said there are still "internal negotiations" taking place regarding new or expanded facilities.
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