A Fee Not Worth the Cost?

After months of lobbying, students at George Washington University this month celebrated the counseling center’s agreement to ease up on its policy regarding per-session fees; instead of charging $50 for each visitation following the initial telephone consultation, students now get up to six for free.

But in dropping this fee, George Washington’s counseling center becomes just one more of the many that have done so in the past few years.

Only 6.7 percent of centers charge a personal counseling fee, at an average of $14 per session, according to the 2010 American College Counseling Association survey of center directors.

The 2010 Association for University and College Counseling Center Directors Annual Survey found that even fewer – about 5.9 percent of centers – charge a fee for counseling sessions, said Victor W. Barr, lead researcher on the survey and director of counseling and psychological services at the University of Tennessee at Knoxville. That survey’s data from the past five years show a fluctuation, but general decline, in the popularity of such fees. Five years ago, 11.3 percent charged per session, but just two years ago, 13.6 percent did. Most centers that charge per-session fees do so only after a certain number of visits.

As student demand rose steadily over time, per-session fees became just another way for counseling centers to try to stay afloat. But many centers have found that such fees don’t always pay off, said Dan Jones, president of the AUCCCD and director and chief psychologist of Appalachian State University’s Counseling and Psychological Services. (The average George Washington student who seeks counseling does so for four or five sessions – slightly less than the national average of 5.6 sessions, according to the ACCA survey.)

“I think it reached a peak and now it’s dropping,” Jones said. “Twenty years ago there were very few that charged fees. As budgets got tighter and resources got lower, more started charging fees because it sounded like a good idea. But in practice, it didn’t turn out to be very useful for most centers.”

That’s because adding that fee also necessitates additional infrastructure, the cost of which can offset the revenue the fee brings in.

“I don’t have any solid data to explain why this decline is occurring, but based on my conversations with counseling center directors over the years, the income gained by charging per-session fees is not worth the difficulty and the added administrative expense of collecting the fees,” Robert P. Gallagher, who conducts the annual ACCA survey, said via e-mail.

But time and money aren’t the only reasons for the decline, said Gallagher, a former counseling center director who is also an adjunct associate professor of administrative and policy studies at the University of Pittsburgh. Colleges are well aware that the majority of students – 60 percent, according to Gallagher’s latest survey – report that counseling helped them improve academically and even stay in school. For them, counseling could be crucial to success – and per-session fees could prevent them from seeking that help.

“It is a pretty well-accepted fact on most college campuses that the normal developmental problems of young people, as well as their more serious mental health problems, adversely affect academic achievement, classroom management and student retention. On an individual level, mental health issues can impact negatively a student’s physical, emotional, cognitive and social well-being, and, in some of the more severe cases, lead to suicide or violent acting out,” Gallagher said. “I believe that it is the recognition of these facts that has led many counseling centers and their institutions to move away from utilization fees.”

Following the fee removal, The GW Hatchet editorialized that students "often" said the fee deterred them from seeking counseling. "The appointment fee was seen as exorbitantly high, pressuring students to focus on their financial constraints when they should have been primarily concerned with their mental health," the editorial board wrote. "As students, we can feel safer at this school knowing our mental well-being is a concern of the university's."

While John Dages, director of George Washington’s counseling center, doesn’t necessarily believe the fee was an insurmountable obstacle for many students – visits continue to rise, and 25 percent pay only some portion of the fee because of their financial aid or other circumstances – but said he wanted to respond to their concerns. Still, just in case demand does shoot up even higher, the center has extended its hours to be open an additional three hours a day.

The number of George Washington students coming in for counseling has risen almost 20 percent in the past two years, Dages said. Nationwide, while 91 percent of counseling center directors say they continue to see more and more students with severe psychological problems, 28.6 percent of them report having a waiting list problem during the busiest time of the year, the ACCA survey says. In the same survey, 67.3 percent of directors said their jobs are more stressful than they were five years ago, citing time pressures (75 percent), increased administrative demands (74 percent) and budget issues (65 percent).

An overflow of students just prompted California State University at Northridge, which has no per-session fee, to limit this year the number of times students can visit to eight, placing them among the 16.3 percent of counseling centers that impose such limits, the AUCCCD survey says. (An additional 32.8 percent limit the number of counseling sessions but with some flexibility, say, if a student is in dire need. Northridge has additional options for those students, such as workshops and group therapy, that don’t require as much staff time.) With some fluctuation from year to year, the number of centers limiting sessions with or without flexibility has generally declined, slowly, since 2007.

Last week alone, Northridge saw 50 new students.

“We want to be able to maximize the number of students who could be seen,” said Mark Stevens, director and psychologist at Northridge counseling services. “For us, it was kind of a moral decision not to go to any kind of fee-based appointments…. You have to look at who the student population is. We have a student population that comes from a lower [socioeconomic status] background. They work a lot, and they’re taking out financial aid.”

However, Northridge, unlike George Washington, does receive revenue through a fee built into the cost of tuition. While more than half of counseling centers report charging no fees at all to support operations, about 20 percent are completely funded by a mandatory fee that all students pay – which can cover counseling or other student health and activity services – according to the AUCCCD survey.

In large part because the George Washington center does not collect money from any tuition or student-body-wide services fee, the per-session fee actually did compose a “substantial” part of the center's budget, Dages said. But he’s not worrying about figuring out how to make up for that revenue until he sees just how much the loss affects operations. “We feel confident that we’ll still be able to generate the revenue that we need,” he said.