Looking for what college mental health jobs are like

[PreHippocrates]

Hey everyone,

Please let me know if this is talked about elsewhere, but I couldn't find another thread.

Background: I'm a PGY3 in the Northeast, and will be staring my 2-year CAP fellowship this summer. I'm interested in practicing in the Pacific NW after fellowship. I have a growing family and would prefer to spend more time with them while they are young instead of focusing so much on work solely in early attending-hood.

Question(s): I'm possibly interested in college mental health and some of the flexibility that might be built in. I had previously seen FT jobs offered which were 9-months per year, with respectively lower salary (140-160k). I'm wondering if these jobs are somewhat normal, and what are the considerations I should be accounting for if I were to pursue one of these jobs. I'm wondering if, at big universities, they typically try to get a lot of patients through during the day, as I would prefer at least 60 min intakes and 30 min follow-ups - is that unrealistic? What are the typical patient-panel types? Do they usually have ADHD evaluations done elsewhere? What's the mix of mood/anxiety, psychotic/bipolar, and personality disorders in a clinic like this? What other things should I be considering?


Thanks in advance.

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[calvnandhobbs68]

Why bother with the CAP fellowship? You're going to utilize that basically not at all if this the career path you're interested in. You can easily see college kids without a CAP fellowship.

Salary is low because these tend to be desirable pretty cush jobs. A lot of people take them because of the affiliation with the respective university gives a lot of benefits, including usually having your kids go there for free. Honestly, people in these positions are also often are part of two-income households, so they get good benefits through the university for lower pay while the partner is in some other decent/high paying job (just my experience so far seeing it).

There's no worrying about billing insurance/collecting payments because all the kids are on the university health insurance plan or pay their health fee every semester that covers it. However, that's also why your salary is so low. Typically give you a decent amount of admin time. If you want to do this full time, need to find a university big enough that can support/pay a full time psychiatrist (although that might be easier to do these days with all the emphasis on mental health). Few people i've talked to have put together part time jobs as 2-3 community colleges/universities nearby each other. They tend to be pretty flexible about scheduling (time-wise) from what I've seen from attendings since again there's no real incentive to be "productive" in any fashion.

If the university is good, they'll have a very clear cut ADHD guideline in place that will keep most of the junk (ex. daily MJ smoking engineering major who suddenly thinks he has ADHD because he's getting a C in sophomore structural engineering and tried a friends Adderall a few times which helped). Different colleges will have different patient populations.
Community college= may look more like a high functioning community mental health center patient wise, will definitely get more people with moderately-severe psych histories who are trying to pull their lives together and go to community college. Will get a decent amount of people with real social stressors, have families, jobs and trying to go to community college part/full time on top of that.
Liberal arts/Private university= Anxiety. Soooo much anxiety and perfectionism. Then some depressed kids (a good chunk of whom are "depressed" because they aren't doing well in college/away from home/etc etc and just need some support which hopefully your therapy services would filter out from the ones who really need med management). A smattering of severe mental illness but for the most part you have to be quite high functioning to survive academically in those environments (some exceptions of course).

 

[dl2dp2]

^^ pretty much.

In my exp few people stay in college mental health for long -- they really exploit you in terms of salary. College student insurance often have very good OON coverage and are more than willing to pay for private treatment.

 

[Merovinge]

If working less is something you can financially swing in the Pacific NW (either due to very low expenses, partner salary, or independent wealth), there are far more options than just college mental health which really is not related to CAP in a meaningful way. You can do telepsych work from home on a part-time basis, take part-time work in the area (for CAP this is usually plentiful, many non-profits, schools, etc looking for help as well as traditional PHP/IOP and residential treatment centers), or do more niche work like forensics/custody evals that will pay more per hour and let you work less overall overs.

As far as how the job looks, it's going to vary widely by institution, but you are specifically choosing one of the most in-demand jobs with pay congruent to the demand of psychiatrists looking for the work.

 

[Candidate2017]

From what I see, easy hours, but high risk work because college students have adult mental illnesses and bodies, but childlike brains.

Being away from home for the first time with adult freedom but heavy academic responsibilities and trying to navigate a social life tends to precipitate first break psychosis/mania, substance/alcohol abuse, suicide attempts, suicides, domestic/sexual assault. Also heavy denial of any of the above, and poor med compliance and follow up. Because... adults with childlike brains.

Plan on calling the university police quite a bit. In addition to SI issues, bomb threats and shooting threats may occur. Plus, Title IX regulations. Bad outcomes related to a young college person have a way of turning into high profile media cases.

But many college students have good insurance through their parents and do not usually utilize the college system, especially the very high functioning ones. I see some of these patients in my residency clinic. They tolerate therapy very well and it can be pretty rewarding to help these students blossom into adulthood and fulfill their potential.

 

[calvnandhobbs68]

From what I see, easy hours, but high risk work because college students have adult mental illnesses and bodies, but childlike brains.

Being away from home for the first time with adult freedom but heavy academic responsibilities and trying to navigate a social life tends to precipitate first break psychosis/mania, substance/alcohol abuse, suicide attempts, suicides, domestic/sexual assault. Also heavy denial of any of the above, and poor med compliance and follow up. Because... adults with childlike brains.

Plan on calling the university police quite a bit. In addition to SI issues, bomb threats and shooting threats may occur. Plus, Title IX regulations. Bad outcomes related to a young college person have a way of turning into high profile media cases.

But many college students have good insurance through their parents and do not usually utilize the college system, especially the very high functioning ones. I see some of these patients in my residency clinic. They tolerate therapy very well and it can be pretty rewarding to help these students blossom into adulthood and fulfill their potential.

I meannn I don’t think it’s that intense.

I was in a college clinic for a year. I called university police exactly 0 times. We did have to send a couple people to the ER to be admitted but nothing out of the ordinary for a regular outpatient adult clinic. I had a couple people with possibly bipolar disorder. Nobody with real deal psychosis, not like my CMHC. Vast majority were depression, anxiety, OCD, some substance use of course. Nobody was calling in bomb threats? There’s usually a crisis line for things that is not actually staffed by a psychiatrist although they may run things by you during hours.

Do I think the reimbursement is worth it? Nah that’s why I wouldn’t do it. But it wasn’t much different in my experience from a regular clinic filled with people in their late teens-20s besides the fact that a lot of them needed to learn to live on their own and self regulate.

 

[Mass Effect]

From what I see, easy hours, but high risk work because college students have adult mental illnesses and bodies, but childlike brains.

Being away from home for the first time with adult freedom but heavy academic responsibilities and trying to navigate a social life tends to precipitate first break psychosis/mania, substance/alcohol abuse, suicide attempts, suicides, domestic/sexual assault. Also heavy denial of any of the above, and poor med compliance and follow up. Because... adults with childlike brains.

Plan on calling the university police quite a bit. In addition to SI issues, bomb threats and shooting threats may occur. Plus, Title IX regulations. Bad outcomes related to a young college person have a way of turning into high profile media cases.

But many college students have good insurance through their parents and do not usually utilize the college system, especially the very high functioning ones. I see some of these patients in my residency clinic. They tolerate therapy very well and it can be pretty rewarding to help these students blossom into adulthood and fulfill their potential.

Uh, yeah, not sure where you're at, but definitely not the norm. Can't imagine why student health/psychiatry would be involved in bomb threats or Title IX regulations. And calling the police with any kind of regularity? Yeah, no.

 

[Candidate2017]

Uh, yeah, not sure where you're at, but definitely not the norm. Can't imagine why student health/psychiatry would be involved in bomb threats or Title IX regulations. And calling the police with any kind of regularity? Yeah, no.

If you don't understand why Title IX obligations extend to university-employed psychiatrists or if you've never made a report required by Title IX, it's obvious you have little experience with college mental health, at least in the setting of a large university system. You also have little experience if you've never had to report shooting or bomb threats made by your college patients to the university police.

College mental health is high risk, especially for large universities. I'll remind you that Tarasoff, which has influenced the standard of care for psychiatric practice in the U.S., arose from a college mental health clinic patient at the country's largest university system.

 

[Mass Effect]

If you don't understand why Title IX obligations extend to university-employed psychiatrists or if you've never made a report required by Title IX, it's obvious you have little experience with college mental health, at least in the setting of a large university system. You also have little experience if you've never had to report shooting or bomb threats made by your college patients to the university police.

College mental health is high risk, especially for large universities. I'll remind you that Tarasoff, which has influenced the standard of care for psychiatric practice in the U.S., arose from a college mental health clinic patient at the country's largest university system.

Aren't you a resident? Not like you have 25 years of experience. I have a college mental health clinic for a fairly large undergraduate university setting as an attending. I also did this as a resident. I've never experienced any of what you're saying. What I'm seeing is ADHD, anxiety, and depression with a fair mix of OCPD thrown in.

 

[calvnandhobbs68]

If you don't understand why Title IX obligations extend to university-employed psychiatrists or if you've never made a report required by Title IX, it's obvious you have little experience with college mental health, at least in the setting of a large university system. You also have little experience if you've never had to report shooting or bomb threats made by your college patients to the university police.

College mental health is high risk, especially for large universities. I'll remind you that Tarasoff, which has influenced the standard of care for psychiatric practice in the U.S., arose from a college mental health clinic patient at the country's largest university system.

Idk I never had to report shootings or bomb threats. Maybe you had some dramatic case but if you're regularly reporting bomb threats to campus police, I'm wondering what the heck is going on at that school. I also don't get the Title IX thing...there's supposed to be a Title IX coordinator at schools to refer a patient. What report is required by Title IX that a psychiatrist has to file as opposed to referring a patient to the Title IX coordinator to let that process play out?

Sounds like you're in the wild west out there.

 

[Candidate2017]

Aren't you a resident? Maybe tone down the condescension by about 100? Not like you have 25 years of experience. I have a college mental health clinic for a fairly large undergraduate university setting as an attending. I also did this as a resident. I've never experienced any of what you're saying. What I'm seeing is ADHD, anxiety, and depression with a fair mix of OCPD thrown in.

Exactly. You ascribe to the fallacy that because you haven't experienced something, it doesn't happen, as evidenced by your incredulity as to why any university psychiatrist would be involved with university police or Title IX reporting. It just means you lack experience in it.

Yes, I am a resident and seem to have way more experience at dealing with university police on student/patient safety and threat issues, and Title IX matters than you are. I often run into situations in my dual capacity as a physician who treats a university-affiliated patient (student, staff etc) vs mandatory Title IX reporting, and need to contact University Counsel for legal guidance every now and then on how to proceed.

 

[Mass Effect]

Exactly. You ascribe to the fallacy that because you haven't experienced something, it doesn't happen, as evidenced by your incredulity as to why any university psychiatrist would be involved with university police or Title IX reporting. It just means you lack experience in it.

Yes, I am a resident and seem to have way more experience at dealing with university police on student/patient safety and threat issues, and Title IX matters than you are. I often run into situations in my dual capacity as a physician who treats a university-affiliated patient (student, staff etc) vs mandatory Title IX reporting, and need to contact University Counsel for legal guidance every now and then on how to proceed.

Might want to reply to what's written rather than what you assume people said. No one said it doesn't happen. We said it isn't the norm. You notice on this thread, you as a resident, are the only person saying this? You realize everyone else's experience is different? Maybe instead of assuming all of us attendings don't know what we're talking about because of our vast inexperience compared to you, you should reflect on how your experience may be an outlier and while it does happen, most of us have a different experience.

 

[Candidate2017]

Idk I never had to report shootings or bomb threats. Maybe you had some dramatic case but if you're regularly reporting bomb threats to campus police, I'm wondering what the heck is going on at that school. I also don't get the Title IX thing...there's supposed to be a Title IX coordinator at schools to refer a patient. What report is required by Title IX that a psychiatrist has to file as opposed to referring a patient to the Title IX coordinator to let that process play out?

Sounds like you're in the wild west out there.

Definitely not the wild west, just a large system with stringent controls in place that take things seriously. Threats are about once or twice a year. Title IX issues are more common. Things like depression, anxiety or PTSD presentations that turn into allegations of sexual assault by fellow students/student-athletes/professors, some of which turn into media-covered cases.

 

[calvnandhobbs68]

Definitely not the wild west, just a large system with stringent controls in place that take things seriously. Threats are about once or twice a year. Title IX issues are more common. Things like depression, anxiety or PTSD presentations that turn into allegations of sexual assault by fellow students/student-athletes/professors, some of which turn into media-covered cases.

Right I still don't get why you're making a sexual assault report instead of referring the patient to the Title IX coordinator or the police? Same way I don't do SANE interviews/exams in the ED...there's a whole different forensic process for that with specific protocols that should be followed that you don't want someone who has intermittent experience with the process screwing up. I'm saying that just straight up isn't the psychiatrists job unless that is explicitly part of the job you agree to when taking that position.

I mean having to to tell the police about some threat made by students 1-2 times a year is a far cry from:
"Plan on calling the university police quite a bit. In addition to SI issues, bomb threats and shooting threats may occur. Plus, Title IX regulations. Bad outcomes related to a young college person have a way of turning into high profile media cases."

You're really into "media covered cases" for some reason?