A week in a student counselling service
Declan Aherne is head of counselling at the University of Limerick – ‘We see the journeys the students have to make’. This article originally appeared in The Irish Times on Tuesday, 10 March 2015.
I’ve been at UL for 29 years so my job has changed a lot over time. Now I’m director of service and I have a team of 20. My job, in running the practice, is to make sure that all of my teams are working properly. I’ll supervise each of them in different groups every week and then I run a number of programmes.
Every day we have 10 or 12 new students coming in looking to access the service, so we had 50 or 60 students last week and the week before. I’m the clinical director, so I have to sign off on every person who comes through here.
With every case that’s screened, I have to sit down with my staff and go through the referral. I allocate which of the team sees them, and then I supervise the team on each person they’re seeing.
I’m involved at the intake stage and the ongoing monitoring and supervision stages, so my job is to supervise and manage that. I’ll have a small caseload of students who I’ll see myself. I take on the more complex work: there may be a few unusual cases.
I get a good sense of the overall level of problems we have. We’re a primary care service, and because they’re walking in off the street, we don’t know what’s going to arise.
We have the largest primary care mental health service for young people. In Ireland there are about 10,000 people attending student counselling services every year, so that’s the largest single agency for dealing with mental health. We’ll see about 900 people, but across the country there are about 10,000 every year.
We run a stepped care model, and this is the most modern approach to try to access as many people as possible. Stepped care basically means everyone has access to step one of the model, which is psycho-educational classes and self-help programmes. Step two is short-term therapy for between six and eight sessions; step three is long-term therapy; and step four is referral to psychiatry or some other specialist service.
Everybody comes in at step one, and perhaps 60 per cent might need step two, so they move on. Of the 60 per cent who do step two, about 20 per cent need step three, and then maybe only 2 or 3 per cent of those need step four.
So, bit by bit you’re filtering out, to ensure everybody gets the right intensity of intervention. That’s the best and most efficient way of trying to get everybody what they need as soon as possible, and that’s the model that we work on here.
The kind of presentations we’d have are people with low mood and depression, anxiety disorders, but then we get people with everything from body dysmorphic disorder to personality disorders to anorexia and eating disorders, so day in day out there’s a broad range of different presentations.
The ones that cause most concern are those presenting who are at risk, particularly of suicide. It’s pretty common for me to have to sit down and to decide whether someone is suicidal, and then decide what action we will take. Do we contact their family? Do we try to engage the students? Very often we have students coming in who are concerned about friends who might be suicidal, and then we have to try to figure out how best to try to engage them with the service.
Embedded in community
I think one of the significant features of the university is that it’s embedded; it’s located in the community. At UL, we have between 12,000 and 13,000 people living on or around the campus, and right in the heart of it you have a student counselling service that’s fully accessible to students free of charge. It’s very unique to have that kind of access.
Every student who comes in here knows about us: they’re given a full introduction in their first week. We’re also networked throughout the campus, so all the faculties and all the schools have access to us, and we have access to them, so we’re very much part of the community. Our visibility is there, our acceptability – and we have a say, so that’s unique.
When I came here first, we saw maybe 20 students in the first year and now, 28 years later, there’s 10 times the number of students coming to us but the student population has increased only five-fold.
The stepped care came as a creative solution to the huge demand on our services because we were running waiting lists of four to five weeks. We’d have 60 students on a waiting list.
Over the past five or six years we’ve had to accept there aren’t going to be any expensive services really within the Higher Education Authority (HEA). There is limited funding, which means we’ve had to come up with creative solutions. We’d like to be out doing more preventative work, but we don’t really get much time for that now.
My background is in clinical psychology, so it’d be a little bit unusual; there are not too many clinical psychologists who work in this position. Most around the country are counselling psychologists and psychotherapists.
A clinical psychologist couldn’t be better situated because you have all the skills needed to screen and assess, and also to treat and manage whatever presents.
Clinical psychologists are trained in abnormal psychology, so all the clinical disorders such as depression and anxiety. From my point of view, it’s been very fulfilling. I wouldn’t find the same level of fulfilment anywhere else.
With primary care, it’s like a GP but for psychologists. You have people walking in off the street to GPs all the time but there’s nobody walking in off the street who has that ease of access to psychologists, and that’s what student counselling provides.
That’s the most important thing: accessibility and availability, giving the right service to the right people at the right time.
One of my hobby horses for a long time has been the development of psychology at primary care level because it’s far too much dominated by, through no fault of their own, GPs.
Everybody ends up going to their GP when, in fact, they’d be far better off coming to talk to someone better equipped for talking about their mental health issues.
The other day I met a student down in the Stables, the student social area. She called me over – I didn’t recognise her – and she said, “Declan, I just wanted to thank you and your team. I’ve just graduated and I’m going on to do my masters and I wouldn’t have done it if it wasn’t for the therapist who worked with me last year.”
It was rewarding just to see the joy and the delight in her face and to know we’ve made a contribution to her; not just to her degree, but to her own self-fulfilment.
We get cards from students or we might get credited on their thesis. It means a huge amount to us because we see the journey. I call these people our heroes, because it would put the hairs up on the back of your head to hear the stories of the people we have to deal with.
The general perception of students is sure they have it all, they go drinking and what kind of problems would they have? You couldn’t be farther from the truth. They are incredible young people who come through third level against all odds – the neglect, the abuse, the trauma and the tragedies – and they still plough on. We’re delighted we can give them support and see them come out the other side.