Story by: Moss Brennan and Hansen Dendinger, News/Opinion Reporters 

Time Lapse by: Maleek Loyd, Visual Managing Editor

Photos by: Halle Keighton, Photo Editor 

Graphics by: Nora Smith, Graphics Editor

If you are experiencing sore throats, itchy eyes, stomach bugs, relationship issues, anxiety, or homesickness, then the Mary S. Shook Student Health Service and Counseling Center are there to help students with their many needs.

Any student who pays the $162.50 health services fee can receive any of the services the student health and counseling centers offer.

Located on the second floor in the Miles Annas Building, Mary S. Shook Student Health Services offers treatment from anything related to a cough and runny nose to X-rays and infections.

The Counseling Center is located on the first floor of the Miles Annas Building, and it offers help to those who need to talk with someone about any problems they may have.

Anxiety, depression and relationship problems are the top three reasons that students go to the Counseling Center according to Dr. Christopher Hogan, director of the counseling center.

While the student health and counseling centers are great resources for students, they inherently have their problems, yet are always looking for ways to improve. Funding for the centers is limited but both directors of the centers work hard to meet the needs of the students with the funding they have.

Section one: Mary S. Shook Student Health Service

The Mary S. Shook Student Health Service is the place to go for illness or injury. They are equipped with facilities to treat most ailments and if they are not able to treat you on campus, they can help get you to a hospital or provide access to other outside resources.

“I think that there are many things that we are able to do very, very well,” Dr. Robert “Bob” Ellison, director of the student health center, said. “We do feel as though we have a scope or a range of services that we really try to focus on. We cannot do everything for everybody, but we can do a lot for a lot of people.”

Ellison has worked at the health center for 11 years, eight of which have been spent as the director. He splits his time between doing administrative tasks in the morning and working with students at the clinic in the afternoon.

The Mary S. Shook Student Health Service employs 103 staff members, including four medical doctors, one psychiatrist, three nurse practitioners, 13 RN/LPN, and 43 PRN along with differing technicians and administrative staff.

One thing about the Mary S. Shook Student Health Services that Ellison is proud of is that they go through an accreditation process that happens every three years. The next accreditation will be the summer of 2018.

“Accreditation is a commitment to ask an outside neutral agency to come and scrutinize anything and everything they want to about this medical facility. Policies, procedures, how do you do things, how do you chart things, what do you do about this, really several hundred items,” Ellison said.

Health Services has been accredited for at least 15 years. The reviewer for the last accreditation was Michael J. Huey, who is the assistant vice president and executive director of student health and counseling services for the Emory University student health center.

While the accreditation is helpful for figuring out what can be improved upon with the function of the health center, Ellison knows that students are the ones who see and feel the effects of the procedures and policies of the facility.

“We try to be open and available to comments, criticisms, compliments occasionally, from students and family and other community members who may have had an initial contact which was not as positive of an experience as they would have appreciated so that I can do anything within my power to improve how we deliver care,” he said.

Another way Ellison and his staff look for ways to improve is by doing quality assessments every year. This means that they look at how they performed one semester and compare the results to the same time the previous year.

“What I tell my staff is when we’re asking a question of ‘are we doing a good job?’ I don’t fear an answer that says ‘we’re not doing a good job’ because what does that do?” Ellison said. “It tells us ‘Hey, we’re not doing a good job, we can do better. So let’s figure out how we can do better and then lets study, did we do better?’ I am not afraid of an opportunity to improve.”

Feedback is very important to Ellison because he knows that health services is not able to provide everything all the time, and that wait times can be a problem for some.

“Our ability to match services is one of our struggles,” Ellison explained. “We feel like we are always behind. We can’t provide enough providers, you know, enough resources, and that’s our struggle.”

Some students present more complex health related issues when they come into the center. Ellison said that in his “short 11 years” at the student health center, he has seen a shift in complexities of college student health and wellbeing needs.

“That complexity [shift] includes so many things,” Ellison said. “Including how complex the illness or the difficulty may be. But also sometimes the complexity of keeping a student able to be in school mentally, physically, emotionally.”

Struggling to provide for the number of students that come into the student health center, the student Counseling Center faces similar problems.

Section two: Counseling Center

The student Counseling Center saw 2,369 students last year. Though not as many as the 17,000 to 18,000 the Mary S. Shook Student Health Service saw, the average student would have between five and six appointments, according to Hogan.

Hogan has been with the Counseling Center for 16 years and is going in his third year as the director.

In the 2016-2017 school year the Counseling Center provided 2,113 initial consultations, 6,140 individual therapy sessions, 1,533 group therapy sessions and 265 after-hours or daytime emergencies.

Hogan has already seen an increase in the number of students the center has seen so far this school year.

When Hogan looked at the first four weeks of classes for this fall there was already an 18 percent increase of students served compared to last year.

That increase is fairly significant for a center that only has 11 full-time staff. The Counseling Center employs eight psychologists, two staff counselors and one social worker.

“When we looked at it last year, 92 percent of the students who walked in the door were able to be seen right at that time,” Hogan said. “Occasionally we have a large number of students that come in at once and so if that’s the case then our front desk tries to manage flow and they might tell them that, ‘ok it might be a little bit of time before you are seen,’ and if students have a class or something, then in that case we will offer to schedule them at another day or time.”

The center also employs five full-time trainees with six adjunct staff counselors working part time between 2-28 hours and five part-time trainees. The Counseling Center also has more than 20 undergraduate mental health ambassadors.

Mental health ambassadors are undergraduate and graduate students who who serve the campus community. They promote mental health, educate others about mental health concerns, help de-stigmatize mental illness and the utilization of mental health services and aid in campus and community prevention efforts, according to their website.

Increasing numbers of students are seeking mental health assistance all over the country, and the number is higher than any other generation in modern history according to The Atlantic.

“We don’t have as many staff to meet all the students we’re seeing walking into the center, so that’s where a lot of the backup occurs,” Hogan said.

In a report done by the Center for Collegiate Mental Health, demand for counseling services outpaced enrollment increases by five times.

The National Alliance on Mental Illness released a mental health guide that can help anyone who wants further resources.

In a chart provided by Hogan, Appalachian State enrollment has increased 9.1 percent from the 2009-2010 to the 2015-2016 school years. The number of students seen by the Counseling Center has increased by 89 percent in that same time period.

According to Hogan, the Counseling Center sees 14 percent of the enrolled student body, which is higher than similar sized schools which see only about 9 percent of their student body.

“I think that [14 percent of student body] speaks to the access that hopefully students are able to have who need something,” Hogan said.

Helping students the best they can, the Counseling Center is there for all students with whatever they may need.

“We serve all students. So it may be adjustment issues to college, eating disorders, career kinds of issues, people that are having family problems, grief or loss, we welcome all students,” Hogan said. “We want to reduce barriers and make sure students can access what they need.”

Three of the main things that Hogan said students see the Counseling Center for are anxiety, depression and relationship problems.

One of the challenges that the student Counseling Center faces, like the student health center, is the rural location which creates some strain on resources for students.

“We have good resources but they are limited because we live in a rural environment and a rural area so those folks get filled up fast too,” Hogan said.

Boone has 15 facilities in the area that list counseling or mental health services as the type of business, according to Google.

The Counseling Center does have a referral coordinator that helps students get connected with a counselor in the community but sometimes that is not enough for students.

Section three: Funding

Both the student health and Counseling Center are funded primarily through the $162.50 that students pay at the beginning of the semester. In addition, the Counseling Center also receives funding from the state.

That fee that students pay provides for almost everything at the Mary S. Shook Student Health Service along with the counseling services.

“As far as I’m aware, the funding for this student health clinic is provided and based almost in entirety on the semester student health fee that full time students are assessed as part of their tuition and fees, so that when a student comes here, the vast majority of what we provide you is covered,” Ellison said.

Some tests at the health center are not covered under the health fee, but the center works closely with Labcorp to give low prices for those tests. The health center also does not mark up tests or medical equipment they give out.

“If you have an injury and I need to put you on crutches, we charge you for the crutches. The crutches cost me about $14.50 to purchase so I’ll charge you $15. So basically we charge a replacement cost,” Ellison said.

Costs for students are very minimal thanks to the health fee, but the centers could always use more funding.

“One of the telling statements is this, ‘our student health center should do, and can do, all we can do based on the budget we are allowed to work under,’” Ellison said. “We do all we can with what we have. Would we love more money? Oh gosh wouldn’t we all.”

In 2016-2017 the Student Government Association recommended to the Board of Trustees to raise the health fee to more than what was asked for originally.

“Our health center needs more funding right now. We are really questioning whether or not it is sustainable just raising it $20,” Alan Lee, senior political science major and student body vice president, said. “We really need to make sure that we give the money they need. We were told some information last year that was kind of concerning about the sustainability of health services if we didn’t raise the fee.”

SGA was able to raise the fee from $147 to the $162.50 fee per semester it is currently.

“I will tell you how appreciative I am,” Ellison said. “Last year under the leadership of a now graduated student president last year, the student government recommended to the Board of Trustees more than what was asked for as an increase in the student health center fee.”

One of the reasons the SGA wanted to increase the health fee was to have at least three months of operating expenses.

The former SGA president, Jalyn Howard, had concerns that health services would not be viable within five to ten years if it kept functioning the way it was, so they wanted to increase the fee to help.

The SGA will meet with the board of trustees for fee requests and go through that process again this year.

In Jan. 2016, the Mental Health on Campus Improvement Act was introduced to Congress by Rep. Janice Schakowsky (D-IL). The act would award grants to be used for “mental and behavioral health services” according to congress.gov.

The bill would have amended the Public Health Service Act, but the last action on the bill was on March 23, 2016 and it never moved forward.

More allocated funds for the centers would lead to an increase in staff, but the building would not necessarily allow for more staff.

“I would love to have some more employees at this time. Budget restraints make that not likely to happen. Physical space to place that employee would be difficult,” Ellison said. “I certainly feel like that over the next few years, as we grow and our student population grows, we will have to have some more staff.”

Section four: What students think

The student body has had mixed experiences with both the health and counseling centers. As each department struggles to meet the needs of the overwhelming number of students, some students walk away feeling less than satisfied.

Out of 104 surveyed students who were asked in person, 89 reported their experiences as positive. Ten, however, felt negatively about their time with the health and counseling centers. Five more were neutral, meaning 14.5 percent of this group had less than positive things to say about these resources.

A separate survey conducted on Sep. 12 via The Appalachian newspaper Twitter yielded 76 percent positive reviews for the health and counseling services, with a remaining 24 percent who were dissatisfied. The poll had 62 votes.

A long standing complaint about both the health and counseling centers has been wait times. During the height of flu and allergy season especially, walk-in appointments can require hours of waiting time before a physician becomes available.

“I first asked if there was an open appointment that week, and they’ve always said it’s probably about a week’s wait to get in for an appointment,” Nelly Brown, a freshman environmental science major, said. “So then I go directly to asking how long the wait is for the walk-in clinic, and it’s always at least a two hour wait.”

Steffey Guigou, a sophomore community and regional planning major, felt that both the Mary S. Shook Student Health Services and Counseling Center focused on the small problems and that they just did not have enough staff to help which contributed to the wait time.

Despite the long wait times, students were often pleased with the quality of care they received.

Laurel Bates, a 2016 App State alumnus, was extremely pleased with her experiences with the student health center.

“While providing the medical care that I needed, Dr. McKay and other staff consistently treated me with compassion and respect,” Bates wrote in an email. “When my health was declining without a discernible cause, the health center was very helpful in both making referrals to specialists in the area, and taking he time to go through the process of making a differential diagnosis.”

One comment Bates had regarding improvements to the care she received included a need for online access to personal medical records.

“It was difficult at times to remember details or appointments or diagnoses, and the only way that I could obtain that information was through paying for medical records,” Bates said.

The number of students seen by the Counseling Center has increased dramatically over the years and this has not gone unnoticed by students

“Overall the hours for the center were very difficult to fit into my busy schedule. The center was also extremely busy whenever I went in,” Abbey Huber, a sophomore sustainable development and anthropology major, said in an email. “While the experiences I have had with individuals at the center have been ok, I just don’t think that they can handle the volume of students that needs to be served.”

Huber went to the Counseling Center during a few weeks before finals of fall of last year unsure what she wanted. They were extremely booked up and she felt that the process of scheduling appointments after the initial consultation was difficult.

She went back this semester knowing that she wanted a referral to an outside source.

“After a very lengthy initial consultation, I was directed to someone who researched mental health services in the Boone area for me. That second time was a much more positive experience, and I think that it’s because I knew what I needed,” Huber said.

Peyton Dayvault, an undecided freshman, goes to the Counseling Center once every three weeks to maintain what she had been doing at home.

“I mean, you don’t get to pick your counselor and mine was a guy, which was uncomfortable at first because they pair you up with someone who’s schedule matches up with yours,” Dayvault said. “Back home I had a woman, which I was more comfortable with.”

Overall, Dayvault said that the Counseling Center has had a positive impact even though she can only go to 10 sessions a year.

The Counseling Center offers 10 individual sessions a year for students, but if more are needed, the Counseling Center will refer a student to a private therapist. The Counseling Center offers unlimited group sessions for students.

“I really like that my counselor asks if I have any critiques for him that can help him help me better. Almost like constructive criticism,” Dayvault said.

Some students feel that there needs to be more of an emphasis on multicultural staff for the centers.

“I’d love to see more multicultural counselors because we have people from marginalized identities going to counselors who really can’t identify with them and help them with their needs,” Lee said. “I would say that’s a number one priority, making sure we have a LGBTQIA+ counselor, making sure we have diverse counselors.”

Ellison is aware of the struggles students may face with during their time at the health center.

He invites students to email him with concerns, and also wants the student population to be aware of anonymous comment boxes located around the health center itself. Sharing your concerns and issues is encouraged by the staff, and utilization of comment boxes and communication is advocated.

Both the health and counseling centers cannot make applicable improvements without comments from students. Both centers are more than willing to listen to the needs and concerns of any student, and are open to utilizing feedback in order to improve the quality of care they provide.

Section five: Improvement

Both the Mary S. Shook Student Health Services and the Counseling Center are working on improvements, or have already made improvements, to the care they provide to students.

“We try to look for opportunities to continue to develop our services and try to stay tuned in nationally and to what other counseling centers are doing,” Hogan said.

One of the recent improvements is contact after-hours. The Counseling Center has partnered with an organization called ProtoCall that puts a student in touch with a clinical professional if the on-call counselor is unavailable.

In the past, a student would have to call campus police who would contact the on-call counselor and then the on-call counselor would call the student in crisis.

Hogan said that the service knows exactly where the call is coming from and that the Counseling Center works with ProtoCall to create exactly how they want them to respond to different situations.

The health center also uses a telephone service for after hours calls. A doctor and two nurses are also at the Mary S. Shook Student Health Services from 10 a.m. to 2 p.m. on Saturday and 1 p.m. to 5 p.m. Sunday.

Ellison and the Mary S. Shook Student Health Services are close to making it so students can make appointments online.

“Students so often are asking for the opportunity to make appointments online,” Ellison said. “We are getting real close to doing that, but we are not there yet.”

Making appointments online would help students who do not have the time to call and make an appointment or help students who have no time to do a walk-in.

As part of adding more resources for students, the Counseling Center has added a program from the NASPA, Student Affairs Administrators in Higher Education, called CU Thrive.

CU Thrive is an online database that provides students with “ready-to-use articles, videos, courses and other information that will help them adjust to campus life, stay healthy, enhance study skills, work through stressful situations and build relationships, improving their overall quality of life.”

Another central focus for the Counseling Center is working more with the multicultural center.

“We are doing a little bit more partnership with the Multicultural Center, and forming a really good relationship with the team they have,” Hogan said.

A program called “Tea for the Soul” has started in the Multicultural Center where one of the counselors goes into the multicultural center and chats with students and answers their questions.

Tea for the Soul happens Wednesdays from 1 p.m. – 2 p.m. in the Multicultural Center.

Hogan and the Counseling Center are also advertising for a staff psychologist or counselor with an emphasis in a multicultural background.

Last year, the Counseling Center instituted a new program called RIO.

“RIO stands for recognition, insight, and openness, and it’s a three session group that really focuses a lot on developing coping skills, new ways of thinking. It’s based on an empirically based formal therapy,” Hogan said.

In the future, the Counseling Center is looking into one of the programs coming out of the Nevada Reno counseling center called ACT on College Life. The program will help students get connected while they do things in between sessions.

The Counseling Center also does workshops every semester and works to educate and provide information to students outside of the counseling center.

One of the workshops they will do in the fall semester are The Feelin’ Good Workshops. It is a series of five workshops that are geared to educate about mental health. More information about The Feelin’ Good Workshops can be found on the Counseling Centers website.

Another workshop is a 5-week expressive arts series in the Multicultural Center. They are also partnering to do a monthly mindfulness meditations in the Multicultural Center.

With more improvements in the future, the centers hope to be able to provide more resources for more students and improve wait times.

“I don’t fear an answer that says we’re not doing a good job. What does that do? That tells us that we are not doing a good job and we can do better,” Ellison said. “Let’s figure out how we can do better and then study if we did better. We can always improve.”