Higher education and community mental health have some things in common when it comes to student and client admissions. Colleges and universities often tout need-blind admissions policies. That means they may admit students without looking at their financial circumstances. Of course, they can then choose whether or not to offer them financial aid. They also remain free to maintain or reject the need-blind policies they put in place. I’m a fan of need-blind admissions for many reasons, especially since it tends to foster greater diversity within schools. Schools with the deepest pockets, those with endowments running into the hundreds of millions and billions, are often the best-positioned to offer need-blind admissions because money for financial aid is not in short supply. As a result, they can actually enroll the students they admit without those students winding up deep in debt.
Let’s compare this to community mental health centers, such as West Central Behavioral Health in New Hampshire. It, like Yale, Harvard, Dartmouth (its neighbor), Princeton, and other Ivy League and elite schools, has a need-blind admissions policy, too. Its policy is an integral part of its mission, meaning it accepts clients regardless of their ability to pay. Of course, there are bandwidth issues that might prevent it from taking everyone who walks through its doors seeking help for mental health or substance use disorders, but that’s usually because of resource scarcity — as in, the demand from the community outstrips West Central’s capacity to provide clinical services. At other times, it’s based on whether a person has insurance or not, typically Medicaid. What happens in these cases is that people in immediate need must be referred to another provider. Often, however, other providers are not willing to take clients whose only insurance is Medicaid, or who have no insurance at all. This puts places like West Central in tenuous ethical and financial straits. How do you turn someone away who needs time-critical help knowing they won’t find it elsewhere because they can’t afford it? Yet, how do you keep the lights on and salaries paid if the money doesn’t flow? It’s a dilemma most Ivy League schools will never face. But community mental health centers face it every day. Of particular note is when a crisis occurs and a call comes into the 24/7 emergency services phone line. Then, a crisis clinician is ready and waiting to help without inquiring about insurance or the caller’s financial circumstances. In the moment of crisis, West Central responds. And COVID-19 has made these “moments of crisis” more numerous, increasing the need for trained crisis support staff.
Need-blind admissions is a common denominator for community mental health centers and elite private colleges and universities. It is there that the commonality between these two types of organizations ends. On the one hand, elite schools are free to drop their need-blind policies if they choose. And students seeking admission generally have other options. On the other hand, community mental health centers are open to all comers unless resources aren’t available to care for them. And, community mental health clients frequently don’t have other options for care. Further, the deep pockets of alumnae and alumni fund colleges and universities far more readily than do the clients of community mental health centers. The clientele of the two types of organizations could not be more different. Alumnae/i are often favorably inclined to give back to their schools at notably-high rates. For many, the recognition their giving brings is often deeply gratifying. On the other hand, clients of community mental health centers tend to be predominately at-risk and marginalized people who have limited (if any) disposable financial resources. Even if they could afford to give, they often give anonymously because of the stigma their treatment carries with it—a very different equation than the notoriety making a gift brings to alumnae and alumni at their alma maters.
Wealthy schools don’t hesitate to let their graduates know that tuition doesn’t cover the actual cost of educating students. Similarly, community mental health centers don’t generate enough revenue to cover their actual costs of providing care. In fact, in my analysis, Medicaid only covers, on average, 73% of the cost of care for West Central’s clients. That leaves a 27% gap to make up in order to keep the doors open for people in dire need of care. Without a multi-billion-dollar endowment like an Ivy League school, West Central Behavioral Health must rely on slim appropriations from towns and counties, along with donations from private individuals, corporations, and foundations. Gifts from individual donors make up the bulk of West Central’s gift revenue stream, followed by gifts from foundations, then by corporations, then by towns and counties. Without this support, it couldn’t keep the lights on or the clinic doors open to serve vulnerable people who need help.
There are numerous reasons why community mental health centers exist, not the least of which is basic but powerful: to help people get well and be productive members of society. The COVID-19 pandemic has highlighted just how tenuous our grip on happiness and stable mental health can be when isolation, physical ill-health, and financial and family stressors come into play. Thankfully, for those who need clinical support from trained therapists, doctors, nurses, social workers, case managers, and crisis clinicians, community mental health centers like West Central do their utmost to accept clients regardless of their ability to pay, in or out of a pandemic. This is the need-blind admissions policy that works only so long as donors support West Central’s mission. The money raised goes to help people with their co-pays, or pay for their therapy if they have no insurance coverage, or to fund crisis support services when a person has no place else to turn, or, these days, to pay for increased expenses due to COVID-19. Further, all ages, genders, races, abilities, and ideologies are welcome. It’s not limited to the best and the brightest, to those who score well on a test, or to star athletes on a playing field. In fact, by its very nature, West Central serves the underserved and those in the greatest of financial and psychological need.
Given my work, I’m a strong proponent of philanthropy, and I’m grateful for the good it does for society through the work of non-profits of all stripes. I encourage people to give to a broad array of organizations far and wide, their alma maters included. Yet, when a pandemic like COVID-19 hits, upending our lives and forcing those already barely hanging on into ever-deepening hardship and despair, it’s time to reconsider our priorities and adjust our giving to recognize and support true need. I encourage people who are able to be philanthropic to turn their attention to local non-profits, and particularly to community mental health centers to support the type of need-blind admissions that will serve well our vulnerable, marginalized, and most at-risk friends and neighbors today and over the long term.
Dave Celone is director of development & community relations at West Central Behavioral Health, a community mental health center serving Sullivan and lower Grafton Counties and the Upper Valley region of NH and VT with offices in Claremont, Lebanon, and Newport, NH. Dave reminds us all to wear masks and wash our hands often as two important ways to stay safe during the COVID-19 pandemic. He may be reached at firstname.lastname@example.org. If you are in crisis, West Central’s 24/7 emergency services number is: 1-800-564-2578. Also see West Central’s website at wcbh.org for more information.