Last year, Stephannie Covarrubias, a first-year campus graduate student studying public health, realized what she thought was depression may have been misdiagnosed.
Her medication wasn’t working, and she suspected she had adult Attention-Deficit/Hyperactivity Disorder, or ADHD.
Covarrubias decided to make an appointment with the Tang Center to discuss her potential diagnosis, she but found that University Health Services, or UHS, clinicians do not diagnose or prescribe medication treatment for ADHD or Attention Deficit Disorder.
UHS’s frequently asked questions page explains that diagnostic assessments for ADD and ADHD are in-depth and time-consuming and that UHS does not have the resources necessary to diagnose the disorders.
“Diagnosing ADHD in adulthood is no easy task … It takes real time,” said campus psychology professor Stephen Hinshaw in an email. “One of the problems in the US is that we’ve come to allow quick ADHD evaluations, for youth and for adults, which can lead to both overdiagnosis and underdiagnosis.”
In an email, UHS Counseling and Psychological Services, or CPS, psychologist Susan Bell confirmed that medicating ADD and ADHD consumes resources the Tang Center can’t afford.
Students who are already diagnosed cannot have ADD-related medication treatment initiated by a UHS clinician or have their existing prescription refilled.
“In the past, CPS psychiatrists did provide medication for ADD and ADHD,” Bell said in her email. “But it was extremely resource intensive and meant that we had long waits for appointments. A few years ago, we needed to make the difficult decision not to treat ADD at Tang.”
Overdiagnosing poses the risk of abuse of medications prescribed for ADD and ADHD, according to Hinshaw. “Diversion” of stimulants for unintended use is an issue on campuses across the nation, according to CPS interim chief of psychiatry Kristine Panik. Students who aren’t diagnosed with ADD or ADHD sometimes turn to prescription stimulants as study aids or for recreational use.
The rate of adult ADHD diagnoses in the United States is about 4 percent, according to the Anxiety and Depression Association of America.
“The trade-off is between students with legitimate ADHD, who have trouble getting valid assessments and needed treatment, and the risk of overprescribing if evaluations aren’t rigorous,” Hinshaw said in his email.
UHS staff currently refers students seeking diagnoses or treatment for ADD-related syndromes to local professionals, according to UHS spokesperson Kim LaPean. The referral list includes local psychiatrists and psychologists who specialize in ADD and accept SHIP, but even with the Tang Center’s guidance, finding a provider off-campus can be difficult, according Covarrubias.
The Bay Area has been affected by a worsening national psychiatrist shortage – in Covarrubias’ case, many of the psychiatrists she reached out to weren’t accepting new patients at all.
“It took me almost a month (to find a psychiatrist),” Covarrubias said. “I spent hours calling people trying to find people who were still taking patients.”
If a local psychiatrist is accepting new patients, they still may not accept a student’s insurance. Campus freshman Sarah Reeves was diagnosed with ADHD and could not find a psychiatrist in Berkeley who was covered by her insurance. Now, her mother fills her prescription from her psychiatrist at home and ships Reeves the medication from New York.
Covarrubias, who is covered by Medicaid, said that while the Tang Center employees she spoke with were compassionate, but they weren’t equipped with knowledge of which specialists would be covered by her insurance.
“They tried to give me a list of potential people I could talk to,” Covarrubias said. “I didn’t end up using any of them because they all only accepted SHIP.”
Panik said that as it’s impossible to provide comprehensive services for everything, the Tang Center must make decisions about which services to offer in order to make the greatest impact on students. For Covarrubias, it’s difficult to understand why her needs didn’t make the cut.
“As a student, I don’t have months to wait around (for treatment), I have tests,” Covarrubias said. “That is not realistic for the world I’m living in.”