Addressing Patients’ Mental Health Needs at a Student-Run Free Clinic


Student-run free clinics are uniquely positioned to understand the barriers to accessing mental health resources. We abstracted patient demographics and clinical characteristics from 355 patient charts and examined referral patterns for a subset of patients. Seventy-three (21%) of patients were found to have a psychiatric diagnosis and were more likely to have more medical comorbidities (10 versus 6, p < 0.001), total medications (8 versus 6, p < 0.001, and to be English-speaking (odds ratio: 1.97, p < 0.05). Of patients who received a referral, 37 (60%) were referred to specialty treatment, the majority to a single outside agency provider. 15 (25%) of patients were interviewed. Barriers to successful referral included transportation and medical symptoms. A facilitator of successful referral was concern for individual’s health. Language, social stigma, and cost were not cited as barriers. This study describes mental health needs at a SRFC and suggests opportunities for improvement.

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  1. Alegría M, Mulvaney-Day N, Woo M, Torres M, Gao S, Oddo V (2007) Correlates of past-year mental health service use among Latinos: Results from the National Latino and Asian American Study. American Journal of Public Health.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Barnes RD, Ivezaj V (2015) A systematic review of motivational interviewing for weight loss among adults in primary care. Obesity Reviews.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G (2012) Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cunningham PJ (2009) Beyond parity: Primary care physicians’ perspectives on access to mental health care. Health Affairs.

    Article  PubMed  Google Scholar 

  5. Garfield RL, Zuvekas SH, Lave JR, Donohue JM (2011) The impact of national health care reform on adults with severe mental disorders. American Journal of Psychiatry.

    Article  Google Scholar 

  6. Gorrindo P, Peltz A, Ladner TR, Reddy I, Miller BM, Miller RF, Fowler MJ (2014) Medical students as health educators at a student-run free clinic: Improving the clinical outcomes of diabetic patients. Academic Medicine 89(4):625–631.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24(2):105–112.

    CAS  Article  PubMed  Google Scholar 

  8. Liberman KM, Meah YS, Chow A, Tornheim J, Rolon O, Thomas DC (2011) Quality of mental health care at a student-run clinic: Care for the uninsured exceeds that of publicly and privately insured populations. Journal of Community Health.

    Article  PubMed  Google Scholar 

  9. Linden A, Butterworth SW, Prochaska JO (2010) Motivational interviewing-based health coaching as a chronic care intervention. Journal of Evaluation in Clinical Practice.

    Article  PubMed  Google Scholar 

  10. McQueenie R, Ellis DA, McConnachie A, Wilson P, Williamson AE (2019) Morbidity, mortality and missed appointments in healthcare: A national retrospective data linkage study. BMC Medicine 17(1):2.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Merz EL, Malcarne VL, Roesch SC, Riley N, Sadler GR (2011) A multigroup confirmatory factor analysis of the Patient Health Questionnaire-9 among English- and Spanish-speaking Latinas. Cultural Diversity & Ethnic Minority Psychology 17(3):309–316.

    Article  Google Scholar 

  12. Mojtabai R, Olfson M, Sampson NA, Jin R, Druss B, Wang PS, Kessler RC (2011) Barriers to mental health treatment: Results from the National Comorbidity Survey Replication. Psychological Medicine 41(8):1751–1761.

    CAS  Article  PubMed  Google Scholar 

  13. Packness A, Halling A, Simonsen E, Waldorff FB, Hastrup LH (2019) Are perceived barriers to accessing mental healthcare associated with socioeconomic position among individuals with symptoms of depression? Questionnaire-results from the Lolland-Falster Health Study, a rural Danish population study. British Medical Journal Open 9(3):e023844.

    Article  Google Scholar 

  14. Piette JD, Wagner TH, Potter MB, Schillinger D (2004) Health insurance status, cost-related medication underuse, and outcomes among diabetes patients in three systems of care. Medical Care.

    Article  PubMed  Google Scholar 

  15. Preventive Services Task Force US. (2009). Screening for depression in adults: U.S. preventive services task force recommendation statement. Annals of Internal Medicine.

  16. Rowan K, McAlpine DD, Blewett LA (2013) Access and cost barriers to mental health care, by insurance status, 1999–2010. Health Affairs.

    Article  PubMed  Google Scholar 

  17. Schutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries TPGM, Richir MC (2015) Learning in student-run clinics: A systematic review. Medical Education 49(3):249–263.

    Article  PubMed  Google Scholar 

  18. Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC, Von Korff M (2007) Depression–anxiety relationships with chronic physical conditions: Results from the World Mental Health surveys. Journal of Affective Disorders.

    Article  PubMed  Google Scholar 

  19. Soltani M, Smith S, Beck E, Johnson M (2015) Universal depression screening, diagnosis, management, and outcomes at a student-run free clinic. Academic Psychiatry.

    Article  PubMed  Google Scholar 

  20. Syed ST, Gerber BS, Sharp LK (2013) Traveling towards disease: Transportation barriers to health care access. Journal of Community Health.

    Article  PubMed  PubMed Central  Google Scholar 

  21. The WHO World Mental Health Survey Consortium (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the world health organization world mental health surveys. JAMA.

    Article  Google Scholar 

  22. Wahle B, Meyer K, Faller M, Kochhar K, Sevilla J (2017) Assessment of hypertension management and outcomes at an indianapolis student-run free clinic. Journal of Health Care for the Poor and Underserved 28(2):694–706.

    Article  PubMed  Google Scholar 

  23. Zucker J, Gillen J, Ackrivo J, Schroeder R, Keller S (2011) Hypertension management in a student-run free clinic: Meeting national standards? Academic Medicine.

    Article  PubMed  Google Scholar 

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Faculty time dedicated to this initiative was supported by the Vanderbilt University School of Medicine and The Shade Tree Clinic. We would like to acknowledge Dr. Bonnie Miller and Dr. Jeffery Balser for their support of the Shade Tree Clinic and to Thao Le and Daniel Sack for their critical review of this manuscript. The clinical operations of Shade Tree Clinic were supported by the Baptist Healing Trust. Thank you to the student and physician volunteers for dedicating their time and effort to the clinic. Thank you to the patients of Shade Tree Clinic without whom this work would not be possible.

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Correspondence to Rohini Chakravarthy.

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Knoll, O., Chakravarthy, R., Cockroft, J.D. et al. Addressing Patients’ Mental Health Needs at a Student-Run Free Clinic. Community Ment Health J 57, 196–202 (2021).

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  • Student-run free clinic
  • Mental health
  • Referral
  • Primary care
  • Vulnerable populations
  • Medical education