Helping Distressed Students

Helping Distressed Students Student Mental Health: How are our students feeling and what can we do to help?

State of student mental health today • How we got to this point • What we can do to help Student Mental Health

Historically, college student mental health was considered from a developmental view • Focused on transition issues of moving from high school to college • Issues related to academics, homesickness, finances, dating relationships, extracurricular activities, parental issues, and racial and cultural issues The World isn’t getting crazier; college is just getting more like the world around it. H.E. Marano, 2002

Suicide is the 2nd leading cause of death among college students • 80% of students who die by suicide have never been seen by • campus mental health service providers. • Only 29% of college students report receiving suicide prevention • information from their schools. The good news, this is up from • 14% in 2006. • Over 1,100 students die each year from suicide, approximately • 3 a day. • Students at risk • Those with a pre-existing mental illness. • Those that develop mental illnesses while in college. • Those lacking coping and other life skills. • Those who stop their mental health related treatments while • away from home. Today

Students reporting a diagnosis of clinical depression increased from 10% in 2000 to 18% in 2008 (NCHA) • Rate of depression is typically higher in college than in the general population (Pace & Trapp, 1995) • Women 21% Men 13% • 80% of students with depression also have symptoms of anxiety and 60% have physical symptoms • People with depression are at increased risk for co-occurring substance abuse, panic disorder, obsessive-compulsive disorder, and suicide Today

92% of depressed students show signs of academic impairment • Heiligenstein, et al., 1996 • 70% of students seeking counseling center services reported that personal problems were affecting academic progress • Turner, 2000 Today

Stress is the number one factor impeding college student success (ACHA, 2009) Impediments to Academic Success • 27.2% Stress • 19.3% Sleep problems • 18.2% Anxiety • 15.4 % Cold/Flu/Sore Throat • 13.1% Work • 11.3% Concern for a troubled friend/family member • 11.2% Depression (37 unique categories listed, the above were the 7 with a prevalence greater than 11%) Today

Shaky Man Effects of Stress and Anxiety

Study by the John Hopkins Children’s Center (June 2010) • 12% of college students studied stated they had thought about committing suicide at least once in the past year • 25% of these thought about suicide repeatedly • 7% of these made specific plans • Greatest risk factors • Depression and lack of social support • Defined as feeling unappreciated, unloved and uninvolved with family and friends • Childhood exposure to domestic violence and having a mother with depression also increased risk Today

The American Freshman: National Norms Fall 2010 • The % of students rating their emotional health as below average rose to a record level • Students rating their emotional health as above average fell to 52%, compared to 64% in 1985 • Gender gap: women have a less positive view than men • Students feeling frequently overwhelmed during their senior year of high school rose from 27% to 29% • Gender gap: 18% for men and 39% for women • Contrast the above with 75% of students seeing themselves as above average in their “drive to achieve and their academic ability” Today

A recent Michigan State study found the critical event having the most influence on whether students drop out of school is depression. • Loss of financial aid was next in influence • Other major influences include • Being recruited by an employer or another school, experiencing a large increase in tuition or cost of living, an unexpected bad grade, and roommate conflicts • Students were less sensitive to events such as • Death of a family member, inability to enter their intended major, substance abuse, coming into a large sum of money, and becoming engaged or married Today

NDSU Survey Used with permission from ACT n=3356, return rate of 25.4%

University of Michigan Public Health Study • Students with depression are twice as likely to drop out of school • Students with depression and/or anxiety have especially poor academic performance • If you compare students at the 50th percentile of the GPA distribution to a student with depression, there is a 13% drop in GPA • If you add anxiety into the mix, the student drops to the 23rd percentile (over 50% drop) Today

University of Wisconsin-Stout Study • Concluded that students at risk for mental health concerns are more likely to be retained if they receive treatment for their concerns • The more severe the distress, the more intervention is needed • An example: Psychosis and Auditory Hallucinations • Psychosis is a disorder in which a person has lost some contact with reality • Bipolar disorder (2.6%), Schizophrenia (1.1%) Today

Increased academic pressure, competitiveness, and sleep deprivation • Fewer students take time off to stabilize after stress or mental health problems • Students stop taking medications when they get to college • Worried about stigma; want to use alcohol/drugs • Students using alcohol or drugs while on medications cause interactive problems Why are students so anxious and distressed?

Increased similarity between college population and general population • Greater availability of medications and counseling services allows individuals to attend school who would not have been able to in the past • Less stigma attached to mental illness and the use of counseling • Students already under care may stop when they get to college Why?

Students believe their generation will be less successful than their parents, so there is more pressure to succeed • Economy and parental unemployment • “Hyper-enriched lives” with cell phones, computers, classes, jobs, sports, travel, volunteer work and more • Lack of academic readiness: being awarded superior grades in high school without learning how to study Why?

Death by Suicide and Psychiatric Disorders • Psychological autopsy studies done in various countries over almost 50 years report the same outcomes: • 90% of people who die by suicide are suffering from one or more psychiatric disorders: • Depression • Especially when combined with alcohol and drug abuse • Bipolar disorder • Alcohol abuse and dependence • Drug abuse and dependence • Schizophrenia • Other psychiatric risk factors with potential to result in suicide (account for significantly fewer suicides than Depression) • Post Traumatic Stress Disorder (PTSD) • Eating disorders Facing the facts…

Myths Versus Facts About Suicide

MYTH: Suicide occurs in greater numbers around holidays in November and December. • FACT: • The highest rates of suicide are in April, while the lowest rates are in December. Myths versus facts…

MYTH: Sometimes a bad event can push a person to complete suicide. FACT: Suicide results from serious psychiatric disorders, not just a single event. One bad event will not normally push someone without a psychiatric disorder to commit suicide. One caveat, when dealing with youth and young adults, impulsiveness needs to be taken into consideration. Myths versus facts…

MYTH: Once a person attempts suicide the pain and shame will keep them from trying again. FACT: The most common psychiatric illness that ends in suicide is Major Depression, a recurring illness. Every time an individual gets depressed, the risk of suicide returns. Myths versus facts…

MYTH: Asking a depressed person about suicide will push him/her to complete suicide. FACT: Studies have shown that individuals with depression often have suicidal thoughts and talking about them does not increase the risk of a person taking their own life. Myths versus facts…

MYTH: Males are more likely to be suicidal. FACT: Men COMPLETE suicide more often than women. However, women attempt suicide three times more often than men. Myths versus facts…

MYTH: People who talk about suicide don’t complete suicide. FACT: Many people who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously. Myths versus facts…

Among all 18-24 year olds who die by suicide: • 1 in 5 occur on the same day as an acute life crisis • 1 in 4 occur within 2 weeks • Almost 50% are due to intimate partner problems • Other reasons include: • Legal/criminal (20%) • Financial (12%) • Relationship problem with friend or family (13%) • Due to the impulsiveness of youth, it is crucial to provide immediate help, develop means for students in crisis to cope, provide a safe haven, and ensure a support system is in place. What do we know about the impulsiveness of youth suicide?

“The solution lies in being aware of it, intervening earlier and providing support with adequate and appropriate services.” NuranBayram and NazanBilgel Uludag University, Bursa, Turkey Bayram & Bilgel, 2008 Mental Health & Retention

The Bottom Line • Students with social and emotional problems are at a higher risk for dropping out of school • Students in counseling have a higher retention rate than those who are not • Counseling helps students address their concerns and stay in school • It’s all about relationships! Retention

Spectrum of Mental Health Interventions Prevention Early Intervention Treatment Well Becoming Unwell Recovering Unwell What can we do to help?

Distressed • Behavior that causes us to feel alarmed, upset or worried (most common) • Disruptive • Behavior that interferes with or interrupts the educational process of other students or the normal business operations of the university • Dangerous • Behavior that leaves us feeling frightened and in fear for our personal safety or the safety of others Distressed, Disruptive, or Dangerous

Be Aware of Warning Signs • Depressed mood, social withdrawal, negative self-esteem, poor concentration • Changes in weight or sleep patterns • Loss of confidence, interest, and motivation • Increased anxiety, obsessive worry • Productive vs. destructive anxiety • Increased use of alcohol/drugs • Excessive procrastination • Too frequent of office visits (dependency) • Crying What can we do to help?

Be Aware of Warning Signs • Decreased quality of work • Listlessness, sleeping in class • Marked changes in personal hygiene • Threats to self or others • Impaired speech or disjointed thoughts • Marked changes in behavior • Absence from class • Under responding to academic notices • Incongruous affect (smiling while crying) • Lack of follow-through What can we do to help?

When someone engages in risky, unhealthy, or suicidal behaviors here is a simple, caring, but assertive way to talk to them. • I care. Express your concern and care first. • I see. Describe what you see or have noticed. • I feel. Use a feeling word (e.g., worried, concerned). • I’m listening. What is going on for you? • Have you been thinking of suicide, hurting yourself? • I want. I want you to talk with someone at the Counseling Center, involve your • parents, etc. • I will. I will help you make an appointment, give you a ride, go with you, call • you tonight, etc. • Get help immediately if someone is actively suicidal, do not leave them alone. The Counseling Center or a local emergency room are your best options. If You See It – Say It

Intervention: Three Basic Steps Show you care Ask about suicide Get help You can help. . .

http://www.ndsu.edu/fileadmin/counseling/COUN_6542_Pamphlet.pdfhttp://www.ndsu.edu/fileadmin/counseling/COUN_6542_Pamphlet.pdf Counseling Center Web Site Decision Making Tree

Mental Health First Aid is the help offered to a person developing a mental health problem or experiencing a mental health crisis. The first aid is given until appropriate treatment and support are received or until the crisis resolves. Just as CPR training helps a layperson without medical training assist an individual following a heart attack, Mental Health First Aid training helps a layperson assist someone experiencing a mental health crisis. 8 hour training course. Mental Health First Aid

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Helping Distressed Students