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Responding to the Changing Landscape of College Mental Health with Comprehensive Crisis Intervention and Health Promotion Strategies. June 10, 2009 Cory Wallack, Ph.D. Today’s Goals.
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Responding to the Changing Landscape of College Mental Health with Comprehensive Crisis Intervention and Health Promotion Strategies June 10, 2009 Cory Wallack, Ph.D.
Today’s Goals • Review the changing landscape of college mental health and the impact on provision of crisis intervention services • Explore both philosophical and practical concerns as they relate to effective crisis intervention services • Discuss readiness issues and questions that should be addressed before implementing crisis intervention strategies, programs, and protocols • Present an overview of Syracuse University’s comprehensive crisis intervention and health promotion model
At intake a client reports: • Frequently feeling overwhelmed because of multiple tasks, responsibilities, and demands to balance • Difficulty prioritizing tasks, difficulty multi-tasking, difficulty balancing various responsibilities • Barely keeping her head above water, always on the run • High performance expectations • Failure is not an option • External and internal expectations of being able to do it all • Sense that multiple others are watching and waiting to see if she fails or succeeds • Although feeling pressured and overwhelmed, she is fearful and/or unable to voice concerns to others for fear of how she may be perceived or judged
Back to Our Case Discussion:Life in a Counseling Center • Fast paced, high demand, high stress work • Increasing intensity of client presenting problems coupled with increasing numbers of students seeking our services • On-going struggle with balancing individual clients, crisis response, group clients, outreach/education, paperwork, etc. • Burnout level is high, feeling stressed and overwhelmed is common • To know where we are going, we have to know how we got here…
The Changing Landscape of College Mental Health • High profile legal and media cases • MIT, Ferrum College, George Washington, NYU • Increased emphasis on studies reporting high rates of hopelessness, depression, suicidal ideation • 2005 National College Health Assessment • 2006 Counseling Center Consortium Data • Counseling Center Directors' reports • Garrett Lee Smith Act and JED Foundation • Virginia Tech and Northern Illinois
The Changing Landscape of SU’s Counseling Center Services 2007 Statistics • 4546 Client Contacts • 1523 Students Receiving Services • 304 Emergency Assessments • 216 Psychiatry Clients • 18.2% of clients report suicidal thoughts 2008 Statistics • 4871 Client Contacts • 1579 Students Receiving Services • 440 Emergency Assessments • 234 Psychiatry Clients • 23.6% of clients report suicidal thoughts Percent Change 7% 3.7% 45% 8.3% 5.4%
The Changing Mental Health Picture of Our Students • Students coming to campus with more significant mental health problems • Students described as: • Facing overwhelming demand • Lacking coping skills • Lacking distress tolerance • Connected-disconnected generation • Impact of global events • Soaring tuition rates • Helicopter parents
Responding to the Changing Landscape • Counseling Centers at maximum client capacity and lacking resources to meet the demand, yet students expecting to be seen immediately – e.g., increased crisis intervention • Increased demand on colleges and universities to demonstrate comprehensive crisis intervention, risk assessment, and suicide prevention programs • Increased employment of mandated assessments, mandated counseling, and forced leave of absences • Increased employment of behavioral consultation teams and case managers
Taking a Step Back: What Exactly Is Crisis Intervention?
Crisis Intervention Broadly Defined • Primary Prevention and Mental Health Promotion • Coping skills, stress management, distress tolerance, relationship skills • Stopping the crises before it starts • Secondary & Tertiary Intervention • Identifying and intervening with distressed students • Postventionand follow-up • Policies and Procedures • Mandated assessments, leave of absence, etc • Ideally, your campus should address all of the above
Where to Begin?The Importance of Sound Data • Know the national and local data on student mental health • Generally speaking, campuses are safe places • A caution about how we reinforce the culture of fear • What is the unique nature of your campus climate regarding mental health? • Consider a needs assessment • Survey students and parents • Survey faculty and staff
Where to Begin:Assessing Your Campus Culture • Some questions to consider: • To what extent does fear impact your system? • To what extent does the language of liability drive decision making? • What is the system’s level of distress tolerance? • Are decisions being made rationally? • Does your system tend to be reactionary or proactive? • Does the system have a balance of prevention and “intervention” • Does your system recognize its limits, resources, etc and create an appropriate model for your students, or is there a parallel process at play? • To effectively move forward, we have to thoroughly understand the culture we are working in and address it first
Philosophical Thoughts on the Role of Counseling Centers • College counseling centers can and should be the leaders in developing mental health protocols, policies, procedures, programs • At times, mental health professionals appear to have lost their voice • Too often we defer to attorneys and administrators who may not be expert in the field of mental health • The vast majority of counseling center staff aren’t qualified to conduct threat assessment • Counseling center staff can’t do it alone • Public health model is a vital approach
Where to Begin?The Importance of Theory • What are your driving beliefs, theories, and passions about crisis response? • Joiner • Baumeister • “Well Theory” • “Dark Nights of the Soul” • Essentially a mission, vision, and values statement • Sound theory allows you to connect all crisis intervention protocols back to central driving themes and values
So You Have a Theory and Know The Culture: Now What?The Example of Gatekeeper Training
Readiness Issues:Preparing the system • Gaining institutional support for the training • Are relevant parties aware of the training? • Will they be trained as well? • Think top-down and bottom-up • Review relevant policies/procedures/protocols for the various departments you will be working with • Mandated assessments • Does your campus have a plan for after hours emergencies • Remember, our students live in a different time zone than most of us!
Readiness Issues:Counseling Center Concerns • Is the counseling center staff trained and prepared to effectively respond to students in crisis? • Crisis intervention is a specific skill set • Threat assessment and suicide assessment • Is the counseling center staff prepared for consultation role? • Is there sufficient availability of emergency appointments and walk-in assessment? • Do you have sufficient availability of psychiatric services • If you don’t have sufficient resources to address the above, do you have referral resources in place?
Readiness Issues:Assessing Your Resources • Driving question: How can you most effectively and efficiently utilize existing resources? • Time • How much do you have? How much do you ideally need? • People • Who are your gatekeepers? • Who are your trainers? • What involvement do you want faculty to have? • What is the role of students? • Money • Can you secure grants or partner with other offices to enhance cost efficiency?
Readiness Issues:Marketing Your Efforts • How can you market the training • Press releases • School newspaper • Mailings • Suicide prevention “Kick-off” event • Handouts to give participants • Reference cards • Certificate of completion
Readiness Issues:Evaluating Your Program • What goals are you trying to achieve? • Need to be realistic • Need a timeline • Need to be measurable • How to measure training “success” • Increased referrals • Base-line data is ESSENTIAL • Increased knowledge and skills • What tools are there available to use?
Other Elements of a Comprehensive Crisis Intervention and Health Promotion Model
Primary Prevention • Students • Stress management • Relationship building skills • Communication skills • Conflict Resolution • Parents • Trainings frequently target identifying warning signs • We have an opportunity to help parents better support students • Helicopter parents will attend workshops if invited!
Secondary and Tertiary Prevention • Individually targeted efforts: • Behavioral consultation committees • Triage issues • Case managers • Broader targeted efforts • Depression/Anxiety screening days • On-line screenings • Gatekeeper training
Postvention and Follow-up • Factors to consider following student death • Do you have a formal crises response team? • Do you have structured processes for conducting debriefings? • Are staff that conduct debriefings properly trained? • Do you have pre-established relationship with appropriate media outlets? • How is information communicated across campus? • What happens days, weeks, months after the event?
A Comprehensive Campus Prevention Model An Example From Syracuse University
Defining Our Philosophy and Strategy • Our beliefs, guiding theories, and passion • Impact of loneliness, isolation, lack of coping skills • Contributions of Joiner and Baumeister • Answering these questions lead to a strategy…. • Connection • Distress tolerance • Acceptance
MH awareness and services utilization survey M.H. policies/procedures which sensitively respond to high risk behaviors (e.g. MLOA, mandated evaluations) Enhanced clinical services—increased emergency and psychiatric services; AMSR training for CC staff Gatekeeper training for students, staff, & faculty-Campus Connect, Distressed Student Module Life Skills Development—MBSR program Facilitating Help-seeking behaviors--campus wide media campaign/ Sustainability Plan Comprehensive Crisis Intervention Initiatives
Creation of Our Broad Goals • Foster a greater sense of individual and community connection • Positively influence campus culture by creating a greater tolerance for and acceptance of emotional distress • Promote life enhancing skills • Destigmatize mental health problems and increase help-seeking behaviors
Creation of Specific and Measurable Goals • Campus Connect • Train ORL, Health Services, Academic Counselors • Measure increased knowledge, skill, efficacy • MBSR • Train students life skills • Measure perceived stress, physical symptoms, coping skills • Counseling Center awareness and utilization • Pre and Post initiative assessments
We Had a Strategy and Goals...But, How to Resource It? • Perfect timing for securing the SAMHSA Suicide Prevention Grant • Stayed true to our philosophy • Comprehensive and preventative • Allowed for innovation and creativity • Grant allowed us to fill in the gaps and create a unique, philosophically connected program • Post-grant considered sustainability
The Program Has Been A Success…But, How Do We Sustain it? • Know, educate and involve key University players • Give them language • Bring them “into” your broad vision • What’s in it for them? • Communicate your program’s data results • Tailor your data to each different audience • Write a good “white paper” • Outline the strategic plan succinctly and realistically go for the “ask” • University Institutionalization • Increased resources • Cross campus mental health task force
New Pieces To be Added • Behavioral consultation committee • Parent/Family workshops • More direct outreach and support for students through Office of Multicultural Affairs and International Student Services • Integrated eating disorder treatment protocols • Community liaison working more directly with community agencies