Building a Team of Support

1. Building a Team of Support Coordinating Collaborative Care for Students with Borderline Personality Disorder Britney Deaver, Student Affairs Case Manager Carrie Smith, Assistant Dean of Students Alicia Talbird, Clinical Case Manager

2. Nonclinical Context: Here’s what we know… • University must make reasonable accommodations for students with disabilities • The profile of a college student continues to change and become more complex • Additional access to mental health resources and information has increased familiarity with symptoms, diagnosis, treatments, and language • Student services, including nonclinical and clinical services, continue to expand to meet the high demand • Perfectionism as a more prevalent cultural characteristic – the pressure to be successful

3. Clinical Context: Here’s what we know… • Roughly 2% of the adult population have a diagnosis of Borderline Personality Disorder (Lenzenweger, Lane, Loranger, & Kessler, 2007) • Sparse data related to the university and college population (Hersh, 2013) • Borderline Personality Disorder (BPD) accounts for 20% of psychiatric hospitalizations (Zanarini & Frankenburg, in press) • Psychiatric disabilities, including borderline personality disorders, are one of the fastest growing categories of disability (Belch, 2011) • BPD behaviors begin to manifest in early adulthood

4. Borderline Personality Disorder Symptom In Practice “I have no friends. No one cares about me.” Constantly self-sabotaging goals; changing course of study abruptly Swinging from “idealization to devaluation” (NASET, 2007) “I’ve never felt good before” Irresponsibility with money, substance abuse, binge eating, unsafe sex Changing care providers, frequent use of on-call services • Difficulty with emotional regulation • Chronic instability in early adulthood • Unstable patterns of social relationships • General Mood Concerns • Impulsive and often dangerous behaviors • Anxious efforts to avoid abandonment

5. Self-Injury, Para-suicidal, and Suicidal Behaviors • High rate of self-injury without suicidal intent (NASET, 2007) • Para-suicidal behaviors • Taking enough medicine to harm, but not kill • Holding a sharp object to your body without cutting yourself • Standing on the edge of a ledge, but not jumping • 4-8% of adults with BPD die by suicide • For university officials is there a difference in how we respond to each?

6. Case Study:Samantha • 19 y/o female • Second year, undergraduate • Transfer student • Lives on-campus with one roommate • 3.8 GPA

7. Timeline • ODOS receives police report regarding a student transport to the hospital after ingesting “several Wellbutrin” • Simultaneously, the Collegiate Recovery Community calls to report that one of their members tried to commit suicide and they are unsure the details • They are at the student’s bedside in the hospital • Student involuntary transported for in-patient hospitalization for five days • BIT, including Counseling Center, is informed • ODOS receives call from the conduct representative on the BIT stating his concern given her recent selection for student judiciary • Upon release, mother schedules a meeting with CRC representative and ODOS

8. Small group discussion questions • What campus partners need to be involved in the meeting? • How do you manage information sharing given privacy restrictions? • What is your responsibility to the institution and/or to the student?

9. Lessons learned • Nonclinical case managers: Our job is not to diagnosis or treat BPD! • Counseling center must be the expert • Nonclinical case managers are responding to behavior and not to any diagnosis that has been disclosed or self-reported • Setting and maintain boundaries with the student while still providing care • Reinforcing the policies of our partners • Consistent, scheduled communication and check-ins • Managing frustration and our own feelings and fatigue • Cooperation and relationships are key • Stay in your lane.

10. Questions • Britney Deaver, Student Affairs Case Manager • Britney.kelley@uga.edu • Carrie Smith, Assistant Dean of Students • cvsmith1@uga.edu • Alicia Talbird, Case Manager, Counseling and Psychiatric Services (CAPS) • atalbird@uhs.uga.edu

11. Collaborative Information Gathering • CRC – recently joined group, attends meetings, references substance abuse without much detail; reports of risky sexual behavior with other members from members of CRC • CAPS • September 2016 – student schedules intake, rescheduling multiple times in one month • Referred out during intake because she needs long-term services • October 2016 – Student appears at CAPS for crisis services with a different clinician, given more referral options and scheduled for a case management appointment • No show for case management appointment and does not respond to follow up • February 3 2017 – Schedules another in-person screening with the original clinician and schedules a case management session for the following week • February 7 2017 – Walks in for crisis services, makes a safety plan, and she says she has an appointment set up with a provider for February 10. • February 9 2017 – Samantha is hospitalized after ingesting “several Wellbutrin” • Housing • Check in with Residence Hall staff who report that Samantha’s roommate says she is “always talking about taking a lot pills” so she didn’t notice in change behavior • Faculty • Email instructor notification of hospitalization. Faculty respond that they she has shared her struggles with depression and they are willing to make any arrangement necessary for success • Continued communication with campus and community partners, and ensured appropriate treatment through the cooperation of mother and care provider

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13. Initial Meeting • Mother discloses in meeting that student was hospitalized previously and has diagnosis of Borderline Personality Disorder • ODOS requests that Samantha sign releases of information between CRC, CAPS, and ODOS. Samantha is hesitant to sign, but ultimately her mother makes her