Responding to Distressed & Distressing Students Elizabeth Gong-Guy, Ph.D. October 2009

1. Responding to Distressed & Distressing Students Elizabeth Gong-Guy, Ph.D. October 2009

2. Goals of Today’s Training • Increase awareness of signs of distress • Build skills for intervening with distressed & distressing students • Facilitate referrals for assessment & treatment

3. College Student Concerns • Only 11% get a good night’s sleep (Buboltz, 2002) • Over 9% meet the criteria for anxiety disorders (NIMH, 2000) • 12% meet criteria for clinical depression (ACHA, 2002) • Less than 1/4 are in therapy for depression • Only 1/3 on medication for depression • Suicide = 2nd leading cause of death among college students (Jed Foundation, 2002) • 9.4% of college students seriously contemplated suicide in the past year (ACHA, 2006) • 1.4% of college students made a suicide attempt (ACHA, 2006)

4. Graduate Student Concerns • 67% of graduate students reported feeling hopeless • 45% said they felt so depressed they could barely function • 10% said they had seriously contemplated suicide (UC Berkeley, 2004)

5. Snapshot of UCLA CAPS • 1 in 6 UCLA students received clinical treatment – more than 7,000 students last year • 35% screened positively for harmful levels of alcohol or drug use • 3 to 5 students per week were seen in the ER for psychiatric or substance abuse crises • 47 students were treated as psychiatric inpatients (FY07-08)

6. Characteristics of Distressed or Distressing Students

7. Goals of this Segment • Recognize situations that pose a potential threat

8. Academic Performance Problems • Poor performance & preparation markedly inconsistent with previous work • Excessive absences or tardiness, especially versus previous functioning • Chronic indecisiveness or procrastination • Repeated requests for special consideration • Increased concern about grades despite satisfactory performance • Increased dependence: excessive appointments or hanging around without a reason

9. Common Stressors • Traumatic Change in Academic Status • Academic Probation or Dismissal • Loneliness & isolation • Identity confusion • Low motivation or inability to establish goals • Serious illness • Academic pressure or failure • Parenting responsibilities • Work or family pressures • Cultural oppression or discrimination

10. Traumatic Change in Relationships • Death of a family member or close friend • Difficulties in marriage or close relationships • Roommate or family problems • Break-up of intimate relationship • Rejection by family

11. Unusual Behaviors • Marked decline in personal hygiene • Consistent disheveled or fatigued appearance • Lethargy, lack of energy, falling asleep in class • Disruptive classroom behavior • Aggressive, angry or threatening behavior • Dramatic weight loss or gain • Use of mood-altering substances

12. Cognitive Impairment • Inappropriate, bizarre or strange behavior indicating a loss of contact with reality • Prolonged or extreme emotionality • Agitation, intense restlessness, hyperactivity, or unusually rapid speech • Marked impairment of attention and memory • Impaired speech or disjointed, confused thoughts • Paranoia or suspiciousness

13. References to Suicide • Overt or veiled references to suicide -- orally or in writing • Expressions of helplessness or hopelessness • Persistent or prolonged unhappiness • Isolation from friends and family • Pessimistic feelings about the future

14. Threatening Behaviors • Violence committed against objects, animals or people • Stalking behaviors • References to homicide and death • Overt or veiled threats to harm others • Threatening and accusatory statements, e-mails, text messages, letters or phone calls • Disturbing or morbid themes consistently present in oral or written work

15. Responding to Distress

16. Goals of this Segment • Understand the Campus response to distressed & distressing students • Know how to access campus resources for crisis consultations and referrals

17. Responding to Distress • Observe the signs of distress • Initiate contact • Clarify your role • Offer support and assistance • Know your limits • Consult with CAPS staff or the Consultation and Response Team

18. Initiate Contact! • Don’t ignore strange or inappropriate behavior -- respond to it • Talk to the student privately • Be direct & matter of fact • Indicate your concern • Early feedback, intervention and/or referral can prevent more serious problems from developing

19. Referring a Student to CAPS • Find a private time & place to express your concern • Suggest a self-check using the CAPS on-line screening • Offer details on how to access CAPS services • Offer to help make the call for an appointment • Offer to accompany the student to CAPS • Call CAPS for a consultation with the Walk-In Clinician

20. Referring a Student to the Consultation and Response Team • Contact the Student Care Manager, Karen Minero, at kminero@saonet.ucla.edu or 310-825-0628. • The Consultation & Response Team meets weekly to determine appropriate responses and referrals to engage resources.

21. CAPS Response to Student Mental Health Crises • Distressed students are referred by • Faculty or Staff • Family or Friends • Themselves • Consultation & Response Team • Assessment plan is developed • Student is typically seen at CAPS • Diagnostic assessment yields risk of dangerousness

22. If a student is dangerous to others • Consultation & Response Team confers (if the case has been referred) • Dean of Students Office • Counseling and Psychological Services • Office of Residential Life • College Academic Advising • UCPD • VC Student Affairs Executive Officer • CRT Care Manager • CAPS clinical plan is simultaneously enacted

23. If a student is dangerous to others • If imminently homicidal • Intended victim is immediately notified • UCPD is immediately notified • Psychiatric hospitalization (voluntary or involuntarily) is arranged • If NOT imminently homicidal • CAPS works with the student to reduce lethality, increase impulse control & increase coping

24. If a student is dangerous to self • If imminently dangerous • Referral for inpatient psychiatric hospitalization (voluntary of involuntary) • If not imminently dangerous • CAPS clinicians work with the student to reduce lethality, increase coping & increase support

25. CAPS continuity of care • CAPS in-house communication • Peer Review Committee insures coordinated interdisciplinary response • Electronic charting facilitates case coordination • Students discharged from ER and NPI • CAPS receives notification of discharge • CAPS Care Manager ensures clinical follow-up

26. Parental Notification • Only occurs for adult students if clinically indicated in order to • Reduce lethality • Increase support resources • Increase treatment compliance

27. Communicating with CAPS • CAPS consults with faculty, staff, students & parents on distressed & distressing students • CAPS contacts students via e-mail or phone to offer assistance -- and students respond 90% of the time • CAPS maintains confidential electronic records of all communications regarding students

28. Frontline Management of Threatening Behaviors

29. Goals of this Segment • Understand tools to de-escalate a volatile situation

30. Statistics…. • Suicide • 22% of women, 9% of men seriously considered suicide • 1.3% reported at least one attempt in past year • Incidence = 7 in 100,000 = half of non-student rate • (ACHA 2004 sample of 47,202 students)

31. Statistics… • Stalking: • 13% of female students stalked in study year • 25-30% of college women and 11-17% of college men report ever being stalked • (Fisher, 2000)

32. Statistics… • Between 1993 and 1998, college professors experienced an average annual rate of 41,600 incidents of nonfatal workplace violence • (Schneider, 1998)

33. The Aggression Cycle • Escalation Phase • Behavioral signs that anger is building • Explosion Phase • Uncontrollable discharge of anger • Verbal or physical aggression • Post Explosion • Negative consequences • Remorse & attempts to repair

34. A Hostile Student May be Communicating: • Vulnerability • Confusion • Overload of Emotional Stress • Fear • Feelings of Helplessness • Powerlessness

35. Basic Response Guidelines • Stay calm, to reduce the student’s anxiety or agitation • Provide a quiet, private place for the student • Speak to the student in a clear, straightforward manner • If the student is suicidal, don’t leave him/her alone • Arrange appropriate intervention or aid

36. Listening is an Action • Encourage the student to talk; listen closely and patiently • Listen to the student’s frustration • Convey an understanding of their situation • Work to understand how the student perceives the situation • Acknowledge the student’s feelings • Identify & acknowledge what the student wants that he/she isn’t getting

37. Defusing Techniques • Project calmness, move & speak slowly, quietly & confidently • Avoid arguing or defending previous actions • Avoid threatening body language (don’t stand with arms crossed) • Calmly but firmly outline limits of the setting • Clearly state your intention to seek a resolution or a pathway to a solution

38. Defusing an Escalating Situation • If the situation continues to escalate, the student will exhibit more nonverbal cues: growing louder, more agitated or more intense with sharper verbalizations • Intervene to defuse: • Reduce stimulation from the setting (move to private space) • Communicate information about the process • Provide choices; break big problems into smaller ones

39. Defusing Techniques • Give the student ample personal space • Allow the frustrated student time to vent • Use delaying tactics to give the student time to calm down: offering a drink of water • Rather than responding to personal verbal attacks, reflect your understanding of the student’s anger and frustration about the situation • Work toward outlining concrete next steps to resolving a conflict

40. Verbally Abusive Students • Verbal abuse happens when students encounter frustrating situations which they believe are beyond their control • Anger & frustration are displaced onto the nearest target • Explosive outbursts & belligerent, hostile behavior are an attempt to gain power and control in an otherwise out-of-control experience

41. Responding to Verbal Abuse • Acknowledge the anger & frustration: “I hear how angry you are” • Acknowledge the issue & ask for clarification regarding what is upsetting • Reduce stimulation: seek a quiet space if you feel safe doing so • Be directive & firm about behaviors you will accept: “I can’t listen to you when you’re yelling” • Help the student refocus on the real issues

42. Responding to Verbal Abuse • Don’t get into an argument or shouting match • Don’t become hostile of punitive yourself • Don’t press for explanations for the abusive behavior • Don’t ignore the situation • Don’t touch the student, as this may be perceived as aggression & may escalate the student’s anger

43. Violent Students • Violence due to emotional distress is atypical, usually occurring when the student’s level of frustration has been so intense and enduring that the student’s emotional controls are eroded. • Violent behavior is often associated with alcohol and other substance use.

44. Responding to Violent Students • Quickly & calmly acknowledge the intensity of the situation: “I can see you’re really upset and I want to de-escalate this for you” • Explain clearly what behaviors are acceptable without denying feelings: “You can be angry but breaking things isn’t okay” • Get necessary help immediately: UCPD dispatch • Stay safe: maintain access to an exit, keep furniture between you & the student, keep doors open if possible, be sure others know you are with the student

45. Responding to Violent Students • Don’t ignore warning signs of escalating aggression: yelling, clenched fists, threats • Don’t threaten or corner the student • Don’t touch the student • Don’t see the student alone if you fear for your safety

46. Seek Help or Consultation • Getting assistance from someone who is neutral can change the dynamics of the situation • Bringing in someone with a different approach can de-escalate the situation • A “consultant” may need to intervene to define unacceptable and inappropriate behaviors: Dean of Students Office, CAPS, UCPD can provide these limits for students • Inform your supervisor to enact a team approach to support your efforts

47. Suicide Prevention Options(Students) • If there is an immediate danger of suicide, contact the UC Police Department or your nearest Police Station by dialing 911 • Go to the nearest hospital emergency room; on campus, go to the UCLA Hospital Emergency Room • Contact CAPS to consult with a crisis counselor at (310) 825-0768 • Call the Los Angeles Suicide Prevention Center 24-hour Crisis Hotline at (310) 391-1253 • The National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis. If you need help, please dial 1-800-273-TALK (8255). You will be routed to the closest possible crisis center in your area.

48. Violence Prevention Options(Students) • If there is an immediate danger of violence or if violence has occurred, contact the UC Police Department or your nearest Police Station by dialing 911 • Go to the nearest hospital emergency room; on campus go to the UCLA Hospital Emergency Room • If you are concerned about another's potential for violence, contact: • the Dean of Students at (310) 825-3871 • the Student Care Manager at (310) 825-0628 • or your residence hall staff • If you are concerned about your own potential for committing violence, contact CAPS at (310) 825-0768 • If you have concerns about your own anger management skills, contact CAPS at (310) 825-0768

49. Crisis Prevention Options(Faculty & Staff) • If there is an immediate danger of violence or if violence has occurred: • Contact UCPD dispatch (310) 825-1491 • Or dial 911 from a campus phone • If you are concerned about a student's potential for violence: • Contact CAPS (310) 825-0768 24-hours daily • Or contact the Consultation & Response Team Student Care Manager, Karen Minrero (310) 825-0628 or kminero@saonet.ucla.edu • Or contact the Dean of Students at (310) 825-3871

50. Please visit our websites www.caps.ucla.edu www.studentaffairs.ucla.edu/crisismanagement