Advising Students with Mental Health Challenges Angel Bowers LPC, NCC

1. Advising Students with Mental Health ChallengesAngel Bowers LPC, NCC It starts with academics and leads to…

2. Trends in College Mental Health… • One third of college students have sought mental health counseling while enrolled • 5000 students in 2011-2012 school year at NCSU (16,495 individual sessions). • Increasing severity in those who do • 34 hospitalizations in 2011-2012 school year at NCSU • 13% increase in students taking medication prior to coming to college in past 10 years. • One third have been in treatment prior to coming to college • Financial pressure exacerbates issues • Counseling Centers cannot handle demand (insurance/referral)

3. What is going on? • More access to medication, outreach and support • Less connected due to technology • Financial pressures • Fundamental lack of coping skills • ***Experience of “trauma” • 45.1% academic • 34.1% financial • 26.9% family problems • Minimal distress tolerance (Dr. Glass) *ACHA-NCHA Spring 2011 Survey

4. Common Causes of Distress • Family problems or other interpersonal difficulties*** • Problems with a romantic partner or spouse • Financial difficulties • Significant changes in circumstance or situation • Academic or work difficulties interpersonal conflicts with authorities or peers) • Over-commitment, performance anxiety • Depression • Grief or loss • A traumatic event or situation • Problems with alcohol or drugs • Social Anxiety***

5. Signs and Symptoms of Emotional Distress • Expressed suicidal thoughts or attempts • High levels of irritability including undue aggressive or abrasive behavior expressed towards you or others • Lack of energy • Marked change in personal hygiene • Bizarre or strange behavior • Sadness, tearfulness • Frequent binge eating episodes or extreme loss of appetite • Sleeplessness • Dependency, e.g., the student who hangs around your office or makes excessive appointments to see you • Infrequent class attendance and inadequate effort put into the assignments • Falling asleep in class • Lack of enthusiasm about various aspects of student life • Unusual bruises on face and/or body

6. Personal and Academic Counseling • Counseling Centers provide a safe place to talk with a professional about concerns or problems, no matter how minor or serious, which might interfere with personal growth and academic achievement. • The academic counseling complements services provided by departmental advisors. Issues addressed might include semester withdrawal requests, poor grades, test anxiety, learning disabilities, dissertation support, study skills, and others. In addition, most staffs often offers workshops on a variety of academic topics.

7. How to get a Student in Distress to the Counseling Center…not in crisis. • Talk to them about your concerns & recommend that they come by or check out the website (our web “hits” doubled in the past year). Offer to come with them if they want. Be sure to explain what to expect and that counseling is often free and confidential. • Check in with the student later to see how they are doing (very important to them). • If they choose not to go to the Counseling Center, don’t be pushy…it often takes a few referrals to get them in. Have an open-door policy and be there to support them.

8. Counseling Services Available • Consultation / Outreach • Worried about one of your students? Wondering how to handle a disruptive student? The professional staff at the Counseling Center will explore your concerns and help you develop ideas for dealing effectively with the situation. This may involve coordinating with other campus offices or off-campus referrals. • In an effort to reach out to students, faculty, and staff, most Counseling Centers provides educational programming on mental health and academic topics of interest to the campus community.

9. What to Expect? • Specific Location: • Urgent access & on-call resources • Most Centers have walk-ins daily • Most will have after hours on-call • Scheduled Appointment • Call Vs. Triage • Check-In • Computer Forms or paperwork to see level of acuity • Confidentiality • Information is strictly confidential unless student is in danger to self or others, this applies to getting info back to you

10. Types of Psychological Crises 93% of college students report being in good to excellent health…yet, 33% say over the past year they have felt so depressed that it was difficult to function… • Suicidal Ideation • Rape/Sexual Assault • Self-harm (e.g. cutting) • Panic Attacks • Eating Disorders (low weight, only health complications) • Out of touch with reality, delusional • Distraught and cannot be consoled • Trauma (death in family, accident, fire, etc.)

11. Your Role • Assessing the situation and getting information • Safety! • Are you safe? • Have they already done something to hurt themselves? • Have they been thinking about suicide? • What is the situation – why are they upset? • Involving Dean’s Office/Student Conduct and/or Counseling staff • Providing support to student • Facilitating process of student speaking with a counselor • Educating student about what to expect, as clear as possible • Communicating with Student Conduct/Dean’s Office and Counseling Center regarding the situation

12. When is intervention necessary? • When it upsets the student… • When it upsets others… • When it disrupts functioning… • When a safety risk develops…

13. How comfortable do you currently feel about the idea of discussing suicidal thoughts with a student?

14. Suicide Clues and Warning Signs… • The more clues and signs, the greater the risk. • Take ALL signs seriously…do not wait to act! • Direct Verbal Clues • Indirect Verbal Clues • Behavioral Clues • Situational Clues

15. TIPS FOR ASKING THE SUICIDE QUESTION • If in doubt, don’t wait, ask the question right away… • “Are you having thoughts of ending your life?” “Do you have plans to kill yourself?” • If the person is reluctant, be persistent • Talk to the person alone in a private setting • Allow the person to talk freely • Give yourself plenty of time Remember: How you ask the question is less important than that you ask it!

16. How to persuade someone to stay alive: • Listen to the problem and give them your full attention • Limit Distractions • Remember, suicide is not the problem, only the solution to a perceived unsolvable problem • Do not rush to judgment • Be careful not to jump to problem solving or invalidate their feelings • Offer hope in any form

17. Referral… • Suicidal people often believe they cannot be • helped, so you may have to do more • The best referral involves taking the person directly to someone who can help • The next best referral is getting a commitment from them to accept help, then making the arrangements to get that help

18. Contacting the Counselor/Campus Resources • During business hours (8-5), you can offer to call or walk the student over to the Counseling Center. After hours, access on-call info. • Speak with the counselor on-call about the situation. The counselor will usually then speak with the student. • Stay with the student until the counselor arrives. Use reflective/active listening. Reassure them that the counselor will be there to help them.

19. Create a culture of caring… • Encourage interpersonal responsibility • Encourage and teach “bystander” interventions • Talk about the value of self-care and mental health openly • Reduce stigma for help seeking

20. Most important…boundaries! • Do not promise the student confidentiality: only that you will only tell others who can offer the most help (parents may not be on the list). • Avoid increasing contact with students (personal e-mails, texting, coffee on weekends, etc.) • Be careful allowing exceptions or accommodations for undocumented concerns. • ***We cannot provide documentation without prior knowledge to support an exception. • If safety is EVER a concern, consult with Student Conduct or CC immediately, with imminent danger, campus police.