Recognizing and Helping Distressed Students

1. Recognizing and Helping Distressed Students Sponsored by: Provost’s Office & Student Health Services April 2nd and 4th, 2013

2. Overview: • Statistics re: college students and mental health • Recognizing warning signs of distress • Communicating with a student in distress • Referring students for help • Managing student requests and situations

3. Top 5 Academic Impacts • MSUB ACHA-NCHA II Fall 2012 (N=588) • 1. Stress 26.6% • 2. Sleep 21.5% • 3. Work 21.1% • 4. Anxiety 20.4% • 5. Depression 13.4% • National Data Spring 2012 (N= 90,666) • 1. Stress 29.0% • 2. Sleep 20.6% • 3. Anxiety 20.2% • 4. Cold/Flu/Sore Throat 15.6% • 5. Work 13.9% • “Academic Impact” • Received a lower grade on an exam, or an important project; • Received a lower grade in the course; • Received an incomplete or dropped the course; • Or experienced a significant disruption in thesis, dissertation, research, or practicum work

4. Stress and Sleep • 48% rated their overall level of stress as “more than average” • 63% felt “tired, dragged out, or sleepy” at least 3 days/week • 54% felt they did not get enough sleep to feel rested in the morning at least 3 of the past 7 days

5. Mental Health • Within the last 12 months, % of students who said the following has been traumatic or very difficult to handle: • Finances 47% • Academics 40% • Family problems 33% • Sleep difficulties 31% • Intimate relationships 29% • Career-related issue 29% • National Data: • Academics 46% • Finances 34% • Intimate Relationships 32% • Family problems 28% • Sleep difficulties 26% • Other social relationships 25%

6. Mental Health • Within the last 12 months: • 85% felt overwhelmed by all they had to do • 31% felt so depressed it was hard to function • 49% felt overwhelming anxiety • 36% felt overwhelming anger • 7% seriously considered suicide • * Note: What may be the unintended message we send students when we craft and ask these questions (vs. questions that focus on resiliency)? • National Data: • 86% felt overwhelmed by all they had to do • 31% felt so depressed it was hard to function • 51% felt overwhelming anxiety • 37% felt overwhelming anger • 7% seriously considered suicide

7. NAMI Survey data • 64% of students who experience mental health problems end up withdrawing • 50% of students who withdrew from school never accessed college mental health services and support • 78% believe mental health training very important for faculty/staff • 22% learned about college services through faculty or staff • National Alliance on Mental Illness web-based survey August-November 2011 N=765

8. Recognizing Students in Distress • Students in mild distress may exhibit behaviors that do not disrupt others but may indicate something is wrong and that assistance is needed. • Behaviors may include: • Serious grade problems or a change from consistently passing grades to unaccountably poor performance. • Excessive absences, especially if the student has previously demonstrated consistent attendance. • Unusual or markedly changed patterns of interaction • Other characteristics that suggest the student is having trouble managing stress successfully • Adapted from University of Michigan (2008)

9. Recognizing Students in Distress • Students in moderate distress may exhibit behaviors that indicate significant emotional distress. They may also be reluctant or unable to acknowledge a need for personal help. • Behaviors include: • Repeated requests for special consideration, especially if the student appears uncomfortable or highly emotional. • New or repeated behavior which interferes with effective management of the immediate environment. • Unusual or exaggerated emotional responses that are obviously inappropriate to the situation. • Adapted from University of Michigan (2008)

10. Recognizing Students in Distress • Students in severe distress exhibit behaviors that signify a crisis and that necessitate emergency care. • Behaviors include: • Highly disruptive behavior • Inability to communicate clearly • Loss of contact with reality • Stalking behaviors. • Inappropriate communications • Overtly suicidal thoughts or threats to harm others • Adapted from University of Michigan (2008)

11. Recognizing Students In Distress • Symptoms of Depression • Persistent sadness • Feelings of hopelessness, worthlessness, guilt • Lack of motivation • Lack of enjoyment of activities or class material the person previously enjoyed • Sleep disturbance • Significant weight gain or loss • Suicidal ideation

12. Recognizing Students in Distress • Symptoms of Anxiety • Excessive worry that is difficult to control • Restlessness • Fatigue • Difficulty concentrating • Irritability • Muscle tension • Sleep disturbance • Panic attacks

13. Recognizing Students in Distress • Symptoms of Psychosis • Delusions (false beliefs) • Hallucinations (false sensory experiences) • Disorganized speech • Disorganized behavior • Flat or inappropriate affect (emotional display) • Absence of motivation • Speech disturbances • Change in hygiene and appearance

14. Recognizing Students in Distress • Counseling isn’t just for mental illness! • Time management techniques • Stress management techniques • Sleep hygiene • Balancing work/family/school • Help managing significant life events (e.g., break-ups, homesickness, roommate difficulties) • Communication and interpersonal skills • Relationship issues

15. Communicating with a Student in Distress • Move the student to a quiet and secure location • Express your concerns in behavioral, nonjudgmental terms • Be direct and specific • Avoid judging, evaluating or criticizing – respect the student’s value system even if you disagree

16. Listen attentively • Give student your undivided attention • Communicate understanding by repeating what he/she has told you • Let the student talk • Do not minimize or immediately provide reassurance • Praise student for openness and honesty

17. Remain calm and respond in a soothing manner • Validate the student’s feelings and experiences • Take the student seriously • Be supportive and express your concern about the situation

18. A Victimized Student • Recognize the student may be vulnerable and experiencing a range of intense feelings, including shame, anger, fear and denial • Believe the student • Respect the student’s right to make his/her own decision • Let the student know that you must, as a university employee, report any abuse, but it can be reported as a “Jane or John Doe” • Refer to MSUB Student in Distress Guide • www.msubillings.edu/VCSA/PDF/GuideforFacStaff-StudentBehavior.pdf

19. A Severely Disoriented or Psychotic Student • Recognize that psychotic states can involve extreme emotion or lack of emotion and intense fear to the point of paranoia • Recognize that a student in this state may be dangerous to self or others • Call Campus Police (2222) before you see the student so they can be in the area in case you need them • Alert someone else near you that you are seeing a student and may need assistance • Speak to the student in a direct and concrete manner regarding your plan for getting him/her to a safe environment

20. The Aggressive, Angry or Potentially Violent Student • Assess your level of safety – Call 911 or Campus Police at 2222 if you feel in danger (9911 if on campus) • Remain in an open area with a visible means of escape • Explain to the student the behaviors that are unacceptable

21. Stay calm and gain control of the situation by setting limits • Use a time-out strategy (that is, ask the student to reschedule a meeting with you once he/she has calmed down) if the student refuses to cooperate and remains aggressive or agitated

22. The Depressed or Suicidal Student • Let the student know you are aware he/she is feeling down and you would like to provide support and assistance • Ask the student if he/she has thoughts of suicide • Take the student’s disclosure as a serious plea for help • Express care and concern and assure the student that you will help him/her reach a professional

23. Distance Education • If any of the situations discussed here are expressed by your online students, the same communication skills apply. • The referral information, however, changes. Mental Health counseling is not available over the phone to students. • You could ask the student if they have ever seen a counselor and suggest he/she call that person • You could look online for resources in the student’s geographical area and refer them

24. Recommendations • Do not become involved with a student beyond your level of expertise or comfort • Do not ignore comments such as, “I won’t be a problem much longer” • Do not become anxious or overwhelmed yourself • Do not minimize the seriousness of the student’s behavior • Do not become defensive or get into an argument or shouting match • Do not convey judgment or criticism • Do not act hostile or punitive • Do not make assumptions

25. Referring a Student For Professional Help • WHEN TO REFER • Student remains distressed following repeated attempts by you and others to be helpful • Student becomes increasingly isolated, unkempt, irritable or disconnected • Student’s academic or social performance deteriorates • Student behavior reflects increased hopelessness or helplessness • You are doing on-going counseling rather than advising

26. How to Refer • Speak to student in direct concerned straightforward manner • Be caring but firm in recommending counseling. Be clear about reasons concerned • Be knowledgeable in advance about services and procedures of SHS Counseling or other campus agencies • Suggest student make an appointment and provide phone number for referral • Remind student that counseling is free and confidential • You may need to be more active in assisting student in making appointment, or walk them to Student Health Services

27. Student Health Services The Student Health Services provides high-quality, cost-effective health care and mental health counseling with an emphasis on health education and wellness initiatives to promote and enhance student success. Hours : • University Campus Clinic & CounselingMonday-Friday 8:00a - 5:00p 2nd Floor Petro Hall • City CollegeClinic: Mon, 1p-4:30p; Wed, 9a - 12p; Tue & Thu, 11p - 2p Tech Bldg. 2nd FloorCounseling: Mon, 9a-4p; Wed 9a-12 noon; Thu, 8a - 11a Phone: • University Campus: (406) 657-2153 • City College Phone: (406) 247-3027 www.msubillings.edu/studenthealth

28. Campus Police • For emergencies dial extension 2222 • For Billings Police emergencies and medical emergencies dial 911 (9911 if on campus) • Sign up for MSUB alertshttp://www.msubillings.edu/msubalert/ • www.msubillings.edu/police/

29. TRIO and SOS • Provides academic support and individualized assistance to first generation, low income or students with disabilities • Services include: Peer mentoring, study groups/tutors, access to cultural events, workshops, financial information, counseling and referral, midterm evaluations, newsletters, assistance in graduation preparation, return to learn and SOS activity club • Student Opportunity Services/TRIOLibrary, LI 141 • Phone: (406) 657-2162Fax: (406) 657-1667Office Hours: 8:00 am to 5:00 pm M-F • www.msubillings.edu/sos/

30. ASC – Academic Support Center • Offers classes in reading, developmental math and developmental reading • Tutoring for math, writing, reading, science, psychology and foreign languages • Services are FREE (prepaid in tuition) • University ASC front desk 657-1641 • City College ASC front desk 247-3022 • www.msubillings.edu/asc/

31. DSS – Disability Support Services • Works with issues related to physical access and issues related to course content • Accessible technology • 4 testing rooms • DSS does not offer tutoring, mental health counseling, financial assistance, personal care attendants or mobility equipment • DSS cannot by law contact a student but you can refer • College of Education Room 135657-2161 • City College Room A008 247-3029 • www.msubillings.edu/dss/

32. Managing Student Requests & Situations—Some Key Components • Location • Safety • Thorough Assessment • Problem Solving • Referral • Clear Communication • Avoid Judgment • Boundaries & Competence • Active Listening & Validation • Supports/Consultation • TAKE CARE OF YOURSELF!

33. Unconfirmed Diagnosis • “I think I’m bipolar.” • “I’m pretty sure I have ADHD.” • “I have test anxiety.” • Think about student welfare • Take them seriously – refer them for diagnosis & treatment • Win-win • Let them know about DSS & other supportive programs

34. Refusal to Work with Medical/ Mental Health • “They don’t understand me.” • “They say I’m faking it.” • Any accommodation should go through some path (e.g., SHS, DSS, etc.) • Acknowledge & validate fears/concerns • Encourage referral

35. Excessive Requests • “Can I do a special study session with you instead of the TA?” • “Will you change my grade for the last exam? My bipolar was really acting up that day.” • “My social anxiety is really bad. Can I skip the required presentation for this class?”

36. Excessive Requests (Continued) • Here are some UNreasonable accommodations: • Anything that poses a threat to health/safety of others • Substantial change in essential element of curriculum (e.g., dropping presentation requirement for speech course) • Altering course objectives (e.g., waiving the writing element of a course) • Undue financial/administrative burden to institution

37. For Additional Assistance • Student Health Services Mental Health Counselors657-2153 • Linda Crummett • Judy Silverman • Amber McDermott (also in Dept of Rehab & Human Services) • Kim Waldmann • Department of Psychology657-2242 or 657-2250 (direct #) • Marie Schaaf Gallagher

38. Resources • Helping Students in Distress--A Faculty and Staff Guide for Assisting Students in Need • University of Maryland Counseling Center • http://www.cte.umd.edu/HSID.pdf • Reaching Out Resources for Responding to Students in Distress • Boise State University Health and Recreation Counseling Services • http://healthservices.boisestate.edu/resources/materials/reachingOutHandbook.pdf • Student in Distress and Sexual Harassment: A Guide for Faculty and Staff • MSU Billings • http://www.msubillings.edu/VCSA/PDF/GuideforFacStaff-StudentBehavior.pdf • National Alliance on Mental Illness web-based survey August-November 2011 N=765 http://www.nami.org/Content/NavigationMenu/Find_Support/NAMI_on_Campus1/NAMI_Survey_on_College_Students/collegereport.pdf

39. Discussion: • Other Student Requests/Situations?