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Help Students with Mental Illness Success in Campus

Help Students with Mental Illness Success in Campus. ChunLin J. Ju, Psy.D. November 28, 2007. Instructor: 朱春林博士 ChunLin J. Ju, Psy.D. 學 歷：佛瑞斯特專業心理學院臨床心理博士班畢業 (Doctorate in clinical psychology in Forest Institute of Professional Psychology, MO, USA)

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Help Students with Mental Illness Success in Campus

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  1. Help Students with Mental Illness Success in Campus ChunLin J. Ju, Psy.D. November 28, 2007.

  2. Instructor: 朱春林博士ChunLin J. Ju, Psy.D. 學 歷：佛瑞斯特專業心理學院臨床心理博士班畢業 (Doctorate in clinical psychology in Forest Institute of Professional Psychology, MO, USA) 執 照：臨床心理師 (心理字第000651號)(Licensed Clinical Psychologist) 現 職：臨床心理諮詢顧問、督導 新竹教育大學教育心理暨諮商心理系／所兼任助理教授 清華大學學生諮商中心兼任臨床心理師 興 趣：兒青心理病理、注意力缺陷與過動症、適應障礙、自閉症、妥瑞氏症、焦慮 症、憂鬱症、躁鬱症、人格疾患、心理諮詢、心理治療、心理衡鑑、專業倫 理、遊戲治療、砂盤治療、催眠、哀傷諮商、女性主義、談判協商、性／別／ 性取向議題 經 歷：西肯塔基州立精神病院 (Doctoral Intern, Western State Hospital, KY, USA) 培尼羅伊心理健康中心兒青診所、成人診所 (Doctoral Intern, Pennyroyal Mental Health Center, Children’s Clinic, Adult Clinic, KY, USA) 佛瑞斯特學院診所 (Psychological Trainee, Forest Institute Clinic, MO, USA) 交通大學學生諮商中心、台積電、世界先進、外貿協會特約心理治療師 青輔會、北市勞工局特約生涯諮商師 新竹教育大學、文化大學、與多所企業講師 聯 絡：(02)2215-4092 junoju@hotmail.com Dr. Juno Ju

  3. Topics Covered • Introduction of mental illness • Common mental disorders in campus • Accommodation to special needs of these students • Q&A • Goals: • Identify the signs of individuals in distress • Take the appropriate steps to get help Dr. Juno Ju

  4. What is Mental Illness? • Mental illness is a term that refers collectively to all diagnosable mental disorders causing severe disturbances in thinking, feeling, relating and functional behaviors • These disorders result in substantially diminished capacity for coping with the ordinary demands of life Dr. Juno Ju

  5. What is Mental Health? (cont’d) • 精神衛生法第三條： • 精神疾病係指個體的思考、情緒、知覺和認知等精神狀態異常，致使適應生活的功能發生障礙，而需要醫療與照顧的疾病，包括精神病、精神官能症、酒癮和藥癮等衛生主管機關認定之精神疾病。 • 精神疾病 = 心理疾病 Dr. Juno Ju

  6. Well Adjusted Reasonably worry-free Can handle the usual daily tensions and crises of living which may involve moments of fear, anxiety, distrust, depression Mentally Ill Frequently and severely worry-bound Tends to exaggerate these same thoughts and feelings of fear, anger, anxiety, distrust and depression What is Mental Health? (cont’d) Dr. Juno Ju

  7. Mental Illness Can be temporary Occurs most often n early adult and middle years Does not necessarily interfere with strictly intellectual abilities Often can be cured by counseling, medication, surgery Mental Retardation Is usually lifelong condition Occurs at or near birth and almost always recognized by school age Is characterized by impaired intellectual development Treatment through therapy but not cured Therapeutic Recreation Dr. Juno Ju

  8. Prevalence • Mild mental illness conditions are common • 1/5 of Americans experience some diagnosable mental disorder during any given year • Anxiety disorders are most common • Depression affects 1 in 10 adults • 3% experience severe and persistent mental illness ( American Psychiatric Association, 2005) Dr. Juno Ju

  9. Signs of Problems • Extremely poor academic performance, or a change from high to low grades • Excessive absences, especially if prior class attendance was good • Unusual or noticeably changed interaction patterns in the classroom • Depressed or apathetic mood, excessive activity or talkativeness, evidence of crying • Noticeable change in appearance and hygiene • Alcohol on the breath/problem drinking patterns • Inability to remain awake in class • Repeated attempts to obtain deadline extensions or postpone tests Dr. Juno Ju

  10. Signs of Problems (cont’d) • New or continuous behavior which disrupts class or student interactions • Inappropriate or exaggerated emotional reactions to situations, including a lack of emotional response to stressful events • Seeking help from multiple other parties instead of counseling professionals • Violent or other extremely disruptive behavior • Obvious loss of contact with reality • Disturbed speech or communication content • Suicidal or other self-destructive thoughts or actions • Homicidal threats • Marked personality change Dr. Juno Ju

  11. Depression • Mood disorder • Depressed mood or loss of interest/pleasure over long period: • 2 weeks vs. 2 years • Emotional: • Depressed, anhedonia • Somatic: • Appetite, weight, sleep, sexual, energy disturbance • Behavioral: • Psychomotor agitation/retardation • Cognitive: • Distraction, indecisive, low self-esteem, guilty, worthless, suicidal Dr. Juno Ju

  12. Bipolar Disorders • Mood disorder • Mania + depression • 10-15% completed suicide • Mania: • Grandiose, euphoric, elevated, expansive, or irritable mood lasts for one week vs. four days • Mood: • as above • Somatic: • Abnormal sleep and energy • Behavioral: • Pressure of speech, goal-directed or pleasurable activities • Cognitive: • Flight of ideas, distractibility Dr. Juno Ju

  13. Bipolar Disorders (cont’d) • Bipolar vs. Schizophrenia: • Variability of content • Dramatic response to mood regulators • 3-generation family history for mood disorder • Bipolar vs. ADHD: • Most manic kids meet ADHD criteria • 20% of those with ADHD symptoms meet mania criteria Dr. Juno Ju

  14. Suicide • The 2nd leading cause of death for college students is suicide(Jed Foundation, 2005) • One out of every 12 college students has made a suicide plan (Mental Health America [Formerly known as National Mental Health Association], 2007) Dr. Juno Ju

  15. Danger Signals for Suicide Risk • Talking about death or suicide • Feelings of hopelessness • Withdrawing from friends and social activities • Taking unnecessary or life-threatening risks • Giving away personal possessions • Losing interest in personal appearance • Increasing use of alcohol or [other] drugs • Having attempted suicide in the past, however half-heartedly (Kadison & DiGeronimo, 2004) Dr. Juno Ju

  16. Anxiety Disorders • Generalized Anxiety Disorder • Excessive worry in general • Obsessive-Compulsive Disorder • Consuming fixation and ritualistic behaviors • Panic Disorder • Overwhelming physiological event • Social Phobias • Incapacitating fear of social interactions • Specific Phobias • Intense fear of specific object, event Dr. Juno Ju

  17. Post Traumatic Stress Disorder • Anxiety Disorder • Exposure to traumatic event • reexperience: Flashbacks • Passively avoiding reminders: Numbing of affect, dissociative amnesia • Heightened general arousal • Duration of disturbance: One month Dr. Juno Ju

  18. Attention-Deficit/Hyperactivity Disorders (ADHD) • Inattention • Hyperactivity • Impulsivity • Age of onset: Before 7 years • Symptoms last for at least 6 months • Seen in two or more settings • 70% of childhood cases persist into adolescence and 65% of adolescent cases persist into adulthood, although some symptoms may improve/change (Barkley et al., 2004) Dr. Juno Ju

  19. Tic Disorders • Tics: Sudden, brief, involuntary or semi-voluntary movements (motor tics) or sounds (vocal tics) • Tourette’s Disorder: • Both multiple motor and one or more vocal tics • Onset before age 18 years Dr. Juno Ju

  20. Schizophrenia • Most serious mental illness • Active-phase symptoms: One month • Thought disorganization: Delusions, hallucinations • Speech disorganization: Incoherence, derailment, • Behavioral disorganization: Catatonic, bizarre, • Negative symptoms: Anhedonia, flat of affect, alogia, avolition, associality • Social/Occupational dysfunction • Duration of disturbance: 6 months Dr. Juno Ju

  21. Personality Traits or Disorders • Inflexible and pervasive enduring pattern of inner experience and behavior in: • Cognition, affectivity, interpersonal functioning, impulse control • No particular psychosis or suffering and usually normal behavior, but can result in anti-social acts without sense of guilt • E.g., Borderline Personality Didorder Dr. Juno Ju

  22. Relationship Violence • Violence against women on college campuses is widespread(B. Fisher, F. Cullen, M. Turner, 2000) • The highest rates of relationship violence are among women 16-24 years of age(U.S. Department of Justice, Office of Justice Programs, 2001) • 13% of surveyed students reported experiencing an emotionally abusive relationship the last school year(American College Health Association, National College Health Assessment, 2006) • Over half of all stalking victims are 18-29 years(U.S. Department of Justice, Office of Justice Programs, 1998) • Midwest University Study: The number of students seen in response to sexual assault quadrupled(Kansas State University Study (1989-2001) of 13,257 students, cited in: Benton, Robertson, Tseng, Newton, & Benton, 2003, p. 69) Dr. Juno Ju

  23. Functional Limitations of Mental Illness • Screening out environmental Stimuli • Sustaining concentration • Maintaining stamina • Handling time pressures and multi-tasks • Interacting with others • Fear of authority figures • Responding to negative feedback • Responding to change • Severe test anxiety Dr. Juno Ju

  24. Causes of Mental Illness • Heredity • Psychological • Physical • Environment Dr. Juno Ju

  25. Treatment of Mental Illness • How • Psychotherapy: Individual or group • Milieu therapy: Environmental change • Medical treatment: Drug therapy • Who • Psychiatrists, clinical psychologists • Where • Mental hospitals, private practice, mental health clinics, health centers, general hospitals, campus counseling centers Dr. Juno Ju

  26. Medication • Take much longer time to take effect • Side effects: • Nausea • Drowsiness • Fatigue • Excessive thirst • Blurred vision • Hand tremors • Initiating Interpersonal contact • Loss of appetite, sexual interest • Weight gain Dr. Juno Ju

  27. Steps In Responding

  28. Steps In Responding • Recognize signs • Assess impact • Identify strategies to assist • Refer Dr. Juno Ju

  29. When to Refer (professional staff) • A student asks for help with a problem outside of your realm of expertise • The student feels uncomfortable talking to you about the problem • What you have done so far, has not sufficiently helped reduce the problem • The student’s behavior is disrupting others • Helping the student could represent a conflict of interest or dual relationship • You are having a strong emotional reaction to the student’s situation • You are extremely busy or stressed, or unable help Dr. Juno Ju

  30. How to Refer • Talk to the student in private • Express concern, while being specific • Listen empathically • Remain neutral • Suggest that it would be helpful to talk to a trained professional at the Counseling Center • Have the student call to schedule an appointment from your office • Demystify and de-stigmatize counseling • Call a psychologist or counselor to consult • Obtain emergency help via Campus Safety if there is a threat of danger or harm • Follow up with the student to find out if he/she kept the appointment Dr. Juno Ju

  31. Accommodation Removalof Barriers to Participation

  32. The emphasis is on ACCESS,NOT on outcome Dr. Juno Ju

  33. Laws Requiring Reasonable Accommodations • 1973 Rehabilitation Act, Section 504 • 1990 Americans with Disabilities Act Dr. Juno Ju

  34. Principles of Accommodation • Address individual needs • Respect student’s desire for confidentiality • Engage in joint problem solving • Make all accommodations voluntary • Review accommodations periodically • Be flexible in enforcing policies • Identify accommodations clearly Dr. Juno Ju

  35. Accommodations Are NOT Reasonable if They... • Pose a direct threat to the health or safety of others • Make substantial changes in essential elements of the curriculum • Require substantial alteration to educational opportunities/course objectives • Pose undue financial or administrative burden Dr. Juno Ju

  36. Strategies for Inclusion in College • Teach to various learning styles: Visual, auditory, kinesthetic • Increase experiential learning activities • Increase knowledge and acceptance of mental illness • Be prepared to set behavioral limits • Know campus mental health resources • Work cooperatively with students • Assist students with time management Dr. Juno Ju

  37. Possible Classroom Accommodations • Preferential seating, near door • Assigned classmate as assistant • Beverages permitted • Prearranged or frequent breaks • Tape recorder, note taker • Early availability of syllabus, text • Text, assignments in alternate formats • Personal and private feedback Dr. Juno Ju

  38. Possible Examination Accommodations • Change in test format: Written to oral and vise versa, dictation, scripted, typed • Permit use of computer software • Exams in alternate format: Portfolio, demo • Extended test taking time • Individual proctoring • Separate, quiet room for testing • Increased test frequency Dr. Juno Ju

  39. Possible Assignment Accommodations • Substitute assignments in specific circumstances • Advance notice of assignments • Allow assignments hand written • Written rather than oral, or vise versa • Change format: Drama, role-play, sculpture • Assignment assistance: Ask • Extensions on assignments Dr. Juno Ju

  40. Campus Safety

  41. Campus Safety • All colleges must guarantee learning environments that are safe and secure • Student mental health emergencies may bring unrest and harm to the student in distress, other students,and faculty/staff/administration • College educators are mandated reporters for child abuse • Examples: Suicide attempts, incidents of stalking, sexual assault, domestic violence, and substance abuse Dr. Juno Ju

  42. Behavioral Issues & Student Conduct • All students must abide by the student code of conduct • Perform behavioral assessment to determine if a student is in emotional crisis, is responding to a real-life crisis situation or is being disruptive • Identify and refer those in emotional distress to a mental health professional • Identify and refer those who are just “acting out” to campus disciplinarian • Involve police when safety is threatened Dr. Juno Ju

  43. Mandatory Hospitalization • 精神衛生法第21條： • 嚴重病人如有明顯傷害他人或自己之虞，或有傷害行為時，經專科醫師診斷有全日住院治療之必要者，前往精神醫療機構辦理住院 • 前項嚴重病人不接受全日住院治療時，應由兩位以上專科醫師鑑定，經書面證明有全日住院治療之必要者，應強制其住院；其強制住院，應在中央衛生主管機關指定之精神醫療機構為之。 • 前項鑑定，以全日住院方式為之者，其住院鑑定期限，以七日為限 • 強制住院治療需要有合作的精神專科醫院，並通知當地衛生主管機關 Dr. Juno Ju

  44. Concluding Remarks

  45. Concluding Remarks • It is critical to develop a campus-wide cultural climate that de-stigmatizes mental illness, removes barriers,and encourages help-seeking behavior • Sensitivity and awareness training is imperative for administrators, faculty, staff,and student workers Dr. Juno Ju

  46. Concluding Remarks (cont’d) • Interventions aim at: • Supporting student success • Assisting in protecting the health, safety, and welfare of the students and members of the campus community Dr. Juno Ju

  47. Reference • ADA: American Disability Association • Anxiety Disorder Association of America (http://www.adaa.org/) • AHEAD (http://www.ahead.org) • Al Souma. Accommodating students with psychiatric disabilities. Disability Support Services. Seattle Central Community College. DO-IT, University of Washington • Center for Psychiatric Rehabilitation Sargent College of Health and Rehabilitation Sciences (http://WEB.bu.edu/sarpsych) • DO-IT The Faculty Room (http://www.washington.edu/doit/faculty/) • Judge Bazelon Center for Mental Health Law (http://www.bazelon.org/) • Office of Civil Rights: Region 10 • National Alliance for the Mentally ill (NAMI) (http://www.nami.org) • National Institute of Mental Health (http://www.nimh.nih.gov/) Dr. Juno Ju

  48. Q & A

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