Best Practices in Accommodating Students with Significant Mental Health Disabilities

1. Best Practices in Accommodating Students with Significant Mental Health Disabilities Enid Weiner, MSW, RSW, Ed.D. April 2012

2. WHO ARE THESE STUDENTS? • Clinical Depression • Anxiety Disorders: generalized anxiety disorders (social anxiety, phobias, panic attacks, obsessive compulsive disorder, PTSD) • Bi-polar disorder • Schizophrenia/thought disorders • Eating Disorders • Personality disorders • Addictions

3. UNIQUE CHARACTERISTICS • Episodic nature of disability • One of the most stigmatized populations • Wide age range • Needing academic accommodations even when in recovery • Heightened sensitivity • Motivation • Class participation and oral presentations • More frequent requests for deferrals • Tend to petition more often

4. IMPACT ON LEARNING • Disability affects: • Concentration, focus, attention, processing and retention of information, pace of learning, perception of social cues, judgment and insight • Require academic accommodations to level the playing field • Often do better with reduced course load

5. PURPOSE OF ACADEMIC ACCOMMODATIONS • Take into account nature and severity of the disability • Accommodations need to uphold academic standards and maintain the integrity of the program and course curriculum/core objectives. • To put students on a level playing field • Should not be viewed as an unfair advantage

6. ACADEMIC ACCOMMODATIONS • Treating students equitably is different from treating them equally • Individualized • Negotiable • Subject to change • Reasonable • Confidentiality maintained

7. COURSE ACCOMMODATIONS • Treating individuals with dignity and respect • Accommodation letters to instructors • Flexibility around deadlines • Flexibility around attendance and class/tutorial/group participation • Seating • Tape recording of lectures (LiveScribe)

8. COURSE ACCOMMODATIONS • Alternate forms of evaluation (written assignment in lieu of oral presentation) • Priority enrolment to access course material early, or take classes at times best suited to medication regime and sleep patterns • Universal Instructional Design

9. COURSE ACCOMMODATIONS • Being flexible, approachable, not interrogating and making assumptions, having expectations and finding a balance between being too harsh and too lenient • Not asking for diagnosis • Challenges: • Request for take home exams • Memory aids • Undue absences

10. COURSE ACCOMMODATIONS • Understanding why student makes accommodation requests late • Understanding how disability affects learning • Thinking outside the box • Individual gains and progress should be acknowledged • Maintain sensitivity – model it and expect it on your classroom

11. COURSE ACCOMMODATIONS • Exam accommodations • Extra time • Separate room • Chunking of exams • Spacing of exams • Access to assistive technology • Access to reader/scribe • Dictionary (when approved) • Memory aids • Rescheduling of test or exams

12. PRACTICUM ACCOMMODATIONS • Workplace issues • Core requirements of the job • Important to have initial meeting with Practicum Supervisor at the beginning of the placement • Important to keep communication open

13. IMPORTANCE OF SELF-ADVOCACY • Benefits of identifying with disability office • Having an advocate who knows services, policies and supports • Learning skills of self-advocacy • Someone familiar with educational policies, practices and procedures and on-campus and off-campus resources • Meeting peers • Communicating their needs

14. TIPS FOR TRANSITIONING • Visit disability web-sites with student in your office • Invite someone from disability office to meet with students/staff/parents at your school • Bring students onto campus for an orientation to meet with staff and self-identified students • Help students understand how their mental health disability impacts on their learning • Empower students to apply to university • Encourage students to start with a reduced course load

15. CASE STUDY: Supporting a student with a mood disorder • Demographics and Family History • J is 29 yr old Caucasian male • Separated (1 ½ yrs) • Father of young daughter who is living with her mom • Student’s parents are retired (both had been in field of education)

16. MEDICAL HISTORY • Diagnosed with bi-polar disorder at age 23 • Prescribed mood stabilizer • Numerous hospitalizations since initial diagnosis • Recently discharged from last stay in hospital

17. ACADEMIC ACCOMMODATIONS • Intake appointment with MHDS in August 2006 • Father attended appointment • Offered peer support • mature male mentor who is part of MHDS • Exam accommodations introduced • 33% extra time • Reduced course load advised • from 3 ½ to 3 courses

18. ACADEMIC PROGRESS • Grades earned for Fall/Winter 2006/2007 • B’s and B+ • Summer 2007 term = C+ • Returned Fall of 2007 • Academic accommodations adjusted (50% extra time & individual room) • Additional supports through BSWD for tutoring and community counselling

19. ACADEMIC PROGRESS – Fall 2007 • J reported having difficulty with anti-psychotic medication (e.g., sedation) • Hospitalized most of month of October 2007 • Dropped a course before academic deadline • Sought support of disability counsellor regarding feasibility of returning to school

20. ACADEMIC PROGRESS – Fall 2007 • J made decision to return to school gradually • Moved into campus housing for mature students early November • Medication dosage changed (lithium & resperidol) • J decided to drop a course • Remained in two courses

21. ACADEMIC SUPPORT – Fall 2007 • Due to financial constraints and disability status J received CPP • Early December J reported feeling depressed • Stated that residence was lonely - missed family • Moved home during Christmas break • Dropped another course (now enrolled in one course)

22. ACADEMIC SUPPORT - 2007/2008 • End of 2007/08 academic year – J reported symptoms more stable • Received a B+ in the one completed course • J stated he would return to studies in the Fall 2008 • Returned for 2008/2009 academic year

23. ACADEMIC SUPPORT - 2008/2009 • University strike began early November 2008 • no classes for four months • Disability counsellor did not hear from J • March 2009 – disability counsellor received an email from student’s mother indicating J only attended a few classes in September 2008

24. MENTAL HEALTH RELAPSE • Mother reported that J disappeared in November 2008 • Symptoms increased • had become manic • Medication stopped • Lived in shelters • January 2009 – homeless, living on streets

25. MENTAL HEALTH RELAPSE • During cold weather J entered a home to keep warm, eat and take a shower • J was charged with break and enter • Arrested and sentenced for 6 months • Released after 6 months • Additional supports: probation officer and ACT team

26. RETURN TO SCHOOL – 2009/2010 • J returned to university Fall/Winter 2009/2010 • Took a reduced course load (two courses) • Changed academic major • Excellent feedback from faculty regarding academic performance • Grades earned = A and B

27. SUMMER 2010 • J decided to take summer off from school • Decided to live independently • Moved to off-campus housing with mature room mates – 5 minute walk to campus • Reported feeling positive and excited about the move

28. SUMMER 2010 • J discharged from ACTT program outside of catchment area) • Continued to receive support from previous psychiatrist (40 km from the university) • End of June 2010 email from mother that J had gone from “wonderful” to “in urgent need of care” • J agreed to go to hospital to see the psychiatrist

29. SUMMER 2010 • J voluntarily brought himself to hospital on a Sunday evening but not kept in hospital as no psychiatrist was on-duty • Ended up in hospital against his will • discharged on technicality • Eventually hospitalized for 5 months • Lived in supported housing and received community support • No immediate plans to return to school

30. REFLECTIONS AND DISCUSSION • It takes time to know a student and the subtleties of their illness, coping strategies and modus operandi • The episodic nature of the disabilities the students live with makes it difficult for them to predict the frequency and severity of symptoms • Set-backs and relapses are a natural part of the recovery process