Supporting a Student Through a Mental Health Crisis

1. Supporting a Student Through a Mental Health Crisis NAFSA: Association of International Educators Region X 2011 Conference The Sagamore at Bolton Landing, N.Y.

2. PRESENTERS • Ellen Badger, Binghamton University ebadger@binghamton.edu • Elaine del Rossi, HTH Worldwide Insurance edelrossi@hthworldwide.com • Brendan O’Brien, Cornell University bpo1@cornell.edu • CHAIR: Patricia Burak, Syracuse University paburak@syr.edu

3. Case Study I ACT I You receive a call from a faculty advisor reporting that a student from country X has been acting strangely: not showing up in the lab, reporting that people have been following her, and not responding to e-mails and phone calls.

4. The professor states that he has research that must get done, and he “can’t deal with her.”   He wants you to make arrangements so that she will go home immediately.

5. First Questions • What additional information do you need? • Who else do you contact? • Is there a Crisis Team/protocol on campus which needs to be contacted? • What do you do?

6. ACT II • The student does not respond to your numerous phone calls and e-mail messages.  facebook • Now what do you do?

7. ACT III • You (and partners) make contact with the student.  You visit her at her apartment and she says “I am fine, go away.” • Do you stop there?

8. ACT IV • After further engagement, the student begins to open up and explains that she is fine but there are a number of people who are following her and she thinks that her apartment is the only place that is safe.

9. ACT V • Somehow you are successful in getting the student connected with the mental health authorities.  She is admitted to the hospital.

10. ACT VI • After 24 hours in the hospital, you check on the student.  She says “this place is for crazy people, I am not crazy, please get me out of here now!”

11. ACT VII • 72 hours later, unbeknownst to you, the hospital has released her because it is determined that she is not an immediate threat to herself or others and therefore she cannot be held against her will.  The student has returned to the lab and is accusing numerous people of plotting to make her look crazy and then kill her. 

12. The professor is furious that she has returned.  The other students in the lab are equally furious……….several of their parents have called the President’s Office saying they need to be protected and the university is “setting them up for another Virginia Tech.”

13. Now what do you do? • What processes need to be in place? • Who else needs to be involved?

14. ACT VIII • The calls to the President’s Office and the irate professor have gotten peoples’ attention.   The academic authorities have placed the student on an academic leave and the University Police have issued a “persona non grata” ruling so that she is not allowed on campus at the present time.   

15. You have been instructed by the Vice-President “to make arrangements to get this student home.”  Everybody thinks the case is closed……… • Is the case closed?

16. ACT IX • You were successful in making your partners around the university understand that this is a very difficult transition period for the student and she will need assistance in planning her immediate future.  You, the department chair, a counselor from the health service, and a representative from Police agree that a meeting should be held.

17. At this meeting, she will be informed that her that she will be going on an academic/health leave and she will not be allowed on campus.  You reach her on her cell phone and inform her of the time and place of the meeting.  She promises to come.

18. The time for the meeting arrives and she does not show up.  You wait 10 minutes, call her cell phone, but there is no response.

19. ACT X • The same cast of characters agree to visit the student’s apartment to have a meeting and deliver the news.  She reluctantly agrees to let you into her apartment.  She apologizes for the mess and offers everyone tea.  She says she is fine and people don’t need to worry about her. 

20. But upon hearing the news about her leave and her status at the university, she refuses to accept the decisions.  She states that she will take her case to “the proper university authorities” and politely asks everyone to leave.

21. ACT XI • You go home concerned and tired…………you open your computer in the evening to try and catch up on all the business of the day which came in while you were out of the office.  Four students are stranded without immigration documents while travelling, five students need assistance with OPT issues, you know the story…..

22. You respond as best you can, finish up at midnight, and go to bed.  • You just fall into a deep sleep when the phone rings at 1:47am.  The university police are responding to an emergency call – the student has made an attempt on her life. 

23. The officer on the phone said he thought “you were taking care of this situation.”  He wants you to come to the scene.

24. ACT XII • You go back to sleep.   • Your alarm goes off at 6:15am and you don’t feel like moving.

25. ACT XIII • You pull yourself out of bed and get organized.  After a few phone calls and e-mails, you learn that the student was taken to the hospital for a psychiatric evaluation at 3:09am.  The police can’t provide any additional information.

26. ACT XIV • You call the hospital psychiatric unit and the staff person states that he cannot tell you whether the student is there or not. • HIPPA factor?

27. ACT XV • After some negotiation, you are able to confirm that the student was admitted to the psychiatric unit and is still there.   The student agrees to meet with you, a member of your university counseling staff, and the hospital staff.

28. At the meeting, the student informs you that there is no way she can go home now because she would be ashamed to return without a degree and “her father would kill her.” • She says she just wants to leave the hospital and go back to her apartment.

29. ACT XVI • Throughout your meeting, your cell phone has been vibrating.  You think there might be an emergency as you notice the Vice-President has tried to call you four times.  You call back and the VP’s assistant says that the VP “heard about the suicide attempt; he thought everything was taken care of, and wants information. 

30. ACT XVII • You refocus your attention back to the meeting with the student and begin to explore the possibility that the student may remain in her apartment on a health leave.  Two large challenges: the student’s funding will end if she is no longer a registered student, and the university counseling service will not provide services to non-registered students.

31. What other challenges are there? • Who else might be helpful? • What do you do?  

32. If this story ends tragically, will you be blamed?  Will you blame yourself?  What support or coping mechanisms would be helpful?

33. CASE STUDY IIIntroduction When someone suffers from depression, what are the kinds of behavior and emotions that you might expect that person to present?

34. CASE STUDY II • You are the director of the international student office at your school. You are notified by University Police that an international graduate student has been arrested in the municipality where his wife lives (his wife is an international student at another US school).

35. The student had attempted suicide by taking pills two days earlier, despondent over having lost his department funding. His wife had discovered him and called 911.

36. He was hospitalized, kept in the hospital for observation for 48 hours, and then released. He and his wife returned to her apartment. Within a few hours of his release, he chased his wife out of her apartment (in the middle of winter) attempting to attack her with a 7 inch meat cleaver. He was angry with his wife for saving his life when he felt he had nothing left to live for.

37. He has been charged with several crimes, including assault, menacing, criminal possession of a weapon, and criminal mischief.

38. What do you do? • How should you respond? Who should you be talking to? • What do you need to know about the victim? • What do you need to know about the student?

39. Who arranges for legal representation? • Should you be concerned about consular notification? http://travel.state.gov/law/consular/consular_753.html • Letter to student?

40. Does the arrest trigger any university police action? • Does the arrest trigger any student code of conduct proceeding?

41. BU Code of Student Conduct: “The University will not, as a matter of general practice, pursue alleged off- campus student misconduct. However, in those exceptional cases that endanger the personal safety or property of members of the University community or others, action may be taken in accordance with the Code of Student Conduct.

42. The University will use the following criteria in deciding when to take action for violations of the Code of Student Conduct that occur off campus when there is sufficient information available to conduct a hearing and when: • a. The incident involves endangering behavior (defined as violent assault, rape,

43. arson, distribution of illegal drugs or other serious offenses that constitute a • threat to the personal safety of others); and/or • b. There has been significant loss of or damage to property; and/or • c. Alcoholic beverages are sold or made available to underage persons; and/or • d. Hazing (as defined in Section II #15)”

44. D. Summary Action (Summary Suspension) “Pending final action on a charge (including the appeal process), the status of the student is not altered, unless the continued presence of the students would constitute a clear and present danger to themselves, to the safety of others or to the property of the University.

45. Summary action may include loss of contact with individuals, denial of access to facilities or suspension from the University pending the outcome of a student conduct board hearing.”

46. When the continued presence of the student on campus is deemed to constitute a clear and present danger to himself or herself, to the safety of others or to the property of the University, summary action may be taken by the assistant vice president for student life or designee.

47. The director of the Office of Student Conduct will consult the dean of students or designee, who will determine if student conduct action is warranted under these circumstances.

48. Does the Summary Suspension Trigger a SEVIS Reporting Requirement? Letter to student?

49. Does the arrest trigger any SEVIS reporting? Does this apply? 8 CFR 214.3 (g) (ii) Schools are also required to report within 21 days any change of the information contained in paragraph (g)(1) or the occurrence of the following events: (D) Any disciplinary action taken by the school against the student as a result of the student being convicted of a crime

50. Act II • You are contacted by the following offices/individuals: • Your school’s university police • Faculty in the student’s department • Incident Team/Crisis Team/Students of Concern Team • Your school’s Dean of Students