Student Mental Health Student Mental Health Issues: Trends and StrategiesIssues: Trends and Strategies
John H. Dunkle, Ph.D., Executive Director, Counseling & Psychological
ServicesNorthwestern University
SSAO Track, NASPA IV-East Regional Conference, Lombard, IL. Monday, November 9, 2009
ObjectivesObjectives
Overview of trends in college student mental health issues and the psychological climate in higher education.
An overview of a model for dealing with students who are disruptive and who have mental health concerns.
A discussion of the importance of reflection and self-care for staff in managing crisis situations.
The Context: A Tipping The Context: A Tipping Point?*Point?*Generational issuesHigh numbers of students
seeking mental health servicesHigh profile casesVarious state and federal lawsVirginia Tech and Northern
IllinoisVirginia Tech Report
*Gladwell (2002)
Continuum of Level of Severity of Continuum of Level of Severity of Counseling Centers: % of Students Counseling Centers: % of Students and Time/Resourcesand Time/Resources
Level of Severity
LowRelatively healthyNormal dev. issues
ModerateAcute crisesMod. mental health issues
HighSevere mental health issueCo-morbidity
% ofStudents/Time and Resources
= % of Students
= % of Time/Resources
0
100
Level of Severity
LowRelatively healthyNormal dev. issues
ModerateAcute crisesMod. mental health issues
HighSevere mental health issueCo-morbidity
% ofStudents/Time and Resources
= % of Students= % of Time/Resources
0
100
Services
Outreach
Intervention
Consultation
Educational programsWorkshopsStudent learning
Gatekeeper Training: e.g., QPRMental Health Screening Days
Brief Therapy ModelsGroup Therapy Models
Crisis intervention services: on-callLonger-term servicesPsychiatric servicesOff-campus referralsMandated assessments/treatment
Liaison systemsThreat Assessment TeamsCrisis debriefings
Other issues to considerOther issues to consider• Systems involvement: generally increase
with increasing severity (takes a great deal of time for center staff to coordinate and need to be skilled at consultation).
• Interventions along the continuum of severity: outreach/educational programming, assessment, individual therapy, group therapy, crisis intervention, psychiatric services, mandated assessments/treatment, medical withdrawals, long term and intensive treatment options, hospitalization
Psychological Climate in Psychological Climate in Higher EducationHigher Education
95% of counseling center directors report students with significant psychological concerns continue to be a major problem on their campuses (Gallagher, 2008)
Wide-reaching impact affects entire university community
Faculty and staff need opportunities for self-care
Psychological Climate in Psychological Climate in Higher EducationHigher Education
Psychological disorders and mental or emotional distress are not an excuse for disruptive behavior in an academic setting
Psychological disorders do not always cause disruptive behavior
Most Concerning Student Most Concerning Student IssuesIssuesViolence toward othersSuicideSubstance use: Alcohol, prescription
drug abuseEating DisordersOther Major Mental Illness: Bipolar
Disorders, Major Depressive Disorders, Psychotic episodes, Post-Traumatic Stress Disorder (Returning Veterans), Asperger’s Syndrome
Amount of DistressAmount of DistressMild Distress - not disruptive to others
◦ Major change in academic work, attendance, appearance
◦ Referral to Counseling Center likely sufficient
Moderate Distress - is disruptive to others◦ Unusual or exaggerated emotional response◦ May involve Public Safety
High Distress - very disruptive to others◦ Overtly suicidal thoughts, homicidal threats◦ Will involve Public Safety
Depression / SuicideDepression / Suicide
Signs: Slow speech, crying, decreased interest and motivation, low energy, disturbing writings of non-fictional nature
What to do: ◦Take the issue seriously◦Listen◦Express your concerns directly to the
student◦Make the appropriate referral
Angry and Upset StudentsAngry and Upset StudentsWhat to do:
◦Respect personal space◦Find a quiet area to speak in private,
if you feel comfortable◦Keep your voice soft and slower than
normal◦Seek clarification of the problem◦Try to see the problem from the
student’s perspective◦Be mindful of your sense of safety
Substance UseSubstance UseSigns: Falling asleep in class, mood
swings, inappropriate clothing, deterioration of appearance
What to do:◦Express your care and concern
directly to the student◦Be well informed about alcohol and
other drugs◦Avoid being judgmental◦Make the appropriate referral
Trauma-Related StressTrauma-Related Stress
Signs:◦Keyed up or on edge◦Sleep/concentration difficulty◦Decrease in academic performance◦Recurring thoughts/nightmares about the event
◦Avoiding activities or places associated with the event
Trauma-Related StressTrauma-Related Stress
What to do:– Listen– Do not try to “solve” the problem with an
immediate solution– Do not minimize student’s reaction– Inform student that his/her reaction is
normal and expected– Make the appropriate referral
““General Signs”General Signs”How much is day to day life
functioning affected?
What are the behavioral implications?
What is the impact on the community?
How many campus resources are being devoted to the student?
* Terms from Delworth (1989)
Mental health concern: “Disturbed”*
YES NO
DisruptiveBehavior:
“Disturbing”*
YES
NO
Disturbed/Disturbing Disturbing
Disturbed Neither
Disturbed/Disturbing Disturbed/Disturbing MatrixMatrix
A Proposed Framework for Campus Assessment A Proposed Framework for Campus Assessment TeamsTeams
Chief Student Affairs Officer
Roles and responsibilities clearly articulatedUniversity policies and procedures
Ethical and legal parametersLocal data/demographics
Best Practices
Mental Health Professional
Senior Student Affairs Administrator:TEAM LEADER
Senior Student Affairs Administrator:TEAM LEADER
LawEnforcement
Legal
Counsel
Other possible Systems•Medical/ Health Service Professional•University Chaplains/Religious leaders•Parents/other family members•Off-campus resources•International office•Study Abroad Office•Other Systems, as appropriate
Primary Systems
President of the Institution
Other Administrative officers
DisabilitySpecialist
*Diagram from Dunkle, Silverstein, and Warner (2008)
Campus Assessment Team: General Guidelines for Campus Assessment Team: General Guidelines for Team Process*Team Process*
Conduct officer contactedWhat is the behavior? What are the ethical/legal issues?Is the identified student in imminent danger? Is there a documented disability?How does the behavior affect the community? Any past documented incidents/behaviors?Where is the behavior occurring? How do our local data inform us?What systems need to be involved?
Mental health consultation
Chief Student AffairsOfficerRole: Monitor roles and responsibilities ofadministrators. Beclear about when he/she needs to get involved with a situationand communicate this to administrators
1. Systems: On or off-campusmental health professionals (MHP)
2. Roles and responsibilities: MHP
assesses for safety and offers treatment recommendations to appropriate conduct officer. Observe ethical and legal parameters, getting releases of information for various systems, unless imminent danger situation. Educate community about mental health issues.
1. Systems: Conduct officer, academicdean, residential life administrator
2. Roles and responsibilities: Keep process focused on behavior, educate about due process, gather all information and determine appropriate sanctions. Determine if other systems need to be involved, including parental notification. Afterinformation is collected, determinesanctions/response and communicate to student
Student conduct process
Disturbing/Disturbed Student Observed
* Diagram from Dunkle, Silverstein, and Warner (2008)
Common InterventionsCommon InterventionsMedical withdrawal
Involuntary withdrawal
Connections to services: on or off-campus
Self-Care for Staff and Self-Care for Staff and FacultyFacultyForming relationships with studentsVicarious traumatizationCompassion fatigueCommunity management and responseSelf-careTeam debriefings Outside consultationClimate managementResources for staff and facultyPlanning for annual markers
Issues to Confront in Self and Issues to Confront in Self and OthersOthersAversion to administering discipline Inaction will lead to spontaneous resolution.No support from administration, and/or key
administrators not identified.Discipline harmful to a student one perceives
to have mental health concerns.Fears of retaliation from student.Meeting hostility with hostilityNot focusing on observable behavior and
focusing on mental health issue.Lack of education for staff and faculty
around FERPA and other related issues.
Issues to Confront in Self and Issues to Confront in Self and Others (con’t)Others (con’t)Lack of institution clarity around disciplinary
policies and procedures.Drawn in by student (perhaps parents)
dynamics, e.g., “secrets”.Administrators incorrectly assume that their
role is done once the student arrives at mental health services.
When to involve parentsUnderstanding the nuances of disturbing and
disturbed behavior cross-culturallyBalancing concerns for the individual with
concerns for the community Inter-personal conflicts among staff.
RecommendationsRecommendationsBe familiar with codes of student conduct.Be familiar with procedures for implementing
disciplinary process. Identify key administrator(s) for handling
these types of cases, e.g., deans, dean of students.
Provide on-going training for staff and faculty training around these issues and the relevant law(s).
Obtain consultation from legal counsel, if available.
Obtain consultation from MHP’s. MHP’s inform the administrators of the conditions that are needed for the student to remain in school and the administrator must decide if the institution can meet those conditions
Recommendations con’tRecommendations con’tDocument observable behavior, avoid
jargon, especially references to mental health issues, unless you are a clinician.
Keep in mind the educational value of an appropriately administered disciplinary process.
On-going staff training in documentation issues.
Selected ReferencesSelected References Archer, J., & Cooper, S. (1998). Counseling and mental health services on campus: A handbook of
contemporary practices and challenges. San Francisco: Jossey-Bass.
Benton, S. A., Robertson, J. M., Tseng, W. C., Newton, F. B., & Benton, S. L. (2003). “Changes in Counseling Center Client Problems Across 13 Years.” Professional Psychology: Research and Practice, 34 (1), 66-72.
Bickel, R. D., & Lake, P. F. (1999). The rights and responsibilities of the modern university: Who assumes the risks of college life? Carolina Academic Press: North Carolina.
Deisinger, G., Randazzao, M., O’Neill, D., Savage, J. The Handbook for Campus Threat Assessment and Management Teams. Applied Risk Management. Available at http://www.arm-security.com/services/threat_assessment_teams.html
Delworth, U. (1989). Dealing with the behavioral and psychological problems of students. New Directions for
Student Services, 45. San Francisco: Jossey Bass.
Dunkle, J. H. (Ed). (forthcoming December 2009). Dealing with the Behavioral and Psychological Problems of Students: A Contemporary Update. New Directions for Student Services. Jossey Bass: San Francisco.
Dunkle, J. H. & Presley, C. (2009). Helping students with health and wellness issues (pp. 265-287). In The Handbook of Student Affairs Administration (3rd Ed), G. S. McClellan and J. Stringer (Eds.). Jossey Bass: San Francisco.
Dunkle, J. H., Silverstein, Z. B., & Warner, S. L. (2008). Managing violent and other troubling students: The role of threat assessment teams on campus. The Journal of College and University Law, 34(3), 586-635.
Gladwell, M. (2002). The Tipping Point: How Little Things Can Make a Big Difference. Back Bay Books: New York.
Selected References (con’t)Selected References (con’t) Howe, N., & Strauss, W. (2000). Millennials rising: The next great generation . Random House:
New York.
Jablonski, M., McClellan, G., & Zdziarski, E. (Eds.). (2008) In Search of Safer Communities: Emerging Practices for Student Affairs in Addressing Campus Violence. New Directions for Student Services: Special NASPA Supplement. Jossey Bass: San Francisco.
Kadison, R., & DiGeronimo, T. F. (2004). College of the Overwhelmed: The Campus Mental Health Crisis andWhat to Do about It. San Francisco: Jossey-Bass.
Lake, P. (2009). Beyond Discipline: Managing the Modern Higher Education Environment. Hierophant Enterprises: Bradenton, Fl.
Lake, P., & Tribbensee, N. (Fall, 2002). The emerging crisis of college student suicide: Law and policy responses to serious forms of self-inflicted injury. 32 Stetson Law Review 125.
Pavela, G. (1985). The dismissal of students with mental disorders: Legal issues, policy considerations and alternative responses. , Asheville, NC: College Administration Publications.
Sandeen, A. & Barr, M. J. (2006). Critical Issues for Student Affairs: Challenges and Opportunities. Jossey Bass:San Francisco.
Zdziarski, E. L., Dunkel, N. W., & Rollo, J. M. (2007). Campus Crisis Management: A Comprehensive Guide toPlanning, Prevention, Response, and Recovery. Jossey Bass: San Francisco.
