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    1. 1. Student Mental Health Issues: Trends and Strategies John H. Dunkle, Ph.D., Executive Director, Counseling & Psychological Services Northwestern University [email_address] SSAO Track, NASPA IV-East Regional Conference, Lombard, IL. Monday, November 9, 2009
    2. 2. Objectives <ul><li>Overview of trends in college student mental health issues and the psychological climate in higher education. </li></ul><ul><li>An overview of a model for dealing with students who are disruptive and who have mental health concerns. </li></ul><ul><li>A discussion of the importance of reflection and self-care for staff in managing crisis situations. </li></ul>
    3. 3. The Context: A Tipping Point?* <ul><li>Generational issues </li></ul><ul><li>High numbers of students seeking mental health services </li></ul><ul><li>High profile cases </li></ul><ul><li>Various state and federal laws </li></ul><ul><li>Virginia Tech and Northern Illinois </li></ul><ul><li>Virginia Tech Report </li></ul>*Gladwell (2002)
    4. 4. Continuum of Level of Severity of Counseling Centers: % of Students and Time/Resources Level of Severity Low Relatively healthy Normal dev. issues Moderate Acute crises Mod. mental health issues High Severe mental health issue Co-morbidity % of Students/ Time and Resources = % of Students = % of Time/Resources 0 100
    5. 5. Services Outreach Intervention Consultation Educational programs Workshops Student learning Gatekeeper Training: e.g., QPR Mental Health Screening Days Brief Therapy Models Group Therapy Models Crisis intervention services: on-call Longer-term services Psychiatric services Off-campus referrals Mandated assessments/treatment Liaison systems Threat Assessment Teams Crisis debriefings Level of Severity Low Relatively healthy Normal dev. issues Moderate Acute crises Mod. mental health issues High Severe mental health issue Co-morbidity % of Students/ Time and Resources = % of Students = % of Time/Resources 0 100
    6. 6. Other issues to consider <ul><li>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). </li></ul><ul><li>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 </li></ul>
    7. 7. Psychological Climate in Higher Education <ul><li>95% of counseling center directors report students with significant psychological concerns continue to be a major problem on their campuses (Gallagher, 2008) </li></ul><ul><li>Wide-reaching impact affects entire university community </li></ul><ul><li>Faculty and staff need opportunities for self-care </li></ul>
    8. 8. Psychological Climate in Higher Education <ul><li>Psychological disorders and mental or emotional distress are not an excuse for disruptive behavior in an academic setting </li></ul><ul><li>Psychological disorders do not always cause disruptive behavior </li></ul>
    9. 9. Most Concerning Student Issues <ul><li>Violence toward others </li></ul><ul><li>Suicide </li></ul><ul><li>Substance use: Alcohol, prescription drug abuse </li></ul><ul><li>Eating Disorders </li></ul><ul><li>Other Major Mental Illness: Bipolar Disorders, Major Depressive Disorders, Psychotic episodes, Post-Traumatic Stress Disorder (Returning Veterans), Asperger’s Syndrome </li></ul>
    10. 10. Amount of Distress <ul><li>Mild Distress - not disruptive to others </li></ul><ul><ul><li>Major change in academic work, attendance, appearance </li></ul></ul><ul><ul><li>Referral to Counseling Center likely sufficient </li></ul></ul><ul><li>Moderate Distress - is disruptive to others </li></ul><ul><ul><li>Unusual or exaggerated emotional response </li></ul></ul><ul><ul><li>May involve Public Safety </li></ul></ul><ul><li>High Distress - very disruptive to others </li></ul><ul><ul><li>Overtly suicidal thoughts, homicidal threats </li></ul></ul><ul><ul><li>Will involve Public Safety </li></ul></ul>
    11. 11. Depression / Suicide <ul><li>Signs: Slow speech, crying, decreased interest and motivation, low energy, disturbing writings of non-fictional nature </li></ul><ul><li>What to do: </li></ul><ul><ul><li>Take the issue seriously </li></ul></ul><ul><ul><li>Listen </li></ul></ul><ul><ul><li>Express your concerns directly to the student </li></ul></ul><ul><ul><li>Make the appropriate referral </li></ul></ul>
    12. 12. Angry and Upset Students <ul><li>What to do: </li></ul><ul><ul><li>Respect personal space </li></ul></ul><ul><ul><li>Find a quiet area to speak in private, if you feel comfortable </li></ul></ul><ul><ul><li>Keep your voice soft and slower than normal </li></ul></ul><ul><ul><li>Seek clarification of the problem </li></ul></ul><ul><ul><li>Try to see the problem from the student’s perspective </li></ul></ul><ul><ul><li>Be mindful of your sense of safety </li></ul></ul>
    13. 13. Substance Use <ul><li>Signs: Falling asleep in class, mood swings, inappropriate clothing, deterioration of appearance </li></ul><ul><li>What to do: </li></ul><ul><ul><li>Express your care and concern directly to the student </li></ul></ul><ul><ul><li>Be well informed about alcohol and other drugs </li></ul></ul><ul><ul><li>Avoid being judgmental </li></ul></ul><ul><ul><li>Make the appropriate referral </li></ul></ul>
    14. 14. Trauma-Related Stress <ul><li>Signs: </li></ul><ul><ul><li>Keyed up or on edge </li></ul></ul><ul><ul><li>Sleep/concentration difficulty </li></ul></ul><ul><ul><li>Decrease in academic performance </li></ul></ul><ul><ul><li>Recurring thoughts/nightmares about the event </li></ul></ul><ul><ul><li>Avoiding activities or places associated with the event </li></ul></ul>
    15. 15. Trauma-Related Stress <ul><li>What to do: </li></ul><ul><ul><li>Listen </li></ul></ul><ul><ul><li>Do not try to “solve” the problem with an immediate solution </li></ul></ul><ul><ul><li>Do not minimize student’s reaction </li></ul></ul><ul><ul><li>Inform student that his/her reaction is normal and expected </li></ul></ul><ul><ul><li>Make the appropriate referral </li></ul></ul>
    16. 16. “ General Signs” <ul><li>How much is day to day life functioning affected? </li></ul><ul><li>What are the behavioral implications? </li></ul><ul><li>What is the impact on the community? </li></ul><ul><li>How many campus resources are being devoted to the student? </li></ul>
    17. 17. Disturbed/Disturbing Matrix * Terms from Delworth (1989) Mental health concern: “Disturbed”* YES NO Disruptive Behavior: “ Disturbing”* YES NO Disturbed/Disturbing Disturbing Disturbed Neither
    18. 18. A Proposed Framework for Campus Assessment Teams Chief Student Affairs Officer Roles and responsibilities clearly articulated University policies and procedures Ethical and legal parameters Local data/demographics Best Practices Mental Health Professional Senior Student Affairs Administrator: TEAM LEADER Law Enforcement Legal Counsel <ul><li>Other possible Systems </li></ul><ul><li>Medical/ Health Service Professional </li></ul><ul><li>University Chaplains/Religious leaders </li></ul><ul><li>Parents/other family members </li></ul><ul><li>Off-campus resources </li></ul><ul><li>International office </li></ul><ul><li>Study Abroad Office </li></ul><ul><li>Other Systems, as appropriate </li></ul>Primary Systems President of the Institution Other Administrative officers Disability Specialist *Diagram from Dunkle, Silverstein, and Warner (2008)
    19. 19. Campus Assessment Team: General Guidelines for Team Process* Conduct officer contacted What 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 Affairs Officer Role: Monitor roles and responsibilities of administrators. Be clear about when he/she needs to get involved with a situation and communicate this to administrators <ul><li>Systems: On or off-campus </li></ul><ul><li>mental health professionals (MHP) </li></ul><ul><li>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. </li></ul><ul><li>Systems: Conduct officer, academic </li></ul><ul><li>dean, residential life administrator </li></ul><ul><li>2. Roles and responsibilities: Keep process focused on behavior, educate about due process, gather all information and determine </li></ul><ul><li>appropriate sanctions. Determine if other systems need to be involved, including parental notification. After </li></ul><ul><li>information is collected, determine </li></ul><ul><li>sanctions/response and communicate to student </li></ul>Student conduct process Disturbing/Disturbed Student Observed * Diagram from Dunkle, Silverstein, and Warner (2008)
    20. 20. Common Interventions <ul><li>Medical withdrawal </li></ul><ul><li>Involuntary withdrawal </li></ul><ul><li>Connections to services: on or off-campus </li></ul>
    21. 21. Self-Care for Staff and Faculty <ul><li>Forming relationships with students </li></ul><ul><li>Vicarious traumatization </li></ul><ul><li>Compassion fatigue </li></ul><ul><li>Community management and response </li></ul><ul><li>Self-care </li></ul><ul><li>Team debriefings </li></ul><ul><li>Outside consultation </li></ul><ul><li>Climate management </li></ul><ul><li>Resources for staff and faculty </li></ul><ul><li>Planning for annual markers </li></ul>
    22. 22. Issues to Confront in Self and Others <ul><li>Aversion to administering discipline </li></ul><ul><li>Inaction will lead to spontaneous resolution. </li></ul><ul><li>No support from administration, and/or key administrators not identified. </li></ul><ul><li>Discipline harmful to a student one perceives to have mental health concerns. </li></ul><ul><li>Fears of retaliation from student. </li></ul><ul><li>Meeting hostility with hostility </li></ul><ul><li>Not focusing on observable behavior and focusing on mental health issue. </li></ul><ul><li>Lack of education for staff and faculty around FERPA and other related issues. </li></ul>
    23. 23. Issues to Confront in Self and Others (con’t) <ul><li>Lack of institution clarity around disciplinary policies and procedures. </li></ul><ul><li>Drawn in by student (perhaps parents) dynamics, e.g., “secrets”. </li></ul><ul><li>Administrators incorrectly assume that their role is done once the student arrives at mental health services. </li></ul><ul><li>When to involve parents </li></ul><ul><li>Understanding the nuances of disturbing and disturbed behavior cross-culturally </li></ul><ul><li>Balancing concerns for the individual with concerns for the community </li></ul><ul><li>Inter-personal conflicts among staff. </li></ul>
    24. 24. Recommendations <ul><li>Be familiar with codes of student conduct. </li></ul><ul><li>Be familiar with procedures for implementing disciplinary process. </li></ul><ul><li>Identify key administrator(s) for handling these types of cases, e.g., deans, dean of students. </li></ul><ul><li>Provide on-going training for staff and faculty training around these issues and the relevant law(s). </li></ul><ul><li>Obtain consultation from legal counsel, if available. </li></ul><ul><li>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 </li></ul>
    25. 25. Recommendations con’t <ul><li>Document observable behavior, avoid jargon, especially references to mental health issues, unless you are a clinician. </li></ul><ul><li>Keep in mind the educational value of an appropriately administered disciplinary process. </li></ul><ul><li>On-going staff training in documentation issues. </li></ul>
    26. 26. Selected References <ul><li>Archer, J., & Cooper, S. (1998). Counseling and mental health services on campus: A handbook of contemporary practices and challenges. San Francisco: Jossey-Bass. </li></ul><ul><li>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. </li></ul><ul><li>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 . </li></ul><ul><li>Deisinger, G., Randazzao, M., O’Neill, D., Savage, J. The Handbook for Campus Threat Assessment and Management Teams. Applied Risk Management. Available at </li></ul><ul><li>Delworth, U. (1989). Dealing with the behavioral and psychological problems of students. New Directions for Student Services, 45. San Francisco: Jossey Bass. </li></ul><ul><li>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. </li></ul><ul><li>Dunkle, J. H. & Presley, C. (2009). Helping students with health and wellness issues (pp. 265-287). In The Handbook of Student Affairs Administration (3 rd Ed), G. S. McClellan and J. Stringer (Eds.). Jossey Bass: San Francisco. </li></ul><ul><li>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. </li></ul><ul><li>Gladwell, M. (2002). The Tipping Point: How Little Things Can Make a Big Difference. Back Bay Books: New York. </li></ul>
    27. 27. Selected References (con’t) <ul><li>Howe, N., & Strauss, W. (2000). Millennials rising: The next great generation . Random House: New York. </li></ul><ul><li>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. </li></ul><ul><li>Kadison, R., & DiGeronimo, T. F. (2004). College of the Overwhelmed: The Campus Mental Health Crisis and </li></ul><ul><li>What to Do about It. San Francisco: Jossey-Bass. </li></ul><ul><li>Lake, P. (2009). Beyond Discipline: Managing the Modern Higher Education Environment. Hierophant Enterprises: Bradenton, Fl. </li></ul><ul><li>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. </li></ul><ul><li>Pavela, G. (1985). The dismissal of students with mental disorders: Legal issues, policy considerations and alternative responses. , Asheville, NC: College Administration Publications. </li></ul><ul><li>Sandeen, A. & Barr, M. J. (2006). Critical Issues for Student Affairs: Challenges and Opportunities. Jossey Bass: </li></ul><ul><li>San Francisco. </li></ul><ul><li>Zdziarski, E. L., Dunkel, N. W., & Rollo, J. M. (2007). Campus Crisis Management: A Comprehensive Guide to </li></ul><ul><li>Planning, Prevention, Response, and Recovery. Jossey Bass: San Francisco. </li></ul>