Counselors As Mental
Health Consultants
Sharon Mitchell, Jessalyn Klein, & Brad Linn
University at Buffalo
Counseling Services
Introductions
• Introduce presenters & context
Learning Objectives
• Understand types of mental health
consultation taking place on a college
campus
• Name most common concerns
consultees bring to counseling centers
• Obtain recommendations for more
effective consultations
Roles and Function of College
Counseling Centers
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•
•
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Counseling (individual, group, couples, family)
Prevention & education
Training
Mental Health Consultation (growing role)
Mental Health Consultation
Assumptions
Consultation is:
•
•
•
•
•
•
a problem solving & educational process
dyadic or triadic
voluntary
collaborative
temporary
focused on mental health problems
Adapted from Michael Dougherty (2009)
Assumptions cont’d.
Consultation:
• helps both Consultee & Person of Concern (POC)
• is a relationship in which Consultant has no
control over Consultee’s actions
• is a situation where Consultant may/may not
have direct contact with POC
• entails working with Consultee to enhance
Consultee’s effectiveness in assisting POC
Venues for Consultation on a
College Campus
• After hours On-Call Crisis Intervention
• Students of Concern (SOC)/Behavioral
Intervention/Threat Assessment Team
• External Consultations: Phone, e-mail, or
face-to-face contact with concerned others
(family, friends, faculty, staff)
How Was On-Call Service Used?
• Total number of calls: 58
• Total number of consultees: 41 people*
• Average call length: 28 minutes, range 8125 minutes
• Most consultees were students seeking
assistance for him/herself (76%)
• 24% were others consulting about a
student
Typical On-Call Consultee
Typical POC was a Caucasian,
heterosexual, undergraduate (male or
female) who reported high level of
general distress and was already a client
at the counseling center
On-Call POC: Demographics
(n =41)
Gender
%
Male
51%
Female
49%
Sexual
Orientation
%
Race/Ethnicity
%
Heterosexual 71%
Caucasian
68%
LGBTQ
17%
Asian
15%
Unknown
12%
Black
5%
Hispanic
5%
Other
3%
Academic
Status
%
Undergraduate
67%
Mean = 23.2
Graduate
25%
Range = 18-39
Age
International Students = 19%
85% were current clients
On-Call Consultees:
Description
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
On-Call Consultations: Reasons
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
On-Call: Interventions
• Coaching (95%)
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•
•
•
• Contracting for safety
• Short-term coping skills or problem-solving
• How to talk to someone you are concerned about
Referred to Counseling Services (93%)
Sent for hospital evaluation (7%)
Referred to community services (2%)
Other points of contact
• 27% Students of Concern
• 44% External Consultations
On-Call: Case Examples
• “My father is annoying me by calling all
the time”
• “Holding on to distress all weekend”
Students of Concern Committee
• Representatives: University Police, Judicial
Affairs, Residence Life, Health Services,
Counseling Services, others as needed
• Meets weekly
• Hospital transports for alcohol or mental
health
• Role of Counseling Services Rep
SOC Referral Source, Contact &
Transports (n = 136)
Referral Source
%
Campus Police
44%
Faculty/Staff
42%
Student
5%
Family
Discussed at SOC
%
Discussed once
55%
Discussed > once
44%
4%
> 1 distinct incident
7%
Student Affairs
4%
No affiliation
2%
Alcohol or Mental Health 20%
Hospital Transport
Typical Student of Concern
The typical SOC is a Caucasian,
undergraduate, male who is not a client
at the counseling center. He was referred
to the committee by campus police or
faculty/staff because of concern about his
suicidal thoughts or behavior.
Students of Concern:
Demographics
Gender
%
Male
57%
Female
43%
Race/Ethnicity
%
Caucasian
54%
Asian
27%
Black
12%
Minimum = 18
Other
5%
Maximum = 29
Hispanic
2%
Age
Mean = 23.2
International Students = 19%
Client Status
%
Non-client
60%
Current client
27%
Former client
13%
Reason for SOC Referral:
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Students of Concern:
Interventions*
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•
•
•
•
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Student support coordinator
Counselor notified
Referred to counseling
Judicial hearing
Police follow-up
Counseling Services outreach
Mandated evaluation
Referred off-campus
Referred to Health Services
66%
38%
17%
14%
13%
8%
6%
3%
2%
Students of Concern: Case
Example
“Victim of Home Invasion“
“Significant Disruption in the Apartments”
External Consultations:
Overview
• Emails, calls, or in-person consultations with
counseling staff during business hours
• 283 unique cases; 553 total consultations
• 36% had multiple consultations
• Only 1 student consulted about him/herself
• 24% were discussed at SOC meeting
• 5% had at least one On-Call Contact
External Consultation:
Demographics
Race/Ethnicity
%
Gender
%
Female
56%
Caucasian
63%
Undergraduate
68%
Male
46%
Asian
19%
Graduate
27%
Transgender
1%
Black
7%
Non-matriculating
5%
Age
Unknown
6%
Client Status
Minimum = 17
Hispanic
2%
Non-client
29%
Current client
54%
Multiracial
2%
Previous client
17%
Maximum = 49
Mean = 23.4
Academic Status
International Students = 18%
%
%
External Consultees: Description
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
External Consultations: Reasons
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
External Consultations:
Interventions
•
•
•
•
•
Referred to Counseling Services
Coaching
Related to hospital evaluation
Referred off campus
Police assistance requested
70%
24%
10%
9%
4%
External Consultations: Case
Examples
• “She was behaving very erratically”
• “My son has a history of anxiety and
depression”
A Special Case: No-Name
Consultations
• Note used when POC was not a student
OR when student name was not shared
• 59 No-Name notes for 55 people
No-Name Consultations:
Demographics
Gender
%
POC: Description
%
Consultee Status
%
Female
47%
Another Person
75%
No UB Affiliation
43%
Male
40%
Self
24%
Faculty/Staff
20%
Family
15%
Student
7%
Non-UB Friends/Partners
2%
Unknown 13%
POC Status
%
No UB Affiliation
47%
UB Student
42%
UB Faculty/Staff
7%
No-Name Consultations: Reasons
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
No-Name Consultations:
Interventions
• 62% of consultees referred to offcampus providers
• 18% of SOCs referred to Counseling
Services
• Only 9% of consultees were coached
Summary Thoughts on Data
• The following varied based on type of consultation:
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POC status
Consultee status
Problem type
Intervention implemented
• Consultation is:
• time-consuming
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•
•
Total of 916 consultation contacts
Requires case management tasks
Requires thorough documentation
Augments AND takes time from direct clinical services
• A pathway to counseling
• An Environmental Management Approach
Recommendations for Effective
Consultations: Consultees
• Provide a student name & ID# or D.O.B
• Be willing to be a part of the solution &
the plan
• Seek to understand limitations of the
consultation
Recommendations for Effective
Consultations: Consultants
• Benefits/necessity of having student
names
• Ask for a call-back number or e-mail
• Follow up with an e-mail
• Be firm, direct, & honest.
• Discuss why confidentiality is not always
possible
• Do risk assessment
• Validate consultee’s feelings & fears
Recommendations for
Consultants Cont’d
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Assume the role of coach
Be “the Calm in the Storm” – debrief later
Provide developmental context
Discuss limit setting & self care
Have policies that support consultation
Have strong partnerships
Provide education to stakeholders PRIOR
to a mental health emergency
Recommendations for
Consultants Cont’d
• Staff training in consultation & crisis
intervention
• TRUST that counselors want to
minimize risk to individuals AND the
campus community
Questions & Discussion