Supporting an International
Student Through a Mental Health
Crisis
NAFSA: Association of International Educators
2012 Annual Conference
Houston, Texas
May 30, 2012
PRESENTERS
Elaine del Rossi, HTH Worldwide Insurance
edelrossi@hthworldwide.com
Trisha Marrapese, University of Texas-Austin
trisha@austin.utexas.edu
Chair: Patricia Burak, Syracuse University
paburak@syr.edu
Stats on Mental Illness and
College Students
One out of every five young people and one
out of every four college students or adults
suffers from some form of diagnosable
mental illness.
Nearly 50% of all college students report
feeling so depressed that they have had
trouble functioning, and 15% meet the
criteria for depression
Suicide is the third leading cause of death
among people ages 15-24, and the second
leading cause of death in college students
ages 20-24
Over 66 percent of young people with a
substance use disorder have a co-occurring
mental health problem.
About 19 percent of young people
contemplate or attempt suicide each year
Four out of every five young people that
contemplate or attempt suicide exhibit clear
warning signs.
An estimated 5 million young females suffer
from eating disorders each year, and eating
disorders are the deadliest mental illness,
claiming more lives than any other illness.
CASE STUDY I
A young international Ph.D. student has
attempted suicide. He continues to
profess suicidal thoughts, and seeks
assistance with the Counseling Center.
At the same time, other actions result in
the student’s expulsion from campus. He
is committed to a mental health facility.
Things to Consider….
Does the student have insurance? If so,
does he have proof of insurance in his
possession?
Has anyone been contacted on the student’s
behalf?
Who are the student’s emergency contacts
and do they speak English?
What is the state of the student’s current
physical and mental health?
How does FERPA come into play
What are the immigration consequences
related to the student’s expulsion?
What are the possible treatment options for
the student once they depart the U.S.?
(is there social stigma to account for)
The Facts of the Case
The student has health insurance coverage,
including medical evacuation and
repatriation
The student’s family is from Indonesia and
does not speak English (nor has he given
permission to contact them)
In the Hospital
The student is placed in a ward with an
empty bed, which happened to be far away
from campus, but close to where someone
from your office happened to be visiting on
the night of the incident (the very person
who was notified of the recent chain of
events by university police)
So….What You Do Now?
The individual who was contacted from the
University went to visit the student in the
facility
The student appeared to be of sound mind
at this time. The actions that had warranted
his expulsion had not been criminal in
nature, and the student pleaded with the
University official to sign him out of the
Mental Health facility….which he did.
Little Did He Know…
Unfortunately, upon signing the student out
of the institution, the University had nullified
any possibility for Medical Evacuation
insurance to be utilized (for which he would
have been eligible, due to his current
condition)
As the student was expelled, and no longer
able to remain in the US in F-1 status, the
University had assumed responsibility (and
expense) for the student’s safe return home.
The Student Now Needs to
Return to Indonesia….
…and guess who was chosen to
accompany him?
Things to Consider When
Planning an Impromptu Trip
to Indonesia…(or anywhere)
• Flight logistics and cost on two-days notice
• Visas….do you need one for your destination
country? How about the countries
you will hit in transit?
• The purchase of your own insurance for the
trip
• How to safely communicate the student’s
situation with their family back home
East Coast U.S. to Indonesia
Is the student’s passport valid?
The purchase of your own insurance for the
trip
How to safely communicate the student’s
situation with their family back home
Things Even The Most
Seasoned Traveler Can’t Plan
For:
Lack of sleep: Total travel time was 27 hours
Erratic behavior: The student tried to open the
emergency exit on the airplane, mid flight
Weather conditions: We made an
unplanned landing in Taiwan because a
minor Tsunami had struck Jakarta,
Indonesia, so we were unable to land
All’s Well That Ends Well
• The student was successfully returned to his
father’s care in Indonesia (despite a
misunderstanding at the airport over my use of
the word “escort”)
• The student was able to seek the counseling
that he needed (with the support of his family,
despite the social stigma and the financial
hardship), which enabled him to apply for
readmission to the university two years later
How could this have played out
differently if the student had
been able to utilize his medical
evacuation insurance?
The “Cup Half Full” Outcome:
Greater collaboration with other offices on
campus (Counseling Center, Dean of
Students Office, International Office, etc…)
in the creation of a “Mental Health Crisis
Response Checklist”
A better understanding of the benefits
offered by most health insurance providers,
including but not limited to protocol on
medical evacuation, availability of
translators, and other such immensely
valuable resources
Checklist for Mental
Health Issues
CASE STUDY II
You receive a phone call from a concerned
parent who has been unable to reach his
daughter for the past four days. As this is
not typical behavior, he is very concerned.
Your phone calls to the residence hall and
academic department confirm that she has
not been on campus for the past four days
• Whom else do you contact?
• Is there a Crisis Team/protocol that needs
to be followed?
The father has made contact with the
president of the national group. A graduate
student, he has found out from friends that
the student was taken to the hospital
You contact the hospital and identify
yourself as the international student advisorthey are willing to give you information
regarding the student
Now what do you do?
Guidelines for Visiting
Psychiatric Unit
• Cannot bring anything glass (ie Flower
Vase)
• Patient cannot have a computer,
cellphone, pens or pencils (only crayons)
• HIPAA Release needed for
insurance company to begin a claim
(very important for future medical
evacuation)
Health Insurance: What you
need to know to help
HIPAA requirements: what is needed?
Medical evacuation: how does it work?
– Escort to home country
– Family member travelling to USA
Repatriation
FERPA
HIPAA
Family
FERPA Release
Syracuse University
Permission to Release Education Record Information as Required by the Family
Educational Rights and Privacy Act (FERPA)
I,
, give permission for Syracuse University (David B. Falk College
of Sport and Human Dynamics) to release academic and graduate assistantship
performance evaluation information to Patricia A. Burak.
Purpose for release: Review of dismissal from Doctoral Program.
Information to be released: Grades, faculty evaluations, Oral exam evaluations.
Signed:_______________________________ Date:___________________
HIPAA Release
HIPAA Privacy Authorization Form
**Authorization for Use or Disclosure of Protected Health Information
(Required by the Health Insurance Portability and Accountability Act, 45 C.F.R.
Parts 160 and 164)**
I, Patient’s name, authorize Name of Facility/Physician to use and disclose the protected health
information described below to HTH Worldwide and/or its representatives including Name of University if
applicable. This authorization for release of information covers the period of healthcare from: 3 Month
time span.
I authorize the release of my complete health record (including records relating to mental healthcare
communicable diseases, HIV or AIDS, and treatment of alcohol or drug abuse). This medical information
may be used by the organization I authorize to receive this information for medical treatment or
consultation, billing or claims payment, or other purposes as I may direct.
This authorization shall be in force and effect until Date from Above, at which time this authorization
expires. I understand that I have the right to revoke this authorization, in writing, at any time. I understand
that a revocation is not effective to the extent that any person or entity has already acted in reliance on
my authorization or if my authorization was obtained as a condition of obtaining insurance coverage and
the insurer has a legal right to contest a claim.
I understand that my treatment, payment, enrollment, or eligibility for benefits will not be conditioned on
whether I sign this authorization. I understand that information used or disclosed pursuant to this
authorization may be disclosed by the recipient and may no longer be protected by federal or state law.
Signature of patient or personal representative:
________________________________________
Patient’s Name
Date: ___________________________________
Supporting the Student
• Academic Notifications
• Health Center Notifications
• Residence Hall Notifications
*Consent of the student is required
Friends
Favorite Foods
Clothing
Books
Preparing for Hospital
Release
• Return to Home Country
• Return to Campus
• Return to Residence Hall
Medical Evacuation
• Medical Escort
• Airfare/Passport/Visa?
• Leave of Absence
SEVIS Actions
• RCL for Medical Reasons
• Leave of Absence
• Discontinue Program
Social Stigmas
• Cultural Taboos Surround Mental Health
• Shame in Front of Peers
• Denial
Comprehensive Resource on
Crisis Management for the
International Student and
Scholar Services Office
• NAFSA Website
Crisis Management in a
Cross-Cultural Setting
Sample Institutional Letters
Mandated Contact
Attachment 1—Mandated Contact
VIA PERSONAL DELIVERY
Student’s Name
Address
Dear [Student’s Name]:
This letter is written on behalf of Senior Vice President and Dean of Student Affairs XXX to follow up on
[state the factual circumstances that brought student within the scope of the Protocol for Responding to
Student Mental Health Incidents].
We are concerned about your well-being, and we would like to make your continued stay at XXX
University as smooth as possible. To promote your access to appropriate resources, you are required to
meet with a Counseling Center therapist to discuss this incident and develop a plan for maintaining safety
and promoting your overall well-being. This policy of referring students to the Counseling Center is
designed to assist students who have demonstrated that they are experiencing difficulty in managing some
aspects of University life.
Please contact the Counseling Center at XXX-XXXX, to schedule this appointment. During this meeting
you will be requested to sign a release of information allowing the Counseling Center staff to confirm
your participation in this meeting to [the administrator designated to act on behalf of the Senior Vice
President and Dean of Student Affairs]. Provided that you participate in this meeting and allow the
Counseling Center to confirm your participation, we anticipate that you will be permitted to continue as a
[residential student, student] of XXX University. All information you share during this meeting will be
held confidential by the Counseling Center.
We are aware that you may feel anxious in anticipation of this meeting. If you need to talk to someone
before the meeting occurs, feel free to contact the Office of student Assistance at XXX-XXXX or the
Counseling Center at XXX-XXXX.
Sincerely,
Designated Administrator Name and Title
cc:
Senior Vice President and Dean of Student Affairs
Counseling Center
Office of Student Assistance
File
Sample Institutional Letters
Mandated Assessment
Attachment 2—Mandated Assessment
VIA PERSONAL DELIVERY
Student’s Name
Address
Dear [Student’s Name]:
This letter is written on behalf of Senior Vice President and Dean of Student Affairs XXX to follow up on
[state the factual circumstances that brought student within the scope of the Protocol for Responding to
Student Mental Health Incidents].
We are concerned about your well-being. To promote your access to appropriate resources, you are
required to meet with a Counseling Center therapist to discuss this incident and develop a course of
treatment, and/or a personal safety plan that may help enhance your overall health and wellness in the
future. This policy of referring students to the Counseling Center is designed to assist students who have
demonstrated that they are experiencing difficulty in managing some aspects of University life.
Due to the serious nature of the incident in which you were involved, you are not permitted to attend
classes, live in or visit the residence halls or South Campus, live in or visit the Greek chapter houses, or
enter onto University owned, operated, or controlled property, except with the permission of the Senior
Vice President and Dean of Student Affairs or his or her designee until this matter is resolved.
In order to begin this process, please contact The Counseling Center at XXX-XXXX. We will arrange for
you to meet with a staff member in the Office of Student Assistance, at 306 XXX Hall to discuss this
process in detail and to answer any questions you may have. Following your appointment with Student
Assistance, you will meet with a staff therapist, at XXX Street Place. During this meeting you will be
requested to sign a release of information allowing the Counseling Center staff to obtain information from
your personal physician(s) and/or therapist(s) and to share its recommendations with the Office of the
Senior Vice President and Dean of Student Affairs. These recommendations will be considered in
making a final determination concerning your status as a student at XXX University. You will be invited
to participate in this process.
We are aware that you may feel anxious in anticipation of this meeting with the Counseling Center. If
you need to talk to someone before the meeting occurs, feel free to contact the Office of Student
Assistance at XXX-XXXX or the Counseling Center at XXX-XXXX.
Sincerely,
Designated Administrator Name and Title
cc:
Senior Vice President and Dean of Student Affairs
Counseling Center
Office of Student Assistance
[Parents or Guardians—where appropriate]
File
Sample Institutional Letters
Follow up to Mandated
Contact
Attachment 3 – Follow up to Mandated Contact
DATE
Name
Address
Dear [Name]:
This letter is written to follow up on your recent meeting with the Counseling Center on [date]
held to discuss an incident that occurred on [date] in which you [state facts that supported the
mandated referral to the Counseling Center].
The Counseling Center confirms that you have successfully met the requirements of my letter
dated [date] mandating your attendance at this meeting.
We hope that this meeting was helpful to you and that you follow any recommendations offered
by the Counseling Center. If at any point you need additional assistance, please contact the
Counseling Center (24 hours a day) at XXX-XXXX or the Office of Student Assistance at XXXXXXX.
Sincerely,
Name
Title
cc:
Senior Vice President or Dean of Student Affairs
Counseling Center
Office of Student Assistance
File
Resource Bibliography
• International Student Resources
bibliography.docx
Don’t we wish that this was
“THE END”?
Such cases will continue as long as we have
students…..
Being prepared to work through a mental
health situation is your best solution.
This powerpoint is posted at
http://international.syr.edu/ be used with the
permission of the presenters.