Mental Health
Concerns in Higher
Education
Vered Birmaher, MD
RMU Counseling Services, Psychiatry
Fellow in Child and Adolescent Psychiatry
Western Psychiatric Institute and Clinic, UPMC
Outline
• How prevalent is mental illness among
college students?
• What are the common diagnoses?
• What causes mental illness?
• What are the treatment options?
• What might I see in the classroom?
• What is the role of faculty?
• What is the RMU referral process?
• How do I approach a student?
How prevalent is
mental illness
among college
students?
• 1 out of 4 college students suffers
from some form of diagnosable
mental illness.
• 44 percent of college students
reported symptoms of depression.
– 62% reported feeling very sad
– 30% felt so depressed it was difficult to
function
– 45% felt things were hopeless
• 45 % reported overwhelming anxiety
• 36 % reported overwhelming anger
• 17 % reported interpersonal violence
• Over 66 % of those with a substance
use disorder have a co-occurring
mental health diagnosis
• 5 million young females suffer from
eating disorders each year, the
deadliest mental illness
• Of students that dropped out of
college, 64% said mental health was
the major cause.
– Of those, 45% did not receive
accommodations for various reasons
– 50% did not access mental health
support
– Others lost financial aid/scholarships
due to low GPA or changing to parttime student status
• Suicide is a leading cause of death
among youth
– 3rd leading cause in ages 15-24
– 2nd leading cause in ages 20-24
• Yearly, at least 7 % of students
report contemplating suicide and
1.5 % report attempting suicide
What are the
common
diagnoses?
Depression
• Sadness
• Loss of interest in
activities
• Feelings of guilt
• Poor concentration
• Low energy
• Changes in appetite
and/or weight
• Poor or excessive
sleep
• Hopelessness
• Thoughts of death or
suicide
Associated symptoms
• Irritability
• Tearfulness
• Anxiety
• Pain
Generalized Anxiety Disorder
• Persistent, significant worries with ongoing,
severe tension
• Feeling helpless to control these worries
• Worries can focus on job responsibilities,
family health, or minor matters such as
chores, car repairs, or appointments
• Many associated physical symptoms
Attention Deficit
Hyperactivity Disorder
• Inattentiveness, distractibility, problems
with concentration
• Impulsivity
• Hyperactivity - may manifest as fidgeting
in this age group
Other disorders
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Social Anxiety Disorder
Panic disorder
Obsessive-Compulsive Disorder
Posttraumatic Stress Disorder
Bipolar Disorder
Schizophrenia
Substance Use Disorders
Eating Disorders
What causes
mental illness?
Depression is a
BIOLOGICAL
illness
What are the
treatment options?
Over two-thirds of young
people do not talk about
or seek help for mental
health problems.
80-90 percent of people
that seek the necessary
form of mental health
treatment can function
the way they used to.
Treatment
• Bolster family, social, religious supports
• Relaxation, stress management
• Exercise, healthy eating
• Provide academic supports
• Therapy
• Substance abuse treatment
• Medication management
What might I see in
the classroom?
The Suddenly Empty Chair
He only missed one day of class. As an
instructor, when you look at your roster and
see exemplary attendance, one day usually
doesn't raise concern. But there's always that
little voice in the back of your mind. The one
that says, "This kid has record attendance.
He's never missed a quiz or an assignment.
E-mails when he's going to be late.
Apologizes when he is. I hope he's OK."
Marguerite Choi
Academic Signs
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Repeated absences or missed work
Deterioration in quality or quantity of work
Disorganization or erratic performance
Written or artistic expression of unusual
violence, morbidity, social isolation, despair,
confusion, thoughts of suicide or death
• Continual seeking of special provisions
• Patterns of perfectionism- must get A’s,
overblown or disproportionate response to
grades or other evaluations
Emotional Signs
• Direct statements indicating distress, family
problems, trauma, loss, etc
• Angry outbursts, yelling, or aggressive comments
• More withdrawn than usual
• Expressions of hopelessness or worthlessness
• Crying or tearfulness
• Severe anxiety or irritability
• Distractibility, problems with concentration
• Excessively demanding or dependent behavior
• Lack of response to outreach from course staff
Physical Signs
• Deterioration in physical appearance or
personal hygiene
• Excessive fatigue, falling asleep in class
• Visible changes in weight
• Noticeable cuts, bruises, or burns
• Frequent or chronic illness
• Shaking, tremors, fidgeting, or pacing
• Confusion; disorganized or rapid speech
• Coming to class under the influence
Safety Risk Indicators
• Written or verbal statements that mention
despair, suicide, or death
• Severe hopelessness, depression,
isolation, and withdrawal
• Statements to the effect that the student
is going away for long time
• Statements that mention hurting
someone else
What can I do?
Set a Positive Environment
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Get to know your students
Foster an open door policy
You need only care and listen
Be mindful and respectful of mental health
issues
• Promote collaboration, friendly competition
• Discuss time and stress management
• Provide constructive feedback
Know the Resources
• Early alerts form - www.RMU.edu/atrisk
– For academic and emotional concerns
– The information goes to Cassandra Oden
– Any referrals for emotional or mental concerns
are passed on to Randon Willard
– If needed, Randon then sends students to the
therapist for intake and she can refer to MD.
• Stop by the Center for Student Success to
talk with one of the staff
• Know resources for information, support
Approaching a Student
• Meet privately with the student
• Turn off all distractions (cell phone,
computer, etc)
• Begin the conversation by expressing your
concerns about specific behaviors you have
observed.
• Your role is to listen, support and provide
referral sources
• Convey hope
Helpful phrases
• Use I statements: “I’ve noticed lately that …”
• Ask open‐ended questions that deal directly
with the issues without judging: “How are
things going for you?”
• “What problems has that situation caused
you?”
• Listen attentively and encourage the student
to talk: “Tell me more about that.”
Helpful phrases
• Paraphrase what you have heard: “It sounds
like x and y have been very stressful for you”
• Convey your concern and caring: “What do
you need to do to get back on track?”
• Help student stay in control: “What do you
think would be helpful for you in this situation?”
• Discuss potential benefits of resources and
referrals: “I know the folks in that office and
they are great at helping students work
through these kinds of situations.”
Referral
• Provide contact info for referral resource
• Your offer of help may be rejected. Respect
student’s autonomy unless you have a concern
for danger.
• Convey that your referral is due to concern
about the student and the knowledge that
professional help works.
• End the conversation in a way that will allow you
or the student to revisit the topic. Invite the
student back to follow up and/or check in with
student.
Lethality Screening
• A student who is considering suicide will likely
be relieved that you asked.
• If the student is not contemplating suicide,
asking the question will not put ideas in their
head.
• If you have an urgent concerns about a
student’s safety, stay with the student and
call Public Safety
• Limits of confidentiality
Lethality Screening
• “Sometimes people in your situation can feel
that life is not worth living anymore. Have you
felt this way?
• “Have you had thoughts of ending your life?”
• “Do you feel that your situation is hopeless?”
• “Have you done anything to hurt yourself in
any way?”
• “As depression worsens, people can become
hopeless and think of suicide. Has that
happened to you?”
Emergencies
• If a student is in imminent danger of
harming self or others, stay with the
student and immediately call Public
Safety at (412) 397-2424
– Safety will transport to Sewickley Valley
Hospital Emergency Room for evaluation
– This student is not appropriate for referral to us
and needs more intensive care immediately
• ReSolve Crisis Network can also provide
support and even send a team to help
1-888-7YOUCAN
Websites
http://www.RMU.edu/AtRisk
• Faculty information about warning signs, how to
approach students, how to refer students,
resources. Fill out the Early Intervention Referral
Form for both personal and academic student
issues
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http://www.gannett.cornell.edu/notice
http://www.jedfoundation.org
http://nami.org -- especially NAMI on Campus
http://www.nimh.nih.gov/health/index.shtml
http://www.samhsa.gov
Contact
information
Vered Birmaher, MD
Psychiatry, RMU Counseling Services
Fellow in Child and Adolescent Psychiatry
Western Psychiatric Institute and Clinic, UPMC
RMU
Birmaher@rmu.edu
412-397-4349
WPIC
Birmaherv@upmc.edu
412-586-9153