Terry Ruthrauff, Psy.D.
Director and Licensed Psychologist
Psychological Services Center (PSC)
St. George’s University

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Psychologist’s view on how to assist students who are atrisk academically or psychologically.
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Summary of:
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PSC services.
Common psychological problems.
SGU’s academic accommodation procedures.
Intervening with someone who is abusing substances, suicidal, psychotic, etc.
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Discussion of these and other relevant matters.

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The mental health side of University Health Services.
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As mental health professionals, our primary mission is to promote student and employee development and wellness.
Active with student retention.
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U.S. accredited – International Association of Counseling
Services since 2009.
800 clients/3,300 clinical appointments per year.
No additional charges for services.
Appointments available most weekdays 8a to 6p.
24-hour emergency service.
90 percent of clients are satisfied with services.

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Counseling and Psychotherapy
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Individuals
Couples and Families
Groups (e.g., Anxiety Management Skills)
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Support and Advocacy (e.g., victims of assault/hate)
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Academic Services
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Disability Services and Academic Accommodations
Performance Enhancement
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Career Counseling and Testing
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Etc.

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To a large extent – people talk, we listen.
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Individuals, families and groups.
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Process experiences and feelings.
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Develop coping strategies.
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Prevent longer-term mental health problems.
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Return to normal functioning.
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Find peace.

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All PSC staff adhere strictly to legal and/or ethical standards of:
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American Psychological Association.
International Association of Counseling Services.
Individual clinician licensing boards, etc.
Client’s privacy and confidentiality is rigorously maintained.
Exceptions:
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Client gives informed, explicit and written consent.
Imminent dangerousness to self or other (e.g., suicidal or homicidal).
Abuse or neglect of child or other vulnerable person.
Certain court orders.
No discrimination – All are treated with dignity and respect.
Administratively neutral.

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Vast majority are free of severe psychopathology!
Interpersonal conflicts
Learning difficulties
Psychological disabilities
Self-esteem and personal growth problems
Sexuality and gender issues
Alcohol and drug abuse
Eating and sleep concerns
Understanding cultural differences
Adjusting to St. George's University and Grenada
Anxiety and stress management
Depression
Loss and grief
Career uncertainty
Violence (e.g. sexual assault, maltreatment of LGBTQQ persons)

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Support Staff
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Corie Christopher, AS
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Marva Gilkes
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Psychiatrists
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Dirk Burkhardt, MD
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Narasimhan Prabhakar, MBBS
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Psychotherapists
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Denise Lewis, MA
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Hillary Ratna, MA (UK)
Lorraine Steele, MA
Cecilia Rougier, PhD (Postdoctoral Resident in Psychology)
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Psychologists (U.S. licensed)
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Kathy Dervin, PsyD
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Jennifer Durst, PhD
John Pettus, PhD (Senior Consulting Psychologist)
Terry Ruthrauff, PsyD (Director)

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Psychotic Disorder, NOS
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Symptoms: Hallucinations, delusions, disorganized thinking.
Worry: Unable to care for self. Tortured. Onset of major mental illness.
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Major Depressive Disorder
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Symptoms: Sadness, impaired sleep/appetite/functioning over weeks.
Worry: Suicide.
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Bipolar Disorder
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Symptoms: Cycles between mania and depression.
Worry: Suicide. Psychosis.
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Substance Abuse/Dependence
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Symptoms: Continued use/abuse of substance despite problems.
Worry: Medical problems. Vulnerability. Impaired functioning.

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Panic Disorder
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Symptoms: Acute intense fear, pounding heart, hyperarousal, sweating.
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Worry: Badly frightened.
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Obsessive-Compulsive Disorder
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Symptoms: Excessive, time consuming repetitive thoughts and behaviors.
Worry: Tortured. Impaired functioning.
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Borderline Personality Disorder
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Symptoms: Emotional dysregulation, interpersonal difficulty, impulsivity.
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Worry: Self-mutilation, suicidal gestures.
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Asperger’s Disorder
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Symptoms: Impaired social interaction, restricted interests, preoccupation.
Worry: Might seem odd.

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Many other disorders represented on our campus that are quite worrisome (e.g., eating disorders 4 to 9 percent of students), but in a less acute way.
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As we cast a wider admissions net, the number of students that are coming to us with major mental illnesses is increasing.
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Students have the legal, moral and ethical right, regardless of diagnosis, to obtain an academic degree.
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That does not mean we cannot intervene when decompensation occurs and someone becomes symptomatic in a problematic way.

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Suicidal or homicidal gestures, talk or plans.
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Signs of psychotic disorders (e.g., hallucinations, delusions).
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Experience of traumatic events such as assault or abuse.
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Inappropriate and extreme anger.
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Inability to care for self or exercise good judgment that leads to endangerment.
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Evidence of disorientation.
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Apparent need for psychiatric hospitalization.

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Death of a loved one.
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Witnessing a traumatic event.
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Stress reactions cause significant impairments in personal, social, academic or occupational functioning.
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Significant and persistent signs of depression.
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Evidence of significant and persistent anxiety.
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Problematic use of alcohol or other drugs.
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Knowledge of another person being abused or assaulted.

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2012: 14 Emergency Evaluations, 119 Crisis Triages.
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If there is some reason to suspect imminent danger to self or other, an emergency evaluation can be mandated:
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Weekdays 8a – 4:30p: Phone UHS Clinic at 444.4671.
All other times: Phone UHS Clinic NOC/DOC at 407.2791.
If a true emergency, do not waste time calling the PSC.
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Clear report of your observations and concerns is necessary to act. Always better to have in writing.
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Could consult with the Dean of Students in some cases to mandate an emergency evaluation.

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Careful with implementing emergency system.
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Can refer to or consult with PSC directly when no imminent danger.
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When in doubt – Access emergency system!
What happens after accessing system?
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Triage.
Clinic physician/PSC clinician evaluation.
Disposition.
Intervention might include:
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No basis for concern – No follow-up.
PSC psychotherapy and ongoing assessment.
Medical Leave of Absence – Voluntary.
Medical Leave of Absence – Involuntary.

(Upcraft, 1982)
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Listen well. Try to understand what the person is thinking and feeling.
Decide whether this is a temporary, situational crisis or something more serious.
Take the person seriously. The perception that one is in crisis feels as real as an actual life threatening crisis.
Keep calm.
Stick with the person. Your physical presence and willingness to stay will have a powerful impact.
Avoid interpretation. It is likely to do more harm than good and elevate emotional states.

(Upcraft, 1982)
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Encourage venting of feelings (e.g., crying and talking).
Avoid arguing. Doing so will just arouse anger and defensiveness.
Follow up. Your continued emotional support will likely be very important.
Be alert to another crisis. Be attentive to the re-emergence of stressors and counterproductive patterns of behavior.
Ask for help when needed. Encourage professional help when appropriate.
PSC has your back!
sgu.edu/psc > Emergencies.

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Test or performance anxiety.
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Very amenable to treatment.
Cognitive Behavioral Therapy.
Sub-clinical ADHD symptoms.
English is not primary language.
Lack of sufficient academic background.
Lack of sufficient cognitive skills and abilities.
Substance abuse.
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10 – 15% of SGU students are abusing alcohol at a very worrisome level.
59% report alcohol consumption increased upon enrolling at SGU.
Medical and psychological disabilities.

(very small percentage of student body)
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Attention-Deficit/Hyperactivity Disorder (SGU’s most common disability)
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Inattention - poor focus and concentration
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Hyperactivity
Impulsivity
Learning Disorders – Certain skill is weaker than should be expected given age, IQ, education, etc
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Reading Disorder (e.g., comprehension, rate)
Disorder of Written Expression
Mathematics Disorder (e.g., weak math ability)
Emotional Disorders
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Anxiety continuum
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Mood disorders
Medical Problems
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Visual
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Diabetes
Etc.

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Learning strategies (DES/PSC):
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Passive vs. active study methodologies
ADHD coaching:
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Organizational skills
Time management
Performance enhancement/wellness (PSC):
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Anxiety management
Sleep hygiene
Holistic health
Psychological assessment (PSC):
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PSC LD/ADHD clinic (limited)
Community referrals
Supplemental instruction, etc:
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Teaching faculty
DES
Academic accommodations

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SGU must comply with Americans with Disabilities Act and other relevant laws.
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Goal is to “level the playing field” for the disabled accommodate.
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Accommodations at SGU are typically limited to:
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Double time on examinations.
Tested in a setting relatively free of distractions.
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Process to obtain academic accommodations:
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Obtain appropriate evaluation (sgu.edu/psc > Disabilities).
Obtain appropriate documentation (sgu.edu/psc > Disabilities).
Apply via DOS for Student Disabilities Committee review.

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Student Disabilities Committee (SDC) reviews applications each
January and August with three possible outcomes:
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Temporary accommodations (e.g., term or two while engaged in treatment or further assessment).
Permanent accommodations for permanent conditions.
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Accommodations not recommended.
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January, 2013 - 30 applications:
20 ADHD
5 Learning Disabilities
3 Physical Disabilities
2 Emotional Disorders
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Results of review:
14 Permanent Accommodations
7 Temporary Accommodations
9 Not eligible or Temporary Accommodations not extended

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Temporary accommodations are possible during times SDC is not available, if student meets disability documentation requirements.
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Students can see following depending on nature of problem:
Psychological – Terry Ruthrauff
Medical – Pat Rooney
TR/PR review documentation.
Recommendation or not for temporary accommodations.
sgu.edu/psc > Disabilities.

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Temporary Accommodations 2012 – 18 approved.
According to school: SOM – 15 (T2 – 7, T4 - 0), SVM – 2, SAS – 1.
Diagnosis: ADHD – 12, LD – 3, Tic – 1, Depression – 1, None – 1.
Long-term best interests of student must be considered.
Licensure board requirements for accommodations are much stricter than SGU’s.
sgu.edu/psc > Disabilities.

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Recent PSC (Durst, 2009) study of 297 anonymous SGU students.
Vast majority of our students do not abuse substances (e.g., alcohol, tobacco, caffeine, illegal and legal drugs).
25% use alcohol in hazardous range as defined by World
Health Organization.
13% reported having health, social, legal, financial or academic problems in past six months because of alcohol use.
11% indicated that they failed to do what was expected of them because of alcohol use.
10% reported weekly binge drinking (3,700 x .10 = 370 students).
59% described alcohol use as having increased upon
coming to SGU.
30% of SGU students drink at least weekly. 40% in SOM.

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Less than 10% of all students indicated they smoked tobacco daily or almost every day.
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14% of the total and 17% of the SOM-only samples indicated use of cannabis in the past six months.
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10% of the SOM students who reported using cannabis in the six months preceding the survey indicated weekly or greater frequency of use. Overall, only 0.7% of student body uses weekly.
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Use of other illegal drugs (i.e., sedatives, amphetamines, cocaine, opioids, hallucinogens, inhalants) are at very low rates. Misuse of legal drugs (e.g., psychostimulants) is a point of contention.
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Oddly, students perceive substance use and abuse at SGU as occurring at much higher rates.

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Policy and enforcement changes (e.g., strengthen policy).
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Research (follow-up to Durst, 2009).
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Limit abuse of psychotropics (e.g., PSC procedural changes?).
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Cultural or social norm changes (e.g., end events that promote high-risk drinking).
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Encourage bystander intervention.
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Environmental changes (e.g., alcohol/drug free dorm space,
Fri/Sat classes).
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Educational changes (e.g. include SOM in SAP Workshop,
academic curriculum infusion).
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Involve neighborhood, parents and other stakeholders.

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No use of illegal drugs.
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No use of tobacco products.
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No “binge” drinking. This is defined in the research literature as the consumption in one day of five or more standard alcoholic drinks (e.g., 1 ounce of 100-proof liquor,
5 ounces of 12% wine, 12 ounces of 5% beer) for men and four or more for women.
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No more than 14 standard alcoholic drinks in any week for men and only 7 for women.
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Use of legal medications only as prescribed.

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Retention – SGU is committed to helping students (and you) succeed in their academic programs.
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Getting help will not jeopardize career potential.
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Not getting help will.

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Bystander intervention – If someone is abusing, let them know you are worried about their behavior in a kind and caring way.
sgu.edu/psc > Substance Abuse.
Psychological Services Center (PSC).
Alcoholics Anonymous, Marijuana Anonymous and Narcotics
Anonymous:
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Tuesdays and Thursdays, 5:30 p.m. to 6:45 p.m.
Room B1C, Windward Hall, SGU's True Blue Campus.
Medical leave for treatment abroad, if needed.
Faculty, peers and family.

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Slides have been posted at sgu.edu/psc > Reading Room.