Areas of Responsibility
 Risk Assessment
 Physical/Mental Health
 Emergency Management
 Health Clearance
 Safety and Security
 Emergency 24/7 First
Responder
 Management and
Reporting of Individual
Student Incidents
 Compliance




Process
Student Health
Insurance
Students with
Disabilities
Student Conduct
Title IX/SHO Officer
Take a Moment
 What are your views about depression, counseling,
mental health, suicide?
 Recognize your own reactions
 Where did you first learn about mental health,
counseling, mental illness?
 How does your family feel about counseling?
 How does your culture view mental health?
Who is Protected by Section 504 and the ADA?
 Persons that
• have a physical or mental impairment that substantially
limits one or more major life activities; or
o Learning is considered a major life activity
• have a record of such an impairment; or
• are regarded as having such an impairment
National Trends
 Depression
•
Rates among college students have doubled since
1998
 Anxiety
 Sexual Assault
 Suicidality
(Benton, 2003)
200%
400%
300%
2010 Counseling Center Directors’ Survey
 91% report trend continues: greater number with
severe psychological problems
 70.6% report crisis required immediate response
 60.0% report learning disabilities
 45.7% report alcohol abuse
 45.1% report illicit drug use (Other than alcohol)
http://www.iacsinc.org/NSCCD%202010.pdf
Prevalent diagnoses on college campuses. . .
 Anxiety/panic disorders
 Depression
 Eating disorders (highest mortality rate)
 Suicidal tendencies
 Self injurious behavior
 Bipolar disorder
College Age (18-25) …
 Emergence of significant mental illness typically
occurs during college years
• Bipolar disorder – increasingly recognized that often the
onset is in adolescence
• Schizophrenia – ¾ develop it between 16 &25; onset
uncommon after 30
• Major Depression
• Personality Disorders
Adding Complexity
 Non-disclosure due to stigma and fear
• fear of being labeled, judged, and perceived differently
 Sleep deprivation (high cost)
• irritability, moodiness, psychopathologies (depression,
ADHD, etc.), decreased concentration and memory
 Stress
 Developmental stages (counseling concerns)
• On campus psychological emergencies overtax delivery of
services to general wellbeing and developmental needs of
the student population
Adding complexity
 High risk behaviors: Substance abuse
• Co-occurring mental disorders are common where
substance abuse is present
 Buying/selling medication; abuse of non-prescribed
medication; abuse of OTC medication (cough and cold
medicines, etc.)
• Adderall
 Self-medicating - non-prescribed
 Non-compliance with medication; significant issue
• Side effects
• Interferes with alcohol consumption
Adding complexity
 Student’s failure to obtain needed help
• Resistance
• Lack of awareness
• Stigma; discrimination
 Therapy reluctance
• Waiting until problems are severe
• Reluctance to continue treatment (time commitment)
• Family cultural values; parental denial
Alcohol Abuse
 Binge drinking: five consecutive alcoholic drinks for
a man, four for a woman
• 2 of every 5 students—more than 40 percent—
 About 1,825 college students die each year in
alcohol-related accidents – unintentional injuries,
including automobile accidents
 About 97,000 students are raped or sexually
assaulted each year
http://www.niaaa.nih.gov/Pages/default.aspx
Alcohol Abuse
 About 696,000 a year are assaulted by another
student who has been drinking
 About 25% say alcohol has hurt their academic
performance
 8% – 400,000 students – report having unprotected
sex when drinking (increased risk for pregnancy,
AIDS, STDs)
 100,000 too intoxicated to know if they consented
to having sex
Are Current Users of Alcohol Excluded from
Protection under Section 504?
 No. Section 504's definition of a student with a
disability does not exclude users of alcohol
 However, Section 504 allows disciplinary action
against students with disabilities using drugs or
alcohol to the same extent as students without
disabilities
Next Exit? Study Abroad
Supporting
students
Consultation
 Consultation is key
 Do not try to handle things on your own
 Know your institutional counseling staff
■ Culture Shock
 A normal developmental phase of adjustment
 Mimics more severe psychological problems such as
clinical depression and anxiety …
o feeling helpless, out of control, vulnerable, fearful, anxious,
confused, crying or sleeplessness
■ Usually Time Limited – (e.g. 2-weeks)
Contributing elements






Separation
Travel stress
Culture shock; different
expectations
Adjusting to local conditions;
social pressures – new friends
Learning or using a learned
foreign language to
communicate
Managing condition in
unfamiliar setting; foreign
language skill








Preexisting or dormant
conditions
Change in medication
Stopping medication
Lack of continuity of care─no
plan
Self medication (drugs,
alcohol, etc.)
Unforeseen events
New relationships gone wrong
Financial hardship
•
Financial hardship of family in
the U.S. due to job loss
Impact on Education Abroad
 Upward trend in the number of students with mental
disorders (mild – severe)
 Local laws are different
 Culture is different
 Local language may be different
Common Issues Abroad
 Substance Abuse
 Anger Management
 Disregard of others within
student community
 Abruptly stopping
medication, or medication
not legal/locally available
• “magic cure”
 History of eating disorder
 Unable to manage health
condition
 History of severe
depression, anxiety,
bipolar disorder
 History of suicide
attempt/ideation
• Suicide is the second
leading cause of death in
college students; the
third leading cause of
death in adolescents.
 Students without any
psychological illness
experiencing symptoms
for the first time abroad
 Cutting
Best Practices
UCEAP Policy
Provide assistance with reasonable
accommodations to qualified students with
disabilities to help their successful participation in
the University's educational programs and activities
Encourage disclosure after acceptance to
assess accommodations in host country
Require pre-departure health clearance
UCEAP Team Approach Abroad
Disability Services Office
Partner Institution
Counseling Center
Local Resources
Student
UCEAP
Alcohol/Drug Program
Student Health Center
Mobility International
Medical Assistance Provider
Best Practices
 Close work with University Counsel and Risk
Manager (protocols, forms/contracts)
 Design policies to allow withdrawal for medical
reasons (involuntary withdrawal?)
• Consider: Work with travel assistance provider, can
student travel alone?
• Treatment resources for a safe transition back to the U.S.
campus
 Design policies to allow return to program; know if
you can stipulate conditions
Best Practices
 Clearly delineated protocols
• Before departure/during program
• Review and update protocols and policies
regularly
• Legal implications should never be the main
concern—student/faculty/staff safety
Best Practices
 Require health insurance; med evac/repat
• Know your insurance/assistance providers
 Require a pre-departure health clearance
•
•
•
•
After acceptance
Explain confidentiality
Encourage self-disclosure
Consider pre-departure safety health plans
Best Practices
 Learn about health resources and have a list
ready before you need a referral
•
•
•
•
•
•
U.S. Embassy
Insurance carrier (travel assistance)
U.S. programs in area
U.S. university counseling center
Local health clinics and hospitals
Local health practitioners and specialists (English
speakers; culturally sensitive)
Best Practices
 Be aware of the attitudes toward mental
disabilities in the local culture; explain to
students
 Determine the role of culture in diagnosis,
treatment and outcome of mental illness
Training
Why is Training Important?
 Some students in distress seek help
 Others will not seek help, but will show warning
signs
 Impact is on ALL students in program
Understand your Role: 5 Simple Steps
1. Learn to spot signs of distress early
(Assess student behavior: Is it normal? Atypical?
Any warning signs?)
2. Know how to offer support; work with student
3. Connect student to resources; know your limits
4. Know emergency procedures; insurance coverage;
assistance provider
5. Do not offer support beyond your expertise and
official duties
Why are Training and Collaboration Important?
 Cross-train Counseling and Student Health staff
•
•
•
•
Consultants
Prevent stigma
Privacy vs safety
Guidance about local resources/legality of prescribed
medications from EAO
• Helps to remain focused and calm
• Helps with international students on your campus and
study abroad students (natural disaster, major unrest
affecting the host country)
 Pre-departure:
• Discuss with student anticipated challenges, management
plan and risks
• Identify treatment provider in host country before leaving
home
• Consider agreeing to a Safety Health Plan (spelling out
expected behaviors and consequences of not following)
• Send message to all students about local resources,
medication
Do’s. . .
 Be realistic about local
resources
 Have contingency plans
in place
 Provide pre-departure
information for
students and parents
 Normalize process to
ask for help
 Express your concern
directly
 Have a plan, especially
if clinical support is
needed when abroad
 Offer assistance with
appointment (use your
assistance provider)
 Remove barriers (lack
of money
 Use a team approach
Don’ts. . .
 Diagnose or analyze
(not your job)
 Minimize problems
 Ignore comments about
suicide
 Be sworn to secrecy
 Try to manage situation
by yourself
 Forget to self care (seek
support for yourself)
 Be caught without a
plan
You can help…
 The majority of students with disabilities can
participate successfully
• Proper planning
• Discuss potential study abroad stressors
• Provide resources
Resources
 Active Minds (peer to peer resource)
• http://www.activemindsoncampus.org/
 The American Association of Suicidology
• www.suicidology.org/
 American College Health Association
• www.acha.org/
 American Foundation for Suicide
Prevention
• www.afsp.org
Resources
 Bazelon Center for Mental Health Law
• www.bazelon.org/
 College Drinking – Changing the Culture
• http://www.collegedrinkingprevention.gov/
 Jed Foundation
• www.jedfoundation.org
Resources
 NAFSA Best Practices in Addressing Mental Health
Issues Affecting Education Abroad Participants
• www.nafsa.org/mentalhealth
 My Student Body
• www.mystudentbody.com
 National Institute on Drug Abuse
• www.nida.nih.gov/
Resources
 Substance Abuse & Mental Health Services Administration
• www.samhsa.gov
• What a Difference a Friend Makes
o http://whatadifference.org/support.asp?nav=nav02_3&con
tent=2_3_3_peers
 Helping your Student when Stress Turns into Distress (Guide for
Parents)
http://uhs.berkeley.edu/parents/stress.shtml
Resources
 The Loneliest Disease
• http://www.wtop.com/?nid=226&sid=1357907
• WTOP's Darci Marchese and Kate Ryan look at the impact of mental
illness
 Urban Dictionary
• www.urbandictionary.com
 World Health Organization
• Mental Health Atlas
o http://www.who.int/globalatlas/default.asp
 University of California, Berkeley Online Staff Training
http://uhs.berkeley.edu/facstaff/CPStraining/index.htm
http://uhs.berkeley.edu/training/violenceawareness/
Contact information:
Inés DeRomaña, Principal Analyst
Health, Security, and Emergency Response
University of California System
Education Abroad Program
6950 Hollister Ave. Suite 200
Goleta, California 93117-5823
U.S.A.
Ph: 1+805.893.7936|Cell: 1+805.451.1704 |Email: ideromana@eap.ucop.edu
Permission to Use
 Conditioned on acknowledgement of Ines DeRomana
as the author, with copyright belonging to The
Regents of the University of California.