Identifying &
Responding to the
Distressed Student
A Guide for Faculty &
Administrators
This Presentation Includes
•
•
•
•
Your Role as a COE Member
Scenarios & Responses
Recognizing a Distressed Student
Addressing Distressed Behavior
– Making a Referral
– Utilizing Campus Resources
– Worst Case Scenario: Suicide
• Confidentiality
• A Snapshot of Engle Center Clients
Your Role as a COE
Member
Your Role as a COE Member
• Recognize that students may need different
levels of care and assistance
• Establish and maintain appropriate learning
environment
• Have knowledge of Messiah, legal
guidelines and campus resources
As a COE Member
• You are more available and more knowledgeable
about the college environment than a student’s
previous support system of friends and family
• You may be the first to recognize something is
wrong
• You are in an excellent position to identify and
respond to students in distress
Scenarios &
Responses
What would you do?
Scenario #1
You observe that a student in your class
appears disheveled, unshaven, and has
stopped participating in class. His grades
and attendance have dropped. You are
concerned about him and want to contact
the counseling center or discuss the
situation with your department head.
Would you be violating FERPA?
Response:
• No. FERPA covers academic
records, and observations are
not “records.” Even so, FERPA
allows for the release of records
without student consent to
employees of the college with a
legitimate interest. Discussing
a student of concern with those
in a position to assist the
student, or assist you in helping
the student, is clearly allowed
under FERPA
Scenario #2
A student turns in a writing assignment
which contains disturbing content such
as: violence, cruelty, paranoia, despair.
You are unsure whether this simply an
assignment to the student or insight into
their psychological state of mind. What
might you do?
Response:
• If the material contains any direct threat
or plan of harm, contact the Department
of Safety.
• If there is not a clear threat, a first step
might be to ask to speak with the student
privately. Be direct. “When I read these
passages in your work, (give specific
examples), I was wondering if you are
talking about yourself. Do you feel as
angry/vengeful/hopeless as this sounds?”
• You might also consult with the Director
of Counseling for another professional’s
opinion and for guidance about how to
handle the conversation and to inquire
about appropriate follow-up for the
student.
Scenario #3
You receive a note from one of the
counseling center staff stating that a
student is having difficulties this
semester, (which does not qualify as a
psychiatric disability covered under
ADA). To what lengths should you go
to assist this student?
Response
• We send such notes only when we deem that the
student’s difficulties warrant some flexibility, but your
judgment as the faculty member is always of primary
importance.
• We will give you as much information as the student
allows, but in some cases (assaults, etc.) the student may
not feel comfortable disclosing the reasons for the
difficulty.
• You are not being asked to re-teach the class to the
student or to unfairly disadvantage other students.
• If there are ways to assist the student without
compromising the integrity of the class, we appreciate you
doing so.
Scenario #4
You have developed a good relationship with a
student, who has then disclosed that she is
having personal difficulties. She schedules time
to talk with you frequently during office hours.
You are glad to listen and have suggested
counseling to her to deal with the matters on her
mind. She continues to request to see you often
and/or stop you after class. You begin to feel
burdened.
Response
It is appropriate to set professional and personal
boundaries with students.
• You may not always be best suited to assist
students, their concerns may be too severe.
• Their requests for your time may interfere with
the ability of other students to access you.
• Their request of you may go beyond what is
appropriate for the role of faculty.
Tell the student plainly how you can and cannot
help. Be firm and gentle. Suggest counseling
again.
In Summary…
Each student situation is unique and
complex.
Whenever you feel the need, contact the
Engle Center. We are glad to help.
Recognizing a
Distressed Student
The Distressed Student
How to recognize?
• Excessive absences, especially if
attendance was previously consistent
• Marked changes in personal
hygiene
• Falling asleep in class
• Poor attendance with little or
no work completed
• Weight gain or loss
The Distressed Student
How to recognize?
• Unusual or exaggerated emotional responses
• Markedly changed patterns of interaction
(avoiding participation or dominating discussion)
• Communicates problems in essays or emails
• Repeated requests for special consideration,
extensions, etc.
• Serious grade problems
The Distressed Student
How to recognize?
Evidence of self-injury
Talk of harm toward
self or others
Loss of contact with
reality
Seeing/hearing things
that do not exist
Indicates immediate
Strange remarks or
intervention needed
disjointed thinking
Addressing Distressed
Behavior
Addressing Distressed
Behavior
Many of us already know this, but remind yourself of these principles:
Give your full attention.
• Don’t try to have a private conversation in the
classroom while others students waiting to talk
with you.
• Don’t stand with your hand on the doorknob.
• Don’t multi-task, put down what
you are working on.
• Sit down somewhere private.
Addressing Distressed
Behavior
Look directly at the
student.
Express your concerns in
behavioral, specific,
nonjudgmental terms.
I've been noticing …
(specific things you have observed)
and I’m concerned because….”
Addressing Distressed Behavior
– Helpful Conversation Starters
“Tell me
how
things are
going?”
“You have a number of missing
assignments lately. Is there
something preventing you from
getting them done?”
“You seem very quiet and
distracted in class. That’s
not like you. Is there
something going on that
you would like to talk
about?”
Addressing Distressed
Behavior
Listen first. Don’t assume you know what the
student is going to say. If you have been
working with students long enough, you
may feel you have heard it all. But this
student is unique and wants to be heard
in order to trust you with their problem.
“People don’t care about what you know
until they know how much you care.”
Addressing Distressed Behavior
– Unhelpful Conversation Stoppers
"Why did you
wait so long to
ask for
assistance?”
“It’s time to grow up and
start taking
responsibility for your
life. You’re not in high
school anymore."
"You had
better get your
act together if
you expect to
pass my
class."
Addressing Distressed
Behavior
• Listen first,
without interrupting.
• Focus on listening,
not on what you will say next.
• Acknowledge the student with attending
behaviors, (nodding, “Ok”, “I see”, “uh-huh.”
Even if you don’t agree, you are communicating
that you are listening and understand what the
student is trying to say.
Addressing Distressed
Behavior
Communicate understanding by summarizing what the
student has said.
Avoid judging, evaluating, or criticizing. Respect the
student’s point of view, even if you disagree with it.
to Make a Referral
• You feel overwhelmed or unsure of how to
proceed.
• Assisting this student is compromising your
time and attention to other students.
• You believe the concern is outside
expectations for your position.
• You want consultation; the behavior does
not need to be severe.
to Make a Referral
“Sounds like you are really struggling with________. That’s
really a lot to deal with, Talking it over with a counselor
might help you sort through it all.”
“Give counseling a try. You have nothing to lose.”
“These are services your tuition pays for; take advantage of
them.”
Let the student know that it is not necessary to know exactly
what is wrong in order to seek assistance.
Assure the student that seeking help does not necessarily
mean their problems are unusual or extremely serious.
Be frank about your own limits of time, energy, training, and
objectivity.
If the Student Is Reluctant
• Normalize help-seeking.
– “Hundreds of students use the Counseling
Center every year.”
• Services are confidential, and will
not go on a student’s academic
record.
• Engle Center is for medical and
psychological concerns.
– “No one needs to know why you are there.”
If the Student Is Reluctant
• Counselors can teach self-help
strategies.
– “They can teach you ways to solve your
problems yourself.”
• No commitment, no cost:
– “Give it a try, you have nothing to lose.”
• Be honest:
– “What you’re doing now is not working /is
not healthy.”
I suggested counseling, but
they didn’t go!
Change is a process, not a
single decision.
Where is this student in this
process?
How can you help move
the student forward at
each stage?
I suggested counseling, but
they didn’t go!
Stage 1- Not interested in
counseling
Student thinks: “The
relationship with you is
safe and familiar, why
involve someone else?”
Encourage re-evaluation
of current behavior and its
effectiveness
I suggested counseling, but
they didn’t go!
Stage 2- Considering
Counseling
Student thinks: “Maybe
counseling could help, I’ll
think about it.”
Encourage evaluation of
pros and cons of
counseling
I suggested counseling, but
they didn’t go!
Stage 3- Getting ready for
counseling
Student thinks: “I want to
sign up for counseling,
but what will I say when
I walk in the door?”
Encourage small steps
and assist in problem
solving.
I suggested counseling, but
they didn’t go!
If you choose to continue your discussions with the
student ask yourself the following questions:
• Do you and the student believe the talks are helpful?
Is the situation getting better?
• Do you believe the situation and problems mentioned
are within your ability and background to
appropriately assist the student?
• Are you able to commit to the student in this way?
Consider the time commitment, your availability,
emotional investment and the potential impact on
your other students.
• Are you in danger of developing a “dual relationship”
with the student that could lead to future
complications?
I suggested counseling, but
they didn’t go!
It is appropriate to establish firm boundaries
with students and let them know that you are
no longer able to best help them. Let them
know that referring them does not mean that
you will have no further contact with them.
You will continue to be concerned and caring
in a way that is appropriate for you. No one
wants to feel “dumped,” especially when most
in need of support. Provide a clear statement
about what you can and cannot do.
Campus Resources
• Engle Counseling and Health Center
– Counseling and appropriate outside referrals.
– Website resources (psycho-educational)
• Office of Community Development
– ext. 5380, Doug Wood
• Office of Disability Services
– ext . 5382, Keith Drahn
– http://www.messiah.edu/offices/disability/
• Support from Residence Life Staff.
• Formation of multi-disciplinary CARE TEAM for some
students needing support from several areas.
• Generous medical leave policy.
Suicide:
What we fear the most
Suicide
National Statistics
• Second leading cause of death among North
Americans of college age.
• For every successful suicide, there are 40 failed
attempts.
• 1 in 12 college students makes a suicide plan.
• More teenagers and young adults die from
suicide than from all medical illnesses combined.
(Sources: Kadison, 2004 & Seaman, 2005)
Students in Crisis:
Signs of a Student Needing
Immediate Assistance
•
•
•
•
Evidence of self injury such as cutting or burning.
Suicidal statements, gestures, or attempts.
Acts or threats of harm to other individuals or property.
Extremely disruptive behavior, such as outbursts,
aggression, or hostility.
• Loss of contact with reality, disoriented thought or
hearing/seeing things that are not present.
• Homicidal threats (written or verbal), or attempted
homicide or assault.
Intervening with a
student in crisis
• Ensure everyone’s safety, including your own.
• Talk to the student in a calm manner.
• Share your concern and belief that the
student needs assistance.
• Avoid touching the student if he or she is
agitated, violent, or intoxicated.
• Do not threaten the student.
• Avoid arguing with the student.
Intervening with a
student in crisis
• Talk to the student sympathetically.
• Do not promise confidentiality to a student
who may be considering suicide.
• Do not avoid discussing the topic of suicide.
Asking the student about suicide won’t "put
the idea into his/her head."
• Recommend that the student seek help from
Counseling Services immediately.
Intervening with a
student in crisis
• If the student agrees to seek help, recommend that
he/she contact Counseling Services right away from
your office/classroom. After regular office hours,
contact the Department of Safety
• If the student is reluctant to call, offer to call and make
arrangements for them, or offer to walk the student over
to the Engle Center.
• If the student refuses, it is important not to let the issue
"resolve itself." Let the student know that you will be
contacting Counseling Services. Call us immediately so
we can contact the student.
• If you are concerned that the student is at imminent
risk, do not leave the student alone. Contact the
Department of Safety immediately.
• Contact Us
Confidentiality
HIPAA, FERPA and Codes of
Professional Ethics
Playing by the Rules
• While not technically bound by HIPPA regulations,
Counseling Services does follow the APA code of ethics
which informs our policy on confidentiality.
• FERPA regulations apply primarily to college faculty and
administration and address, among other things,
disclosure of educational records within the college.
• The APA code of ethics, which the Engle Center follows,
and FERPA regulations, which faculty and administration
must follow[1], have very different rules regarding the
release of information.
[1] FERPA does not consider counseling records part of a
student’s “educational record.”
Confidentiality Q and A
If I refer a student for counseling will I be
notified when the student makes an
appointment?
Confidentiality Q and A
If I refer a student for counseling will I be
notified when the student makes an
appointment?
It is our policy to notify you when a student
you have referred makes an appointment;
however we must ask the student’s
permission and they can choose to refuse.
Confidentiality Q and A
Could I inquire at the counseling center
about whether a student is receiving
counseling?
Confidentiality Q and A
Could I inquire at the counseling center
about whether a student is receiving
counseling?
No. We can disclose that information to you
only in those situations where you have
referred the student and the student gives
us permission to speak to you about the
treatment.
Confidentiality Q and A
Can the counseling center give me more
detailed information regarding a
student’s treatment?
Confidentiality Q and A
Can the counseling center give me more
detailed information regarding a student’s
treatment?
Generally speaking, we can only provide that kind
of information if it would be of some specific
benefit to the student and then only with her or
his written permission.
Ex. if a student is requesting an “I” in a course at
semester’s end or leaving school for a short time
for mental health reasons, it is likely that we will
encourage the student to give us permission to
speak with faculty.
Confidentiality Q and A
If I am concerned about a student, may I
consult with a counselor about how to
be helpful?
Confidentiality Q and A
If I am concerned about a student, may I
consult with a counselor about how to
be helpful?
Yes. We encourage you to call us anytime
you would like to discuss your concerns,
regardless of whether the student is a client
or not.
A Snapshot of
Engle Center
Clients
Current Trends in the Mental Health of College Students
A Snapshot of Engle Center
Clients*
– Total of 365 clients last year
– 40% had anxiety/stress
– 21% had relationship
difficulties
– 19% experienced depression
*Because students may present with multiple complaints,
total is greater than 100%
A Snapshot of Engle Center
Clients
•
•
•
•
•
6 were hospitalized (national average =5.6)
2 attempted suicide (as high as 5 in past years)
28 engaged in self-injury
16 left school for psych reasons
30% were taking psychotropic medication
Percentage of Engle Center Clients with
Anxiety Symptoms
50%
40%
30%
20%
10%
95
/9
6
96
/9
7
97
/9
8
98
/9
9
99
/0
0
00
/0
1
01
/0
2
02
/0
3
03
/0
4
04
/0
5
05
/0
6
06
/0
7
0%
Students in Counseling &
Total Enrollment through Time
3500
450
400
3000
Students Enrolled
350
2500
300
2000
250
1500
200
Students Enrolled
150
Students in Counseling
100
Linear (Students in Counseling )
50
1000
500
0
0
Academic Period
y = 80.091x + 32.273
R2 = 0.7949
Mental Disabilities
Registered With
Disabilities Services
Number of Students Registered with Messiah
College Disability Services
60
Attention Deficit
Disorder
50
40
Autism
30
20
Learning Disability
10
0
Psychological Disability
98- 99- 00- 01- 02- 03- 04- 05- 06- 0799 00 01 02 03 04 05 06 07 08
Growth in Use of Psychotropic
Medication
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Trend Among New Students
Bringing Medication to College
Percentage of New Students Coming with
Psychiatric Drug Rx
06/07
05/06
04/05
03/04
02/03
0.0%
2.0%
4.0%
6.0%
8.0%
Nationally: 94.4 % of college centers report an increase in number
of students taking meds before seeking counseling services.
Messiah Student Problems vs.
National College Student Norms
in the Past Year
• Felt so depressed it was
hard to function
• Seriously considered
suicide
 Attempted suicide at
least once
• Had an anxiety disorder
Messiah
College
National
Norms
39.0%
42.3%
7.8%
10.6%
1.0%
10.9%
2.0%
13.5%
Factors Affecting Academic
Performance




Depression/Anxiety
Sleep difficulties
Stress
Internet/Computer
Game Use
Messiah
College
National
Norms
16.2%
26%
35.2%
15.6%
23.8%
30.8%
16%
12%
The Engle Center is not just
for marginal students!
• 29% of our clients were on the
Dean’s List
• 5% of our clients were Residence
Life Staff