Martha Lou Scott
Associate Vice
President for
Student Life
Bethany McCraw
Associate Dean for
Judicial Affairs
Chris Holmes
Assistant General
Counsel
Jim Marsh
Director of
Counseling Services
Baylor University
IDENTIFYING AND
RESPONDING TO
STUDENTS OF
CONCERN
Our Lens Today
 Jim Marsh—Our environment and
resources
 Chris Holmes—Legal concerns
 Bethany McCraw—Distinguishing
between concerning and alarming
behavior
 Martha Lou Scott—Making referrals
and other resources
Baylor University
Jim Marsh
Director of
Counseling
Services
Baylor University
COUNSELING
SERVICES
Headlines
Psychological Troubles on the Rise
(Inside Higher Education, 3/29/2006)
Counseling Crisis
(Inside Higher Education, 3/13/2006)
Worried Colleges Step Up Efforts Over Suicide
(The New York Times, 12/3/2004)
More College Students Report Diagnoses of Depression
(The Chronicle of Higher Education, 12/10/2004)
As Mental Illness among Collegians Rises, Students’
Privacy Rights and Treatment Clash with Families’
Need to Know
(Los Angeles Times, 9/3/2007)
Off to College Alone, Shadowed by Mental Illness
(New York Times, 12/8/2006)
The College of the Overwhelmed
(Kadison and Geronimo, 2004)
Baylor University
ACHA 2007 (Fall)
 43.2% felt so depressed they found it difficult to function.
 91.6% had felt overwhelmed.
 88.7% found themselves exhausted (not from physical






activity).
76.5% had felt very sad.
61.5% had thought things were hopeless.
10.3% had seriously considered suicide.
1.9% had attempted suicide.
Students diagnosed with depression increased from 10.3%
in 2000 to 14.9% in 2004 to 16% in 2005 dropped to 14.8%
in 2006 and rose again to 16% in 2007.
Of the 16% in 2007, 39.2% were diagnosed in the past
year.
American College Health Association. American College Health Association-National College Health Assessment: Reference Group
Executive Summary Fall 2006. Baltimore: American College Health Association; 2007
Baylor University
Counseling Center Director’s Survey
2008
 16% of center clients are referred for psychiatric
evaluation.
 26% are on psychiatric medication. The latter is up from
20% in 2003, 17% in 2000, and 9% in 1994.
 93% of directors report an increase in students coming to
counseling who are already on psychiatric medication.
 95% of directors report that the recent trend toward greater
number of students with severe psychological problems
continues to be true on their campuses.
Baylor University
Counseling Center Director’s Survey
2008
 81% report a significant increase in calls from faculty and
others on campus seeking a consultation about a student of
concern since the Virginia Tech tragedy
 9% of the students at participating schools sought
counseling last year.
 Directors report that 49% of their clients have severe
psychological problems, 7.5% have impairment so serious
that they cannot remain in school, or can only do so with
extensive psychological/psychiatric help, while 41.5%
experience severe problems but can be treated successfully
with available treatment modalities.
Baylor University
National Trends
 14% of college students have been treated for
depression before entering college.
 27% of 18- to 24-year olds have a
diagnosable mental illness. (National
Alliance on Mental Illness)
 Odds are now 50-50 that a student entering
college will become depressed or experience
some other problem during the college years.
(Kadison and DiGeronimo, 2004)
Baylor University
Baylor Counseling
Services Resources
Baylor University
Staff Profile
Staff
7 Psychologists
4 Graduate Assistant Counselors – 20 hrs/wk
Full-Time Psychiatrist
Part-Time Staff (20 hrs/wk and peak times)
Licensed, Registered Dietitian (15 hrs/wk)*
Baylor University
Services
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
Individual Counseling
Couples Counseling
Group Counseling
Faculty, Staff, Parent, and Student Consultations
Crisis Intervention
Outreach Programs
Online Mental Health Screenings
Psychiatric Services – evaluations and
pharmacotherapy
 Medical Nutrition Therapy
 Referrals
Baylor University
Services
 12 session limit – per year
 First 7 counseling sessions (Baylor career) – Free
 All additional sessions – $10 each
 Group Therapy – Free
 Psychiatric Intake – Bill insurance (1 hour)
 Psychiatric Follow-up – Bill insurance (20 minutes)
 Medical Nutrition Therapy – first 3 sessions are free –
additional sessions = $20
Baylor University
Online Resources
 www.baylor.edu/counseling_center
 Free and Anonymous mental health
screenings for depression, anxiety, eating
disorders, and alcohol abuse
 e-CHUG
 BareTruth – pornography
 Links to College Student Mental Health
Information – ex. Ulifeline
 Outreach Presentation Request
Baylor University
Baylor Counseling
Services Statistics
Baylor University
Counseling Center Statistics
04-05
05-06
06-07
07-08
08-09
Fall ’09
414
610
790
888
1,105
550
Counseling
Appointmen
ts
3,552
4,900
5,061
5,721
5,830
2,945
Psychiatric
Appointmen
ts
784
919
828
748
814
728
78
88
123
121
114
123
1,058
4,731
27,464
67,716
5,183
9,350
569
449
Students
Emergencies
Students
Attending
Workshops
and
Presentations
Triage
Baylor University
Statistics on Presenting Problems
’07-’08
 Mood Disturbance – 27%









Baylor University
– Depressive Disorder – 24%
– Bipolar Disorder – 3%*
Adjustment – 11%
Anxiety – 14% (GAD and Social Phobia)*
Relationship Conflict (non-family) – 5.3%
Marital/Couples Counseling – 1.5%*
Eating Disorder – 4.4% (1% increase)
Physical Problem/Medical Condition – 2.6%*
Family Problems – 2.5%
Academic Performance – 1.5%
Bereavement – 1.5%
Statistics on Presenting Problems
Continued







Baylor University
Substance Abuse – 1.5%
Stress – 1%
Sexual Abuse – 1%
Conduct Disturbance – 1%
Psychotic Disorder – 1%
ADHD – 1%
Pornography – 1%
Significant Challenges
 Historically, a waiting list started around
the third week of September (20 students)
and peaked in late October to around 40
students
 October – November and March – April
the busiest months
 Increase in emergencies from 05-06 to 06-
07 from 88 to 123 per year
 Always see students in a psychological
emergency
Baylor University
System Changes
 In Spring 2008, we implemented emergency
appointment hours at 10 a.m. and 2 p.m. each day
with multiple staff available on Mondays and
Wednesdays.
 In Fall 2008, we implemented a triage system.
Created 40 appointment slots from Monday
through Thursday for brief assessment (30
minutes). Goal is to see every student.
 Received funding for both full-time and part-time
positions
 Committed to building our group therapy program
(creative arts, bipolar, depression)
Baylor University
Waiting List Fall 2007
40
36
37
35
30
27
27
35
35
26
25
23
19
20
15
11
10
8
5
0
2
0
0
0
0
Weeks in the Semester
Baylor University
2
Waiting List Fall 2008
30
28
25
25
20
20
15
10
8
5
5
0
0
0
0
0
0
0
0
0
0
1
Weeks in the Semester
Baylor University
Emergency Appointments
Fall 2007
8
7
7
6
6
5
2
2
1
2
1
0
0
Weeks in the Semester
Baylor University
5
3
3
0
6
4
4
1
7
6
5
5
7
Emergency Appointments
Fall 2008
8
7
7
7
6
5
4
4
4
3
3
3
2
2
1
4
1
1
4
3
2
2
3
2
1
0
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19
Weeks in the Semester
Baylor University
3
Warning Signs
Baylor University
Warning Signs
 Marked decline in quality of course work, class
participation, quality of papers, or test results
 Increased absence from class or failure to turn in work
 Chronic fatigue and low energy
 Attention and memory difficulties
 Low self-esteem and prolonged depression, suggested
by a sad expression, apathy, weight loss, sleep
difficulties, or tearfulness
 Nervousness, excessive worry, rapid speech
 Isolation from others
Baylor University
Warning Signs - Continued
 Alcohol and other drug abuse
 Agitation, irritability, and sudden outbursts of
anger, threats of harming others, or
aggressiveness
 Abrupt or radical changes in behavior or bizarre
behavior, speech, writing, or thinking
 Abnormal eating or exercise behaviors, excessive
weight loss
Baylor University
Warning Signs - Continued
 Extreme dependency on faculty, staff, or
Community Leader, including spending much of
his or her spare time visiting during office hours
or at other times
 Marked change in personal hygiene
 Talk of suicide, either directly or indirectly, such
as, “I won't be around to take that exam anyway”
(most common reason for faculty/staff
consultations)
Baylor University
Making a Referral
 When a student agrees that counseling might be
useful, there are several possible steps to take,
depending on the student’s attitude and the
urgency of the situation:
A. Give the student information about counseling
options and urge him or her to call for an
appointment.
B. Invite the student to call the counseling center
from your office or room right then.
C. Offer to accompany the student yourself to the
counseling center.
Baylor University
Making a Referral
When a student is reluctant to seek counseling:
• Remind the student of the counseling center’s policy of
strict confidentiality.
• Remind him or her that services are available at no or
minimal cost and that both male and female counselors
are on hand.
• Point out that a situation does not have to reach crisis
proportions for him or her to benefit from professional
help.
• Acknowledge, validate, and discuss the student’s real
fears and concerns about seeking help.
Baylor University
Making a Referral
When a student is reluctant to seek counseling:
• Emphasize that, although some people feel that
seeking counseling is an admission of weakness or
failure; in fact, it takes considerable courage and
integrity to face oneself and acknowledge one’s
limitations.
• Offer to accompany the student to the counseling
center or offer to assist them in setting up an
appointment.
Baylor University
Contact Information
Jim Marsh, Ph.D.
Director of Counseling Services
254-710-2467
Jim_Marsh@baylor.edu
Baylor University
Chris Holmes
Assistant General
Counsel
Baylor University
LEGAL ISSUES
RELATED
TO
MENTAL HEALTH
Legal Implications
 Legal implications are NEVER the
main concern—student and
employee safety is.
 Potential liability concerns
 Privacy concerns
 Discrimination on the basis
of mental or psychological
disabilities is prohibited.
Baylor University
Liability Concerns
 Liability for harm to self
– Failure to inform parents
– Failure to respond reasonably
 Liability for harm to others
– General Rule-no liability
– Foreseeability
Baylor University
Privacy Concerns
 FERPA — “Educational Records” may
not be shared with third parties.
– Exceptions: legitimate educational interest,
emergency, etc.
– Frustrating to parents
 Work with student to notify parents
Baylor University
Discrimination Is Prohibited
 Protection under Rehabilitation Act and ADA
– Accommodations in educational services
– Office of Access and Learning Accommodation
 Discipline — if student’s mental illness is
disruptive or presents danger to self or others
– Courts view conduct codes as “essential
function” and not subject to accommodation.
– Compliance with honor code is also an “essential
function.”
Baylor University
Bethany McCraw
Associate Dean
for
Judicial Affairs
Baylor University
MENTAL HEALTH
ISSUES
AND
STUDENT CONDUCT
Concerning
Behavior
Baylor University
Alarming
Behavior
Threatening
Behavior
Concerning
Behavior
Alarming
Behavior
Threatening
Behavior
 Behavior – Concerning vs. Alarming
 Policy on Threats or Harm to Self or Others
 Student Needs vs. Community Needs
Baylor University
Concerning Behavior
A student may demonstrate concerning behavior,
but it may not necessarily be alarming,
threatening in nature or a violation of policy.
• Unsolicited e-mails, text messages, or Facebook
messages
• Unwanted attention that violates personal space
• Poor social skills – unable to read social cues
• Inappropriate statements – disruptive
May result in the University having a
conversation with the student.
Baylor University
Concerning Behavior
MASS SHOOTINGS AT VIRGINIA TECH
Report of the Virginia Tech Review Panel
Summary of Key Findings
August 2007
2. During Cho’s junior year at Virginia Tech, numerous
incidents occurred that were clear warnings of mental
instability. Although various individuals and departments
within the university knew about each of these incidents,
the university did not intervene effectively. No one knew
all the information and no one connected all the dots.
Baylor University
Concerning Behavior
Tell Someone
• It is possible the student may be demonstrating
similar concerning behavior elsewhere in the
Baylor community (residence halls, offices, etc.).
• Knowing the extent of the disruptive behavior can
be helpful in determining the level of intervention
the student may need.
Baylor University
Concerning
Behavior
Baylor University
Alarming
Behavior
Threatening
Behavior
Alarming Behavior
A student may demonstrate alarming behavior that
causes others to feel very uncomfortable or
frightened.
The student’s actions or comments may not reach
the level of “threatening” behavior but may cause
the educational pursuits of others to be disrupted.
May result in the University initiating a
charge of student misconduct.
Baylor University
Alarming Behavior
MASS SHOOTINGS AT VIRGINIA TECH
Report of the Virginia Tech Review Panel
Chapter IV., Part A.
August 2007
(Page 42)
Dr. Giovanni began noticing that fewer students were
attending class, which had never been a problem for her
before. She asked a student what was going on and he
said, “It’s the boy…everyone’s afraid of him.” That was
when she learned that Cho also had been using his cell
phone to take pictures of students without permission.
Baylor University
Alarming Behavior
• Offensive or inappropriate e-mails, text
messages, or Facebook messages
• Unwanted attention that not only violates personal
space, but becomes persistent
• Unwarranted or repeated anger or outbursts;
destructive behavior
• Inappropriate statements that cause alarm to the
listener
May result in the University initiating a
charge of student misconduct.
Baylor University
Classroom Conduct Policy
“Students are expected to conduct themselves in a
mature manner that does not distract from or disrupt
the educational pursuits of others.”
Baylor University
Classroom Conduct Policy
“Students are expected to conduct themselves in a
mature manner that does not distract from or disrupt
the educational pursuits of others.”
“Should a professor determine that a student’s
conduct is distracting or disruptive, the professor may
impose the student’s immediate removal from the
classroom until the student can conduct himself or
herself in an appropriate manner.”
“If the professor is unable to obtain the cooperation
of the student, the student may be referred for
disciplinary action.”
Baylor University
Student Conduct
Baylor University
Student Conduct
The term “misconduct” at Baylor refers to
personal behavior on or off campus that:
1) interferes with Baylor's pursuit of its educational
and Christian objectives,
2) fails to exhibit a regard for the rights of others,
3) shows disrespect for the safety of persons and
property, and/or
4) violates, or attempts to violate, University rules,
regulations, and policies or violates, or attempts to
violate, local, state, federal, or international laws.
Baylor University
Student Conduct
We can not necessarily remove a student from
campus just because his or her behavior is
concerning or alarming.
If the student’s conduct is disruptive,
the University can take action; but the student must
be afforded the institution’s due process.
Baylor University
Student Conduct
If there is a problem with a student in a class, in an
office, or on campus be sure to DOCUMENT!
• Record the date of the incident.
• Provide a description of the incident.
• Include what was done to address the situation.
• Inform the department chair, dean’s office, or
your supervisor.
• Inform Judicial Affairs if the behavior or conduct
is concerning or alarming.
Baylor University
Student Conduct
We focus on the behavior.
We must follow our printed policies.
We do not mandate counseling.
• Baylor Police Department
• General Counsel
• Judicial Affairs
• (Counseling Services)
Baylor University
Concerning
Behavior
Alarming
Behavior
Threatening
Behavior
 Behavior – Concerning vs. Alarming
 Policy on Threats or Harm to Self or Others
 Student Needs vs. Community Needs
Baylor University
Policy on
Threats or Harm to Self or Others
Baylor University is concerned about the well-being
of all students. The University takes seriously any
behavior, including a non-privileged verbal statement,
that tends to demonstrate a student may harm himself
or herself or another.
Baylor University
Policy on
Threats or Harm to Self or Others
Implemented when a student:
• States an intent or desire to harm himself or herself
or another, or
• Attempts to harm himself or herself or another, or
• Is in the process of harming himself or herself or
another
• Exhibits behavior that indicates the student could be
a danger or risk to himself or herself or another.
Baylor University
Policy on
Threats or Harm to Self or Others
The intervention that occurs as a result of the
implementation of this policy is often what students
need to help them gain some stability during
extremely stressful or critical periods.
So Please Tell Someone
Call the Baylor Police Department 254-710-2222,
the Counseling Center 254-710-2467,
or 911.
Baylor University
Policy on
Threats or Harm to Self or Others
Baylor Police officers will attempt to locate the
student to assess whether or not the student needs
immediate medical attention or if a counselor should
be contacted.
The counselor will assess whether or not the student
is at risk of hurting himself or herself or another.
The Baylor Counseling Center has counselors
on call 24-hours a day.
254-710-2467
Baylor University
Tell Someone
• It is essential for a student to be referred
for a prompt, professional assessment as
quickly as possible.
• Leave the assessments to the professionals.
• Time can be of the essence.
Baylor University
Concerning
Behavior
Alarming
Behavior
Threatening
Behavior
 Behavior – Concerning vs. Alarming
 Policy on Threats or Harm to Self or Others
 Student Needs vs. Community Needs
Baylor University
Student Needs vs. Community Needs
• Student Success
• Community Safety
• Student Privacy
Baylor University
Concerning
Behavior
Alarming
Behavior
Threatening
Behavior
 Behavior – Concerning vs. Alarming
 Policy on Threats or Harm to Self or Others
 Student Needs vs. Community Needs
 FERPA (Family Educational Rights and Privacy Act)
Baylor University
Student Records
A student’s educational records are protected by
the Family Educational Rights and Privacy Act
(FERPA).
When a student enters a postsecondary institution, the
student becomes sole possessor of his or her educational
records. (The rights of the parent transfer to the student.)
• An “educational record” is any record maintained on a
student that can be accessed by others. (This includes
e-mails.)
• An institution of higher education may not disclose
personally identifiable information from the educational
records of one of its students without the written consent
of the student.
Baylor University
Helping Students Succeed
• Watch for warning signs.
• Know when to tell others.
• Know what campus resources are
available.
Baylor University
Martha Lou Scott
Associate Vice
President for
Student Life
Baylor University
Reporting Process
and
Intervention Plans
Key Departments Identified to Help Keep
Students from Falling in the Cracks
These individuals serve as consultants to various campus constituents
who may have concerns about students on the campus:
• Academic Areas
• Academic Support Services
•
•
•
•
•
•
Baylor University
•
•
•
•
•
Baylor Police Department
Campus Living and Learning
Counseling Center
General Counsel
Judicial Affairs
Office of Access and Learning
Accommodations
Parents League
Paul L. Foster Success Center
Spiritual Life
University Relations
Student Life Deans
Ruth Prescott
Ron English
Sally Firmin
Jim Doak
Tim Powers
Jim Marsh
Chris Holmes
Bethany McCraw
Dae Vasek
Judy Maggard
Brandon Miller
Kristen Richardson
Lori Fogleman
Martha Lou Scott
Tell Someone – Tell One of Us
A Crisis
Baylor Police Department, 254-710-2222
Legal Issues
Chris Holmes, 254-710-3821
Warning Signs or Concerning Behavior
Jim Marsh, 254-710-2467
Problem Behavior
Bethany McCraw, 254-710-1715
Anything Else
Martha Lou Scott, 254-710-1761
Baylor University
Ongoing Efforts
• Monthly Meetings of the Work Group
• Educational Programs for Faculty and Staff
• Online Materials
• Newsletters to Faculty and Staff
• Student Mental Health Summits
• QPR Training
• Monitoring of Counseling Center Needs
•
Baylor University
Report It!
Martha Lou Scott
Associate
Vice President for
Student Life
254-710-1314
Bethany McCraw
Associate Dean for
Judicial Affairs
254-710-1715
Chris Holmes
Assistant
General Counsel
254-710-3821
Jim Marsh
Director of
Counseling Services
254-710-2467
Baylor University
IDENTIFYING AND
RESPONDING TO
STUDENTS OF CONCERN