Matt Dwyer, Ph.D.
Director
Center for Counseling and Student
Development
 Discuss
National Trends related to student
mental health
 Discuss ECU specific data related to student
mental health
 Discuss the most prevalent emotional health
needs of our students
 Discuss opportunities to offer help & support
 Identify resources
 Think
of a student that you’ve had concerns
about his/her emotional health or functioning
in the past
 Write down what factors were involved in you
having concern
 How concerned were you (mild, medium,
severe)
 How did you handle your concern? Looking
back, would you have done anything
differently?
 College
students are presenting with greater
mental health needs than ever before

Archives of General Psychiatry, December 2008
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Data from 2001-2002 National Survey on Alcohol and
Related Conditions
n=5092 19-25 year-olds; n=2188 attending college
Face-to-face structured interviews
Almost half of college-aged individuals had a
psychiatric disorder in past year
TOP 4: Alcohol Use Disorders (20%), Personality
Disorders (18%), Anxiety Disorders (12%), Mood
Disorders (10%)
 2010


American College Health Assoc. Survey
95,712 Students Surveyed
Within the last year:
 48% felt overwhelming anxiety
(12,960)
 38% felt overwhelming anger
(10260)
 30% felt so depressed difficult to function(8100)
 6% seriously considered suicide
(1620)
 5% engaged in self-inflicted violence
(1350)
 1.3% attempted suicide
(351)
 2010


American College Health Assoc. Survey
95,712 Students Surveyed
Within the last year, % diagnosed or treated for:
 10% Anxiety
(2700)
 10% Depression
(2700)
 6% Sleep Disorder
(1620)
 5% Panic Attacks
(1350)
 4% ADHD
(1080)
 Fall
2010 National Survey of First Year
Undergraduates

Data from 200,000 incoming full-time freshman
students

Record LOW levels of perceived Emotional Health

Record HIGH levels of perceived Stress
 Professional


Psychology Res & Prac; 2003
Data from UCC therapists for 13 years retrospectively
Significant increases in the following problem areas:
 Stress and Anxiety
 Suicidal thoughts/concerns (tripled)
 Depression (doubled)
 Psychotropic medications being used
 Sexual Trauma (quadrupled)

2010 National Survey of Counseling Center Directors

Data from 320 UCC Directors

24% of clients on psychotropic medications

Greater clinical (versus developmental) demands

91% of Directors report trend toward greater number of
students with severe psychological issues

44% of clients having ‘severe psychological problems’
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‘Crisis issues requiring immediate response’ being largest
growing category
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On average, UCCs hospitalize 1.4 students per 1000 per
Academic Year [= 38 at ECU]

2011 Center for Collegiate Mental Health Report

Data from 97 University Counseling Centers obtained from a
clinical instrument (CCAPS) on 74,000 students seen at UCCs

30% of students reported having some thoughts of ending
their lives

50% of students reported having spells of terror or panic

45% of students reporting some feelings of being ‘out of
control when I eat’

25% of students reported some concerns of losing control and
acting violently
 Center

for Counseling & Student Development
2010-2011 Academic Year

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3862 Individual Therapy Appointments
834 Intake (initial) Appointments
459 Emergency Crisis Appointments
1253 Psychiatric Appointments
Top Reasons for being seen
 Relationship Issues
 Adjustment
 Anxiety
 Depression
 Substance Use
 Center

2010-2011 Academic Year


for Counseling & Student Development
Top Psychotropic Medications:
 Zoloft—Antidepressant and Anti-anxiety medication
 Celexa—Antidepressant
 Prozac—Antidepressant and Anti-anxiety medication
 Lexapro—Antidepressant and Anti-anxiety
medication
F11 Compared to F10

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
36% Increase in Individual Therapy appointments
42% Increase in Intake (initial) appointments
19% Increase in overall clinical appointments
 What
Does All This Mean?
 ECU
will likely continue to have more and more students
with significant mental health concerns that impact
multiple aspects of their lives.
 Greater needs of
ECU faculty/staff to be aware of these
trends and how they may impact the ECU community.
 Greater needs of
University.
ECU students to receive support by the
 Signs
and Symptoms to Look For

Appearance

Behavioral Markers

Interpersonal Markers
 Appearance

Deteriorated grooming or hygiene
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Bloodshot or swollen eyes
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Dramatic weight loss or gain
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Radical change in clothing
 Behavioral
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Markers
Poor or erratic attendance or tardiness to class
Student seems anxious, depressed, irritable, angry,
or sad
Lethargic or perpetually tired
Lack of interest in meeting class requirements
Indications of hopelessness or helplessness
Marked changes in habits
Sleeping in class
Marked withdrawal in a normally outgoing person
 Behavioral
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Markers
Uncharacteristically poor work
Repeated requests for special consideration
Excessive anxiety about class performance or
evaluation
Inappropriate tearfulness or intense emotion
(hostile; dramatic; excessive or rapid speech, etc.)
Evidence of self-destructive behaviors (e.g. self mutilation, substance abuse, etc.)
Expressions of harm to self or others, either verbal
or written
 Interpersonal
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Markers
Dependency on professor
Avoidance of professor or peers
Poor relational boundaries (e.g., inappropriate
disclosure to professor)
Behavior that disrupts class
Student’s comments or behavior seem unusual to
others
Complaints from peers, other faculty, or staff
 Opportunities
to Offer Help & Support

Talking to a student you are concerned about

Consulting with someone else
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Referring the student to appropriate resources
 Talking
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to a Student You Are Concerned About
Talk to the student in private when both of you have the time and
are not rushed or preoccupied
Be clear on your objectives, which may include assessing ability to
perform in class, problem-solving around obstacles to
performance, and consideration for overall well-being of the
student
Express concern for his/her well-being and behavior
Listen with sensitivity and understanding; paraphrase his/her
comments
Strike the balance between encouraging the student to express vital
information and respecting your student’s (and your own)
boundaries
 Talking
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to a Student You Are Concerned About
Be non-judgmental, as criticism will push him/her away from you
and the help he/she may need
Clarify that you cannot promise complete confidentiality
Give hope that things can get better and identify available help on
campus
Maintain clear teacher-student relationship boundaries and
consistent academic expectations
Follow-up with student to check on how he/she is doing
Questions: What gets in the way of us doing this more? What
anxieties/fears do we have that may hold us back from reaching out
to a student?
 Consulting
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With a Trusted (or New) Resource
Who do you have you can go to for a trusted consultation?
Friend, Peer, Supervisor
Center for Counseling and Student Development
Dean of Students Office
Student Health Services
Office of Student Rights and Responsibilities
Disability and Support Services
 Referring
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a Student: When
When you are doing more “counseling” than feels appropriate
When the problems or requests made are outside the scope of your
role with the student
When after some effort, you feel like you are not making progress
in helping the student
When you wonder if the student has a disability or is struggling
psychologically
 Referring
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a Student: How
Ask “Are you talking to someone about this?”
Express your concerns directly to the student and focus on
objective behaviors versus personality characteristics or diagnostic
labels
Let the student know that the issues they are discussing with you
are not your area of expertise and/or beyond your ability to help
Normalize help seeking behavior and recognize it as a courageous
and healthy thing to do; don’t say “you need help”
Wonder with the student if seeing a counselor might be helpful
Encourage the student to call the Counseling Center and make his
or her own appointment; offer to do this from your office/phone
 Referring
a Student: How
If a crisis, call the Counseling Center yourself, maybe even offer to
walk with the student over to the Center for support
Follow up with the student to check on status and follow-thru
It is helpful to remember:
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May not follow thru with a referral
May only attend one appointment
May stop counseling at any time
Just because a student is engaged in counseling does not mean that things are
better (or will get better)
Student may attend counseling only because he/she feels ‘coerced’ into it, or
to obtain a more favorable status with the instructor/staff member
 Example
Statements:
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“I wanted to touch base with you because I’ve noticed _________
and I just wanted to see how you’re doing.”
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“Maybe one of the things we can do is get you some support, to
help you with what you’re going through right now.”
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“I’ve seen some changes in you over the past couple of weeks and
I’m concerned that you don’t seem like yourself”
 Center
for Counseling and Student
Development
 Dean of Students Office

ECU Cares

(www.ecu.edu/cs-studentlife/dos/onlinereporting.cfm)
 Student
Health Services
 Disability Support Services
 Office of Student Rights and Responsibilities
 Individual
and Group Psychotherapy
 Psychiatric Services
 Crisis Intervention:
 Daily Crisis Hours
 24 hour Crisis On-Call
 Educational and Preventative Outreach
 Consultative Services
 Case Management Services
 Referrals to other providers

It is late into the semester, with only a handful of weeks
left until finals. Johnny, a freshman in your Intro class,
has been one of your favorite students this semester in
class. He is typically active, engaged, one of the students
you can count on to be a part of the class discussion,
someone who typically sits near the front and appears
eager to learn. Over the past several weeks, you’ve
noticed that Johnny has missed a few classes, which
isn’t like him. He also has made some poor grades
recently. He seems less engaged in class, staring out the
windows, seems less interested. You’ve noticed that he
seems less ‘put together’ in class as well, sometimes
wears hoodies that almost seem to cover up his face.
His eyes look bloodshot at times, but this is an 8:00am
class, so that really isn’t all that unique. One day, at the
end of class, Johnny comes up to you saying that he
wants to talk to you about his grades. He indicates that
he knows he has made some poor grades recently, and
hopes that you might ‘take it easy on him,’ and discloses
that he has been having some ‘family problems’
recently. What do you do?

Suzie, a sophomore in your writing class, has always seemed
quiet, withdrawn, and does not talk much in class. She sits in
the back, often coming in right when class begins, and seems
to look for a seat that is away from others. Her work is often
spotty, her grades have been mid-pack. Even though you
have a strict no cell phone policy, you have noticed her
texting over the past few class periods (which is new for
Suzie). This, of course, has annoyed you and you have made
several comments to Suzie reminding her of your cell phone
policy, which she has acknowledged and said ‘sorry.’ Suzie’s
writings have seem to become increasingly dark, but not to
the point that you feel the need to turn them into anyone in
an official manner. After class one day, when you are packing
up, ready to go, with the remaining students walking out the
door, Suzie comes to the front, says that she has a question
about class. Before you know it, she quietly discloses that her
father just died, that she is going home every weekend to
help her mom and younger siblings, that she is barely
managing things, sometimes even wonders about ‘not being
here,’ wants to see her dad again, and then asks you to not
tell anyone because she is worried about people thinking she
is crazy. She quickly says she has seen a therapist in the past
who was crazier than she was, and isn’t interested in doing
that again. What do you do?
 Location:
137 Umstead Building
 Phone: (252) 328-6661
 Office hours: M-F 8:00 AM – 5:00 PM
 Website: www.ecu.edu/counselingcenter