mental health

This post is an entry for Part III of the Mentally Healthy resource guide for UP faculty and academic staff working with students who might have mental health concerns.

While no one would ever wish a trauma experience on a student, the reality is that trauma experiences are common and often unavoidable. The question becomes how we respond. While ‘post-traumatic stress disorder (PTSD)’ has come into common parlance and helped people better recognize the possible long-term effects of trauma, psychologists are also very interested in ‘post-traumatic growth’ and encourage a recognition that with the right support trauma is not always debilitating.

The Portland-based Education Northwest organization makes available a broad guide on Trauma-Informed Practices for Postsecondary Education that covers a wide range of trauma experiences. The American Counseling Association also has information available about what to expect from “Distressed College Students Following Traumatic Events” including examples of effects that might include suicide threat, memory loss, comments trigger flashbacks, and survivor’s guilt.

Here I’ll also just briefly discuss two types of trauma experiences seem particularly common among college students: the death of a loved one, and experiences of sexual assault.

According to the University of California guide for Promoting Student Mental Health “Between 35 and 48 percent of college students have lost a family member or close friend within the last two years (Balk, 1997; Wrenn, 1999; Balk, Walker & Baker, 2010). Furthermore, 8.6 percent of college students’ academic performances have been affected by the death of a family member or close friend within the last year (Servaty-Seib & Hamilton, 2006). Research shows that a student’s GPA significantly decreases during the semester of loss, providing empirical support for the assertion that bereaved students are at risk for declined academic performance (Servaty-Seib, 2006).”

Beyond referring students with significant grief needs to the UP Health and Counseling Center and to the Early Alert / Care Team, there are quite a few resources for educators working with grieving students. While many of these are geared at K-12 educational contexts, an organization called Actively Moving Forward is specifically geared toward “connecting and empowering grieving college students” while also being part of a broader Coalition to Support Grieving Students offering resources such as these suggestions of “what not to say”:

The University of California guide for faculty and staff also notes that “The statistics for the sexual assault of college women is staggering: one in four or five college women will be survivors of a sexual assault during their college career. While approximately 90 percent of sexual assault survivors are female, it is estimated that 10 percent of survivors are male. While most sexual assaults are committed by men against women, men are also assaulted by women, and same-sex assaults also occur. The transgender population is also at risk. The majority of sexual assaults are committed by someone known to the survivor (e.g., an acquaintance, date, partner or former partner, or family member) and most of these assaults go unreported.”

When faculty and academic staff are confronted with this type of trauma, the UP Title IX office offers a helpful guide elaborating on a five step model:

Step 1 – Support. Offer support non-judgmentally and with empathy.

Step 2 – Safety. Assess for safety. [contacting Public Safety at 503 943 7161 if necessary]

Step 3 – Confidentiality. Inform about the limits of confidentiality to conversation. [noting that with UP employees it cannot be completely confidential]

Step 4 – Resources. Refer to appropriate resources.

Step 5 – Report. Report to the Title IX Office.

 

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This post is an entry for Part III of the Mentally Healthy resource guide for UP faculty and academic staff working with students who might have mental health concerns.

The bad news: data suggests that colleges and counseling centers are finding increasing needs for mental health services in ways that stretch capacity and create concern about a “fragile” generation. The good news: much of this increase in need may relate to the destigmatization of mental health concerns among younger generations, and opportunities for students to persist with education in the face of challenges that may have previously gone unacknowledged. Working with college students thus requires a combination of concern, recognition, understanding, and encouragement.

While the story of mental health concerns among college students is multi-faceted, the increasing recognition of these concerns comes with an increasing value to mental health literacy among faculty and staff. While there are many educational opportunities to develop that literacy, here I’ll just highlight and offer a brief overview of the three most common. As reported in the Association for University and College Counseling Center Directors Annual Survey, these are: anxiety, depression, and relationships.

Anxiety concerns can range from relatively common concerns about academics, social situations, and finances to more profound psychological disorders – which often onset around the typical college age. One challenge with anxiety disorders is that some degree of anxiety is normal and adaptive  — feeling nervous about a big exam can help us prepare, while being anxious about unfamiliar social situations can keep us safe. But it is easy for these stressors to step over an imaginary line to become debilitating and disruptive.  Here’s how the American Psychological Association describes the most common ways anxiety manifests when it steps over that line:

Depression often overlaps with anxiety, and it too often starts with relatively normal experiences – a low mood or periods of sadness can be quite normal when dealing with the new challenges of college life. But major depression is often diagnosed when those moods are disproportionate to life events, and when they become disruptive to regular functioning. Depression is diagnosed based on a constellation of symptoms that do not necessarily look the same across individuals. But, as illustrated by a Huffington Post infographic, there are some common physical and emotional manifestations (not all of which need to be present for any one individual diagnosis):

Relationship concerns can also come in a wide range of forms – from romantic, to roommates, to parents, to professors. Jeffrey Jensen Arnett is a developmental psychologist who did much to define “Emerging Adulthood” as a new stage of the lifespan where many, including most traditional age college students, engage in intensive identity exploration around love, work, and worldview. He also argues that relationship expectations are less structured than in the past – parent-child relationships have to be re-normed when kids leave for college, but most are not just left on their own; romantic relationships are more diverse and less bound by cultural norms and expectations. This can be disorienting, and requires skill building. Some relationship issues relate to interpersonal violence, and need to by addressed through mechanisms including the Title IX office. In other cases, students simply need support for building skills to have healthy relationships.

More good news is that all these types of concerns can in fact be addressed through quality counseling and support. When we as faculty and academic staff recognize the need in our students, make the right referrals and know that the very commonness of these concerns means they can be, and regularly are, successfully navigated as part of the college experience.

 

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This post is an entry for Part II of the Mentally Healthy resource guide for UP faculty and academic staff working with students who might have mental health concerns.

So you want to know more? Good. Developing an understanding of mental health may help you not only confront and address acute mental health concerns that students (or other people in your life) present, but may also improve your general ability as an educator to be inclusive in your work. The hope is that learning about mental health is not an additional burden, but instead an opportunity for professional development and growth. Below are several practical outlets toward that end.

As a low cost and modest effort way to learn more, you can always access on-line resources relevant to faculty and academic staff roles. This on-line guide book for UP is based partially on a thorough guide for faculty and academic staff produced by Cornell University, which in turn was adapted by the University of California system into a useful handbook. The Cornell guide no longer seems available on-line, but the California update is freely available and worth a read. For links and other more policy oriented information, the Jed Foundation has made extensive efforts to offer resources related to its specific mission of addressing college student mental health concerns.

Probably the best way to educate yourself, however, is through an in-person training. The UP Academic Network for Mental Health is planning to offer at least one such training on campus each academic year – so keep an eye out for those opportunities. But we are also fortunate in Portland to have an on-line hub called gettrainedtohelp.com specifically promoting local mental health trainings provided as the collaborative public health efforts of Multnomah County, Clackamas County, and Washington County. This resources locates a range of standardized and evidence-based training programs offered in the greater Portland area, often for free or at reduced cost.

Examples of the program offerings at gettrainedtohelp.com, which are also programs offered by national and international mental health / suicide prevention efforts, include:

ASIST – Applied Suicide Intervention Skills Training. As explained on the Get Trained to Help web-site, “ASIST is a two-day interactive workshop that teaches you how to recognize someone who may be at risk for suicide, how to intervene and promote safety and how to identify appropriate supports to help keep the person safe. Participants will receive an informational workbook and wallet card that summarizes the training as well as a list of community resources.”

Mental Health First Aid. The eight-hour introductory course (for which we have trained trainers on the UP campus) is explained on the Get Trained to Help web-site as “Essential first aid training for anyone age 18 and older who wants to learn how to help a person who may be experiencing a mental health related crisis or problem. This course teaches you to recognize signs and symptoms and provides the steps to take to provide help. Participants will come away with the skills and tools to offer help to others and increase their personal knowledge.”

QPR – Question, Persuade, & Refer. As explained on the Get Trained to Help web-site, “QPR is an educational program that teaches community members how to recognize that a person may be experiencing thoughts of suicide and offer first aid until more experienced help is available. Participants will learn about warning signs, risk factors, common myths about suicide and a three step suicide prevention first aid action plan.  Participants will receive a booklet and wallet card with summary information at the end of the training.”

CALM – Counseling on Access to Lethal Means. As explained on the Get Trained to Help web-site, “CALM is intended to assist helpers in offering strategies to help clients at risk of suicide and their families reduce access to lethal means, particularly (but not exclusively) firearms. The workshop will introduce participants to the knowledge and skill components included in the completed 2 hour, interactive workshop. CALM is a means reduction program developed at the Injury Prevention Center at Dartmouth and evaluated by researchers at the Harvard Injury Control Research Center. The CALM workshop includes: a power point presentation regarding why CALM is effective and a model videotaped attempt scenario.    CALM is recognized on the SPRC/AFSP Best Practice Registry, Section III. CALM is for anyone who works with people in a clinical/counseling situation such as health and mental health, veteran affairs, schools, peer support, clergy, domestic violence, etc.”

Finally, there are some on-line training programs to help people educate themselves on mental health – though at present none seem directly available to UP faculty and academic staff. There are some examples available at the web-site of the Suicide Prevention Resource Center, though these specific programs may be less relevant for faculty and academic staff. If you find other good on-line trainings, let us know and we can keep updating here on the Mentally Healthy portion of the TLC blog!

 

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This post is an entry for Part II of the Mentally Healthy resource guide for UP faculty and academic staff working with students who might have mental health concerns.

Just how flexible should we be in classrooms and in our academic work for students seem to be struggling with mental health concerns? This type of question came up a few years back during a UP Faculty Development Day on mental health: How much should we be willing to let assignment deadlines slip? How much adjusting should we do to our attendance policies? How much time should we give to students who seem to need extra attention outside of class?

While acknowledging nuance and variable circumstances, the then-director of UP Counseling Services Dr. Will Meek offered a general response that surprised me for erring on the side of inflexibility: it’s really important for faculty to set good boundaries and maintain high expectations when students have mental health concerns. His sense was that good boundaries and high expectations often give a reliable and helpful structure to the lives of students who are otherwise prone to drift and disengage. It is human to sympathize with the extra academic needs of students struggling with mental health concerns, but too much flexibility can sometimes encourage further disengagement.

There is no magic formula for setting perfect boundaries, but the suggestion here is that it is important for faculty and academic staff to think about intentionally and to draw on best practices. This is particularly true in two related domains: 1) class policies and procedures, and 2) interactions with students outside of the classroom.

What would it look like to think intentionally about these things? In an Inside Higher Ed article addressing the challenges of undertaking excess ‘emotional labor’, Kerry Ann Rockquemore offers the following:

“I encourage you to spend some time asking yourself: 1) What precisely are my responsibilities as a professor? 2) What are my students’ responsibilities? and 3) Where exactly does my responsibility end and my students’ responsibility begin? This clarity will help you to feel more comfortable defending your boundaries when students cross them, without any guilt whatsoever.”

In regard to class policies and procedures, one result of such thinking would be clear policies that are set out at the beginning of the semester with the right balance of challenge and support. Give students clear deadlines, and clear consequences. But also build in chances to learn from mistakes. Allow them to drop a quiz score or two, provide some choice on which writing assignments they submit, offer some free passes if they miss a class. And then be consistent and up front so that students know what to expect when, and be careful about exceptions.

As a ChronicleVitae article on the challenges of being an ‘empathic teacher’ by Tracey M. Lewis-Giggetts phrases it:

“I want to give students the benefit of the doubt each and every time. But I’ve come to learn that doing so doesn’t always help them. If anything, it enables them. So while I’ll offer second chances like extra-credit work or a make-up assignment — because I think those things really do exist in life — I never deviate from the initial rules of engagement in my classroom.”

In regard to interactions with students outside the classroom, remember that for academics best practice is to leave psychological counseling to the professionals. We can and should listen, care, and get to know our students. But we should also maintain boundaries that allow us to be effective at our own profession: teaching and learning. In the Inside Higher Ed essay cited above, Rockquemore suggests a stock phrase to manage situations where boundaries may be getting crossed:

“It sounds like you need a space to have a confidential conversation, and I can’t help you because I’m not trained as a _______ (therapist/crisis counselor/financial aid specialist, etc.). Do you know how to connect with the _______ on campus (insert appropriate support service)?”

There is no perfect formula, but the suggestion here is to think carefully about how to set boundaries “just right”: not too loose, but not too rigid. As explained by psychologist Amanda J. Wyrick in her article “Professor Goldilocks and the Three Boundaries”:

“Rigid boundaries, in which a professor does not try to build connections with students, may negatively impact student perception of the emotional support available to them. Conversely, loose boundaries, in which a professor fails to establish any kind of authority, takes student problems too personally, and shares too much personal information with students, may also damage the instructor-student relationship. Loose boundaries may confuse the student, potentially leading to a conceptualization of the professor as a friend rather than a teacher and mentor.”

Wyrick also draws from bell hooks writing in Teaching to Transgress for a useful summary of why sometimes erring on the side of good boundaries matters: “teachers must be actively committed to a process of self-actualization that promotes their own well-being if they are to teach in a manner that empowers students.”

 

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