mental health concerns in higher education

Mental Health Mental Health Concerns in Higher Concerns in Higher

EducationEducationVered Birmaher, MD

RMU Counseling Services, Psychiatry Fellow in Child and Adolescent Psychiatry

Western Psychiatric Institute and Clinic, UPMC

OutlineOutline• How prevalent is mental illness among

college students?• What are the common diagnoses?• What causes mental illness? • What are the treatment options? • What might I see in the classroom?• What is the role of faculty?• What is the RMU referral process?• How do I approach a student?

How prevalent is How prevalent is mental illness mental illness

among college among college students?students?

• 1 out of 4 college students suffers from some form of diagnosable mental illness.

• 44 percent of college students reported symptoms of depression.– 62% reported feeling very sad– 30% felt so depressed it was difficult to

function– 45% felt things were hopeless

• 45 % reported overwhelming anxiety• 36 % reported overwhelming anger• 17 % reported interpersonal violence• Over 66 % of those with a substance

use disorder have a co-occurring mental health diagnosis

• 5 million young females suffer from eating disorders each year, the deadliest mental illness

• Of students that dropped out of college, 64% said mental health was the major cause. – Of those, 45% did not receive

accommodations for various reasons– 50% did not access mental health

support– Others lost financial aid/scholarships

due to low GPA or changing to part-time student status

• Suicide is a leading cause of death among youth – 3rd leading cause in ages 15-24– 2nd leading cause in ages 20-24

• Yearly, at least 7 % of students report contemplating suicide and 1.5 % report attempting suicide

What are the What are the common common

diagnoses?diagnoses?

DepressionDepression• Sadness• Loss of interest in

activities• Feelings of guilt• Poor concentration• Low energy • Changes in appetite

and/or weight• Poor or excessive

sleep

• Hopelessness• Thoughts of death or

suicide

Associated symptoms• Irritability• Tearfulness• Anxiety• Pain

Generalized Anxiety DisorderGeneralized Anxiety Disorder

• Persistent, significant worries with ongoing, severe tension

• Feeling helpless to control these worries• Worries can focus on job responsibilities,

family health, or minor matters such as chores, car repairs, or appointments

• Many associated physical symptoms

Attention Deficit Attention Deficit Hyperactivity DisorderHyperactivity Disorder• Inattentiveness, distractibility, problems

with concentration• Impulsivity• Hyperactivity - may manifest as

fidgeting in this age group

Other disordersOther disorders

• Social Anxiety Disorder• Panic disorder• Obsessive-Compulsive Disorder• Posttraumatic Stress Disorder• Bipolar Disorder• Schizophrenia• Substance Use Disorders• Eating Disorders

What causes What causes mental illness?mental illness?

Depression is a Depression is a BIOLOGICAL BIOLOGICAL

illnessillness

What are the What are the treatment options?treatment options?

Over Over two-thirdstwo-thirds of young of young people do not talk about people do not talk about or seek help for mental or seek help for mental

health problems.health problems.

80-90 percent80-90 percent of of people people

that seek the necessary that seek the necessary form of mental health form of mental health

treatment can function treatment can function the way they used to.the way they used to.

Treatment Treatment • Bolster family, social, religious supports• Relaxation, stress management• Exercise, healthy eating • Provide academic supports • Therapy • Substance abuse treatment• Medication management

What might I see What might I see in the classroom?in the classroom?

The Suddenly Empty ChairThe Suddenly Empty ChairHe only missed one day of class. As an instructor, when you look at your roster and see exemplary attendance, one day usually doesn't raise concern. But there's always that little voice in the back of your mind. The one that says, "This kid has record attendance. He's never missed a quiz or an assignment. E-mails when he's going to be late. Apologizes when he is. I hope he's OK."

Marguerite Choi

Academic SignsAcademic Signs• Repeated absences or missed work• Deterioration in quality or quantity of work• Disorganization or erratic performance• Written or artistic expression of unusual

violence, morbidity, social isolation, despair, confusion, thoughts of suicide or death

• Continual seeking of special provisions • Patterns of perfectionism- must get A’s,

overblown or disproportionate response to grades or other evaluations

Emotional SignsEmotional Signs• Direct statements indicating distress, family

problems, trauma, loss, etc• Angry outbursts, yelling, or aggressive comments • More withdrawn than usual • Expressions of hopelessness or worthlessness• Crying or tearfulness • Severe anxiety or irritability• Distractibility, problems with concentration• Excessively demanding or dependent behavior • Lack of response to outreach from course staff

Physical SignsPhysical Signs• Deterioration in physical appearance or

personal hygiene • Excessive fatigue, falling asleep in class• Visible changes in weight• Noticeable cuts, bruises, or burns • Frequent or chronic illness • Shaking, tremors, fidgeting, or pacing• Confusion; disorganized or rapid speech • Coming to class under the influence

Safety Risk IndicatorsSafety Risk Indicators• Written or verbal statements that

mention despair, suicide, or death • Severe hopelessness, depression,

isolation, and withdrawal • Statements to the effect that the

student is going away for long time• Statements that mention hurting

someone else

What can I do?What can I do?

Set a Positive EnvironmentSet a Positive Environment• Get to know your students• Foster an open door policy• You need only care and listen• Be mindful and respectful of mental health

issues• Promote collaboration, friendly competition• Discuss time and stress management• Provide constructive feedback

Know the ResourcesKnow the Resources• Early alerts form - www.RMU.edu/atrisk

– For academic and emotional concerns– The information goes to Cassandra Oden– Any referrals for emotional or mental

concerns are passed on to Randon Willard– If needed, Randon then sends students to

the therapist for intake and she can refer to MD.

• Stop by the Center for Student Success to talk with one of the staff

• Know resources for information, support

Approaching a StudentApproaching a Student• Meet privately with the student • Turn off all distractions (cell phone,

computer, etc) • Begin the conversation by expressing your

concerns about specific behaviors you have observed.

• Your role is to listen, support and provide referral sources

• Convey hope

Helpful phrasesHelpful phrases• Use I statements: “I’ve noticed lately that “I’ve noticed lately that

…”…”• Ask open‐ended questions that deal directly

with the issues without judging: “How are “How are things going for you?”things going for you?”

• ““What problems has that situation caused What problems has that situation caused you?”you?”

• Listen attentively and encourage the student to talk: “Tell me more about that.”“Tell me more about that.”

Helpful phrasesHelpful phrases• Paraphrase what you have heard: “It sounds “It sounds

like x and y have been very stressful for you”like x and y have been very stressful for you”• Convey your concern and caring: “What do “What do

you need to do to get back on track?”you need to do to get back on track?”• Help student stay in control: “What do you “What do you

think would be helpful for you in this think would be helpful for you in this situation?”situation?”

• Discuss potential benefits of resources and referrals: “I know the folks in that office and “I know the folks in that office and they are great at helping students work they are great at helping students work through these kinds of situations.”through these kinds of situations.”

ReferralReferral• Provide contact info for referral resource • Your offer of help may be rejected. Respect

student’s autonomy unless you have a concern for danger.

• Convey that your referral is due to concern about the student and the knowledge that professional help works.

• End the conversation in a way that will allow you or the student to revisit the topic. Invite the student back to follow up and/or check in with student.

Lethality ScreeningLethality Screening• A student who is considering suicide will A student who is considering suicide will

likely be relieved that you asked. likely be relieved that you asked. • If the student is not contemplating suicide, If the student is not contemplating suicide,

asking the question will not asking the question will not puput ideas in t ideas in their head.their head.

• If you have an urgent concerns about a student’s safety, stay with the student and call Public Safety

• Limits of confidentiality

Lethality ScreeningLethality Screening• “Sometimes people in your situation can feel

that life is not worth living anymore. Have you felt this way?

• “Have you had thoughts of ending your life?”• “Do you feel that your situation is hopeless?”• “Have you done anything to hurt yourself in

any way?”• “As depression worsens, people can become

hopeless and think of suicide. Has that happened to you?”

EmergenciesEmergencies• If a student is in imminent danger of If a student is in imminent danger of

harming self or others, stay with the harming self or others, stay with the student and immediately call Public student and immediately call Public Safety at (412) 397-2424Safety at (412) 397-2424– Safety will transport to Sewickley Valley

Hospital Emergency Room for evaluation– This student is not appropriate for referral

to us and needs more intensive care immediately

• ReSolve Crisis Network can also provide support and even send a team to help 1-888-7YOUCAN

WebsitesWebsiteshttp://www.RMU.edu/AtRisk• Faculty information about warning signs, how

to approach students, how to refer students, resources. Fill out the Early Intervention Referral Form for both personal and academic student issues

• http://www.gannett.cornell.edu/notice• http://www.jedfoundation.org• http://nami.org -- especially NAMI on Campus• http://www.nimh.nih.gov/health/index.shtml• http://www.samhsa.gov

ContactContact informationinformation

Vered Birmaher, MDPsychiatry, RMU Counseling ServicesFellow in Child and Adolescent PsychiatryWestern Psychiatric Institute and Clinic, UPMC

RMU WPICBirmaher@rmu.edu Birmaherv@upmc.edu412-397-4349 412-586-9153