Help Students with Mental Illness Success in Campus

ChunLin J. Ju, Psy.D.November 28, 2007.

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Instructor: 朱春林博士 ChunLin J. Ju, Psy.D.

學 歷：佛瑞斯特專業心理學院臨床心理博士班畢業 (Doctorate in clinical psychology in Forest Institute of Professional Psychology, MO, USA)執 照：臨床心理師 ( 心理字第 000651 號 )(Licensed Clinical Psychologist) 現 職：臨床心理諮詢顧問、督導 新竹教育大學教育心理暨諮商心理系／所兼任助理教授 清華大學學生諮商中心兼任臨床心理師興 趣：兒青心理病理、注意力缺陷與過動症、適應障礙、自閉症、妥瑞氏症、焦慮 症、憂鬱症、躁鬱症、人格疾患、心理諮詢、心理治療、心理衡鑑、專業倫 理、遊戲治療、砂盤治療、催眠、哀傷諮商、女性主義、談判協商、性／別／ 性取向議題經 歷：西肯塔基州立精神病院 (Doctoral Intern, Western State Hospital, KY, USA)

培尼羅伊心理健康中心兒青診所、成人診所 (Doctoral Intern, Pennyroyal Mental Health Center, Children’s Clinic, Adult Clinic, KY, USA) 佛瑞斯特學院診所 (Psychological Trainee, Forest Institute Clinic, MO, USA) 交通大學學生諮商中心、台積電、世界先進、外貿協會特約心理治療師 青輔會、北市勞工局特約生涯諮商師 新竹教育大學、文化大學、與多所企業講師聯 絡： (02)2215-4092 junoju@hotmail.com

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Topics Covered

Introduction of mental illness Common mental disorders in campus Accommodation to special needs of

these students Q&A Goals:

Identify the signs of individuals in distress Take the appropriate steps to get help

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What is Mental Illness?

Mental illness is a term that refers collectively to all diagnosable mental disorders causing severe disturbances in thinking, feeling, relating and functional behaviors

These disorders result in substantially diminished capacity for coping with the ordinary demands of life

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What is Mental Health? (cont’d)

精神衛生法第三條： 精神疾病係指個體的思考、情緒、知覺和認知等精神狀態異常，致使適應生活的功能發生障礙，而需要醫療與照顧的疾病，包括精神病、精神官能症、酒癮和藥癮等衛生主管機關認定之精神疾病。

精神疾病 = 心理疾病

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What is Mental Health? (cont’d)

Well Adjusted Reasonably worry-

free

Can handle the usual daily tensions and crises of living which may involve moments of fear, anxiety, distrust, depression

Mentally Ill Frequently and

severely worry-bound

Tends to exaggerate these same thoughts and feelings of fear, anger, anxiety, distrust and depression

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Therapeutic Recreation

Mental Illness Can be temporary Occurs most often n

early adult and middle years

Does not necessarily interfere with strictly intellectual abilities

Often can be cured by counseling, medication, surgery

Mental Retardation Is usually lifelong

condition Occurs at or near

birth and almost always recognized by school age

Is characterized by impaired intellectual development

Treatment through therapy but not cured

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Prevalence

Mild mental illness conditions are common

1/5 of Americans experience some diagnosable mental disorder during any given year

Anxiety disorders are most common

Depression affects 1 in 10 adults

3% experience severe and persistent mental illness ( American Psychiatric

Association, 2005)

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Signs of Problems Extremely poor academic performance, or a

change from high to low grades Excessive absences, especially if prior class

attendance was good Unusual or noticeably changed interaction

patterns in the classroom Depressed or apathetic mood, excessive

activity or talkativeness, evidence of crying Noticeable change in appearance and hygiene Alcohol on the breath/problem drinking

patterns Inability to remain awake in class Repeated attempts to obtain deadline

extensions or postpone tests

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Signs of Problems (cont’d) New or continuous behavior which disrupts

class or student interactions Inappropriate or exaggerated emotional

reactions to situations, including a lack of emotional response to stressful events

Seeking help from multiple other parties instead of counseling professionals

Violent or other extremely disruptive behavior Obvious loss of contact with reality Disturbed speech or communication content Suicidal or other self-destructive thoughts or

actions Homicidal threats Marked personality change

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Depression Mood disorder Depressed mood or loss of interest/pleasure

over long period: 2 weeks vs. 2 years

Emotional: Depressed, anhedonia

Somatic: Appetite, weight, sleep, sexual, energy disturbance

Behavioral: Psychomotor agitation/retardation

Cognitive: Distraction, indecisive, low self-esteem, guilty,

worthless, suicidal

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Bipolar Disorders Mood disorder Mania + depression 10-15% completed suicide Mania:

Grandiose, euphoric, elevated, expansive, or irritable mood lasts for one week vs. four days

Mood: • as above

Somatic: • Abnormal sleep and energy

Behavioral: • Pressure of speech, goal-directed or pleasurable

activities Cognitive:

• Flight of ideas, distractibility

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Bipolar Disorders (cont’d)

Bipolar vs. Schizophrenia: Variability of content Dramatic response to mood regulators 3-generation family history for mood

disorder

Bipolar vs. ADHD: Most manic kids meet ADHD criteria 20% of those with ADHD symptoms meet

mania criteria

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Suicide

The 2nd leading cause of death for

college students is suicide (Jed Foundation, 2005)

One out of every 12 college students has made a suicide plan (Mental Health America [Formerly known as

National Mental Health Association], 2007)

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Danger Signals for Suicide Risk

Talking about death or suicide Feelings of hopelessness Withdrawing from friends and social activities Taking unnecessary or life-threatening risks Giving away personal possessions Losing interest in personal appearance Increasing use of alcohol or [other] drugs Having attempted suicide in the past, however

half-heartedly (Kadison & DiGeronimo, 2004)

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Anxiety Disorders Generalized Anxiety Disorder

Excessive worry in general

Obsessive-Compulsive Disorder Consuming fixation and ritualistic behaviors

Panic Disorder Overwhelming physiological event

Social Phobias Incapacitating fear of social interactions

Specific Phobias Intense fear of specific object, event

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Post Traumatic Stress Disorder

Anxiety Disorder Exposure to traumatic event reexperience: Flashbacks Passively avoiding reminders: Numbing

of affect, dissociative amnesia Heightened general arousal Duration of disturbance: One month

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Attention-Deficit/Hyperactivity Disorders (ADHD)

Inattention Hyperactivity Impulsivity Age of onset: Before 7 years Symptoms last for at least 6 months Seen in two or more settings

70% of childhood cases persist into adolescence and 65% of adolescent cases persist into adulthood, although some symptoms may improve/change (Barkley et al., 2004)

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Tic Disorders

Tics: Sudden, brief, involuntary or semi-voluntary movements (motor tics) or sounds (vocal tics)

Tourette’s Disorder: Both multiple motor

and one or more vocal tics

Onset before age 18 years

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Schizophrenia

Most serious mental illness Active-phase symptoms: One month

Thought disorganization: Delusions, hallucinations

Speech disorganization: Incoherence, derailment,

Behavioral disorganization: Catatonic, bizarre,

Negative symptoms: Anhedonia, flat of affect, alogia, avolition, associality

Social/Occupational dysfunction Duration of disturbance: 6 months

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Personality Traits or Disorders

Inflexible and pervasive enduring pattern of inner experience and behavior in: Cognition, affectivity, interpersonal

functioning, impulse control

No particular psychosis or suffering and usually normal behavior, but can result in anti-social acts without sense of guilt

E.g., Borderline Personality Didorder

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Relationship Violence Violence against women on college campuses is

widespread (B. Fisher, F. Cullen, M. Turner, 2000)

The highest rates of relationship violence are among women 16-24 years of age (U.S. Department of Justice, Office of Justice Programs, 2001)

13% of surveyed students reported experiencing an emotionally abusive relationship the last school year (American College Health Association, National College Health Assessment, 2006)

Over half of all stalking victims are 18-29 years (U.S. Department of Justice, Office of Justice Programs, 1998)

Midwest University Study: The number of students seen in response to sexual assault quadrupled (Kansas State University Study (1989-2001) of 13,257 students, cited in: Benton, Robertson, Tseng, Newton, & Benton, 2003, p. 69)

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Functional Limitations of Mental Illness

Screening out environmental Stimuli Sustaining concentration Maintaining stamina Handling time pressures and multi-tasks Interacting with others Fear of authority figures Responding to negative feedback Responding to change Severe test anxiety

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Causes of Mental Illness

Heredity

Psychological

Physical

Environment

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Treatment of Mental Illness How

Psychotherapy: Individual or group Milieu therapy: Environmental change Medical treatment: Drug therapy

Who Psychiatrists, clinical psychologists

Where Mental hospitals, private practice, mental

health clinics, health centers, general hospitals, campus counseling centers

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Medication

Take much longer time to take effect Side effects:

Nausea Drowsiness Fatigue Excessive thirst Blurred vision Hand tremors Initiating Interpersonal contact Loss of appetite, sexual interest Weight gain

Steps In Responding

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Steps In Responding

Recognize signs

Assess impact

Identify strategies to assist

Refer

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When to Refer (professional staff) A student asks for help with a problem outside

of your realm of expertise The student feels uncomfortable talking to you

about the problem What you have done so far, has not sufficiently

helped reduce the problem The student’s behavior is disrupting others Helping the student could represent a conflict

of interest or dual relationship You are having a strong emotional reaction to

the student’s situation You are extremely busy or stressed, or unable

help

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How to Refer Talk to the student in private Express concern, while being specific Listen empathically Remain neutral Suggest that it would be helpful to talk to a trained

professional at the Counseling Center Have the student call to schedule an appointment from

your office Demystify and de-stigmatize counseling Call a psychologist or counselor to consult Obtain emergency help via Campus Safety if there is a

threat of danger or harm Follow up with the student to find out if he/she kept the

appointment

Accommodation

Removal of Barriers

to Participation

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The emphasis is on ACCESS,NOT on outcome

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Laws Requiring Reasonable Accommodations

1973 Rehabilitation Act, Section 504

1990 Americans with Disabilities Act

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Principles of Accommodation

Address individual needs Respect student’s desire for confidentiality Engage in joint problem solving Make all accommodations voluntary Review accommodations periodically Be flexible in enforcing policies Identify accommodations clearly

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Accommodations Are NOT Reasonable if They...

Pose a direct threat to the health or safety of others

Make substantial changes in essential elements of the curriculum

Require substantial alteration to educational opportunities/course objectives

Pose undue financial or administrative burden

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Strategies for Inclusion in College

Teach to various learning styles: Visual, auditory, kinesthetic

Increase experiential learning activities Increase knowledge and acceptance of

mental illness Be prepared to set behavioral limits Know campus mental health resources Work cooperatively with students Assist students with time management

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Possible Classroom Accommodations

Preferential seating, near door Assigned classmate as assistant Beverages permitted Prearranged or frequent breaks Tape recorder, note taker Early availability of syllabus, text Text, assignments in alternate formats Personal and private feedback

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Possible Examination Accommodations

Change in test format: Written to oral and vise versa, dictation, scripted, typed

Permit use of computer software Exams in alternate format: Portfolio, demo

Extended test taking time Individual proctoring Separate, quiet room for testing Increased test frequency

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Possible Assignment Accommodations

Substitute assignments in specific circumstances

Advance notice of assignments Allow assignments hand written Written rather than oral, or vise versa Change format: Drama, role-play, sculpture Assignment assistance: Ask Extensions on assignments

Campus Safety

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Campus Safety

All colleges must guarantee learning environments that are safe and secure

Student mental health emergencies may bring unrest and harm to the student in distress, other students, and faculty/staff/administration

College educators are mandated reporters for child abuse

Examples: Suicide attempts, incidents of stalking, sexual assault, domestic violence, and substance abuse

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Behavioral Issues & Student Conduct

All students must abide by the student code of conduct

Perform behavioral assessment to determine if a student is in emotional crisis, is responding to a real-life crisis situation or is being disruptive

Identify and refer those in emotional distress to a mental health professional

Identify and refer those who are just “acting out” to campus disciplinarian

Involve police when safety is threatened

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Mandatory Hospitalization

精神衛生法第 21條： 嚴重病人如有明顯傷害他人或自己之虞，或有傷害行為時，經專科醫師診斷有全日住院治療之必要者，前往精神醫療機構辦理住院

前項嚴重病人不接受全日住院治療時，應由兩位以上專科醫師鑑定，經書面證明有全日住院治療之必要者，應強制其住院；其強制住院，應在中央衛生主管機關指定之精神醫療機構為之。

前項鑑定，以全日住院方式為之者，其住院鑑定期限，以七日為限

強制住院治療需要有合作的精神專科醫院，並通知當地衛生主管機關

Concluding Remarks

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Concluding Remarks

It is critical to develop a campus-wide cultural climate that de-stigmatizes mental illness, removes barriers, and encourages help-seeking behavior

Sensitivity and awareness training is imperative for administrators, faculty, staff, and student workers

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Concluding Remarks (cont’d)

Interventions aim at: Supporting student success Assisting in protecting the health, safety,

and welfare of the students and members of the campus community

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Reference ADA: American Disability Association Anxiety Disorder Association of America (http://www.adaa.org/)

AHEAD (http://www.ahead.org)

Al Souma. Accommodating students with psychiatric disabilities. Disability Support Services. Seattle Central Community College. DO-IT, University of Washington

Center for Psychiatric Rehabilitation Sargent College of Health and Rehabilitation Sciences (http://WEB.bu.edu/sarpsych)

DO-IT The Faculty Room (http://www.washington.edu/doit/faculty/)

Judge Bazelon Center for Mental Health Law (http://www.bazelon.org/)

Office of Civil Rights: Region 10 National Alliance for the Mentally ill (NAMI)

(http://www.nami.org)

National Institute of Mental Health (http://www.nimh.nih.gov/)

Q & A