College Student Mental Health

1
IDENTIFYING AND RESPONDING TO STUDENTS OF CONCERN
Bethany McCrawAssociate Dean forJudicial Affairs
Jim MarshDirector of Counseling Services
Chris HolmesAssistant General Counsel
Martha Lou ScottAssociate Vice President
forStudent Life
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Our Lens Today

• Jim MarshOur environment and resources
• Chris HolmesLegal concerns
• Bethany McCrawDistinguishing between concerning
  and alarming behavior
• Martha Lou ScottMaking referrals with you
  resources

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COUNSELING SERVICES
Jim MarshDirector of Counseling Services
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Objectives

• Review the national trends in college student
  mental health
• Review the resources available at the counseling
  center
• Review Counseling Center statistics students
  seen, presenting problems, etc.
• Warnings signs and how to make a referral

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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)
• Prozac Campus More Students Seek Counseling and
  Take Psychiatric Medication
• (The Chronicle of Higher Education, 2/14/2003)

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News Headlines

• The Dorms May Be Great, But Hows the Counseling?
• (The New York Times, 10/26/2004)
• Counseling Demand Overwhelms Colleges
• (Cincinnati Enquirer, 3/18/2002)
• 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)
• And the list goes on

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National Trends
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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

9
Counseling Center Directors Survey 2006

• 16.4 of center clients are referred for
  psychiatric evaluation, 12 in 2004.
• 25 are on psychiatric medication. The latter is
  up from 20 in 2003, 17 in 2000, and 9 in 1994.
  
• 92 of directors report an increase in students
  coming to counseling who are already on
  psychiatric medication.
• 92 of directors believe that in recent years
  there has been an increase in the number of
  clients with severe psychological problems.

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Counseling Center Directors Survey 2006

• 92 believe that students with significant
  psychological disorders are a growing concern on
  campus.
• 9 of the students at participating schools
  sought counseling last year.
• Directors report that 40 of their clients have
  severe psychological problems, 8 have impairment
  so serious that they cannot remain in school, or
  can only do so with extensive psychological/psychi
  atric help. While 32 experience severe problems,
  they can be treated successfully with available
  treatment modalities.

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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)

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Baylor Counseling Services Resources
13
Staff Profile

• Staff
• 6 Psychologists
• 1 Licensed Professional Counselor
• 4 Graduate Assistant Counselors 20 hrs/wk
• Full-Time Psychiatrist (open position)
• Part-Time Staff (20 hrs/wk and peak times)
• Licensed, Registered Dietitian (15 hrs/wk)

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Services

• 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

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Services

• 12 session limit per year
• First 7 counseling sessions (Baylor career)
  Free
• All additional sessions are 10 each
• Group Therapy Free
• Psychiatric Intake 80 (1 hour)
• Psychiatric Follow-up 40 (20 minutes)
• Medical Nutrition Therapy first 3 sessions are
  free additional sessions 20

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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

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Baylor Counseling Services Statistics
18
Counseling Center Statistics
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Demographics 07-08

• Gender
• Male 234
• Female 541
• Age
• 17 years 1
• 18 years 104
• 19 years 144
• 20 years 172
• 21 years 125
• 22 years 76
• 23 years 44
• 24 years 34
• 25 years 19
• 26-30 years 43
• 31-35 years 7
• 36-40 years 4
• 41 years and over 2

• School Status
• Freshman 173
• Sophomore 162
• Junior 150
• Senior 189
• Graduate 88 (3 increase)
• Law 8
• Seminary 4
• Other 1

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Demographics 07-08

• GPA
• 0.00 (first semester BU Student)
  114
• 1.99 or less 49
• 2.00 - 2.50 98
• 2.51 - 3.00 161
• 3.01 - 3.50 158
• 3.51 and above 195

• Race/Ethnicity
• Caucasian 584
• African-American 54
• Hispanic 72
• Asian 42
• Other 23

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Statistics on Presenting Problems 07-08

• Mood Disturbance 27
• 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

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Statistics on Presenting Problems Continued

• Substance Abuse 1.5
• Stress 1
• Sexual Abuse 1
• Conduct Disturbance 1
• Psychotic Disorder 1
• ADHD 1
• Pornography 1

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What about the Waiting List?

• Historically, a waiting list has started near the
  end of September
• October November and March April are the
  busiest months
• On average, the wait has been 8.5 days
• Always see students in a psychological emergency
• Fall 2008 started a triage system

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Waiting List Fall 2007
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Waiting List Spring 2008
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Waiting List Fall 2008
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Emergency Appointments Spring 2007
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Emergency Appointments Fall 2007
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Emergency AppointmentsFall 2008
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Warning Signs
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(No Transcript)
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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

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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

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Warning Signs - Continued

• Extreme dependency on faculty, staff, or
  Community Leader, including spending much of
  his/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)

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Making a Referral

• When a student agrees that counseling might be
  useful, there are several possible steps to take,
  depending on the students attitude and the
  urgency of the situation
• A. Give the student information about counseling
  options and urge him/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.

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Making a Referral

• When a student is reluctant to seek counseling
• Remind the student of the counseling centers
  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/her to benefit
  from professional help.
• Acknowledge, validate, and discuss the
  students real fears and concerns about seeking
  help.

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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 ones limitations.
• Offer to accompany the student to the
  counseling center or offer to assist them in
  setting up an appointment.

38
Contact Information

• Jim Marsh, Ph.D.
• Director of Counseling Services
• 710-2467
• Jim_Marsh_at_baylor.edu

39
LEGAL ISSUES RELATEDTOMENTAL HEALTH
Chris HolmesAssistant General Counsel
40
Legal Implications

• Legal implications are NEVER the main
  concernstudent and employee safety is.
• Potential liability concerns
• Privacy concerns
• Discrimination on the basis
• of mental or psychological disabilities is
  prohibited.

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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

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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.

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Discrimination Is Prohibited

• Protection under Rehabilitation Act and ADA
• Accommodations in educational services
• Office of Access and Learning Accommodation
• Discipline if students 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.

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MENTAL HEALTH ISSUESANDSTUDENT CONDUCT
Bethany McCrawAssociate Dean for Judicial
Affairs
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Concerning Behavior
Alarming Behavior
Threatening Behavior
46
Concerning Behavior
Threatening Behavior
Alarming Behavior

• Behavior Concerning vs. Alarming

• Policy on Threats or Harm to Self or Others

• Student Needs vs. Community Needs

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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.
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Concerning Behavior
MASS SHOOTINGS AT VIRGINIA TECH Report of the
Virginia Tech Review Panel Summary of Key
Findings August 2007
2. During Chos 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.
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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.

Contact Bethany McCraw Judicial Affairs
254-710-1715
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Concerning Behavior
Alarming Behavior
Threatening Behavior
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Alarming Behavior
A student may demonstrate alarming behavior that
causes others to feel very uncomfortable or
frightened.
The students 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.
52
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, Its the
boyeveryones afraid of him. That was when she
learned that Cho also had been using his cell
phone to take pictures of students without
permission.
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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.
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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
students conduct is distracting or disruptive,
the professor may impose the students 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.
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Student Conduct
The term Misconduct at Baylor refers
to personal behavior on or off campus that

• interferes with Baylor's pursuit of its
  educational and Christian objectives,
• fails to exhibit a regard for the rights of
  others,
• shows disrespect for the safety of persons and
  property, and/or
• violates, or attempts to violate, University
  rules, regulations, and policies or violates, or
  attempts to violate, local, state, federal, or
  international laws.

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Student Conduct
We can not necessarily remove a student
from campus just because their behavior is
concerning or alarming.
If the students conduct is disruptive, the
University can take action but the student
must be afforded the institutions due process.
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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, Deans office, or
  your supervisor.
• Inform Judicial Affairs if the behavior or
  conduct is concerning or alarming.

58
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)

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Concerning Behavior
Threatening Behavior
Alarming Behavior

• Behavior Concerning vs. Alarming

• Policy on Threats or Harm to Self or Others

• Student Needs vs. Community Needs

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Threatening Behavior
A student demonstrates threatening behavior when
he or she

• States an intent or desire to harm himself/
  herself or another, or

• Attempts to harm himself/herself or another, or

• Is in the process of harming himself/herself or
  another

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Policy on Threats or Harm to Self or Others

• This policy is only a tool.

• It is not automatically implemented in every
  situation.

• Process of the policy

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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 an intent or desire of a student to
inflict harm upon himself/herself or another.
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Policy on Threats or Harm to Self or Others
If you observe a student

• Stating an intent or desire to harm

• Attempting to harm

• In the process of harming

Call the Baylor Police Department
254-710-2222, the Counseling Center
254-710-2467, or 911.
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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/herself or
another.
The Baylor Counseling Center has counselors on
call 24-hours a day. 254-710-2467
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Policy on Threats or Harm to Self or Others
Students can be prohibited from living in
University residential facilities, participating
in academic programs, or participating in other
University activities the University may deem to
be harmful to the student until the student is
cleared to do so in accordance with the policys
clearance procedure.
We will always attempt to minimize the amount of
time a student is out of the residence halls and
classes.
An exception might be a case where a student has
threatened to harm someone else.
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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
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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.

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Concerning Behavior
Threatening Behavior
Alarming Behavior

• Behavior Concerning vs. Alarming

• Policy on Threats or Harm to Self or Others

• Student Needs vs. Community Needs

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Student Needs vs. Community Needs

• Student Success

• Community Safety

• Student Privacy

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Concerning Behavior
Threatening Behavior
Alarming 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)

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Student Records
A students 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/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.

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Helping Students Succeed

• Watch for warning signs.
• Know when to tell others.
• Know what campus resources are available.

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Reporting ProcessandIntervention Plans
Martha Lou ScottAssociate Vice President for
Student Life
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Key Departments Identified to Help Keep Students
from Falling in the Cracks
These departments have been identified to serve
as consultants to various campus constituents who
may have concerns about students on the campus
Academic Areas Ruth Prescott Academic Support
Services Ron English Sally Firmin Baylor
Police Department Jim Doak Campus Living and
Learning Terri Garrett Counseling Center Jim
Marsh General Counsel Chris Holmes Judicial
Affairs Bethany McCraw Office of Access and
Learning Accommodations Dae Vasek Parents
League Judy Maggard Paul L. Foster Success
Center Brandon Miller University Relations Lori
Fogleman Student Life Deans Martha Lou Scott
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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
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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
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IDENTIFYING AND RESPONDING TO STUDENTS OF CONCERN
Bethany McCrawAssociate Dean for Judicial
Affairs 254-710-1715
Jim MarshDirector of Counseling
Services254-710-2467
Chris HolmesAssistantGeneral Counsel254-710-38
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Martha Lou ScottAssociateVice President for
Student Life254-710-1314