1. Even Champions Have Their Down Days: Helping Students in On-going Crisis Presented By: Megan Scott, The Ohio State University Angelia Zielke, Ball State University

2. Why This Topic? “Many young people are coming to college with an existing diagnosis and treatment history. Some of those students might not have made it beyond high school in previous generations, but this means that more young people need access to comprehensive mental health care.” http://www.healthyminds.org/collegestats.cfm

3. Bleed like me Garbage (2005) avalanche is sullen and too thin she starves herself to rid herself of sin and the kick is so divine when she sees bones beneath her skin and she says: hey baby can you bleed like me? c'mon baby can you bleed like me chrissie's all dressed up and acting coy painted like a brand new christmas toy he's trying to figure out if he's a girl or he's a boy he says: hey baby can you bleed like me? c'mon baby can you bleed like me doodle takes dad's scissors to her skin and when she does relief comes setting in while she hides the scars she's making underneath her pretty clothes she sings: hey baby can you bleed like me? c'mon baby can you bleed like me therapy is speedie's brand new drug dancing with the devil's past has never been too fun it's better off than trying to take a bullet from a gun and she cries: hey baby can you bleed like me? c'mon baby can you bleed like me it's gets all fucked up in some karaoke bar after two drinks he's a loser after three drinks he's a star getting all nostalgic as he sings "I will survive" hey baby can you bleed like me? c'mon baby can you bleed like me you should see my scars you should see my scars you should see my scars you should see my scars and try to comprehend that which you'll never comprehend These lyrics are copyrighted by their respective owners (Garbage)

4. College Mental Health Statistics One out of four young adults will experience a depressive episode by age 24. According to a 2004 survey by the American College Health Association, –Nearly half of all college students report feeling so depressed at some point in time that they have trouble functioning, –14.9 percent meet the criteria for clinical depression. Students reported during the last school year feeling the following: –Over 60% of the students reported feeling things were hopeless one or more times. –Almost 40% of the men and 50% of the women reported feeling so depressed that they had difficulty functioning one or more times. –10% of the students reported seriously considering attempting suicide at least one time. http://www.healthyminds.org/collegestats.cfm

5. College Mental Health Statistics Anxiety disorders affect over 19 million American adults every year, and anxiety levels among college students have been rising since the 1950s. In 2000, almost seven percent of college students reported experiencing anxiety disorders within the previous year. Women are five times as likely to have anxiety disorders. According to the Federal Centers for Disease Control and Prevention (CDC), 7.8% of men and 12.3% of women ages 18-24 report frequent mental distress – a key indicator for depression and other mental disorders. http://www.nmha.org/camh/college/index.cfm

6. Resisting the Temptation to Diagnose Diagnosis and treatment are the responsibility of counseling/mental health professionals Not diagnosing doesn’t mean you can’t observe Research and observation are important Referrals Campus resources

7. Anxiety Disorders & Depression Who? –Anxiety disorders and depression are the two most common mental illnesses experienced by Americans. –Approximately half of all people who suffer from anxiety disorders also suffer from depression. What? –Anxiety disorders are characterized by feelings of panic, fear, and discomfort that arise with no clear cause, in situations that are not usually stressful or dangerous –Anxiety disorders are linked to depression. Two out of three people with depression also have symptoms of anxiety. Treatment? –Antidepressant medication –Psychotherapy –Combination of the two.

8. The Major Anxiety Disorders Generalized Anxiety Disorder (GAD) –Six months or more of continual, extreme worry and tension that is not based on real concerns. Obsessive-Compulsive Disorder (OCD) –Marked by obsessions - repeated, upsetting thoughts and images - that a person cannot control by self –Repetitive rituals (compulsions) to combat these images and thoughts and ease anxiety. Panic Disorder –Often characterized by the presence of panic attacks, which are feelings and symptoms such as a pounding heart, chest pain, sweating, trembling, shortness of breath, numbness and fear of dying. Phobias –Deep-seated fears that are extreme, irrational and upsetting to a person’s life. Post-Traumatic Stress Disorder (PTSD) –Long-term, severe and continuing reaction a person may experience following a disaster (such as a fire or earthquake) or a very traumatic experience (war, rape, or sexual abuse). http://www.nmha.org/infoctr/factsheets/index.cfm

9. Depression Who? –Nearly one in 10 adults each year—nearly twice as many women as men. –Depression can strike at any time, but on average, first appears during the late teens to mid-20s. What? –A serious medical illness that negatively affects how a person feels, thinks, and acts. –Variety of symptoms, but the most common are a deep feeling of sadness or a marked loss of interest or pleasure in activities. –Other symptoms include: Changes in appetite Insomnia or oversleeping Loss of energy or increased fatigue Restlessness or irritability Feelings of worthlessness or inappropriate guilt Difficulty thinking, concentrating, or making decisions Treatment? –Antidepressants - correct imbalances in the levels of chemicals in the brain. Full benefits require two to three months. –Psychotherapy, or “talk therapy,” http://www.healthyminds.org/multimedia/depression.pdf http://www.nmha.org/infoctr/factsheets/index.cfm

10. Suicide & Depression In 1998, suicide was –the eighth leading cause of death for all Americans, –the third leading cause of death for those aged 15-24, –the second leading killer in the college population. Although women suffer from clinical depression and attempt suicide more than men, men are more likely to complete the act. Depression alone or in combination with aggressive behavior, substance abuse and/or anxiety is found in over half of all suicides. If depression is present, substance abuse, anxiety, impulsivity, rage, hopelessness and desperation may increase the risks of suicide. Any talk of suicide by a student should be taken seriously and help should be sought immediately. http://www.nmha.org/infoctr/factsheets/index.cfm

11. Schizophrenia Who? –About 1% of the world population. –Symptoms usually appear between the ages of 13 and 25 –often appear earlier in males than females. What? –Serious disorder which affects how a person thinks, feels and acts. –May have difficulty distinguishing between what is real and what is imaginary; be unresponsive or withdrawn; and have difficulty expressing normal emotions in social situations Treatment? –If you suspect someone is experiencing symptoms of schizophrenia, encourage them to see a medical or mental health professional immediately. –New generation of anti-psychotic medications - help to reduce the biochemical imbalances and decrease the likelihood of relapse. http://www.nmha.org/infoctr/factsheets/index.cfm

12. Schizophrenia : Behaviors & Early Warning Signs A change in personal hygiene and appearance A change in personality Increasing withdrawal from social situations Irrational, angry or fearful response to loved ones Inability to sleep or concentrate Inappropriate or bizarre behavior Extreme preoccupation with religion or the occult. Hearing or seeing something that isn’t there A constant feeling of being watched Peculiar or nonsensical way of speaking or writing Strange body positioning Feeling indifferent to very important situations Deterioration of academic or work performance

13. Self Injury Who? –Experts estimate the nearly 1% of the population, with a higher proportion of females than males. –Typical onset is at puberty. Behaviors often last 5-10 years but can persist much longer without appropriate Treatment?. What? –Also termed self-mutilation, self-harm or self-abuse. –Defined as the deliberate, repetitive, impulsive, non-lethal harming of one’s self. –A way to cope with or relieve painful or hard-to-express feelings, and is generally not a suicide attempt. –Can be a symptom of several psychiatric illnesses: Treatment? –Outpatient therapy –Partial (6-12 hours a day) and inpatient hospitalization. –Medication for management of depression, anxiety, obsessive- compulsive behaviors, and the racing thoughts that may accompany self-injury. –Contracts, journals, and behavior logs http://www.nmha.org/infoctr/factsheets/index.cfm

14. Bipolar Disorder Who? –More than 2 million Americans suffer from bipolar disorder. What? –Illness involving one or more episodes of serious mania and depression. –Causes a person’s mood to swing from excessively “high” and/or irritable to sad and hopeless, with periods of a normal mood in between. How? –Although a specific genetic link to bipolar disorder has not been found, studies show that 80 to 90 percent of those who suffer from bipolar disorder have relatives with some form of depression. Treatment? –Professional help and support from family, friends and peers –Medication. A common medication, Lithium, is effective in controlling mania in 60% of individuals with bipolar disorder. http://www.nmha.org/infoctr/factsheets/index.cfm

15. Medications Depression –Tricyclics (Dioxipin, Amoxopine) –Hetrocyclics –MAOIs (Nardil, Parnate) –Lithium (Eskalith, Lithobid) Anxiety –Valium (Seduxen, in Europe Apozepam, Diapam) Bipolar Disorder –Lithium Schizophrenia –Antipsychotic drugs –Glycine therapy

16. The Millennial Generation Parents Expectations Dependency Are the mental health issues and crises we’re seeing signs of a generation without interdependence?

17. 7 Characteristics of Millennials 1.Special 2.Sheltered 3.Team Oriented 4.Confident 5.Conventional 6.Pressured 7.Achieving

18. Millennial Family Life Smaller families Older parents Highest parental education levels Least Caucasian

19. Millennial Students & Relationships No memories of innocent times Accountability and standards stressed Schools emphasize core subjects – less on arts and music Character education in schools College education is expected

20. Bad things happen to good people Is it possible, too, that mental health crises are a result of situations/events?

21. Sexual Assault Among college students nationwide, between 20% and 25% of women reported experiencing completed or attempted rape (Fisher, Cullen, and Turner 2000). Emotional consequences –Numbness –Shock –Anxiety –Fear –Guilt –Shame –Depression –Loss of trust Recovery is a process; takes time http://www.studentlife.villanova.edu/counselingcenter/psychtopics/sexualassault.html http://www.cdc.gov/ncipc/factsheets/svfacts.htm

22. Drug & Alcohol Abuse Drug/alcohol abuse can be brought on from the stress of broken relationships, loss of employment, or other lifestyle stressors Risk factors include poor coping skills; lack of rewarding and nurturing relationships; failure in school; inappropriately shy and/or aggressive behavior; and affiliation with deviant peers. Rates are lower in women than in men. In a 1999 NMHA survey, 52% of drug/alcohol abusers also experienced some other kind of mental health disorder.

23. Dealing With Grief & Loss If a parent dies at a time when the student is physically and emotionally pushing the parent away, the student’s guilt feelings may be significantly increased, especially when the student realizes that all the ‘unfinished business’ can never be accomplished (Berson, 1998, in Janowiak, et al, 2001). Death and loss can affect a student’s identity development Even years after the death of a loved one, students are commonly unable to talk about their feelings regarding the loss (O’Brien, 1991). Students who want to help will avoid conversations about loss because of the knowledge that those close to them will someday die as well (Janowiak, et al, 2001).

24. Homesickness Homesickness, isolation, & feelings of not belonging Homesickness occurs in both outgoing and shy students Research has shown that a secure attachment base (support from parents) allows students to explore new roles and explore independence (Schwartz & Buboltz, 2004).

25. Providing Support Be honest and express your concerns. –Be specific. –Ask directly. –If suicidal thoughts are expressed it is important to contact the university counseling center, student health center or the local mental health association. Offer emotional support, understanding and patience. Listen Be nonjudgmental. Convey the message that mental health issues are real, common, and treatable. Set aside time – don’t rush. Ensure confidentiality.

26. Tools for the Hall Director Know their Social Network –Group who needs support as well –Roommates & Friends –Knowledge about student Internet Communities –IM –Facebook –Live Journals

27. Tools for the Hall Director Research, Learn, Consult –Supervisor –Counseling Services –Web –Police (procedures, consulting) Referrals –Accompany Student –Waivers Document –Conversations –Student Actions

28. Campus & Community Resources Supervisor Campus Counseling/Health Center –Knowledge Intake process Available sessions or groups Emergency/On-call procedures Services: Counseling, Psychiatric, Groups –Action Call ahead (urgent appt., accelerate the process) Use the Website Consult/Advice Office of Disability Services Community Options –Hospitals –In-patient options

29. Know Your Campus Procedures Process for reporting? Mandated response? –Mandated counseling? –Reporting/Documenting UIUC Suicide Report Form BSU Self Injury Form Parental Contact? –Who, when, why, if?

30. Legal Considerations Most college mental health professionals look to their university’s general counsel for guidance. Americans with Disabilities Act (ADA) –Ensures that people with disabilities, such as severe mental illness, have legal protection against discrimination in the workplace, housing and residential settings, public programs, and telecommunications Protection and Advocacy for Individuals with Mental Illness (PAIMI). –State programs to safeguard the rights of people with mental illness Family Educational Rights and Privacy Act (FERPA) –Confidentiality –Different interpretations by university counsels –Considerations when student in a risk to self or others http://www.mentalhealth.samhsa.gov/publications/allpubs/ken98-0051/default.asp http://www.sprc.org/library/college_sp_whitepaper.pdf

31. Relevant Court Cases Schieszler v. Ferrum College –Federal court found that Ferrum officials had had a legal duty to ensure the safety of the student, because they knew of the "imminent probability" that he would try to harm himself. –Ferrum settled the lawsuit in 2003, admitting "shared responsibility" for his suicide -- the first such acknowledgment by an American college. Shin v. MIT –In June 2005, state judge ruled that the parents can proceed with their claims against MIT administrators and staff members for failing to prevent student’s death –Plaintiffs cannot seek damages from MIT itself http://chronicle.com/free/v51/i49/49a00101.htm

32. Taking Care of Your Self Don't take it personally. –Students in crisis are not in crisis to upset you or make you feel guilty. Understand your feelings. –Be honest with yourself about how the student's crisis makes you feel. –Don’t pretend that you are doing alright if you are not. –Take a break when you need to. Don’t force things. –Realize that developing trust and respect with a student can take time. –But remember to cover your bases as a university staff member.

33. Resources Your Campus Counseling Services National Mental Health Association www.nmha.org 1-800-969-6642 American Psychiatric Association, Healthy Minds http://healthyminds.org/