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Counseling And Psychological Services

Recognizing Students At Risk

 

I. The Faculty: First Line of Assistance for Students

I. THE FACULTY: FIRST LINE OF ASSISTANCE FOR STUDENTS

The frequency and special nature of the faculty-student interaction puts faculty in a unique position to see students and to be aware of their needs. Students often look to faculty advisors as their first resource for advice and support. In turn, members of faculty and staff often question their professional roles and responsibilities regarding academic or personal problems they observe with students. One role of a university counseling center is to facilitate faculty and staff with this process. Faculty will, in fact, often need to consult with a counselor regarding specific students with whom they are working, the significance of certain behaviors, and the procedures for referring students for services. This brief referral guide will explain that process, answer questions and offer suggestions relating to the personal problems that students may bring to faculty.

INDICATORS THAT A STUDENT WOULD BENEFIT BY A REFERRAL TO THE COUNSELING CENTER.

Stated Need for Help

The student may state a need for counseling directly or indirectly. We must respond to the student's request for help by understanding the intentions and feelings underlying his or her message. When a student seeks advisement or help, it is crucial that we listen and communicate clearly that we have understood them.

Unusual Behaviors

A student who begins to act in an unusual or a typical fashion may be signaling the need for individual attention. The behaviors listed below may suggest a problem that requires assistance:

  • Withdrawal from typical social interactions or discussion patterns as usually seen in the classroom or department
  • Marked seclusion and unwillingness to communicate
  • Persistent lying, stealing, or other grossly antisocial acts
  • Obvious shyness or lack of social skills
  • Complaints of inability to sleep or excessive sleeping
  • Complaints of loss of appetite or excessive appetite
  • Dramatic weight gain or loss
  • Unexplained crying or outbursts of anger
  • Acutely increased activity, e.g., excessive talking or extreme restlessness
  • Repeated absence from classes, with little or no work completed
  • Unusual displays of irritability
  • Impaired speech or garbled, disjointed thoughts
  • Thought disorder, that is, the student's conversation does not make sense, sounds like incoherent rambling, disjointed thoughts, etc.
  • The student expresses unusual suspiciousness or irrational feelings of persecution
  • Irrational worrying or expressions of fear
  • Dramatic change in hygiene, dress and appearance
  • Listlessness, lack of energy, or frequently falling asleep in class
  • Bizarre or strange behavior which is obviously inappropriate to the situation
  • Normal emotions that are displayed to an extreme degree or for a prolonged period of time, e.g., fearfulness, tearfulness, and nervousness
  • Behavior which regularly disrupts classroom

To prevent a misinterpretation or overreaction to a student's speech and behavior, it is useful to look for clusters of the behaviors described above as opposed to single, isolated occurrences.

Traumatic Changes or Significant Stressors

Students will sometimes disclose to faculty significant life events or stressors because of incomplete work, low test scores or poor progress in the course. The list below provides several illustrations in which students may benefit from a referral to aid in coping.

  • Death of a family member or a close friend
  • Difficulties in marriage or family relationships
  • Dating or relationship difficulties
  • Trauma associated with physical or sexual assault, criminal activity, natural disasters
  • Physical illness - particularly chronic/serious medical conditions
  • Acculturation problems or difficulties adjusting to a different culture

Signs of Substance Abuse

Alcohol consumption is generally considered a normal part of college life and tends to be taken for granted in many university traditions or cultural customs. While some students are of legal age and are able to drink responsibly, as a group, college students are at a significantly high risk for alcohol related problems. Regardless of the size or location of the university, traditional college students (ages 18-22) engage more frequently in high risk drinking behaviors. In fact, they may spend more money on alcoholic beverages than for their textbooks. First year students are especially vulnerable to problems with substance abuse because of a changing environment and freedom from the control of their parents. There is also an expectation to drink as part of college life. Remember, substance abuse is related to lower academic performance, a tendency to drop out of college and high-risk behaviors such as alcohol related accidents and sexual assault. It is important to familiarize yourself with the behavioral characteristics of substance abuse that potentially affect our students' successful completion of their college careers.

Appearance
  • Change in style of dress
  • Change in grooming
  • Change in personal hygiene
Personal Health/Personality
  • Subtle changes in personality
  • Dramatic mood swings
  • Weight loss or weight gain
  • Erratic sleeping and/or eating habits
  • Dilated pupils, red eyes, frequent use of eye drops and/or sunglasses
  • Short-term memory loss, blackouts
  • Hangovers, recurring headaches
  • Flashbacks
  • Loss of inhibitions or poor judgment while under the influence
Academic
  • Grades fall
  • Skips classes or entire days
  • Sleeping in class
  • Lack of motivation, lack of self-discipline
  • Change in study habits
  • Problems with professors
Interpersonal
  • Drops out of activities
  • Changing attitudes toward rules and regulations
  • Breaking residence hall rules
  • Isolating, staying in room much of the time
  • Lying, blaming others for troubles
  • Changes in friendships, most friends abuse substances
  • Most activities involve use of drugs or alcohol
  • Irritable or angry at others
Direct Events
  • Speeds or drives recklessly, arrested for DUI
  • Large expenditures on drugs or alcohol
  • Thefts, assaults, arrests
  • Drunkenness, obvious intoxication
  • Possession of drugs/alcohol or drug paraphernalia
  • Persistent use of substances despite negative consequences
  • Inability to stop or cut down on substance use
  • Direct reference to own substance abuse problem
Academic Problems
  • Excessive procrastination
  • Uncharacteristically poor work
  • Inconsistent work
  • Repeated requests for special consideration
  • Career/Major indecisiveness

References to Suicide

Over the past four decades, suicide has become the second leading cause of death on college campuses. The actual act of suicide is a complex behavior that is generally not a response to a single event. It is a series of events, feelings and thoughts that place an individual at risk for suicidal behavior. College students at risk for suicide appear to share a number of risk factors. Some of the more common risk factors that are associated with suicide include depression, loneliness, stress and hopelessness. It is usually possible to distinguish between a theoretical discussion of suicide in contrast to a statement of personal anguish, such as "life is not worthwhile." If a person talks about suicide, a referral is necessary, especially if the conversation includes the details of how, when or where. Regardless of the circumstances or context, any clear reference to suicide, threat of suicide, or attempt at suicide is extremely serious. To assess a student's suicidal comments as a bid for attention is extremely risky. A judgment about the seriousness and the possible lethality of a suicidal thought or gesture should not be made without consulting with the Counseling Center. Faculty interest in or concern for students who appear at risk should not be in reaching an accurate assessment of suicide. Rather, it should be in recognizing any symptoms that indicate the student is troubled, and directing the student to seek the appropriate professional care.

Danger Signals

At least 70 percent of all people committing suicide give some clue as to their intentions before they make an attempt. Becoming aware of these clues and the severity of the person's problems can help prevent such a tragedy. If a person you know is going through a particularly stressful situation--perhaps having difficulty maintaining a meaningful relationship, having consistent failure in meeting present goals, or even experiencing stress at having failed an important test watch for other signs of crisis.

Many persons convey their intentions directly with statements such as "I feel like killing myself" or "I don't know how much longer I can take this." Others in crisis may hint at a detailed suicide plan with statements such as "I've been saving up my pills in case things get really bad," or "Lately, I've been driving my car like I really don't care what happens." In general, statements describing feelings of depression, helplessness, extreme loneliness, and/or hopelessness may suggest suicidal thoughts. It is important to listen to these "cries for help" because they are usually desperate attempts to communicate to others the need to be understood and helped.

Often persons thinking about suicide show outward changes in their behavior. They may prepare for death by giving away prized possessions, making a will, or putting other affairs in order. They may withdraw from those around them, change eating or sleeping patterns, or lose interest in prior activities or relationships. A sudden, intense lift in spirits may also be a danger signal, as it may indicate a sense of relief knowing the problems will "soon be ended."

Myths About Suicide

Myth: "You have to be crazy even to think about suicide."
Fact: Most people have thought of suicide from time to time. Most suicides and suicide attempts are made by intelligent, temporarily confused individuals who are expecting too much of themselves, especially in the midst of a crisis.

Myth: "Once a person has made a serious suicide attempt, that person is unlikely to make another."
Fact: The opposite is often true. Persons who have made prior suicide attempts may be at a greater risk of actually committing suicide; for some, suicide attempts may seem easier a second or a third time.

Myth: "If a person is seriously considering suicide, there is nothing you can do."
Fact: Most suicidal crises are time-limited and based on unclear thinking. Persons attempting suicide want to escape from their problems. Instead, they need to confront their problems directly in order to find other solutions--solutions that can be found with the help of concerned individuals who support them through the crisis period, until they are able to think more clearly.

Myth: "Talking about suicide may give a person the idea."
Fact: The crisis and resulting emotional distress already have triggered the thought in a vulnerable person. Your openness and concern in asking about suicide will allow the person experiencing pain to talk about the problem, which may help reduce his or her anxiety. This may also allow the person with suicidal thoughts to feel less lonely or isolated, and perhaps a bit relieved.

UCLA suicide prevention experts have summarized the information to be conveyed to a person in crisis as follows:

"The suicidal crisis is temporary. Unbearable pain can be survived.
Help is available. You are not alone."

Emergency Situations--GET HELP IMMEDIATELY!

  • Expression of suicidal thoughts
  • Expression of homicidal thoughts
  • Severe loss of emotional control
  • Significant impairment in thinking abilities
  • Bizarre behavior

STEPS IN MAKING THE REFERRAL TO COUNSELING SERVICES

When you recognize that a student may benefit from counseling, referrals are important and easy to make:

  • If you are unsure if a referral is necessary, contact the counseling center for a consultation.
  • Encourage the student to talk to you. Invite the student to your office to discuss work or past academic performance. Typically, students who are in distress are aware that things are not going well and this provides an opportunity to discuss what the student might do.
  • Encourage the student to make an appointment with the counseling center.
  • Invite the student to call from your office or give the student the telephone number. The counseling center will schedule an appointment within the week of the call, and in case of emergency will meet with the student immediately. There is an additional sense of commitment when a faculty member is involved and the student has agreed to follow through.
  • Encourage the student to identify you as their referral source. The student may choose whether the counseling center can contact you regarding the student's progress.
  • Remember, even if the student does not immediately contact the counseling center, your expressed concern will likely be facilitative and will heighten the student's awareness of professional help in the future.

HOW TO COMMUNICATE WITH OUR STUDENTS EFFECTIVELY

When attempting to talk with a student about a personal or emotional situation, it is helpful to:

  • Talk to the student in a private setting
  • Listen actively, with interest and concern
  • Avoid promising secrecy
  • Avoid alarm reactions.
  • Talk in a calm, even voice, despite the student's level of emotionality
  • Repeat back the essence of what the student has told you
  • Respect the students right to their own values. Avoid making judgmental or moralizing remarks
  • Consider Counseling & Psychological Services as a resource and discuss a referral with the student
  • Involve yourself to the extent that you are comfortable. Extending oneself can be a gratifying experience when kept within realistic limits
  • If the student resists help and you are concerned, contact the Counseling Center to discuss your concerns
  • Display openness to the student
  • Provide feedback: paraphrase or briefly summarize what you see as the root of the person's message
  • Be honest and really listen: set aside time to talk with the student if you are unable to at that time
  • Listen for requests and intentions

WHEN TO REFER TO THE COUNSELING CENTER

In addition to the behaviors and events listed above, a referral is advisable:

  • When a student presents a problem or requests information, which is outside your range of knowledge
  • When you feel that personality differences between you and the student will interfere with your ability to help the student
  • When your relationship with the student is other than professional (friend, neighbor, relative, etc.)
  • When the student is reluctant to discuss his or her concern(s) with you
  • When you do not believe your counseling with the student has been effective
  • When the student presents a serious suicide threat
  • See section on learning disabilities for information related to referring a student for a learning disability evaluation

HOW TO REFER TO THE COUNSELING CENTER

When you decide that a student might benefit from professional counseling, speak directly to the student in a straight-forward, matter-of-fact fashion. Show concern. Never trick or deceive. Ask them, "Are you talking with anyone about this?" Make it clear that your suggestion represents your best judgment based on your observations. Be specific about the behaviors that have raised your concerns. Avoid generalizations or attributing negatives to the individual's personality or character.

Except in case of emergency, the student should have the freedom to accept or refuse counseling. If the student is skeptical or reluctant for whatever reason, accept his or her feelings. Continue to be supportive. Give the student room to consider the alternatives. Suggest that you can talk about it after he or she has had some time to think it over. If the student emphatically says "no," then respect the decision. Leave the door open for future discussion should he or she decide to reconsider. If you push the issue too far, insisting, prodding, or appearing as an authoritarian parent, you may close the door to future communication. Above all, do not rush. Unless it is a matter of clear urgency, go slowly.

In cases of emergency, students can be seen on an immediate basis.

There are times when a faculty member may wish to make counseling mandatory because of poor performance or behavior(s) on the part of the student. Occasionally, CAPS has worked with students in these situations. However, students do not tend to be motivated to make gains from counseling under these forced circumstances. It is more helpful to the student if you state specifically which behavior changes you want the student to make. You can write these out in the form of a contract and sign it along with the student. Add to the contract, in writing or verbally, a strong recommendation that counseling at CAPS will aid the student to meet the goals of the contract. Give the student information about CAPS. A student approaching counseling under these circumstances is more likely to benefit from the service and make the necessary changes to enhance his/her academic and/or personal functioning.

If the student agrees to a referral, help the student arrange for an appointment at CAPS. We find that students are more likely to follow through on a referral when they receive help in making an appointment. Encourage the student to call CAPS (Ext. 8050) while in your office. Our receptionist will schedule an appointment as quickly as possible.