Recognizing Students in Distress

Everyone feels stressed, depressed or anxious from time to time. However, some behaviors occurring over a period of time can suggest that the problems with which the student is dealing are beyond his or her ability to cope. The following three levels of behaviors indicate relative severity of distress.

Level 1: Although not disruptive to others, these behaviors may indicate that intervention is needed:

• Seriously poor grades or a change from consistently good to unaccountably poor performance
• Despite satisfactory performance, a student who appears anxious, constantly seeks you out and is concerned about grades
• Excessive absences, especially if the student previously demonstrated consistent class and/or work attendance
• Unusual or markedly changed pattern of interaction (e.g. totally avoiding participation, becoming excessively anxious when called upon, dominating discussion, withdrawal from social contact, etc.)
• Depressed mood, excessive crying and/or inability to make transition to school environment
• Other characteristics, such as lethargic behavior, excessive activity and very rapid speech; swollen, red eyes; marked change in personal dress or hygiene; anxious behavior; and falling asleep in class or at work

Level 2: These behaviors may reflect significant emotional distress, a need for intervention, as well as a reluctance or inability to acknowledge a need for personal help:

• Repeated requests for special consideration, such as deadline extensions (especially if the student appears uncomfortable or highly emotional disclosing the circumstances prompting the request)
• New or consistent behavior which pushes the limits of decorum and which interferes with the effective management of your class, work setting or living arrangements
• An unusual or exaggerated emotional response that is obviously inappropriate to the situation
• A student with no apparent physical illness loses a dramatic amount of weight in a short time period
• A student seems agitated and restless in class, constantly argues with you and is shunned by classmates

Level 3: These behaviors usually suggest a student is in crisis and requires emergency intervention:

• Highly disruptive behavior (hostile, aggressive, violent, etc.)
• Inability to communicate clearly (garbled or slurred speech, disjointed thoughts)
• Loss of contact with reality (seeing/hearing things that are not present, beliefs or actions greatly at odds with reality or probability)
• Overtly suicidal thoughts (referring to suicide as current option)
• Homicidal threats

Staying calm, being willing to help and knowing whom to call is important in any of these situations. You may choose to approach the student or the student may seek your help with a problem. Below are some suggestions that might help you deal with a distressed student.

Listening and talking (at all levels):

• Demonstrate your respect for the student by talking to the student when both of you have sufficient time and are in a private place free from disturbance by others
• Be matter-of-fact. Controlling your emotions may help the student to do the same
• Give the student your undivided attention
• Express concern for the student in clear, direct, behavioral, non-judgmental terms (e.g., “I’ve noticed you’ve been absent from class lately, and I’m concerned,” rather than “Why haven’t you been in class?” or “Where have you been lately?”)
• Listen in a respectful, non-threatening way to the student’s description of the problems. Let the student talk
• Convey support and understanding by summarizing what you hear the student saying by including both content and feelings (“It sounds as if the experience of moving away from home was a big change and now you’re feeling lonely and isolated.”)

Level 1: Suggest that the student call 402.472.7450 for an appointment during office hours.

Level 2: Suggest that the student use your telephone to arrange an appointment by calling 402.472.7450 while the student is still in your office. When the call is made from your office, you know that at least an appointment has been made. By making the student call her/himself, the student is more likely to follow through to get help. Your willingness to let her/him handle this part of the process affirms her/his positive coping capacities.

Level 2 and 3: Call Counseling and Psychological Services yourself at 402.472.7450 while the student is still in your office and arrange an appointment for the student. If you think this is an urgent situation, please indicate this when you contact us. Let the student know your willingness to provide Counseling and Psychological Services with information about the nature of the problem and the reason for your referral.

Level 3: In an urgent situation, you may decide to accompany the student to Counseling and Psychological Services (located in University Health Center, Suite 223) in person so that the student may be seen immediately by the counselor who is available to handle emergencies (Monday through Friday, 8 a.m. to 5 p.m.). If possible, a call to 402.472.7450 indicating that you are bringing a student to Counseling and Psychological Services would be helpful.

**In an emergency, call the University Police: 402.472.2222.

When in Doubt, Consult

If you have specific questions about a student or are unsure about whether or how to approach an individual to make a referral, call Counseling and Psychological Services at 402.472.7450, indicate that you are concerned about a student and ask to speak to the case manager or director. The staff member will help you:

• Assess the seriousness of the situation
• Learn about resources, both on and off campus, so that you can provide the student with potential options for obtaining assistance
• Decide how best to initiate the referral process
• Clarify your own feelings regarding the student and consider how you can be most effective

Generally, the first visit will be a 20 to 30 minute conversation with a counselor to assess the concerns and determine the best next step for the student.

Most counseling services are no charge to students who pay the University Program and Facilities Fee, also known as "student fees." We collaborate with the psychiatric providers at the University Health Center; medication management appointments are provided as needed at a cost, which can be submitted to insurance. Students should be encouraged to make their own appointments by calling 402.472.7450 or stopping by Counseling and Psychological Services during office hours. Due to heavy service demands, there may be a wait for several hours to several days before the first therapy intake appointment can be arranged. In emergency situations, however, a student will be seen as soon as possible.

At the student’s first therapy appointment, they will fill out confidential information forms before meeting with a mental health professional. During this appointment, the professional will assess the student’s concerns and needs. Communication with Counseling and Psychological Services is confidential. A student’s situation, or even the fact that counseling is being received at here, may not be shared without the student’s written permission. The main exceptions to this are imminent suicide, homicide or suspected child abuse.

If the counselor and student agree that individual counseling is appropriate, the student may choose to see a counselor on a regular basis, usually bi-weekly, for approximately 45 to 50 minutes each session. Other options include couple or group counseling, support and therapy groups, workshops, alcohol and other drug services, eating disorder services, referral to another campus or community agency and more. It’s possible the student may leave the initial appointment feeling able to handle the problem on her/his own. Counseling and Psychological Services has no authority to require a student to accept any suggestions that are made unless professional judgment indicates that psychiatric hospitalization is mandatory due to imminent harm.

After a referral has been initiated, it can be helpful at times to follow up with the student to determine if she/he attended the appointment. Depending on the nature of your relationship with the student, you may also find yourself wondering, “How is it going?”. However, the student should be the one to initiate these types of conversations. The student’s rights to privacy should always be respected.

If you wish to share information with Counseling and Psychological Services about a student you referred, you may do so. Please remember that the counselor-client relationship is confidential. Therefore, counselors are not able to release information about a specific student without permission from the student.

If the behavioral warning signs of student distress are detected early and a positive, supportive referral is made, there is good chance that the problem can be addressed effectively. As faculty and staff members who care about the well-being of the campus community, you can make a major difference in the student’s success both personally and academically.