Responding to Distressed & Distressing Students Elizabeth Gong-Guy, Ph.D. October 2009

Responding to Distressed & Distressing Students

Elizabeth Gong-Guy, Ph.D. October 2009

Goals of Today’s Training

• Increase awareness of signs of distress• Build skills for intervening with distressed &

distressing students• Facilitate referrals for assessment &

treatment

College Student Concerns

• Only 11% get a good night’s sleep (Buboltz, 2002)• Over 9% meet the criteria for anxiety disorders (NIMH,

2000)

• 12% meet criteria for clinical depression (ACHA, 2002)– Less than 1/4 are in therapy for depression– Only 1/3 on medication for depression

• Suicide = 2nd leading cause of death among college students (Jed Foundation, 2002)

• 9.4% of college students seriously contemplated suicide in the past year (ACHA, 2006)

• 1.4% of college students made a suicide attempt (ACHA, 2006)

Graduate Student Concerns

• 67% of graduate students reported feeling hopeless

• 45% said they felt so depressed they could barely function

• 10% said they had seriously contemplated suicide

(UC Berkeley, 2004)

Snapshot of UCLA CAPS

• 1 in 6 UCLA students received clinical treatment – more than 7,000 students last year

• 35% screened positively for harmful levels of alcohol or drug use

• 3 to 5 students per week were seen in the ER for psychiatric or substance abuse crises

• 47 students were treated as psychiatric inpatients (FY07-08)

Characteristics of Distressed or Distressing Students

Goals of this Segment

• Recognize situations that pose a potential threat

Academic Performance Problems

• Poor performance & preparation markedly inconsistent with previous work

• Excessive absences or tardiness, especially versus previous functioning

• Chronic indecisiveness or procrastination• Repeated requests for special consideration

• Increased concern about grades despite satisfactory performance

• Increased dependence: excessive appointments or hanging around without a reason

Common Stressors• Traumatic Change in Academic Status

– Academic Probation or Dismissal• Loneliness & isolation• Identity confusion• Low motivation or inability to establish goals

• Serious illness• Academic pressure or failure• Parenting responsibilities• Work or family pressures• Cultural oppression or discrimination

Traumatic Change in Relationships

• Death of a family member or close friend

• Difficulties in marriage or close relationships

• Roommate or family problems• Break-up of intimate relationship

• Rejection by family

Unusual Behaviors

• Marked decline in personal hygiene• Consistent disheveled or fatigued appearance

• Lethargy, lack of energy, falling asleep in class

• Disruptive classroom behavior• Aggressive, angry or threatening behavior

• Dramatic weight loss or gain • Use of mood-altering substances

Cognitive Impairment

• Inappropriate, bizarre or strange behavior indicating a loss of contact with reality

• Prolonged or extreme emotionality• Agitation, intense restlessness, hyperactivity, or unusually rapid speech

• Marked impairment of attention and memory

• Impaired speech or disjointed, confused thoughts

• Paranoia or suspiciousness

References to Suicide

• Overt or veiled references to suicide -- orally or in writing

• Expressions of helplessness or hopelessness

• Persistent or prolonged unhappiness

• Isolation from friends and family • Pessimistic feelings about the future

Threatening Behaviors

• Violence committed against objects, animals or people

• Stalking behaviors• References to homicide and death• Overt or veiled threats to harm others • Threatening and accusatory statements, e-mails, text messages, letters or phone calls

• Disturbing or morbid themes consistently present in oral or written work

Responding to Distress

Goals of this Segment

• Understand the Campus response to distressed & distressing students

• Know how to access campus resources for crisis consultations and referrals

Responding to Distress

• Observe the signs of distress• Initiate contact• Clarify your role• Offer support and assistance• Know your limits• Consult with CAPS staff or the Consultation and Response Team

Initiate Contact!

• Don’t ignore strange or inappropriate behavior -- respond to it

• Talk to the student privately• Be direct & matter of fact• Indicate your concern• Early feedback, intervention and/or referral can prevent more serious problems from developing

Referring a Student to CAPS

• Find a private time & place to express your concern

• Suggest a self-check using the CAPS on-line screening

• Offer details on how to access CAPS services

• Offer to help make the call for an appointment

• Offer to accompany the student to CAPS• Call CAPS for a consultation with the Walk-In Clinician

Referring a Student to the Consultation and

Response Team• Contact the Student Care Manager, Karen

Minero, at [email protected] or 310-825-0628.

• The Consultation & Response Team meets weekly to determine appropriate responses and referrals to engage resources.

CAPS Response to Student Mental Health

Crises1. Distressed students are

referred by• Faculty or Staff• Family or Friends• Themselves• Consultation & Response Team

2. Assessment plan is developed• Student is typically seen at CAPS• Diagnostic assessment yields risk

of dangerousness

If a student is dangerous to others

• Consultation & Response Team confers (if the case has been referred)

• Dean of Students Office• Counseling and Psychological Services• Office of Residential Life• College Academic Advising• UCPD• VC Student Affairs Executive Officer• CRT Care Manager

• CAPS clinical plan is simultaneously enacted

If a student is dangerous to others

• If imminently homicidal– Intended victim is immediately notified

– UCPD is immediately notified– Psychiatric hospitalization (voluntary or involuntarily) is arranged

• If NOT imminently homicidal– CAPS works with the student to reduce lethality, increase impulse control & increase coping

If a student is dangerous to self

• If imminently dangerous– Referral for inpatient psychiatric hospitalization (voluntary of involuntary)

• If not imminently dangerous– CAPS clinicians work with the student to reduce lethality, increase coping & increase support

CAPS continuity of care

• CAPS in-house communication– Peer Review Committee insures coordinated interdisciplinary response

– Electronic charting facilitates case coordination

• Students discharged from ER and NPI– CAPS receives notification of discharge

– CAPS Care Manager ensures clinical follow-up

Parental Notification

• Only occurs for adult students if clinically indicated in order to

•Reduce lethality•Increase support resources•Increase treatment compliance

Communicating with CAPS

• CAPS consults with faculty, staff, students & parents on distressed & distressing students

• CAPS contacts students via e-mail or phone to offer assistance -- and students respond 90% of the time

• CAPS maintains confidential electronic records of all communications regarding students

Frontline Management of Threatening

Behaviors

Goals of this Segment

• Understand tools to de-escalate a volatile situation

Statistics….

• Suicide– 22% of women, 9% of men seriously considered suicide

– 1.3% reported at least one attempt in past year

– Incidence = 7 in 100,000 = half of non-student rate

• (ACHA 2004 sample of 47,202 students)

Statistics…

• Stalking:– 13% of female students stalked in study year

– 25-30% of college women and 11-17% of college men report ever being stalked

• (Fisher, 2000)

Statistics…

• Between 1993 and 1998, college professors experienced an average annual rate of 41,600 incidents of nonfatal workplace violence

– (Schneider, 1998)

The Aggression Cycle

• Escalation Phase– Behavioral signs that anger is building

• Explosion Phase– Uncontrollable discharge of anger – Verbal or physical aggression

• Post Explosion– Negative consequences– Remorse & attempts to repair

A Hostile Student May be Communicating:

• Vulnerability• Confusion• Overload of Emotional Stress• Fear• Feelings of Helplessness• Powerlessness

Basic Response Guidelines

• Stay calm, to reduce the student’s anxiety or agitation

• Provide a quiet, private place for the student

• Speak to the student in a clear, straightforward manner

• If the student is suicidal, don’t leave him/her alone

• Arrange appropriate intervention or aid

Listening is an Action

• Encourage the student to talk; listen closely and patiently

• Listen to the student’s frustration• Convey an understanding of their situation

• Work to understand how the student perceives the situation

• Acknowledge the student’s feelings• Identify & acknowledge what the student wants that he/she isn’t getting

Defusing Techniques

• Project calmness, move & speak slowly, quietly & confidently

• Avoid arguing or defending previous actions

• Avoid threatening body language (don’t stand with arms crossed)

• Calmly but firmly outline limits of the setting

• Clearly state your intention to seek a resolution or a pathway to a solution

Defusing an Escalating Situation

• If the situation continues to escalate, the student will exhibit more nonverbal cues: growing louder, more agitated or more intense with sharper verbalizations

• Intervene to defuse: – Reduce stimulation from the setting (move to private space)

– Communicate information about the process– Provide choices; break big problems into smaller ones

Defusing Techniques

• Give the student ample personal space• Allow the frustrated student time to vent

• Use delaying tactics to give the student time to calm down: offering a drink of water

• Rather than responding to personal verbal attacks, reflect your understanding of the student’s anger and frustration about the situation

• Work toward outlining concrete next steps to resolving a conflict

Verbally Abusive Students

• Verbal abuse happens when students encounter frustrating situations which they believe are beyond their control

• Anger & frustration are displaced onto the nearest target

• Explosive outbursts & belligerent, hostile behavior are an attempt to gain power and control in an otherwise out-of-control experience

Responding to Verbal Abuse

• Acknowledge the anger & frustration: “I hear how angry you are”

• Acknowledge the issue & ask for clarification regarding what is upsetting

• Reduce stimulation: seek a quiet space if you feel safe doing so

• Be directive & firm about behaviors you will accept: “I can’t listen to you when you’re yelling”

• Help the student refocus on the real issues

Responding to Verbal Abuse

• Don’t get into an argument or shouting match

• Don’t become hostile of punitive yourself

• Don’t press for explanations for the abusive behavior

• Don’t ignore the situation• Don’t touch the student, as this may be perceived as aggression & may escalate the student’s anger

Violent Students

• Violence due to emotional distress is atypical, usually occurring when the student’s level of frustration has been so intense and enduring that the student’s emotional controls are eroded.

• Violent behavior is often associated with alcohol and other substance use.

Responding to Violent Students

• Quickly & calmly acknowledge the intensity of the situation: “I can see you’re really upset and I want to de-escalate this for you”

• Explain clearly what behaviors are acceptable without denying feelings: “You can be angry but breaking things isn’t okay”

• Get necessary help immediately: UCPD dispatch

• Stay safe: maintain access to an exit, keep furniture between you & the student, keep doors open if possible, be sure others know you are with the student

Responding to Violent Students

• Don’t ignore warning signs of escalating aggression: yelling, clenched fists, threats

• Don’t threaten or corner the student

• Don’t touch the student• Don’t see the student alone if you fear for your safety

Seek Help or Consultation

• Getting assistance from someone who is neutral can change the dynamics of the situation

• Bringing in someone with a different approach can de-escalate the situation

• A “consultant” may need to intervene to define unacceptable and inappropriate behaviors: Dean of Students Office, CAPS, UCPD can provide these limits for students

• Inform your supervisor to enact a team approach to support your efforts

Suicide Prevention Options(Students)

• If there is an immediate danger of suicide, contact the UC Police Department or your nearest Police Station by dialing 911

• Go to the nearest hospital emergency room; on campus, go to the UCLA Hospital Emergency Room

• Contact CAPS to consult with a crisis counselor at (310) 825-0768

• Call the Los Angeles Suicide Prevention Center 24-hour Crisis Hotline at (310) 391-1253

• The National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis. If you need help, please dial 1-800-273-TALK (8255). You will be routed to the closest possible crisis center in your area.

Violence Prevention Options(Students)

• If there is an immediate danger of violence or if violence has occurred, contact the UC Police Department or your nearest Police Station by dialing 911

• Go to the nearest hospital emergency room; on campus go to the UCLA Hospital Emergency Room

• If you are concerned about another's potential for violence, contact: – the Dean of Students at (310) 825-3871– the Student Care Manager at (310) 825-0628– or your residence hall staff

• If you are concerned about your own potential for committing violence, contact CAPS at (310) 825-0768

• If you have concerns about your own anger management skills, contact CAPS at (310) 825-0768

Crisis Prevention Options(Faculty & Staff)

• If there is an immediate danger of violence or if violence has occurred:– Contact UCPD dispatch (310) 825-1491– Or dial 911 from a campus phone

• If you are concerned about a student's potential for violence:– Contact CAPS (310) 825-0768 24-hours daily– Or contact the Consultation & Response Team Student

Care Manager, Karen Minrero (310) 825-0628 or [email protected]

– Or contact the Dean of Students at (310) 825-3871

Please visit our websites

www.caps.ucla.eduwww.studentaffairs.ucla.edu/crisismanagement