Identification and Referral of Students in Distress:
A Guide for Staff and Faculty
Staff and Faculty are in an ideal position to identify students who may be experiencing distress and to refer them to University Counseling Services for assistance. Students who are away from their family and friends at home will often turn to staff and faculty for support in times of crisis. We would like to offer the following guidelines to help in the identification and referral of students in need.
University Counseling Services (UCS) provides clinical services to students who are experiencing emotional distress, academic difficulties or behavioral problems.
Services provided by University Counseling Services include:
- Brief individual counseling
- Group counseling
- Psychological education
- Substance abuse counseling
- Intern training
The mission at University Counseling Services is to assist students in problem solving, assertiveness, self-care and an improved sense of well being. These skills will enhance academic performance and enable students to function more effectively at the university and in their personal lives.
Types of Distress
A state of personal discomfort and/or difficulty in coping with some aspects of one's life; some examples of reasons students are referred include: anxiety, depression, sleep disturbance, crying, relationship difficulties, family conflict, substance abuse, academic difficulties, time management problems, etc.
Referral to University Counseling Services is appropriate whenever students appears to be experiencing personal discomfort or difficulty in coping that interferes with their daily functioning .
Behaviors that differ from conformed expectations and/or violate other's rights
Referral to University Counseling Services is appropriate whenever there are concerns about a student's behavior; prior to making a referral staff/faculty can contact UCS directly to consult regarding the issue.
Sources of Distress
Mental health issues:
Mental health issues can interfere with effective student functioning, both personally and academically.
Examples of mental health issues:
- Eating disorders
- Substance abuse.
Frustration can arise when expectations of self or others are not realized, and can be caused by failure (which may affect self esteem) or loss (social, emotional or financial).
Students may experience feelings of social isolation as their environment shifts from home to school; they may lack self confidence and have difficulty in knowing how to get their needs met in relationships; students also may experience a struggle with finding meaning or purpose in life.
Students feel pressure from a variety of sources which can arise from academic expectations, social expectations, family expectations, competition with other students, financial strain, and vocational uncertainty.
Conflict occurs when intentions or motivations are divided, and may result from issues with roommates, romantic partners, family, staff/faculty, struggles for independence, sexuality, work/play constraints, busy schedules, financial problems.
Illness and injury can disrupt a sense of personal well being.
Guidelines for Dealing with Symptom Patterns
There are several manifestations of students' distress that appear to be of the greatest concern to staff and faculty. Below you will find a brief description of each pattern with some suggestions for response. It is recommended that University Counseling Services be called for consultation whenever a student appears to be experiencing any of the following problems and they do not seem to be resolving. University Counseling Services clinicians can be helpful in assisting staff and faculty with the best way to approach students who are in distress.
The Verbally Aggressive Student
Students can become verbally aggressive when they feel frustrated and believe they have been treated unfairly or experience circumstances beyond their control; their anger can become displaced on others; fear of rejection and feelings of righteous indignation are frequently associated with this pattern.
- Allow the student to ventilate and tell you what has upset them.
- Tell them you are not willing to accept their abusive behavior, e.g., "when you yell and scream at me it is hard for me to understand what you are saying".
- If they are physically too close, ask them to step back, or move back yourself.
- Reduce stimulation by inviting them to a quiet place, but not isolated.
- Invite them to return at another time when they are calm.
- Call University Police if you feel there is any possibility of physical harm.
- Get into an argument.
- Press for an explanation for their behavior.
- Be afraid to leave the situation if you feel concerned for your safety.
- Take unnecessary risks such as isolating yourself in a back room with the door closed when a student is verbally aggressive.
The Violent or Physically Destructive Student
Violence can occur when a student is experiencing intense frustration or when sustained frustration erodes the student's emotional controls; some violence may be related to substance use.
- Explain what behaviors are acceptable/unacceptable.
- Call University Police if violence or destruction is occurring.
- Threaten, dare, taunt or back the student into a corner.
- Touch the student, even if it is meant to calm the student, it may be interpreted as an attack.
- Don't be afraid to get help or ask someone else to get help by calling University Police.
The Student in Poor Reality Contact
These students may have difficulty distinguishing fantasy from reality; their thinking may be illogical, confused, disturbed; they may be using jumbled speech and experiencing hallucinations (seeing or hearing things that are not there), delusions (false beliefs) and exhibiting bizarre behavior.
These students can frighten others by their behavior, but they are typically not dangerous.
- Respond to the student with kindness.
- Acknowledge the feelings/fears without supporting the misperceptions, e.g., "I understand that you think they are trying to hurt you and I see how real it seems to you, but I don't hear the voices (see the devil, etc.)."
- Acknowledge their concerns and state you can see they need help.
- Focus on the here and now.
- Offer to escort the student to University Counseling Services.
- Argue with them or try to convince them of their irrational thinking (they will just try to defend their position more firmly)
- Play along, e.g., "I hear the voices, too."
- Encourage them to talk more about their hallucinations.
- Demand, command or order.
- Expect customary emotional responses.
- Panic; this gives them the message that you expect something catastrophic to happen and feeds into their fears.
The Depressed Student
The depressed student frequently goes unnoticed; symptoms can include low self esteem, feelings of worthlessness and inadequacy, physical problems such as change in appetite and sleep disturbance, decreased interest in daily activities, poor concentration, procrastination, statements about not wanting to live.
- Tell the student that there is help for these symptoms (give hope).
- Communicate your sincere concern and recommend that the student seek counseling.
- Offer to escort the student to University Counseling Services.
- Say "don't worry," "everything will be better tomorrow," or anything else that could discount the intensity of the student's feelings.
The Suicidal/Homicidal Student
Any student expressing a desire to harm themselves or others should be taken very seriously and immediate help should be obtained by calling University Counseling Services and/or University Police.
- Call University Police if there is any imminent danger.
- Call University Counseling Services to consult.
- Offer to walk the student to University Counseling Services.
- If the student refuses help and has said they intend to harm themselves, call University Counseling Services and University Police.
- Minimize the situation ("you really don't mean what you just said").
- Try to counsel the student yourself.
The Anxious Student
Students experience anxiety for a variety of reasons that may include biochemical imbalance, unfamiliar situations, social situations, and high and unreasonable self expectations
- Be clear and explicit, e.g., "I understand you are nervous; let me explain the assignment in detail."
- Let them discuss their feelings and thoughts; this can often relieve a great deal of pressure.
- If the anxiety appears unresolved, refer to UCS.
- Take responsibility for their emotional state.
The Demanding, Passive or Dependent Student
This student typically takes vast amounts of time and energy and will not feel like it is enough; they may seek to control your time
- Let them make their own decisions as much as possible.
- Set appropriate boundaries regarding your availability both in person and on the telephone.
- Become the only source of their support
The Suspicious Student
Suspicious students typically complain about something other than psychological difficulties; they may appear tense, distrustful, isolated, with few friends. These students can interpret a minor oversight as a significant personal rejection and may overreact to insignificant occurrences. These students may see themselves as the focal point of others behavior and believe that everything that happens has special meaning to them; they can be overly concerned with fairness and being treated equally; feelings of inadequacy may underlie most of their behavior; they may seem capable and bright
- Express compassion without overstepping boundaries
- Be clear, punctual and consistent
- Be specific regarding the standards of behavior you expect
- Make promises you cannot keep
- Be overly warm and nurturing, cute or humorous
- Challenge or agree with any delusions
MAKING REFERRALS TO UNIVERSITY COUNSELING SERVICES
Your attitude of sincere interest and helpfulness toward the student is crucial.
Make the purpose of the referral clear. For example, "University Counseling Services has a great deal of experience working with students who are struggling with some of the same issues that you are experiencing. I think it would be very helpful for you to speak with one of their counselors. If you like, you can call them from my office."
Timing is crucial. When a student is receptive toward referral, offer to let them use your telephone to make the appointment at that time, or ask them if they would like you to place the call for them.
Write down the date and time of appointment and describe where the counseling services is located (105 Payson Smith; 110 Upton Hall).
Referrals are most effective:
When you escort the student yourself.
When the student calls in your presence or you make the call for them.
Referrals are less effective:
When you merely suggest that the student see a counselor.
Referrals for seriously disturbed students:
Need extra attention as they often cannot initiate getting the help they need.
Counseling is a personal and private matter and any referral should be handled with as much confidentiality, respect and concern for the student as possible.
If you are concerned about imminent violence to self or others, University Police should be contacted immediately.