“Mad” or Bad? Helping Faculty To Recognize & Manage Student Mental Health Issues

1. “Mad” or Bad? Helping Faculty To Recognize & Manage Student Mental Health Issues Peggy Mitchell Norwood, Ph.D. Professor of Psychology Community College of Aurora Peggy.Norwood@CCAurora.edu

2. Which scenario really happened? • A 22 year old female student never spoke in class, pantomimed, and had her boyfriend “interpret” for her. • A 25 year old male student accused his female professor of constantly staring at him and aggressively bumped up against her as he left the classroom. • A 17 year old female student burst into tears and ran out of the classroom when it was her turn to make her oral presentation to the class. • A 16 year old concurrent enrollment high school student tipped his chair backwards, intentionally fell to the floor, and remained there until the whole class noticed.

3. Behavior Problem vs. Mental Health Issue • Some classroom behavior problems might be related to mental health issues • You might use different classroom management strategies and recommend different resources if you believe a student has a mental health issue

4. “Sometimes I feel like I am invisible, a silhouette which cannot be touched or touched in return and at times that seems maddening to me…I can catch hints enough to know I do not really belong…You don’t have to be afraid of me or anything crazy like that, and I am not mentally ill. Just alone.”- email from a student

5. Mental Disorder A pattern of persistent, maladaptive behavior or psychological experience that causes significant distress or impairment Continuum of Behavior Any one behavior is not sufficient to diagnose a mental disorder

6. Why is This Topic Important? NIMH Statistics: Any disorder among adults, retrieved from http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml

7. NIMH Statistics: Any disorder among adults, retrieved from http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml

8. More Statistical Information National Institute of Mental Health (2012) Statistics, retrieved from http://www.nimh.nih.gov/statistics/index.shtml on March 28, 2012.

9. Discharge Plan: “Why don’t you take a class or two at the local community college?” Freedigitalphotos.net

10. “When I was a child my parents often criticized me, calling me ‘stupid’ so often that I believed them. I now know that my parents were just being cruel, that it wasn’t true, but I still have my doubts, deep down…. When I get depressed and feel I have no one to talk to, I can get suicidal. It’s pretty scary. So I guess you’re one of the people I’ve adopted to talk to.” - email from a student

11. BAD Disruptive Inappropriate Attention-seeking Irritating Immature Rude “MAD” Schizophrenia & Other Psychotic Disorders Bipolar Disorder Major Depressive Disorder Personality Disorders Anxiety Disorders

12. Defining Abnormal Behavior - 4 Ds • Distress • Disability • Deviant • Dangerous

13. Are students allowed to be “just plain strange”?

14. Mental Health and Campus Life “…national surveys show that nearly half of the students who visit counseling centers are coping with serious mental illness, more than double the rate a decade ago. More students take psychiatric medication, and there are more emergencies requiring immediate action.” Gabriel, Trip (2010, December 19). Serious mental health needs seen growing at college campuses. The New York Times. Retrieved from http://www.nytimes.com/2010/12/20/health/20campus.html?pagewanted=all on March 28, 2012. American Psychological Association (2012). The state of mental health on college campuses: A growing crisis. Retrieved from http://www.apa.org/about/gr/education/news/2011/college-campuses.aspx on March 28, 2012.

15. Brief Overview of Disorders

16. DSM IV TR Behavenet.com http://behavenet.com/apa-diagnostic-classification-dsm-iv-tr Screenshot http://www.amazon.com/gp/product/0890420254/ref=pd_lpo_k2_dp_sr_1/183-28797662404540?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=lpo-top-stripe-1&pf_rd_r=0JN3VEX4GCSKRVE8MAJ8&pf_rd_t=201&pf_rd_p=486539851&pf_rd_i=0890420262

17. Schizophrenia • Severe disorder characterized by disturbance in thought, behavior and emotions • Marked impairment in social or occupational (or school) functioning Freedigitalphotos.net

18. “I was scared because I was having weird thoughts, that cameras were watching me in the school.” -email from a student

19. Symptoms of Schizophrenia • Delusions - false, fixed beliefs • Hallucinations - false sensory experiences • Disturbance in thought (evidenced by odd or bizarre speech or writing) • Disorganized behavior and movements • Diminished range of emotional expression • Loss of interest or pleasure

20. Examples Hallucinations: http://www.youtube.com/watch?v=s33Y5nI5Wbc Disorganized speech: http://www.youtube.com/watch?v=avbfd_OkLoU&feature=results_main&playnext=1&list=PLDE8B2510DB23030E

21. Other Psychotic Disorders Screenshot http://www.nextmovie.com/blog/youngest-oscar-nominees-winners-of-all-time/ • Delusional Disorder - Erotomanic Type (eg.,John Hinckley) • Brief Psychotic Disorder (eg., “Snapped”) Screenshot http://en.wikipedia.org/wiki/John_Hinckley,_Jr.

22. It’s a myth that mentally ill people are more violent Screenshot http://www.imdb.com/title/tt0081505/

23. I worked in an Elite-Pioneering Research, Development and Design Environment. TheDogma was “Zero-Anomalies”. I was a Defense Contractor. But, “Was” and in respect to my other positions: Contractual and Confidentiality Agreements are always binding. (Recalling your Academe being Virginia based, Bethesda and Langley will hopefully shed some light. Virginia is a Beautiful State. It reminded me of Illinois.) “Dr. Norwood, I have no problems sharing my Portfolio with only you. It will give insight into many items. Dr. Norwood, I will stop with the Meticulous Boredom. But, I do recognize how [student’s name] seems to be “Odd or Something?”. I still require Mandible, (TM-Disorder), repair. When I speak, care must be taken not to dislodge my jaw. I dislike mentioning this but yes I am watched and investigated by the Respondents: If for any reason someone/? makes any inquiries about me; please follow this legality. [student’s name], is on Social Security Disability Insurance. I qualify under the protection of the Department of Justice. This entitlement is provided through the ‘Americans With Disabilities Act’ and the United Stated Department of Human Health Services, Mandate; ‘Hospitalization Insurance Portability Accountability Act’. Without the written permission/waiver of such individual, [student’s name], information cannot be “shared or Transmitted by any Media-Type.” Doctor, I do hope your classes will be available again. I wish to re-enroll. I will still follow the syllabus on my own. And, please no worries…I have excellent personal Attorneys. - email from a student

24. Disturbance in mood typically characterized by periods of mania and depression Bipolar Disorder Freedigitalphotos.net

25. Elevated, euphoric, or irritable mood Inflated self esteem or grandiosity Decreased need for sleep Pressured speech Flight of ideas Distractibility Self-destructive, pleasurable activities Symptoms of Mania http://youtu.be/h5aSa4tmVNM?t=57s “I’m not bipolar, I’m bi-winning!” - Charlie Sheen

26. Appearance (“Manic Makeup”) Screenshot https://illreviewanything.wordpress.com/2011/06/10/baby-wipes/

27. Symptoms of Depression • Depressed, sad mood • Loss of pleasure or interest • Feelings of worthlessness • Diminished ability to think or concentrate • Indecisiveness • Recurrent thoughts of death, suicide attempts Freedigitalphotos.net

28. Example of Bipolar Disorder http://www.youtube.com/watch?v=f-znjojBojc&feature=related http://www.youtube.com/watch?v=ahfwEgpIAWg&feature=related

29. “I was really depressed. My therapist wanted me to be hospitalized, but I didn’t want to go. My extreme and bewildering reaction - I was suicidal and having wild mood swings - ruined my spring break.” - note from a student

30. Suicidal Ideation • Never be afraid to inquire directly • “Are you having thoughts of killing or harming yourself?” • Assess the seriousness of the thoughts using “SLAP” • Specificity • Lethality • Availability • Proximity

31. Have you ever encountered a suicidal student? How did you handle the situation?

32. Suicide Intervention • Call 911 or Mobile Crisis Unit • Share Suicide Hotline numbers • 1-800-SUICIDE • 1-800-273-TALK

33. Personality Disorders Rigid, pervasive, enduring, self-defeating personality patterns that cause significant distress or impairment • Narcissistic Personality Disorder • Histrionic Personality Disorder • Borderline Personality Disorder • Antisocial Personality Disorder Screenshot http://ateenagersguideto.blogspot.com/2011/11/what-is-personality-disorder.html

34. Narcissistic Personality Disorder • Arrogant • Monopolizes discussions • Self-centered • Lacks empathy • Puts others down • Requires excessive admiration • Sense of entitlement Screenshot http://www.motherrr.com/help/topics/narcissism

35. Histrionic Personality Disorder • Excessively emotional • Dramatic attention-seeking • Sexually provocative behavior or appearance • “Drama King” or “Drama Queen” Freedigitalphotos.net

36. Borderline Personality Disorder • Unstable moods, relationships, and self-image • Intense anger • All or nothing thinking • Eg., Glenn Close in “Fatal Attraction” Screenshot http://www.ew.com/ew/gallery/0,,20256078_20572167,00.html#20572167

37. “I was so enraged and hurt by him that I cut my arm; this was a compromise and brought relief. Until I saw myself bleeding, terrible thoughts were going through my mind. Making the superficial cuts was better than hurting someone or killing myself.” - note from a student

38. Antisocial Personality Disorder • Violates rules, laws, others’ rights • Irresponsible or Impulsive • Deceitful • Lack of remorse • Aggressive • Charming yet manipulative • Eg. Ted Bundy Screenshot http://www.clarkprosecutor.org/html/death/US/bundy106.htm

39. Anxiety Disorders Excessive, irrational dread, worry, or nervousness that is out of proportion to the situation or persists longer than reasonable

40. Social Phobia • Fear of social or performance situations in which the person is exposed to possible scrutiny by others • Fears acting in a way (or showing anxiety symptoms) that will be humiliating or embarrassing

41. Panic Attack • Palpitations, sweating, trembling, chest pain, dizziness • Fear of going crazy • Feeling detached from oneself Screenshot http://www.sheknows.com/parenting/articles/810080/could-it-be-a-panic-attack

42. Have you ever encountered a student who showed signs of a mental disorder? Schizophrenia | Bipolar Disorder | Depression | Suicide | Personality Disorders | Anxiety Disorders

43. How does believing a student has a mental disorder (vs. a behavior problem) change your response?

44. How did you handle the situation?

45. Stay in Your Lane Be clear in advance how you plan to handle these types of situations Freedigitalphotos.net

46. Managing Disruptive Behaviors • Make expectations about classroom behavior (for everyone) clear on day one (eg. Syllabus) • Acknowledge and deal with inappropriate, bizarre, or disruptive behavior sooner rather than later • Differentiate between bad behavior and mental health issues • Refer students who self-disclose a mental disorder to Accessibility Services before granting special accommodations.

47. Tips for Managing Disruptive Behaviors • Speak with students privately and respectfully • Read student’s body language and voice for escalating anger or impulsivity: • Glaring • Clenching fists or teeth • Invading your (or other students’) personal space or “bumping” you • Yelling • Pacing (“psychomotor agitation”)

48. Making a Referral • Make referrals and/or reports to appropriate college or community resources • Call Security or 911 if you feel threatened or if a student may be suicidal…better safe than sorry! Freedigitalphotos.net

49. Making a Referral • Acknowledge a change in behavior or inappropriate behavior • State your concern directly and what you intend to do about it • Provide student with resource information or walk them to appropriate campus office if practical • Offer to let them call from your office depending on urgency/need

50. Top 5 Helpful “Soundbites” • “I’m concerned about the outburst you had in class yesterday and want to refer you to speak to someone.” • “You wrote in your essay that you are depressed and feeling suicidal. I am concerned and I’d like for you to get some help.” • “I don’t feel comfortable letting you leave here today without getting some help.” • “Would you be willing to call or walk over to the Counseling Office right now and make an appointment?” • “Your behavior is disruptive and scary to your classmates. I need to refer you to the Student Disciplinary Committee.”