Assisting Distressed Students Making Referrals to CAPS

1. Assisting Distressed Students Making Referrals to CAPS Shannon M. Bowles, Ph.D. Licensed Counseling Psychologist Counseling and Psychiatric Services University Health Center

2. Trends in College Student Mental Health ACHA-NCHA-II (Fall 2011)

3. Trends in College Student Mental Health ACHA-NCHA-II (Fall 2011)

4. Trends in University Counseling Centers • More students coming to campus on psychiatric medications (92%) • More students with severe psychological problems (91%) • Average yearly psychiatric hospitalizations—1.4 per 1000 students (45-50 per year at UGA) • In the past 5 years, increases in: • Crises requiring immediate response (78%) • Psychiatric medication issues (77%) • Illicit drug use (49%) and alcohol abuse (42%) • Marked increase in student to student violence (33%) • Increasing pressure to disclose concerns about troubled students (68%) National Survey of Counseling Center Directors (2011) (N = 228)

5. Students Served by CAPS In 2011 CAPS provided services to approximately 11.5% of the UGA student population In 2011 directors of counseling centers of universities of over 35,000 students reported providing services to 8.7% of the student population National Survey of Counseling Center Directors (2011) (N = 228)

6. Recognizing Distressed Students—Academic • Deterioration in academic performance • Requests for extensions or special considerations • Excessive absence or tardiness • Inappropriate or disruptive classroom behavior • Avoiding or dominating discussions • References to harming self or others verbally, in writing, online, or by email Helping a Distressed Student: Information for Faculty and Staff (CAPS, 2012)

7. Recognizing Distressed Students—Interpersonal • Avoidance • Excessive dependency/reliance on others • Withdrawal/social isolation • Conflict with students, instructors/professors • Complaints from other students • Strong reactions to feedback from instructors/professors or other students Helping a Distressed Student: Information for Faculty and Staff (CAPS, 2012)

8. Recognizing Distressed Students—Behavioral • Depressed or elevated mood • Changes in sleep, appetite, and personal hygiene • Severe anxiety, irritability, or agitation • Disorientation, odd or unusual behavior (delusions, hallucinations) • Increased emotional reactivity • Alcohol or substance use/abuse/dependence • Thoughts, plans, or intentions of harming self or others Helping a Distressed Student: Information for Faculty and Staff (CAPS, 2012)

9. Disruptive Behavior • Violations of expectations/rules • Habitual interference with environment • Persistent and unreasonable demands for time and attention • Intimidating or harassing others through words and/or actions • Threats of physical violence May be caused by: • Confusion about processes and expectations • Difficulty with transition to university • Poor assertiveness skills • Underlying psychological condition or combination of stressors

10. Other Considerations • History of prior mental health problems or treatment/alcohol or substance abuse • Family history of prior mental health problems or treatment/alcohol or substance abuse • History of disruptive behavior in classroom or other settings, conduct, or legal problems • Prior references to harming self or others • Prior suicide attempts or assaultive behavior

11. Suicide—College Students • Hopelessness • Rage, uncontrolled anger • Engaging in risky activities • Feeling trapped • Increased alcohol or drug use • Withdrawing from friends, family and society • Anxiety, agitation, unable to sleep or sleeping all the time • Dramatic mood changes • Expressing no reason for living The Jed Foundation, 2012 http://www.jedfoundation.org/

12. Barriers to Seeking Help • Concerns about confidentiality • Student does not feel therapy is needed or will not help with her/his concerns • Stigma associated with seeking mental health care • Lack of support from family or friends • Cultural considerations • No insurance, limited financial support • Transportation issues

13. How to Respond—General Info • Safety first • Remain calm/avoid escalation • Ask direct questions • Avoid making assumptions • Avoid labeling • Know your limits

14. How to Respond—Specific Suggestions • Talk to the student privately • Avoid making promises of confidentiality • Discuss your observations directly and honestly (focus on behaviors) • Discuss your concerns nonjudgmentally Helping a Distressed Student: Information for Faculty and Staff (CAPS, 2012)

15. How to Respond—Specific Suggestions (cont.) • Be frank with the student about the limits of your ability to help them • Let the student know that you can guide them to professionals who can help them • If the student appears to be in imminent danger of harming self or others contact the UGA Police immediately • Do not promise to keep threats of harm to self or others confidential Helping a Distressed Student: Information for Faculty and Staff (CAPS, 2012)

16. How to Respond—Facilitating a Referral • Encourage the student to contact CAPS or go to CAPS if in crisis • Offer to assist student in contacting CAPS • Offer to accompany student to CAPS if in crisis • Agree to follow-up with student after she/he has made contact with CAPS Helping a Distressed Student: Information for Faculty and Staff (CAPS, 2012)

17. Confidentiality • Mental health information cannot be released without consent of student • Exceptions include immediate threat of harm to self, others, or the university community • Confidentiality does not prevent you from sharing information

18. FERPA • Protects educational records from disclosure without consent • Permits school officials to disclose without consent those records needed to protect the health and safety of students and other individuals

19. Behavioral Assessment & Response Council (BARC) BARC is “a group of key administrators who assess and determine the appropriate response to students who exhibit threatening behavior to self and/or others.” BARC is “empowered to take necessary steps to remove from campus any student who may present a direct threat of harm to themselves, to other students and/or to other members of the campus community.” Behavioral Assessment & Response Council (BARC) 2012 http://dos.uga.edu/barc/index.html

20. Members of BARC • Dr. William M. McDonald, Dean of Students, Chair • Dr. Eric Atkinson, Associate Dean of Students • Mr. Tim Kelly, Assistant Director, Office of Legal Affairs • Dr. Gayle Robbins, Director, CAPS • Mr. Jimmy Williamson, Chief of University Police • Other campus representatives Behavioral Assessment & Response Council (BARC) 2012 http://dos.uga.edu/barc/index.html

21. Services are confidential, information not released without written consent with some exceptions Services are offered at reduced cost for students and eligible partners who pay the student health fee Financial assistance is available for students who are unable to pay for services (students who do not have insurance or who have concerns about filing insurance) Multidisciplinary team of CAPS clinicians (LCSWs, LPCs, psychologists, psychiatric providers, trainees) Multidisciplinary team of UHC clinicians offering integrated care (ED and AOD Treatment Teams) CAPS Services—General Information

22. Short-term individual counseling Group counseling Psychiatric services Crisis intervention (during and after hours) Psychological testing (ADHD, Anxiety/Depression Accommodations, AOD) Consultation and Outreach Training Specialty Services (ED and AOD Teams) Services Offered at CAPS

23. Student calls CAPS and requests to complete a phone screening Student’s needs will be assessed during a brief phone screening and a clinician will determine the level of care needed Students requiring specialty services or more intensive services may be provided with referral recommendations/assisted with referral process If appropriate for CAPS services student will be scheduled for an initial consultation and will complete paperwork prior to this visit During periods of peak demand there may be delays in accessing services or in scheduling after initial consultation At Initial Contact—Routine

24. During Regular Working Hours Students may contact CAPS and ask to speak with the walk-in clinician Students who walk-in to CAPS will be instructed to compete initial paperwork and will briefly meet with a clinician who will assess their needs If appropriate for services student will be scheduled for a follow-up appointment After Regular Working Hours Students may call the UGA Police (706) 542-2200 and ask to speak with the CAPS on-call clinician At Initial Contact—Crisis

25. Location CAPS is located on the second floor of the University Health Center, on the corner of College Station and East Campus Roads Hours Fall/Spring Semester:Monday - Friday, 8 am - 5 pmTuesday, Wednesday & Thursday, 5 pm - 7 pm by appointment only Summer Semester and Breaks:Monday - Friday, 8 am - 5 pm Location and Hours

26. Contact Information Phone: 706-542-2273 After Hours Emergency: 706-542-2200 (UGA Police) More Information: http://www.uhs.uga.edu/caps/