Mental_Health_Problems

A Faculty Guide to Common Mental Health Problems Among Students and Typical Academic Manifestations

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by Staff (updated January 14, 2005)

Based on a presentation given by Dr. Robert McGrath, Director of Counseling and Consultation Services, in a session sponsored by the College of Agricultural and Life Sciences Instructional Improvement Committee on November 13, 2003, 1360 BioTech Genetics.

UW-Madison students exhibit the same range of mental health problems as students nationally. Many faculty will encounter students with mental health problems in their role as faculty advisors or in their role in classroom teaching. It is important for faculty to be able to recognize the signs of a mental health problem and encourage the student to seek appropriate counseling or medical services. The following mental health problems are those most commonly found in students who seek help at the UW-Madison Counseling and Consultations Services. The most frequent type of problem is mood disorders (33% of all students visiting the C&CS) followed by anxiety disorders (20%), relational disorders (12%) and eating disorders (7%).

What can you do to help students?

Very few of us have specialized training as mental health specialists. The information here is an attempt to promote a better understanding of behaviors you might see in students. If you see behaviors or hear conversations that you think reflect problems, you are encouraged to be ask the student how they are doing (note: open-ended questions are better for opening discussion). Many students who are having problems may not recognize their situation or know what to do even if they are aware. Some will not want to talk with you about the situation. It can still be valuable to tell them you will help if they want to talk. If you are successful in getting students to open up to you, be aware of your own limits. Be ready to call on someone.

Emergency and After Hours

If there is a medical emergency, please call 911.
For 24-Hour Mental Health Crisis Response Line 265-5600 During regular business hours Mon | Tue | Thu | Fri – 8:30 a.m. to 5 p.m.; Wed – 9 a.m. to 5 p.m. 265-6565 for all other times. This service is available to individual and groups of students, as well as faculty and staff concerned about students.
After-Hours Medical Consultation Line 265-8200 M to F – 5 p.m. to 9 p.m.; Weekends and holidays – 12 noon to 9 p.m. This is an answering service, which will help you get information about your medical concern, and if necessary page a doctor to call you back
You can call the CALS Undergraduate Programs and Services Office to talk with one of the Deans (262-3003).
You can also contact the UW-Madison Counseling and Consultation Services Office at 115 North Orchard Street to help a student set an appointment with one of the counselors (265-5600).

If you are uncertain about how you might start a conversation with a student who seems to be struggling, the following suggestions may be useful: (see the Tips Table below for more)

Do not ignore strange or inappropriate behaviors.

Invite the student to talk with you at some appropriate time.

Talk in private not an open area.

Be sensitive and not callous.

Do not make judgmental comments, criticism or evaluation of acts.

Talk in confidence and listen carefully.

Be direct and ask the student if they have a problem they would like help in addressing.

Do not discuss your concerns with other students.

Always offer to help them make contact with someone who can help.

Potential conversation points:

Mood Disorders: “I notice that you have missed a lot of classes (assignments, tests, etc.) and wonder if something is going on with you? How has your sleep been? How is your eating? Energy level?” If answers indicate difficulties, (or ambivalence), you might say “These are possible signs of depression and I wonder if you are depressed? Have you talked with anyone? If not, would you like to do so? Can I help you make an appointment?”

Remember, just one question at a time, and as much as possible ask questions in an open-ended manner, not in a way that just gets a yes or no answer.

Anxiety Disorders: “I have noticed that you get really nervous for exams or when projects, etc are due. Do you think anxiety is interfering with your academic work? Has this been a problem in the past? Have you talked with anyone? If not, would you like to do so? Can I help you make an appointment?”

Relational Disorders: (This group can be sensitive to approach since the student may feel that any problems are due to the others in the group.) “How is that group project going?” Perhaps also “I hear there has been some difficulty with that group project. What's your take on that?”

Often relational concerns may just emerge from conversation about academic issues. The student may indicate that they have done poorly on an exam because a relationship just terminated. If there appears to be distress related to such a relationship termination, then you might ask “Have you talked with anyone? If not, would you like to do so? Can I help you make an appointment?”

Eating Disorders: This category is tough and you may never see it through direct observation. You will most likely hear about it in a conversation for advising or something related to their personal life. “I am wondering if your concerns about your eating are interfering with your academics, or relationships? Have you talked with anyone? If not, would you like to do so? Can I help you make an appointment?”

h1 Tips on trying to help distressed students

Advice	Explanation	Conversation points
Request to see the student in private.	Avoid public discussion of your concerns and invite the student to meet with you.	“Could I talk with you about how your semester is going?”
Speak directly and honestly to a student when you sense that he/she is in academic and/or personal distress.	Be sensitive to what you have observed and how the student might be feeling. Avoid sounding like an attack.	“It appears to me that you are having some problems with your grades. Is there anything concerning you that I might help with?”
Ask if the student is talking to anyone, such as family or friends, about the problem. People tend to isolate themselves when in distress but this is rarely a useful stance.	If they are not talking with someone you might ask if they would like to do so to a counselor or other person they might trust. Have a resource in mind if you make the offer.	“Have you shared your problem or concern with anyone else? Has that been helpful? If not, would you like to talk with someone?”
If you have initiated the contact, express your concern in behavioral, nonjudgmental terms.	Avoid something like this: “Where have you been lately? You should be more concerned about your grades.”	Try something like this instead: “I have noticed you have been absent from class lately and I am concerned.”
Listen to thoughts and feelings in a sensitive, non-threatening way.	Communicate understanding by repeating back the essence of what the student has told you. Try to include both content and feeling.	“It sounds like you are not accustomed to this much work in so short a period of time and you are worried about failing.”
Avoid judging, evaluating and criticizing even if the student asks your opinion. It is important to respect the student's value system, even if you do not agree with it.	Avoid comments like, “That is a dumb thing to do?” Or “That choice was a real mistake.”	Try something like, “How well did that approach work for you?” “Have you thought about other ways to address the problem?”
Behavior that is strange or inappropriate should not be ignored.	Comment directly on what you have observed.	“You talked a lot throughout the lecture today when others were speaking. Is there something going on that I need to know?”
Do not discuss your concerns with other students.	Student behavior problems should be treated with high levels of confidentiality for reasons of interpersonal trust and law that protects the sharing of information.	You might reassure the student of your intention to keep things confidential unless they say it is ok to share.

Descriptions of the Most Common Problems Among Students on the University of Wisconsin Madison Campus.

Mood Disorders

The most common mental health problem among students is depression, either major depression, a milder but long-term form termed “dysthymia, or a situational form: Adjustment Disorder with depressed mood.” The faculty member is most likely to see some of the academic manifestations.

Major Depression

Mood: The mood is characterized by feelings of depression or sadness, decreased interest or pleasure, or persistent irritability or anger.
Persistence: The mood is present most of the day for a prolonged period of time (usually at least a couple of weeks).
Symptoms: Loss of interest in usual activities; change in eating or weight (either increase or decrease); change in sleep pattern (increase or decrease); feeling physically agitated or slowed down; extreme fatigue; low self-esteem; feelings of hopelessness; inability to concentrate or think normally; suicidal thoughts or recurring thoughts about death
Academics: The first academic sign of depression will probably be poor performance on an exam, failure to hand in required assignments such as a lab report, or other poor academic performance. Academic work requires great energy, both in time spent studying and the level of concentration required. If the depression is accompanied by insomnia, loss of appetite or feelings of fatigue, then the student will likely not have the energy needed for good academic performance. Alternatively, the student may sleep for 12-15 hours every day and miss classes. If a student has trouble concentrating or thinking normally for an extended period then obviously high-level learning will be greatly impeded.

Dysthymia

Mood: The mood is characterized by feelings of depression or sadness, decreased interest or pleasure, or persistent irritability or anger. However, the intensity is less than with major depression.
Persistence: This low mood usually persists, at a lower level of intensity than in major depression, on a majority of days for 2 years or more. The student may have days here and there or even blocks of time when the low mood is not present and things seem normal.
Symptoms: The symptoms are the same as major depression but are likely to be less severe.
Academics: The first academic signs will most likely be poor academic performance on exams or assignments.

Adjustment Disorder with Depressed Mood

Mood: Mood is depressed: intensity is less than with Major depression, but tearfulness and feelings of hopelessness are present.

Persistence: Typically less than 6 months. What distinguishes an adjustment disorder from Major depression is an identifiable stressor or stressors, as adjustment to the university, feeling overwhelmed by academic demands, relationship loss.

Symptoms: Less severe than major depression, but in excess of what might be expected, with significant impairment in social or academic functioning.

Academics: Decrease in academic performance, lessening of interest in academics, feelings of hopelessness

Anxiety Disorders

Generalized Anxiety

Problem: Persistent and excessive anxiety and worry about several events or activities; anxiety feels uncontrollable
Symptoms: Feels restless, edgy, keyed up; tires easily; trouble concentrating; irritable; increased muscle tension, trouble sleeping
Academics: Some anxiety about performance can stimulate action and can be helpful. However, excessive anxiety leads to behavior that is dysfunctional.The academic consequences may be poor performance due to an inability to follow-through on assignments in a timely manner.

Panic Disorder

Problem: The student suddenly develops an overwhelming fear or discomfort that peaks within 10 minutes. The feelings usually seem to come out of nowhere and the student may often perceive it as a heart attack.
Symptoms: Sudden onset of chest pain; chills or hot flashes; dizzy, lightheaded or faint; fear of dying, heart pounds or races; nausea; numbness or tingling; sweating or shortness of breath
Academics: The faculty member may see this as a sudden inability to function in an exam, or even to attend the class. Some students will experience panic at the thought of attending class.

Social Phobia

Problem: Strong, repeated fears of at least one social or performance situation that involves facing strangers or being watched by others. The student fears behaving in some way that will be embarrassing or humiliating.
Symptoms: General anxiety symptoms are common and the student will typically try to avoid situations that cause anxiety.
Academics: This may appear as a test anxiety problem, but not all test anxiety problems are due to social phobia. The student feels a strong need to avoid people, but this is not possible in a class setting. The student may sit by the door and bolt out suddenly when an attack seems imminent. Learning is affected because the student cannot concentrate in class or in an exam because of the constant feelings of nervousness or general unease.

Obsessive-Compulsive Disorder

Problem: The problem could appear in two ways: 1) Recurring, persisting thoughts, impulses or images that are not just excessive worries about ordinary problems; attempts at ignoring or suppressing the thoughts do not work; or 2) Feeling the need to repeat physical behaviors (checking the stove to be sure it is off, hand washing) or mental behaviors (counting things, silently repeating words) in order to reduce anxiety or prevent something from happening (“if I do not wash, I will get a terrible disease.”)
Symptoms: The thoughts and behaviors cause severe distress and consume much time.
Academics: A small amount of obsession can be helpful but an excessive amount is dysfunctional. The student can be at the very top academically if the obsession and compulsive behavior is focused on academics. The student may feel compelled to study 12 or 14 hours every day because of an exaggerated fear of falling behind or incurring some other bad result. It is the fear that “something bad will happen” that leads the behavior to counter-productive levels. The first signs may come be in an office visit or in an after-class discussion when the student shares what seems to be an unusually high level of concern over a grade or an assignment.

Relational Disorders

Problem: The student has problems in maintaining satisfying and appropriate relationships with others (friends, significant others, professors, advisors, parents); usually a pervasive problem across many relationships and situations.
Symptoms: Of the many types of relational disorders, the most disturbing at UW-Madison is Borderline Personality Disorder. The student typically feels an extreme need to connect personally but also has a deep fear of abandonment. The disorder is characterized by unstable relationships that alternate between idealization and devaluation; mood instability; potentially self-damaging impulsiveness (e.g., self-mutilating behaviors like cutting); inappropriate expectations and anger.
Academics: As a faculty member, you may feel that a student has idealized you is going to great lengths to establish a relationship. Yet poor performance on an exam or assignment may lead to an outburst of anger or other inappropriate behavior.

Eating Disorders

Anorexia

Problem: The student cannot/will not maintain a minimum body weight; despite being underweight, the student has intense fear of becoming fat.
Symptoms: The student may have an unreasonable emphasis on weight or shape in self-evaluation; denies seriousness of low weight; has a distorted perception of own body shape or weight. Also, an all-or-nothing type of thought process is common.
Academics: This problem is not likely to become obvious to a faculty member in the normal process of teaching or advising. The only hint may come during conversation with the student during office hours of advising session.

Bulimia

Problem: The student repeatedly eats in binges, consuming much more food than most people would in similar circumstances and in a similar time period; feels eating is out of control; binges and purges to relieve distress; typically difficult to see because usually person is average weight and behaviors are conducted in solitude.
Symptoms: The student's self-evaluation is strongly affected by perception of weight and body shape. The student repeatedly controls weight gain by inappropriate means such as fasting, self-induced vomiting, excessive exercise or abuse of laxatives, diuretics or other drugs. An all-or-nothing type of thought process is common.
Academics: There may be little evidence in a typical academic setting. (See anorexia above).

Guidelines for Dealing with Distressed Students

There are no absolutely correct procedures for dealing with a distressed student. Each person has his or her own style of approaching and responding to others. Furthermore people have differing capacities to deal with others' problems. It is important to know your personal limits as a helper.

If you choose to try to help a distressed student, or if a student approaches you to talk about personal problems:

Request to see the student in private.

Speak directly and honestly to a student when you sense that he/she is in academic and/or personal distress.

Ask if the student is talking to anyone, such as family or friends, about the problem. People tend isolate themselves when in distress but this is rarely a useful stance.

If you have initiated the contact, express your concern in behavioral, nonjudgmental terms. For example, “I have noticed you have been absent from class lately and I'm concerned,” rather than “Where have you been lately? You should be more concerned about your grades.”

Listen to thoughts and feelings in a sensitive, non-threatening way. Communicate understanding by repeating back the essence of what the student has told you. Try to include both content and feeling (“It sounds like you are not accustomed to this much work in so short a period of time and you are worried about failing.”)

Avoid judging, evaluating and criticizing even if the student asks your opinion. It is important to respect the student's value system, even if you do not agree with it.

Behavior that is strange or inappropriate should not be ignored. Comment directly on what you have observed.

Do not discuss your concerns with other students.

If you are concerned about a student's suicide potential, keep in mind that mental health professionals assess suicide potential, in part, by asking if the student has a plan for exactly how he/she would act on these thoughts, when and where the student intends to carry out the plan, and if he/she has ever attempted suicide before. The more specific and lethal the plan, the fact of having made a previous attempt and the greater the ability to carry out the plan, the higher the risk that a suicide will occur. You need not be afraid to ask these questions. For people who are considering suicide, these questions will not furnish them with new ideas. Most people who are actively suicidal are willing to answer these questions. Conversely, many people consider suicide from time to time in passing. The less specific and lethal the plan (e.g., “I guess I would take a couple sleeping pills sometime”), the less likely a suicide attempt, although one should not dismiss references to seemingly non-lethal means of attempting suicide.

Copyright – 2003 The University of Chicago Student Counseling & Resource Service
5737 S. University Ave., Chicago, Illinois 60637

Making a Referral for Counseling

Even though you may be genuinely concerned about students, and interested in helping them, you may find yourself in situations where it would be better to refer them to other resources. Circumstances that might necessitate a referral include:

the problem is more serious than you feel comfortable handling.

you are either extremely busy, or are experiencing stress in your own life, and are unable or unwilling to handle other requests for help.

you have talked to the student and helped as much as you can, but further assistance is needed.

you think your personal feelings about the student will interfere with your objectivity.

the student admits that there is a problem, but does not want to talk to you about it.

the student asks for information or assistance that you are unable to provide.

Let the student know your reasons for making a referral (e.g., lack of time, conflict of interest, limited training) and emphasize your concern that they do get help from an appropriate source. It may help the student to know that you support his/her desire to seek help.

If a Student is Reluctant to Seek Professional Help

Many people believe that only very disturbed people seek therapy, so your referral might be interpreted as a comment on the severity of the problem. Reassure the student that therapists at Student Counseling work with people with a wide range of concerns. Problems need not reach crisis proportions for students to benefit from professional help. In fact, it is much easier to work on problems if they are addressed before they reach crisis level. Normalizing the process of seeking help may be especially helpful for international students whose countries may not have similar views of psychological counseling. Reluctant students might also be relieved to know that they can speak with a therapist on a one-time basis without making a commitment to ongoing therapy. Furthermore, any contact and information shared by the student is kept strictly confidential and will not be disclosed to parents, faculty, other University departments, or even you, except with the student's written permission. Finally, it is important to acknowledge, validate and discuss the student's real fears and concerns about seeking help. It takes considerable courage to face oneself and acknowledge one's limitations.

In some cases, you may find that the student has already sought counseling services, and was unsatisfied with the experience. There are many reasons why counseling may not be successful in a given situation. Please encourage the student to consider giving counseling another try, perhaps with a different counselor.

While it is important to care about the emotional well-being of students, we cannot make their decisions for them, and counseling is always a personal choice. Occasionally even your best efforts to encourage a student to seek counseling will be unsuccessful. If the student resists referral and you remain uncomfortable with the situation, contact Counseling and Consultation Services at 905 University Avenue, Room 401, 608/265-5600 to discuss your concern.

Copyright – 2003 The University of Chicago Student Counseling & Resource Service
5737 S. University Ave., Chicago, Illinois 60637.

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