-Mental Health TrainingTCNJ Residential Education

August 2015
Mark J. Forest, Ph.D.

Counseling and Psychological Services (CAPS)

Kelly S. Hennessy, Ed.D.

Dean of Students Office

Process of Helping

We ought to respect the effect we have

on others. We know by our experience
how very much others affect our lives,
and we must remember that we in turn
must have the same effect on others.
George Elliott

Personalizing a crisis..

The Big Picture

Learning Outcomes

To gain an understanding of (TCNJ

specific) mental health concerns of students
Improve skills in talking to students about
mental health issues
Familiarity with campus and local mental
health resources
Establish reasonable, personal self-care
strategies

Overview of Presentation

CAPS Introduction
TCNJ Cares
MHPSP Task Force
Self-Care
Why Students Seek Counseling
Signs / Symptoms
Helping Skills
Suicidal Students
Campus Response to Crises
Resources

Questions?

Other concerns not

addressed by
overview?

Counseling and Psychological Services

(CAPS)

Services
Hours of Operation / Location
Statistics
TCNJ & National Data
Brief Therapy Model
Accessing Services
Myths about Mental Health / CAPS

TCNJ Clinic

Training Clinic masters level therapists

under close supervision.
Open to TCNJ students and community.
Services
Hours of Operation / Location
Accessing Services

TCNJ vs National Data

At TCNJ

Nationally

32.8% of all college students say

they felt so depressed they found it
difficult to function in the past
school year

46.8% felt things were hopeless

during the past year

86.2% felt overwhelmed by all they

had to do during the past year

56.4% felt overwhelming anxiety

during the past year

8.6% seriously considered suicide

during the past year

33.2% of all college students say

they felt so depressed they found it
difficult to function in the past
school year
47.8% felt things were hopeless
during the past year
87.1% felt overwhelmed by all they
had to do during the past year
54.7% felt overwhelming anxiety
during the past year
8.6% seriously considered suicide
during the past year

American College Health Association / National College Health Assessment Spring 2014

College Student MH Concerns

95%
70%
24.5%
21%
40%

Mental health concerns getting more serious

Severe problems increased past year
Taking psychotropic medications.
Severe mental health concerns
Mild mental health concerns.

Anxiety
Depression
Relationship problems

41.6 percent
36.4 percent
35.8 percent

Annual Survey of College Counseling Center Directors (2014)

Dispelling Some Common

Myths about Mental Health:

Mental health problems are uncommon.

Mental health problems are caused by the person
suffering from them.
Mental health problems are purely biological or
genetic in nature.
Mental health disorders are often life-long and
difficult to treat.
Psychotherapy takes forever and gets into
childhood issues.

More Myths.

I can handle my own mental health problems, and if I

cant, Im weak.
If I admit I have problems, everyone will think Im crazy
and Ill need to go into the hospital for a very long time.
Being suicidal means Im crazy.
Mental health problems are best treated by my primary
care physician or a general practitioner (GP).
Mental health professionals (psychologists, psychiatrists,
social workers, psychiatric nurses, marriage and family
counselors, etc.) make a ton of money off of people
suffering from these disorder.

Myths about CAPS

If you go to CAPS for help with a problem, you might

get kicked out of school.
CAPS only works with suicidal students, they dont
offer services for regular problems.
You have to wait a long time (at least 3 weeks) to get an
appointment at CAPS.
The Request for Service form is really long and takes
forever to complete.
CAPS is not really private and doesnt maintain
confidentiality.

TCNJ Cares

Care Team

Purpose of team
Composition of team
Regular meetings

Supporting Students in Need

Filing a report
What happens after filing a report

MHPSP Task Force

Mental Health Promotion and

Suicide Prevention Task Force

Purpose of task force

Composition of task force
Regular meetings

Postvention

Safe messaging
Communication: concentric circles
Coordination of key campus constituencies

Self-Care
Boundaries
Roles
Personal Triggers
Post Care

Why Do Students Seek Mental

Health Counseling?

The Three Is

Independence /Autonomy Issues

Identity Issues

Intimacy Issues

Developmental Tasks of
College Students
1.

2.
3.
4.

5.
6.
7.

Developing Competence
Managing Emotions
Moving through Autonomy toward Interdependence
Developing Mature Interpersonal Relationships
Establishing Identity
Developing Purpose
Developing Integrity
(From: Chickering 1969; Chickering & Reisser, 1993)

Developmental pressures
can lead to

MONEY

CAREER / JOB

EMOTIONS

STRESS
SELF-ESTEEM
PARENTS
ACADEMICS

ROMANTIC
RELATIONSHIPS

Impact of Stress
on Performance
P
E
R
F
O
R
M
A
N
C
E

Performance deteriorates
significantly when stress
or anxiety gets too high.

High

Low

Low

High
STRESS or ANXIETY

College Students and Mental Health

Mental health issues are prevalent on
college campuses
Mental health issues are a leading
impediment to academic success
College students are not seeking help
Suicide is a real concern
More campus-based mental health
services and supports are needed on
campus

American College Health

Association Survey
Students reported feeling the following in the past year:
Male

Female

Total

Felt things were hopeless

38%

49%

45%

Felt overwhelming anxiety

38%

55%

50%

Felt so depressed that it was difficult to function

25%

33%

30%

Felt overwhelming anger

33%

38%

36%

Seriously considered suicide

3%

7%

7%

The survey also found that 62% of students had used alcohol and 14%
had used marijuana in the last 30 days.

College Student Problems

The most common problems* seen at CAPS over the past two years
include:*
Relationship Difficulties
Anxiety
Family or Parent Problems
Depression
Academic/Study Related
Self-Image and Identity Issues
Reaction to Loss or Separation
Major/Career/Staying in College
Traumatic Events
* An individual can have more than one problem

40%
37%
36%
24%
20%
20%
13%
8%
6%

Signs & Symptoms

A review of some of the more
prevalent mental health concerns
presented by college students,
but first..
JED Foundation
Emotional Health 101

Anxiety

Anxiety is the top presenting concern among college

students (41.6 percent)
Short Video by Anxiety Disorders Association of America
Types of Anxiety
Generalized Anxiety Disorder
Obsessive Compulsive Disorder
Panic Disorder
Social Anxiety Disorder
Post Traumatic Stress Disorder
Phobias

Depression

Depression is the 2nd most common problem in college

students.
30 percent of college students reported feeling so
depressed that it was difficult to function in the past year.
Short video on the science of depression.

Types of Depression
Major Depression
Dysthymia
Seasonal Affective Disorder
Bipolar Disorder

Bipolar Disorder

Bipolar Disorder is characterized by a mood cycle that shifts from

severe highs (mania) or mild highs (hypomania) to severe lows
(depression).
During the manic phase, a person may experience abnormal or
excessive elation, irritability, a decreased need for sleep, grandiose
notions, increased talking, racing thoughts, increased sexual desire,
markedly increased energy, poor judgment, and inappropriate social
behavior.
During the depressive phase, a person experiences the same
symptoms as would a sufferer of major depression.
Short Video on Bipolar Disorder by Dr. Sanjay Gupta.

Autism Spectrum Disorders

Autism Spectrum Disorders are developmental

disorders that impairs the ability to communicate
and interact.
Short Video on Aspergers Disorder
Types of Autism Spectrum Disorders
Autism
Aspergers
Pervasive Developmental Disorder

Self-Harm/Injury

Self-injury is the deliberate, repetitive, impulsive,

non-lethal harming of ones self.

ie: cutting, burning, scratching

It is estimated that approximately 17% of college

students have engaged in self-injury at some point.
Short Video on Self-Injury with Demi Lovato

Stigma

Three out of four people with a mental illness report that they
have experienced stigma.
Two types of stigma

social stigma is characterized by prejudicial attitudes and discriminating

behavior directed towards individuals with mental health problems as a
result of the psychiatric label they have been given.
perceived stigma or self-stigma is the internalizing by the mental health
sufferer of their perceptions of discrimination, and perceived stigma can
significantly affect feelings of shame and lead to poorer treatment outcomes

Stigma contd

Culture and Stigma

Impact of Stigma

Questions / Break

Facebook & Instagram:

6 signs your friend may be struggling

1. Feeling alone, hopeless, isolated, useless,
or a burden to others:

Facebook & Instagram Contd

2. Withdrawal from everyday activities:

Facebook & Instagram Contd

3. Showing irritability and hostility that is
out of character:

Facebook & Instagram Contd

4. Showing impulsive behavior:

Facebook & Instagram Contd

5. Insomnia posts:

Facebook & Instagram Contd

6. Use of Negative Emoticons
and/or hashtags:

How You Can Help

Reach out, let them know they are not
alone in feeling this way and that its ok
to ask for help.

How You Can Help

contd

Understand that your offer to help may be rejected, but

you should not give up or take it personally. If they
dont want to speak to you, encourage them to talk to
someone else, or connect them with a professional for
additional support. Regardless, be sure to continue
these conversations offline.

Helping Skills

How do you approach and talk with a

student you are concerned about?

Draw on personal experiences (S.O.S)

Basic 5-step helping strategy
Effective listening skills
Peer counseling strategies
CA role challenges

Basic 5-step Helping Strategy

1. Establish a relationship

2. Define the problem

3. Explore feelings

4. Explore past coping attempts

5. Explore alternatives and develop
an action plan

Guidelines for
Effective Listening

Look directly at the person speaking

Avoid being preoccupied with your thoughts

Try to listen to more than just the spoken words

Say something which communicates that you

are following the conversation

Do not evaluate or judge

Basic Peer Counseling

Techniques

Be primarily a listener
Avoid judgmental reactions
Dont make decisions for the student
Help student focus on real problems, one at a time
Keep meetings shortone hour or less
Dont take notesgive full attention
Offer to see the student again
Key to a helping relationship: warmth, concern
and understanding
Always remain aware of the feelings of student

Practice, Practice, Practice

Pair up.
One person acts as distressed student the
other is the CA
Practice using the 5-step Helping Strategy

Challenges

What circumstances strain the helping

relationship for community advisors?

Multi-Cultural differences
Difficulties balancing role of CA with role
of friend/peer

What specific challenges are presented

by students?

Adjustment, transitional, developmental

More severe problems

CA Role Challenges

Authority figure or friend?

Need for approval/acceptance

Conflict avoidance

Setting limits

Role model? or, do as I saynot as I do

Guidelines for Effective

MultiCultural Communication

Confidentiality
Respect
Speak from own experience
Active listening
Taking responsibility
Value risk taking
Focus on analysis and change

Barriers to Cross-Cultural
Communication

Assumed Similarities

Non-Verbal Misinterpretations

Preconceptions and Stereotypes

Tendency to Evaluate

High Anxiety

Making a Referral
for Counseling

Summarize your understanding of the problem to the

student (based on what they tell you or what you
observe).
Express your concern for the student and suggest that
often people find it helpful to speak to a mental health
counselor, and ask how they feel about doing that.
Keep in mind that some people have negative reactions
to the idea of psychological counseling (and there are
often cultural, familial or religious issues involved).

Making a Referral (contd)

Counseling is not just for crazy people (in fact, most

clients have normal adjustment reactions to difficult
situations in their life).
Counseling does not encourage dependency (most
clients are seen on a short-term basis at the center).
Counseling does provide a chance to explore feelings
and solve problems with the help of an objective,
sensitive and concerned listener.
Counseling is voluntary and confidential.

Making a Referral (contd)

Once the student has agreed that counseling might be useful, there are
several possible steps to take, depending on the student's attitude
and the urgency of the situation.

Give the student information about CAPS and urge him/her to fill
out a request for service form.
Offer to help the student fill out the form from your office right
then, so that a public commitment will have been made.
Accompany the student to CAPS yourself to make sure he or she
arrives if more urgent, and provide the center with any necessary
information.
Once the referral is made talk with your supervisor and fill out
an IR.

Student Ambivalence

Triggers:

When to bring in reinforcements

Any mention of suicide or homicide

When there appears to be a level of
urgency that concerns you
When you start feeling uncomfortable
(trust your gut on this one)
When health or well-being is at risk
When in doubt consult, consult,
consult (MH professionals do it all the time)

Videos How to help

Subtext sometimes you have to read between the lines
to see how your friends are really doing.
Getting Low A friend who seems closed off might be
going through something bigger. Sometimes just being
there is the first step towards helping out
Pretty Picture It can be hard to tell whether a friend
is just having an off night or is struggling with a
bigger problem. If you are concerned about someone,
reach out and offer support.

BREAK

Suicidal Students: Some Statistics

Suicide is the 2nd leading cause of death in

college students
Although most depressed people are not
suicidal, most suicidal people are depressed.
Over 60% of all people who die by suicide
were suffering from major depressive
disorder, often unrecognized and untreated.
Depression is treatable.
MH treatment is protective. Students
plugged into services less likely to suicide.

Suicidal Students: Warning Signs

Recent Significant Loss / Precipitating Event

Intense Emotional State + Depression
Changes in Behavior:

Actions:

Withdrawal , Suicidal Statements

Giving away possessions, writing goodbye letters,

seeking access to firearms, pills or other means.

Deterioration in Functioning:

Not going to class or work; poor self-care; increase

in substance use or self-destructive behavior.

Suicidal Students:

Appropriate
Responses

Talk to the student. Express concern.

Dont be afraid to address suicide directly. Ask if
they ever think about suicide.
Listen, show interest, offer support, and take it
seriously.
Dont be sworn to secrecy. Always consult with
others and seek support from Professional Staff.
Do not leave the person alone if the person is in
imminent or immediate danger.

Suicidal Students: Res Ed Process

Contact Professional Staff whenever a student

talks of suicide.
Professional Staff will administer C-SSRS
Call Campus Police /EMS
Will Assess/Consult with Capital Health
Mobile Outreach
Transport to Capital Health if warranted

Suicidal Students: Role Play

Suicidal Students: Return to Floor

When everyone knows

When a few people know

When no one knows

Campus Response to Crisis

Emergency Response Team

Concentric Circles
Res Ed Response to Notifying Student
Staff
Postvention Plans

Important Campus Resources

Self-Care Revisited
https://www.youtube.com/watch?v=VjfCS88Gc7Q

http://marc.ucla.edu/body.cfm?id=22

Questions and Answers