Recognizing and Referring Students in Crisis

Often faculty, staff and administration are the front line to student behavior, affect and overall difficulties. We want to aid the campus community in their awareness of crises and support all efforts to make referrals for services. Please take a moment to review the information below outlining how to refer students or staff, recognize students and staff in trouble and signs indicating possible crises. In an effort to aid students facing mental health concerns, the campus community can help by educating themselves on these signs and utilize CAPS services for further intervention. Due to the multiple contacts that a student has, it is imperative for the campus to act as a referral source to CAPS.

How to Make Referrals to CAPS

How to Recognize Students in Trouble

Introduction:
Everyone working at the university has contact with students. Sadly, many students experience severe psychological problems that may go unnoticed or ignored until it is too late. Therefore, please take a minute to acquaint yourself with the signs that a student may need help.

The Impact of Stress:
Research indicates an alarming trend in our society-more people are experiencing emotional problems, and these problems are becoming more severe. Consider the following: a) one out of every three Americans reports episodes of depression severe enough to warrant professional help, and b) a completed suicide (an attempt that results in death) occurs every 20 minutes in the United States. These national numbers are startling by themselves, but they are probably a gross underestimate for the typical university population. All college students face a tough period of transition. Some move away from home for the first time, some face difficult academic pressures, and some experience different cultures for the first time. Additionally, college thrusts many students into a world of strangers where making friends may be difficult and chemical use/abuse (alcohol, marijuana, etc.) is relatively common. International students face not only academic stress but often some degree of "culture shock" as well. Most important is the common denominator of these various transitions-STRESS. College students often face depression, anxiety, relationship difficulties, feelings of isolation, fear of failure, family pressures, and "difficulty in adjusting." Without help, the pressure may build until it becomes a crisis situation (severe depression, suicidal thoughts and/or attempts, panic attacks, etc.).

Signs Indicating a Possible Crisis:

Obviously, the more stress in a student's life the higher the probability of a crisis, but remember that level of stress is relative. What one student considers stressful might seem a mere inconvenience to another student. Everyone has a different coping ability to deal with problems, whether the problem is doing poorly on a final exam, dealing with the loss of a loved one, or feeling like a failure. Some people seem to recover easily from setbacks while others become sad and self-denigrating at even minor failures. Despite any rational analysis of how much emotional pain should accompany a particular problem, it is the person's individual perception that is crucial. A student's support system (including family, friends, acquaintances, etc.) is critical. The more extensive the support system, the better the prognosis for the student. The attitude students convey also influences how they respond to pressures. For example, if the problem were poor academic performance, the student who began to express an apathetic attitude by saying things such as "Who cares?" would likely be in a more critical state than someone who responded by saying, "Well, I better get my act together." Even if you only see a person occasionally (once a semester when he/she pays tuition) or perhaps at a distance (as in a large auditorium class), it is often possible to detect extreme changes in his or her behavior or mood. An example would be a student who previously attended class regularly, socialized with fellow students and was casual but neat in appearance. Now, suppose that as a university official (professor, staff member, etc.), you begin to notice that the student appears to be down or depressed, turns in assignments late or not at all, doesn't talk very much, seems to dislike speaking, and appears more disheveled. This change might indicate the student is deteriorating in his or her coping ability and some action is vital before a crisis occurs.

Understanding and Helping the Suicidal Student
Seven signs of a potential suicide attempt are:

  1. Early morning awakening
  2. Having the morning blues
  3. Little or no interest in activities or conversation
  4. Sudden improvement indicating that the person has decided to commit suicide or initial improvement that may indicate the person has regained enough energy to act on suicidal thoughts.
  5. Becoming increasingly withdrawn and isolated
  6. Not being able to express pain and "keeping everything inside"
  7. Not having remorse about a previous suicide attempt.

Remember, each factor can range from mild to extreme, with mild indicating a lower suicide potential. At the extreme end, it is likely the person is extremely lethal, requires immediate professional assistance, and should never be left alone. When a student displays a change in his/her usual sleep pattern, especially if that change is early morning awakening, this usually indicates emotional depression. This is problematic if the change lasts for several months. Morning Blues means that the person is more likely to feel worse in the morning and at his/her best in the afternoon or evening. Decreased general level of interest results in a person expressing little interest in discussion or activity. The greater the loss of interest, the higher the risk for suicide. Initial or sudden improvement is perplexing because it initially appears to be a positive sign. Indeed, it sometimes may indicate a genuine improvement. However, when a seriously depressed person suddenly feels much better there is a danger that he or she has passed a stage of being confused and has made the definite decision to take his or her own life. Likewise, when a seriously depressed person begins feeling better, special caution is in order because the student may have regained enough energy to act upon his/her suicidal thoughts. If a person expresses a lot of remorse about a previous suicide attempt, then he/she is in less danger of an immediate second attempt. Some people believe that people who talk about suicide will never go through with it. In fact, just the opposite is true. Almost every successful suicide attempt follows at least one attempt to communicate this level of desperation. Thus, every suicidal threat should be taken seriously, especially if the threat includes mentioning previous attempts and increasing suicidal thoughts.

Take particular caution if the person discusses the means by which he/she plans to commit suicide (gun, pills, razor blade, etc.). This is extremely critical when the proposed means is available to him or her. Often, students perceive faculty and staff members as the first (and usually primary) source of advice and support. If you identify students you believe may be experiencing some of the previously mentioned problems, it is important to remember that you are not trained or responsible for counseling them, but rather your task is to try to get them professional mental health assistance. The primary agency for this at the University of Houston is Counseling and Psychological Services. We are located on the second floor of the Student Service Center 1, and the telephone number is (713)743-5454. It is appropriate for you to call us for a recommendation about a student you feel is in psychological trouble. To introduce the idea of getting professional help, you might say something like, "Did you know you can talk to a psychologist, free of charge, here on campus about what's going on with you?" If the circumstances warrant it, you may advise the student to come over by giving them our location, calling ahead to get the name of the counselor who will be seeing them or, if it seems best, you might escort them yourself or request that a counselor come to your office. Any formal counseling or referral to a community mental health agency then becomes the responsibility of a professional mental health service provider trained in such matters.